Dr. Paul Shapiro and Coalition Membership

[Guest Cousin_It]

B..

 

Thank you for shedding some additional light on this issue. I want to make one point perfectly clear, my dissension on the issue is based solely on the process of entrance which transpired, not on Dr.P Shapiro qualifications, I simply do not have the information on this aspect yet, though I have tried to obtain. In no way would I consider several photos of his work sufficient to formulate an educated opinion.

 

As I have previously stated, Pat made the magnanimous gesture of stating that members would become an integral part of the decision making process in the induction of future doctors in the Coalition through their voting privileges. Previous to that Pat had the sole discretion in this matter, perhaps he would ask for comments, but ultimately it was his decision. I applaud this action and feel that it was appropriate, a long time coming and justifiable, since this forum belongs to its members, not Pat or Media Visions. Members, such as yourself, tirelessly contribute time and effort to make this one of the premier sites of educating the consumers of the facts and fallacies of hair transplantation without any compensation. I as you, take pride in this responsibility and will continue to make contributions to further the cause.

 

My "gripe" is that an offer was made, accepted by it members, then disregarded without due course. No real voting had occurred, the jury was still out, yet the "defendent" (Dr.P Shapiro) was given a verdict. I view this as a "slap in the face" to the democratic process and to those members that unselfishly contribute to this forum. Due to these facts it is inevitable that dissension would occur. It has become a highly controversial issue as noted by the posts which have transpired. Unfortunately Dr.P Shapiro's entrance has become somewhat questionable and tainted, though no fault of his own. In the end, a process with may have ultimately allowed Dr.P to enter with open arms, had it been allowed to progress its full course, has resulted in this unhappy ending. At this point I see no viable alternatives to rectify this. The damage has been done. Things are what they are and we will all have to live with the ramifications which follow.

 

I sincerely hope in the future we will not revisit this scenario, since ultimately this will cause further harm to the credibility of the entire Coalition and reduce it to just another web site advertising doctors.

 

PS...

 

In a previous post Pat appropriately summed up his stance on the process of induction,

 

"In my opinion, members of the Coalition are the cream that has risen to the top over the last seven plus years that this community has been in existence. So like cooking or marriage, this selection process should never be rushed"

 

So what happened?

 

 

NN...

 

Just for the record, I totally agree with your stance. Apparently we are of one mind. I also thank you for speaking out on this issue, I highly regard your opinion as I am sure others do.

[Gorpy]

You guys don't remember that Dr. Paul was offering a discount rate? I think he was just trying to establish himself and attract more customers. I found this old thread from Feb. 2006 from poster Slick:

QUOTE

Hey guys first post been lurking here for a while. Had a second consult with Shapiro today and I'll probably go foward with my first transplant. I have the chance to do surgery with Shapiro's brother who, according to Matt is just as good. They've offered a pretty decent discount if I decide to go with the brother. Although I'm sure I have nothing to worry about with any docs at that clinic I really don't want to chance anything. Any feedback on this doctor? Thx END QUOTE

 

... and yes, he was a "relative" newbie. That's why no one had heard of him until recently. I didn't mean that in a disparaging way. I think he does excellent work and I would agree that he should be in the coalition.

[NervousNelly]

B Spot,

 

I did a little more research myself and got some of the answers that I was looking for and not provided. Yes, the Coalition members do in fact have to pay dues in order to be members. Let me make this very clear---I AM NOT IMPLYING ANYTHING. I just like to know all facts.

 

I myself am a member of different professional societies for my career. Do we pay dues--absolutely. I understand that it is imperative that money is provided for inorder to have the continuation of said societies. Do we constantly strive for new membership--again absolutely. There is power in numbers. Do we do this for the benefit of ourselves or the benefit of those we serve? That is where things become a little grey. I like to think of it as a win win situation. It certainly does benefit both sides, no questions.

 

Again, nothing is implied but I believe that it is a good idea that everything is out in the open. I had always wondered why there seemed to be an urgency for new Coalition members and what is more key--Why do the docs contact Pat wanting membership??? It definitely will benefit all involved and I don't believe that it SOLELY is just for patient satisfaction--But there is nothing wrong with that.

