Your views on Antonio Armani

[hairworthy]

Yesterday I noticed for the first time that Antonio Armani was on the IAHRS list. Whilst this list is by no means a guarantee of outstanding work, it prompted me to have yet another look at Dr Armani's website, which keeps changing. There are several points that I would like to raise and have this Community's views on.

 

1. I don't like the before/after pics, they are very uneven: whilst you see fantastic results with guy nr 1 (no wonder he's nr 1), Shane at nr 10 and guy nr 18 (always the same 3 by the way), you also see some grafty looks like guy nrs 7 and 9. Guy nr 16 is combed back before and forward after, whilst it is usually the opposite with HT patients, why? Trying to hide something or to give the impression of density for the picture?

 

2. I don't like the fact that Armani clinics are opening everywhere. To quote from Pat's page on Dr Seager (for example): "despite the popularity of his work, Dr. Seager has resisted the temptation to open clinics in other cities, as he feels quality control would suffer. He prefers to keep all training and supervision of his staff under his careful and close watch."

 

3. Whilst no one denies Dr Armani is a great surgeon, there is not a word about the other docs who work under the Alvi Armani banner. Who are they? Where do they come from? There is a link on the Armani website which targets MDs and offers them to become HT surgeons. I am not very comfortable with that kind of marketing strategy.

 

4. Does Dr Armani still perform surgeries himself? What are the chances to actually have him as your surgeon?

 

5. Has Pat been invited to visit Dr Armani's clinic in Toronto?

 

For us Europeans it is very tempting not to travel to North America and go to European outfits like Armani or DHI, but the big question mark is the surgeon who will actually perform the procedure. Again, the chances to have Zontos at DHI or Armani himself are slim. If you go with Hasson, Shapiro, Epstein, Rose and the others, you are guaranteed to have them in person working on your scalp. To me, it makes all the difference.

[Pat - Community Publisher]

Hairworthy,

 

When Dr. Armani applied to be presented on our community about two years ago one of the first things I noticed in reviewing his patient photos was the inconsistency of the results, as you pointed out.

 

I also had reservations about what in my opinion was the very aggressive closure of the temples in very young men. Just where will these patients be in twenty years if their hair loss progresses into their crown and they end up with the dense packed hairline of a 19 year old and the thinning pattern of a 40 or 50 year old in back?

 

Having technical skills is critical. But using them appropriately is just as important.

 

I also have reservations about the way his clinic has been promoted online.

 

For these reasons I declined to recommend him on the Hair Transplant Network. Could I be wrong? Yes, possibly. But I prefer to be conservative in adding new surgeons. There are already plenty of great surgeons on this site with proven track records. So why potentially dilute the value and credibility of these recommendations.

 

As for this phenomena of clinics getting a big online name and then setting up virtual franchises to handle the influx of patients, this is a slippery slope into the dark side of becoming a mini mill in my opinion. I see it happening with at least a couple other clinics who started out doing solid work. But when they got an influx of patients from the Internet they started hiring novice surgeons to handle the over flow. It's hard to turn away money. But a truly ethical surgeon will make turning away potential patients a regular part of their practice.

 

Best wishes, Pat

[Alvi Armani]

Hairworthy:

 

I'm not sure if you are knowingly making false statements or not.

 

We are currently based out of Toronto, Canada. He personally performs each procedure. I'm curious, have you had a chance to take a look at our website? Or visit other hair loss forums? If you did, you would notice that our patients have and are sharing their results.

 

Long story short: If you visit us in Toronto, you are guaranteed to have him perform your procedure.

 

Pat:

 

We are recommended by the IARHS and American Hair Loss Association. It's widely known that the IAHRS only recommends the "best of the best" and is the oldest and most respected community.

 

I'm curious as to how many of your recommended surgeons are able to transplant at 80 grafts cm/2 or are even capable of harvesting 5000-6000 grafts in a session?

 

We refuse to be associated with this community due to reservations about the way it's been promoted online by Pat.

 

Read between the lines guys...

 

Why is it that the top three surgeons in the business are not recommended by Pat?

 

There is more to the story.

[the B spot]

Hey Guys....

I like to consider myself an objective person, someone who can view both sides of an argument without bias. With that said, I have some comments here.

IAHRS does not guarantee sucess for patients, nor will it ever. Hairtransplant doctors make enormous amounts of money (justifiably if they work the miracles they say they can) so one would have to say any "exclusive" membership can be bought into.(nature of the beast)

Second, Hairworthy is simply raising a question as to the philosophy and CURRENT practices of Alvi Armani & co. Nothing in "Alvi Armani's" response to Hairworthy leads me to believe they truly care to inform those of us who are "mis-informed" about their practices.

Third, it has LONG been noted that Alvi Armani placed low hairlines on younger patients. FACT.

