Dr. Paul Rose/Shapiro Medical

[PA Veteran]

I am a veteran of eleven transplantation procedures including two scalp reductions and approximately 3000 mini/micro grafts. The large number of sessions was due to the relative small number of grafts per procedure; initially 200 and progressing to 400. My approach was purposely conservative in order to camouflage each session and attempt to replace hair at a rate consistent with fall-out. My initial surgery was done in the early 90s. I did my best to research suitable options/procedures and consulted with six transplant physicians including Dominic Brandy, two plastic surgeons at the Cleveland Clinic and several others. Dr. Brandy's recommendation was a series of "hair lifts" with subsequent grafting. I felt this approach was too aggressive and radical for my balding pattern and degree of thinning. I decided to proceed with Affiliated Dermatology in Columbus, Ohio.

 

The results of the "cut to size" mini/micro grafting with dilators (sterilized finish carpenter nails - I'm not joking) are less than optimal with insufficient density. Selection of the donor sites was not well planned, resulting in scars scattered sporadically on the sides and rear without proper excision of residual scar tissue from previous sessions. The recipient area is thin and the hairline lacks proper transition from single to multi hair grafts. Many of these problems were not obvious until several years ago when all the native hair was gone. The final result is not poor, but careful styling is required to create the illusion of adequate density. To be fair, many physicians were still doing 4 mm plugs at that time. If performed at all, follicular unit transplantation was not common in the early 90s.

 

After my last session three years ago, I decided against further treatment. Over the past few years I was continually reminded (mostly by mirrors) of the imperfect final result. Although drained by the previous work - financially, emotionally and follicularly - I am fortunate to have the financial means and sufficient donor area to proceed cautiously with additional work if improvement and a good final result are possible.

 

I began additional research mostly via the internet (a tool not available when my treatment began) and Shapiro Medical kept appearing in this and other websites as one of the best HT practices. I contacted Dr. Shapiro's office and spoke at length with Matt Zupan. Matt's approach was very professional, helpful and lacked any pressure to schedule surgery. After many subsequent conversations, I decided to schedule surgery with Dr. Paul Rose. Arrangements were made for the pre-op meeting to occur the day before surgery. I thought it best to travel to Dr. Rose's Florida office several weeks before surgery to discuss my many concerns: remaining donor supply; scalp laxity; removal of scar tissue in the donor area and closure; refining the hairline; the follicular unit procedure; and frankly to assess Dr. Rose himself.

 

Dr. Rose impressed me profoundly with straight talk, extensive knowledge and candor about what results were and, more importantly, were not possible. I am now one week post-op and the advantages of the follicular unit procedure relative to the old method are immense. Trauma to the recipient site is minimal in comparison and, at only one week out, virtually impossible to detect. I do have the advantage of coverage provided by previous grafting. A significant portion of the scarring from previous harvesting was excised and Dr. Rose was still able to yield 1400+ FUs without excessive tension on the closure. This session softened the hairline and increased the core density. Our plan is for two more sessions: the next will increase density posterior (top of the head); a final session (donor supply and scalp laxity permitting) will treat the crown.

 

As for Dr. Rose, he is a perfectionist. He invested more time drawing, re-drawing, measuring, reviewing and consulting with me on placement of the hairline than my previous doctor spent dumbing, harvesting and closing the donor area (for those of you new to this, that is a good thing). As I am an out-of state patient, he personally made numerous calls on my behalf to find a local dermatologist available for suture removal. I have never seen a negative posting of his work, and I now know why. SEEK OUT THIS MAN AS HE IS ONE OF THE BEST IN THE FIELD.

 

I believe many HT docs continue to knowingly do sub-par work because it takes a huge investment in equipment and staffing to convert to the ALL follicular unit procedure. My recommendation to anyone considering surgery: do your research; stay with an ALL follicular unit procedure; choose a facility like Shapiro Medical which has made the staffing and equipment investment, enabling the best possible results; select only a physician with an impeccable reputation - like Paul Rose.