 

Again just my 2 cents

[TonyQ]

from what you guys say sounds like a suitcase of cash changed hands, i always thought some thing fishy was going on here $$$$$

[the B spot]

NN I sent you a PM.

[Dr. Paul Shapiro]

To all members of the coalition:

 

I have been preparing a response to Cousin_It and Bill question last week. I am sorry the response took so long but the subject of density and my goals in surgery is complicated These are topics of chapters in textbooks and hour long lectures at the ISHR surgery meetings. It has been difficult for me to give a concise answer that seems to hit all the important points but does not go on for pages. The following answer is the result of many re-writes over the last week.

 

I was going to post this answer on Monday. In the meanwhile Pat posted his announcement that I am accepted into the coalition. I am honored of Pat's confidence in me but at the same time I was not aware of his decision until I received an email form him. I just think that Pat is very busy and thought that the members of the coalitions concerns had been met. If the members believe that their concerns have not been answered then maybe Pat should wait to put me in the coalition. I am not sure how Pat plans to run the process of allowing a new member into the coalition and I will comply with all and any request.

 

The main reason I would like to be a member of the coalition is to establish a profile for myself so potential patients can see my work. I know there has been confusion in the past about who is Dr. Paul Shapiro and it will help establish my identity. As for the financial aspect. At SMG the price of surgery with my brother, Dr. Ron Shapiro, has always been higher then the other doctors working there, whether it be Dr. Rose, Dr. Keen or Dr. Charles. It just makes sense that a price with Dr. Ron Shapiro would be greater due to his reputation.

 

I will send Pat a copy of this email and let him decide on what to do about my membership to the coalition. I am sorry if anyone thinks they have been deprived of enough information to make an informed decision and I think the best action at this time would be to delay my membership until your concerns have been met.

 

I will send the answer to the questions about densities and my goals in another post. I think this one is long enough.

[Dr. Paul Shapiro]

Some answers to qeustions about Paul Shapiro MD,s surgeries

 

Thank you for your positive comments. In the future with new patient postings I will be giving more information. But the photos I have posted were just a way to give the community an idea of what my results look like.

 

I am going to give a brief answer to the questions of what type of densities I strive for and what goals I attempt to achieve in hair transplantation. As Bill and Cousin-It pointed out, there are many factors that go into deciding what density a doctor will chose to use in a surgery. I also need to point out that when speaking of density there are two types of densities to consider. The density of FU/sqcm and the density of actual hairs/sqcm. If I plant a density of 30FU/sqcm of 2 hair FU's I will get 60 hairs/sqcm. If I plant the same density with 3 hair FU's I will get 90 hair /sqcm.

 

All this said and done, I would say that in a typical surgery my density ranges from 25 to 45 FU/sqcm. In general my goal is to recreate a density gradient that looks natural and imitates nature. The same density throughout the entire recipient area often creates a diffuse unnatural look that is see through. I try and create higher densities in areas of greater aesthetic significance such as the frontal tuft area, the area right behind the transition zone of the hairline, and in the central core.

 

To accomplish this goal I plant one hair FU's in the hairline at lower densities to give a soft, natural look. Behind the hairline, in the temperal area and the beginning of the central core area I plant the two hair follicular units with a density anywhere from 30 to 45 FU/sqcm.

Behind the 2 hair FU's I will plant the 3 and 4 hair FU's in the central core. The 3 and 4 hair FU's differ in size depending on each patient's hair and skin quality. In some patients the 3's will fit into a .8mm incision and I can plant them closer together. In other patients the 3's need a 1.0mm incisions to fit properly and I have to place them further apart. The 4's usually need a blade .1 to .2 mm larger then the 3's. I would say in general I plant the 3 and 4 hair follicular units in a density form 20 to 35 FU/sqcm. Remember, if I plant 4 hair FU's at 25FU/sqcm that is 100 hairs/sqcm as opposed to 2 hair FU's at 25FU/sqcm which would be 50 hairs sq/cm. To put it another way by planting 4FU hairs at a density of 25FU/sqcm I am getting the same number of hairs as planting 2 hair FU at a density of 50FU/sqcm. As you can see I create the higher densities by placing incisions closer together( i.e my incision density can ranger from 25-45 or more), and by selectively choosing to use a greater population of the 3-4 hair grafts in areas I want the greatest density

 

I know you all will be wondering how many 1,2,3 and 4 hair follicular units I usually get in a session. It varies from patient to patient. I will post my numbers of 1,2, 3, and 4 hair FU's in my future.