Fourth, I would imagine that quite a few of the "top docs" could push the envelope and dense pack up to 80cm/2 and harvest 5000-6000 grafts should they choose to do so. I guess the question shouldn't be "can they", but "why aren't they". True, some doctors choose not to pursue high graft yield as a more cost effective approach, but those doctors are becoming fewer and fewer. What some of us are questioning is growth percentage of hair so densely packed and the size of the donor tissue necessary to complete such a task. These are issues that are being worked out right now, with Hasson & Wong pushing the evnvelope AND giving anyone who asks complete access into their procedures and methods. As with any new approach, the rest of the industry will wait and see and then catch up. What happens if these patients experience issues down the road? We shall see.

Now, as far as your "reservations". Having a belligerent attitude towards a community that only attempts to help others make informed decisions is NOT the way to promote your practice (I assume you work for A.A.)In addition, you mention the top three docs? I assume you meant Shapiro, Rose, Hasson, Wong, Epstein,Charles,Keene,and many others that are either supported by this site, or supported elsewhere. I think your attitude towards this website lends credence to the idea that money, and not patient care, is the sole driving force behind your practice. In addition, I will readily support the fact that Dr. Armani produces technically superior hair transplants, I will not back away from the idea that I have serious concerns about the ethical philosophy practiced at A.A. with regards to age, and hairline work.

[Alvi Armani]

The B spot:

 

I agree with you that we produce technically superior hair transplants. And I can assure you that patient care in the sole driving force behind our practice.

 

Fourth, I would imagine that quite a few of the "top docs" could push the envelope and dense pack up to 80cm/2 and harvest 5000-6000 grafts should they choose to do so. I guess the question shouldn't be "can they", but "why aren't they".

 

Here is a scenario: a male who is a Norwood 6. He has enough donor density to harvest 5000 grafts in one session, then a second session of 2500 grafts at a later date.

 

Any surgeon up-to-date on current advances has the ability to harvest as many grafts as safety possible, allowing the patient to achieve his desired result in the shortest period of time.

 

However ??“the approach taken by many surgeons, not up-to-date, is to harvest two smaller sessions of 2500+ grafts and then a third.

 

As a patient, would you rather two sessions or three to achieve your goal?

 

Your view about temple angle closure and hairline design is also an outdated one. As you may or may not know ??“ we do not take a standard approach to hairline design. Unfortunately ??“ many clinics do. And not knowing the difference; the patient is then left with the standard "u" or "v" shape that is not natural looking by any degree. I attached some photos to help illustrate my point.

 

If you are happy the surgeon placing a bowl on your head and drawing a perfect "u", then we are not the surgeons for you. But if you want a completely natural looking and undetectable design that's individualized ??“ then we are your surgeons.

 

I also attached my most recent photos. Fortunately ??“ I didn't fall for the "you need to have the hairline of a 40 year old" and went with a more youthful and natural look. Now, at almost 30, I'm enjoying a hairline that is "truly undetectable".

[Alvi Armani]

Mature hairline using temple angle closure.

[hairworthy]

Pat,

Thanks for the update. I share most of your views on this.

 

Mr Alvi Armani, or shall I call you Shane, or PRGuy,

Funny how you carefully choose the questions to answer and leave the other ones out. But don't worry I'll be happy to rewrite them for you below.

 

1. It is not my business to "knowingly make false statements". Frankly, I've got better things to do with my time. I only come here to seek answers and raise some issues, as B spot pointed out.

 

2. If you had read my post more carefully, you would have seen that I browse your website regularly. I also post on 3 other hairloss-related forums

 

3. I am very happy to read that Dr Armani still performs the procedures himself at the Toronto clinic. He's a great surgeon and he should continue to make hairloss sufferers benefit from his skills.

 

4. What I STILL don't know is WHO I would get, should I choose to go to ANY other Armani clinic. Again, who are all these "Armani surgeons", what are their credentials? Can EACH of them provide a full list of satisfied patients?

 

5. How do you explain the differences in quality between the few before/after pictures on your website?

 

6. You keep quoting figures, great harvesting numbers, density records: WHAT IS YOUR POINT? To say that you're the best? Well let me spare you the suspense: you're not. These figures are meaningless because they simply don't apply to every patient. I too would like mega-giga-sessions and a density of 80FUs/cm2, but there's just no way I could get them.

 

7. Can you please NAME these famous "top 3 docs" that are not recommended by Pat, or at least the other 2 since I guess one of them has to be Armani?

 

8. Temple closure. Here's a good one. Have you only looked around you at real people in the real life? The "standard "u" or "v" shape that is not natural looking by any degree" according to you, is everywhere. Take the vast majority of people over 30, they all have it. I'm 36, and all of my friends of the same age have this U shape to one degree or another. Your pictures are those of young guys and I can only hope for them that their hairloss is going to stop otherwise they'll have some nasty surprises in the future.