[PA Veteran]

I am a veteran of eleven transplantation procedures including two scalp reductions and approximately 3000 mini/micro grafts. The large number of sessions was due to the relative small number of grafts per procedure; initially 200 and progressing to 400. My approach was purposely conservative in order to camouflage each session and attempt to replace hair at a rate consistent with fall-out. My initial surgery was done in the early 90s. I did my best to research suitable options/procedures and consulted with six transplant physicians including Dominic Brandy, two plastic surgeons at the Cleveland Clinic and several others. Dr. Brandy's recommendation was a series of "hair lifts" with subsequent grafting. I felt this approach was too aggressive and radical for my balding pattern and degree of thinning. I decided to proceed with Affiliated Dermatology in Columbus, Ohio.

 

The results of the "cut to size" mini/micro grafting with dilators (sterilized finish carpenter nails - I'm not joking) are less than optimal with insufficient density. Selection of the donor sites was not well planned, resulting in scars scattered sporadically on the sides and rear without proper excision of residual scar tissue from previous sessions. The recipient area is thin and the hairline lacks proper transition from single to multi hair grafts. Many of these problems were not obvious until several years ago when all the native hair was gone. The final result is not poor, but careful styling is required to create the illusion of adequate density. To be fair, many physicians were still doing 4 mm plugs at that time. If performed at all, follicular unit transplantation was not common in the early 90s.

 

After my last session three years ago, I decided against further treatment. Over the past few years I was continually reminded (mostly by mirrors) of the imperfect final result. Although drained by the previous work - financially, emotionally and follicularly - I am fortunate to have the financial means and sufficient donor area to proceed cautiously with additional work if improvement and a good final result are possible.

 

I began additional research mostly via the internet (a tool not available when my treatment began) and Shapiro Medical kept appearing in this and other websites as one of the best HT practices. I contacted Dr. Shapiro's office and spoke at length with Matt Zupan. Matt's approach was very professional, helpful and lacked any pressure to schedule surgery. After many subsequent conversations, I decided to schedule surgery with Dr. Paul Rose. Arrangements were made for the pre-op meeting to occur the day before surgery. I thought it best to travel to Dr. Rose's Florida office several weeks before surgery to discuss my many concerns: remaining donor supply; scalp laxity; removal of scar tissue in the donor area and closure; refining the hairline; the follicular unit procedure; and frankly to assess Dr. Rose himself.

 

Dr. Rose impressed me profoundly with straight talk, extensive knowledge and candor about what results were and, more importantly, were not possible. I am now one week post-op and the advantages of the follicular unit procedure relative to the old method are immense. Trauma to the recipient site is minimal in comparison and, at only one week out, virtually impossible to detect. I do have the advantage of coverage provided by previous grafting. A significant portion of the scarring from previous harvesting was excised and Dr. Rose was still able to yield 1400+ FUs without excessive tension on the closure. This session softened the hairline and increased the core density. Our plan is for two more sessions: the next will increase density posterior (top of the head); a final session (donor supply and scalp laxity permitting) will treat the crown.

 

As for Dr. Rose, he is a perfectionist. He invested more time drawing, re-drawing, measuring, reviewing and consulting with me on placement of the hairline than my previous doctor spent dumbing, harvesting and closing the donor area (for those of you new to this, that is a good thing). As I am an out-of state patient, he personally made numerous calls on my behalf to find a local dermatologist available for suture removal. I have never seen a negative posting of his work, and I now know why. SEEK OUT THIS MAN AS HE IS ONE OF THE BEST IN THE FIELD.

 

I believe many HT docs continue to knowingly do sub-par work because it takes a huge investment in equipment and staffing to convert to the ALL follicular unit procedure. My recommendation to anyone considering surgery: do your research; stay with an ALL follicular unit procedure; choose a facility like Shapiro Medical which has made the staffing and equipment investment, enabling the best possible results; select only a physician with an impeccable reputation - like Paul Rose.