The patient I transplanted last Friday will give you an typical example of distribution. On Friday's patietn I got a total of 2595 Follicular Units. That broke down as follows:

Type # Grafts # Hairs

1 Hair FU 510 510

2 Hair FU 1465 2930

3 Hair FU 818 2454

4 Hair FU 175 700

Total 2959 6594

 

For the hairline in this patient I used 400 one hair FU's. I doubled the rest of the one hair FU's to make them into 2 hair FU's to get more density behind the hairline.

 

I hope this helps answer your questions.

[NervousNelly]

Tony Q,

 

I don't want to be known as the individual that started all kinds of rumors and smeared the name of this awesome site. For the record, that is not what I was saying and there is no "suitcase of money" changing hands.

 

My point is that from what I have seen, it is equally beneficial for the doctors to be appointed as members of the coalition. And for that priviledge and to cover expenses involved there are fees. I just don't want anyone to lose sight of that fact. I'm sure that on occasion, there are some less than honest individuals that do try to "buy" their way into membership. From what I have seen this will never happen with Pat at the helm. He has done a great job of protecting the integrity of this site.

 

I want that trend to continue and if someone is voted into membership in what looks like a hasty and premature manner, it ofcourse gets questioned. End of story.

 

I don't believe there is any "palm greasing" going on but if there continues in the future to be a quick and simple approval of membership others might start to wonder.

[Bill - Seemiller]

Wow,

 

There have been a lot of postings since yesterday, and I'll confess right off the bat that I did not READ all of them, but skimmed all of them. From what I did see, this is a great discussion. I confess, I do not know the ENTRE process a doctor has to go through to become a member of the coalition, however, there is some detail under the membership criteria and membership selection process.

 

http://www.hairlosslearningcenter.org/hair-loss-content...ership-standards.asp

 

It's difficult because though as members we have voice, I'm not sure how adequate we really are to make a decision to allow a doctor into the coalition, for a number of reasons, and the reasons go well beyond education. We can know all we need to know about the current developments and techniques of hair transplantation, but how do we really know if a doctor performs quality surgery unless we've not only observed several surgeries, but have also seen a number of patients post their before/during/after results on this forum? So this is where we have to rely on Pat's knowledge, visitations, and expertise to make decisions that will benefit the community. BUT...I do admit, that perhaps the process of selection of coalition doctors should be more defined and explained. I can truly appreciate the concerns of people on this forum that this process may have moved quickly....truly I see that everyone wants the same thing. We truly want to make sure that the coalition doctors are truly doctors we feel comfortable recommending to others. Though I don't have any legal obligation, I feel I have a moral obligation to direct seeking patients to the best of the best who I KNOW for sure will do an excellent job. Dr. Paul Shapiro seems to meet all the qualifications, and now I've seen before/during/after pictures, AND he's personally recommended by his brother Dr. Ron Shapiro who is a well respected top coalition doctor. Based on that knowledge, I have agreed with the promotion to membership...however, should we perhaps draw out the process longer? Perhaps one suggestion is to have patients of his, post during the whole process and then as a whole, we all see how it turns out. That way, we know for sure that it's not just a doctor selecting their best patients and work and posting them.

 

 

 

Whereas I agree with B-Spot that live surgery doesn't lie, I think it's also just as important to see the end results of the "live" surgery in order to deem it a success or lack of success (which I believe B Spot will also agree with). I think the primary concern of some members here (including myself generally speaking), is that to some degree, if we've only just begun to see a doctor's work, people simply aren't comfortable admitting them to the coalition because they aren't making an informed decision. Whereas I believe most people, probably everyone believes Dr. Paul does excellent work, very few people feel 100% comfortable in recommending him at this point, because we haven't seen a lot of work done by him. But then...should that really be a requirement to admit a doctor into the coalition? Could I as an informed and educated patient possibly know all there is to know about all the doctors? I doubt it...unless I made this as my profession. It seems pretty obvious by photos that Dr. Paul uses the latest technologies, has credible recommendations from his brother, the well respected Ron Shapiro, and Pat gives his recommendation. Anyway...just thought I'd share some of my thoughts.