 

Yes I would like to look like guy nr 1 on your website (who wouldn't) with my temples fully closed. But I estimate my donor area capability to about 2000 FUs. Now what do I do with these precious 2000? Close my temples and pray that my mid scalp and crown don't let me down... or play it safe and go with a mature look that I know I'll keep for the rest of my life?

 

Your "undetectable design" might be undetectable now, but what about in 5, 7, 10 years time? What will you tell the guy who comes back to you with his nice "undetectable hairline" and nothing behind, if that guy's donor area has nothing more to offer?

 

Temple closure will probably be the standard once cloning and unlimited hair supply becomes available. Right now, it is simply a bet that I am not ready to make.

[Pat - Community Publisher]

"Alvi Armani" I'm assuming that you are a patient who now works in some capacity as an advocate for Dr. Armani. Your posts are welcome on this forum as long as such a relationship is disclosed in your posting signature (see our posting rules).

 

I do agree that many clinics, even those doing "follicular unit grafting", have not risen to the challenge of developing the capacity to do large sessions of ultra refined follicular unit grafting and dense packing. Often these physicians will make excuses for why they do only small sessions rather than do the hard work to gear up for doing such sessions.

 

But many of these physicians, who have not risen to the challenge of performing this higher standard for hair transplant surgery, are members of the IAHRS, which you describe as the "Best of the Best".

 

In my opinion, the standards for what is really the "Best of the Best" have risen in recent years. But not all clinics and membership groups have risen to meet these higher standards.

 

In my opinion, a group becomes a meaningless and irrelevant club if its membership standards do not rise higher as the standard of care goes higher.

 

That is why the membership standards for the Coalition of Independent Hair Restoration Physicians were raised this past spring to a very demanding standard that requires all members to perform Ultra Refined Follicular Unit Hair Transplantation with excellent results.

 

When this new and higher standard was implemented six clinics were not invited to have their memberships renewed. This did not mean that they were not ethical or performing good work, they simply had not moved up to the highest standard possible.

 

Based on these ultra high standards, many of the IAHRS members would not qualify for membership in the Coalition of Independent Hair Restoration Physicians. In fact, some of the IAHRS members were not offered to renew their membership in the Coalition when the membership standards were raised.

 

Bspot - I do not agree with your statement that ". . . any "exclusive" membership can be bought into." I know this is not true in the case of the Coalition.

 

As we all know, when it comes to physicians careful selection is critical. This applies to choosing a physician for surgery or for membership.

 

Not every outstanding physician is a member of the Coalition. But in my opinion every member of the Coalition is truly outstanding.

 

Pat

[the B spot]

Pat,

 

I retract that statement, but what I was referring to was the country club attitude of some of these exclusive memberships. In addition, I was merely offering a counterpoint to A.A., who is basing his faith in his dr. on some supposed membership that allows anyone in the door. I thought that everyone would see this in my comments, and make the connection. In reading my comments, I should have worded them another way. I apologize.

[Telephone Man]

Well this is certainly a 'lively discussion'. I think it is important to realize that this forum while providing an great benefit to the HT community through education also is not perfect as with any forum like this. There are several docs part of the 'coalition' that are wonderful, ethical, perform great things and do offer mega sessions, which I personally think is an important option to have!!!!

 

I applaude Pat for this forum and all the contributions to educating and supporting people looking for HT's.

 

I also caution people as there are physicians in the 'coalition' that have had less than favorable reviews about wide scars, low growth rate, past history with other clinics that butchered people etc, nothing is perfect.

 

You need to be your own best advocate, follow the advice of this forum and research, research, research!!!

 

As usual just my opinion.

[hairworthy]

Still no answer from AA... I wonder why.

[Beefy]

not for nothing those look like good results.

[j12]

hi,

this discussion certainly seems to be prety intense.but as a prospective hair transplant candidate i would like to know wheteher dr.armani's work ranks with the best or not and if does then where is the problem......very dense packaging, higher fees or neglect of hair loss in future........

can anyone tell me about the quality of work performed by dr.armani ?

[matwiz]

Armani has become arrogant lately. He may think that I am impressed by his world wide advertisement. As a matter of fact - that scares me - because all this cost money and guess who pays for his overhead - the patients.

 

His consultants dont have a clue what you need for your transplant - they dont even look at your HEAD to analyze your grafts - they "categorize" with the number of grafts and its corresponding costs: For example:

 

1000 grafts = $14K +

 

I have had 5 transplants in my life and I don't need this much - all I asked was temple closure and since this is NOT MAKING HIM SO MUCH MONEY, he and his "consultants" decided to IGNORE me. Someone needs to tell the Ontario College of Physicians of his "business" practice of just tending to those whom he could rake in $$$ than help them....

[Jeffrey Epstein MD, FACS]

As a surgeon, I have always felt it is my responsibility to perform every one of the procedures myself- and this approach has served me, as well as some of my leading colleagues who have been mentioned in this discussion, well. Hair transplantation is no different than any other plastic surgery procedure, where subtle differences in aesthetics can make a significant difference. It is ny philosophy that the surgeon, and not the technicians or the clinic, determines the final quality.

 

 

Another important point brought up in this discussion thread is the issue of graft counts- where the performance of 3000 or even 4000 plus graft procedures are promoted as "superior". The reality is, all graft counts are not equal- for it is the number of hairs and not the number of grafts that are important in determining density. I cannot tell you how many patients I have seen for second opinions have been told that they are a candidate for a 3600 graft procedure - when in reality, unless follicular units are separated or there is some creative graft counting, the maximum graft count may max at 2600 or so. I don't know how to explain this difference- but I cannot emphasize strong enough to perspective patients to do their research, look at photos of the surgeon's actual results, and see what kind of graft counts were obtained.

 

Jeffrey Epstein, MD, FACS

www.foundhair.com

[Bill - Seemiller]

Dr. Epstein,

 

Thanks for your post.

 

I think everything has to be conditional on the patient, to be honest. IMO, there are times when larger sessions ARE superior, and there are times when smaller sessions are more appropriate.

 

Clearly doing a 4000 graft megasession in the hairline on a NW2 patient would be extreme, and not a good strategy. IMO, it would be a waste of grafts. 2000 grafts would be a much more strategic and appropriate number, especially when taking into consideration other variables such as age, future loss, etc.

 

Regarding graft/hair counts, I agree with you. It would be helpful if more clinics would provide these numbers, but I still believe we must be careful. Just as there are some clinics doing larger sessions of sub-follicular unit grafts (which is deceiving to the patient), there are other clinics who use the hair count discussion as a crutch in order not to push themselves to do larger sessions.

 

I'd encourage all clinics to provide hair counts (just so we know we are comparing apples to apples), however, I agree that before/after photos comparisons (especially in natural lighting) is especially key when considering a surgeon.

 

Bill

[the B spot]

Hey Bill, I think the doc was trying to point out that a session earmarked as 4100 grafts, may infact be comparable to a session of say 2600-3000 grafts.

 

I think he is just saying EXACTLY what he/she is getting, ie hair moved AND graft totals.

 

Take Care,

J

[hairbank]

Originally posted by the B spot:

Hey Bill, I think the doc was trying to point out that a session earmarked as 4100 grafts, may infact be comparable to a session of say 2600-3000 grafts.

 

I think he is just saying EXACTLY what he/she is getting, ie hair moved AND graft totals.

 

Take Care,

J

 

Good point, B-

 

At the same time, I believe we have also seen truth in "other clinics use the hair count discussion as a crutch in order not to push themselves to do larger sessions".

 

It'a a both/and scenario. If a clinic is dividing grafts just to benefit the clinic, that's just plain deceptive. At the same time, I think clinics that only offer max sessions of 2500 for a NW5 or 6 with stats that would allow a person to get 4000, 5000 or more in one session, clearly need to education the prospective HT patient that it will take many grafts (and hairs) for anything close to full restoration.

[hairworthy]

Glad to see that my topic is still active after 1 and a half year. Haven't changed my mind re: AA. He may be good but the docs I went to (one of them's just posted above) are probably better. Beware of money-hungry businessmen.

[Guest wanthairs]

Hey Guys,

 

As one of Dr. Epsteins patients, I discussed my concern about not getting enough grafts and he explained the same thing to me as he has above. He told me I had excellent donor laxity and about 7500 grafts available, however he only wanted to do UPTO 3000 THE FIRST TIME. With my 2900 grafts he did for me, post op I had much more coverage than I have seen of anyone else with this number of grafts, (immediately post op, from Dr.'s websites.) I come from a family of doctors / surgeons/ dermatologists and they all agreed on this fact. I told Dr. Epstein to take as many grafts as possible. My contract said I would have to pay an additional $3.00 per graft above 3000 grafts. For all I know, he could have told me he took 4000 grafts and taken an etra $3000 but he did not and I paid nothing extra although I told him I was more than willing. This message is not intended to advertise his services. Its only been 6 weeks now and I have yet to see the final results. I will post some before and afters when the proof is pertinent.

[hairbank]

I'm a fan of Dr. Epstein and believe he does solid work.

 

My earlier post was pointing out that there are Docs that do not peform sessions of more than 2500-3000, period. If a NW5 with great donor hair walks in to one of these offices, it would have been better, both financially and time-wise, if he had gone somewhere that he could possibly have gotten 5000 grafts in one pass.........not 2500-3000.

 

As for the coverage per graft.........as long as the surgeon is strategically using only 1's when necessary for the hairline and multi's everywhere else that should be no different from one clinic to the next.