 

Bill

[Bill - Seemiller]

Cousin_It,

 

Thank you for the compliments you have posted about me. I believe you are here for the same purpose that I am. Additionally, you, and many others have truly helped challenge some of my views and helped expand them. I think these conversations are beneficial for everyone, as long as one remains open minded, knowledge can be aquired, and views can be expanded. An individual can only grow through challenges. So I thank you for that. You are truly an asset to this community and I'm personall glad to know you.

 

 

Bill

[Bill - Seemiller]

Dr. Paul,

 

I appreciate you taking the time to write out your response to my and Cousin_It's questions. Thank you for your detailed response and we look forward to hearing more from you and seeing more of your work.

 

Bill

[Bill - Seemiller]

Again, nothing is implied but I believe that it is a good idea that everything is out in the open.

 

Nervous,

 

Not sure if you were aware, but the fact that coalition doctors pay dues is out in the open posted at the link below.

 

http://www.hairlosslearningcenter.org/hair-loss-content...ership-standards.asp

 

So I agree...it's good that this is stated.

 

Bill

[Bill - Seemiller]

Cousin, NN, you guys are ALWAYS welcome to share anything, especially with me!!!!

 

I have no hard feelings at all toward either of you, and as a matter of fact, respect your involvement here immensely!!!!!

 

Well said B_Spot! The same goes with me too...I greatly appreciate honest opinions, whether or not they differ from my own. The fact that Nervous and Cousin_It (not to mention you, me, Pat, everyone else) are voicing their opinions intelligently and respectfully is what makes this community the great community that it is. Difference of opinion is part of life and by discussing things openly, honestly, and intelligently, great things can happen.

 

 

Bill

[Pat - Community Publisher]

I want to thank everyone for their input. I know that everyone involved in this topic ultimately shares the goal of keeping the Coalition membership standards ultra high.

 

Over the past seven years feedback from patients and members of this forum, both in private emails and in posts, has been a great source of information about hair transplant physicians. This information has helped me both eliminate physicians from potential recommendation and identify those producing impressive results

 

There are over 600 physician members of the world's biggest hair restoration professional society - the International Society of Hair Restoration Surgery (ISHRS). Hundreds more physicians practice hair transplantation without belonging to any hair transplant professional organization. Only two dozen of these physicians have been chosen for membership in the Coalition after seven years of my researching various physicians, including visiting dozens of clinics and attending over a dozen international hair transplant conferences

 

In my opinion, the vast majority of practicing hair transplant physicians are not eligible for recommendation on the Hair Transplant Network or for membership in the Coalition. Many physicians over the years have applied to be recommended on our community and been quietly rejected. Typically the members of this forum are not aware of these decisions because these physicians were never presented on this forum for consideration.

 

No one person or persons has definitive information about the quality of work being done at all clinics at all times. But through a collective process of elimination and addition, like mining for gems in the rough, I have developed a list of physicians and clinics over the past seven years that are recommended on the Hair Transplant Network and who are elite members of the Coalition.

 

These physicians and clinics need to meet the criteria listed on the Hair Transplant Network page "How we select the physicians recommended on this site". If a physician fails to meet these requirements over time they are promptly removed.

 

This review process is not perfect and not all will agree on all decisions. But I do believe that it has served many patients well over the years.

 

There are many considerations in granting Coalition membership to a physician. As a part of this review process I will continue to seek input not only from current Coalition physician members but also the members of this forum community.

 

Ultimately I reserve the right to make the final determination on the membership. I don't expect everyone to always agree with me on all physicians who are either added or removed. But I will strive to build as much consensus as possible before making a decision.

 

I apologize to those forum members who feel that I rushed Dr. Paul Shapiro's membership review. I had been reviewing his work and progress, including watching his surgery and seeing his results, long before this topic was posted. So perhaps I was comfortable with him before members of this community had time to become equally comfortable with him.

 

I hope that members of this community will accept my decision to grant Dr. Paul Shapiro membership in the Coalition.

[nobuzz4me]

Pat,

 

No apologies are neccessary and thanks for the explanation, we trust your judgement or we would not hang around your site. Now, where is the party you are throwing with all your suitcases full of cash????

[Bill - Seemiller]

Pat (and everyone),

 

Well written post Pat. You hit the nail on the head. I don't believe it's possible for any person or all persons to know everything about any given doctor at any given time...therefore, it's probably not possible for everyone to agree on coalition membership into the community all the time...though in an ideal world, it would be wonderful. That being said...I support your decision to grant him full membership into the coalition.

 

It might take me (and others) some time to feel more comfortable recommending him as a surgeon to someone seeking, simply because his work is new to me/us. but I will most likely recommend him with words such as "appears" rather than "is" with a disclaimer that I don't have that much knowledge of his work personally, though I admit, I'm much more comfortable recommending him than some other doctors. I suggest to others that this may be the approach we take...just like anything else...how can we recommend with certainty what we don't fully know? Yet, at the same time, it's important to trust Pat and others who have witnessed first hand experiences such as B-spot. Does that mean we allow them to speak for us? Certainly not. We have our own voice and can voice it on the forums any way we want. BUT, regarding membership, I believe it's right to trust Pat because I believe his interest is the same as ours, to keep the standards of the coalition high. After all, his reputation and moral conscious is more on the line than us for making a quick decision. Therefore, it is also right that we voice our opinions and give recommendations based on the accurate information we KNOW.

 

As I wrote above...I might saying something like "Dr. Paul appears to be an excellent physician and has met the high quality standards of the coalition according to the coalition selection process. I don't have any personal experience with him because he's relatively new...but the cards seem to fit. I have seen some before/during/after photos that he's posted and they do look impressive from what I've seen."

 

Long story short...I think that it's fair that we admit him membership based on what we've seen so far and your expertise and experience with Dr. Paul...and then, as a result, I hope that as Dr. Paul posts more on this community, and additionally, his patients, that people will become more comfortable recommending him.

 

The other interesting you pointed out...is a membership is not written in stone. If a doctor begins to digress from the ultra high standards of the coalition during the review process, a physician can certainly be removed, both from the coalition and as a recommended physician. I believe this is an important part of keeping the coalition's standards ultra high as well...so thank you for pointing that out.

 

Bill

[Guest Cousin_It]

Guys...

 

I am glad we finally put a close to this unpleasent chapter. I for one found this extremely disturbing and detrimental to the credibility of the Coalition.

Pat...

 

May I suggest in the future you do not make statements which you do not intend to follow through on. Contradictions such as this, if continued, will ultimately negate the good work "unpaid" members of this forum are trying to accomplish. This is by no means personal, you seem like a nice guy on the surface, just an opinion of someone who has seen similar scenarios unfold with detrimental effects.

[Bill - Seemiller]

Cousin,

 

Hello my friend. Take a deep breath...seems like you are more stressed about this than you ought to be. Personally, I'm not sure why you found this conversation so detrimental. I'm also not quite sure of the contradiction you are referring to...though from a previous post, I can assume you are talking about Pat's comment about us being involved in the membership selection process? Forgive me, since I am at work, I don't have time to reference back to the original posts, but I never was under the impression from Pat's post that the decision had to be unanimous in order to welcome a new physician into the community as a coalition member. considering there is no way for the even the most faithful unpaid members to know everything about doctors before they are presented to this community, I think it is important that we have a little trust and faith. It is important to question things, as we have been doing, but ultimately, we have to leave the final decision to Pat, who has been following these doctors for quite some time.

 

There have been many times that I've seen Pat listen to our collective community voice and hold off certain doctors of membership because there were logical arguments presented which caused Pat to question it. Dr. Rassman and Dr. Nakatsui are two doctors that come to mind.

 

Additionally, I think we have to be careful. Just because Pat is paid for his work, doesn't mean that his work is any less credible. In fact, who other than a "paid" member (which to my knowledge is only Pat) can really take the time it takes to research and visit physicians all over the world.

 

Bill