[al]

Hi PA,

 

I am glad you are pleased with Dr Rose. I just had 800 FU HT done, and contemplating a future procedure with Dr Shapiro. In the meantime am trying to educate myself as much as I can. Could you tell me if you had any swelling after the procedure, if you were given any steroid anti-iflammatory medications prior to the surgery. Where was the location of your previous scar that was included in the recent harvesting? If the entire scar was removed? Did Dr Rose insert the grafts himself, or he was assisted by his technicians. Do you think it is important for the grafts to be inserted by hte surgeon, or the insertion part does not require much artistic skills. And lastly, do you have any opinions about Dr Brandy.

 

Thank you,

al

[PA Veteran]

Redness in the recipient area was noticable for 4-5 days. Prednisone was prescribed the day of and for four days after surgery. I had virtually no swelling.

 

The harvest excision runs from ear to ear along the lower third of the donor area. One scar located below the recent incision was purposely not excised by Dr. Rose because it is wide and would not yield transplantable hair, and closing it would increase tension on the suture. I am hopeful it can be removed in a future session.

 

The location and angle of the graft incisions, which are obviously made by the Doctor, dictate their placement, so the technicians need only select the proper sized graft - 1 to 4 hairs. Dr. Rose placed the most crticial grafts at the anterior section of the hairline, supervised and participated in placement throughout the session.

 

As for Dr. Brandy, he is a lightning rod. Doctors and patients either love him or hate him. His early work with hair lifts and scalp reductions resulted in numerous lawsuits, whether warranted or not. I have personally seen several examples of his graft work and all were exceptional. My decision not to use him was based on an earlier consult when he suggested several radical hair lifts. Although cost should never be a determinate factor, his fees are high - $7,100 for 800 grafts; his associate Dr. Sunseri charges $5,100 for the same number.

 

Good luck.

[al]

Good talking to you.

al

[Guest]

PA

i read the post. it was very helpful. i had telephonic conversation with Matt Zupan. also sent my pics to him. Matt is knowledgeable and explained in details all the aspects.

PA if i am not wrong, you are in Pennsylvania.. right ...

why didn't you choose dr. bernstein in fort lee

rather than travelling all the way to MN.

 

i sent my pics to matt, he suggested me 2000+ units. i am wondering how much his estimates are close to the actual done on you. here i am just trying to get a clearer picture of what i might need to get done.

 

i also have the option of going to dr. bernstein who suggested me 1500+.

 

i have to pick out of these 2 options. and i have to decide by monday, so that i can go ahead with the reservation of date.

 

if any of you guys could help me ??

thanks

[PA Veteran]

During several telephone consults with Matt, his estimate was appropriately conservative @ 1000 grafts based on e-mailed photos and a description of the prior surgeries. Dr. Rose was able to yield 1400+.

 

For an accurate assessment of graft yield, you need to have a personal consultation with the physician performing the surgery. As noted above, I flew to Florida to meet with Dr. Rose two weeks prior to surgery to allay my concerns about the procedure and the doctor. Slow down and be as objective as possible in your decision. The difference in airfare between Florida, New York and Minnesota is nominal. You have to live with the results for the rest of your life.

[Guest]

i have decided to go ahead with dr. paul rose for my HT. PA veteran could you please let me know more about dr. rose and how your grafts are doing now ?

hope everything goes well with the surgery planned in may.

 

arpit

[PA Veteran]

There is not yet any progress to report at six weeks post-op. My experience with previous cut to size sessions using dilators was no growth for at least seven to ten weeks. I was told to expect a longer resting phase for the FU procedure due to the concentrated number of grafts. Hopefully you took my advise and met personally with the physician, in this case Dr. Rose.

I've provided a fairly detailed account of my experiences in previous posts and don't want to bore readers with repetitive information. In my opinion, web sites such as this one are invaluable to prospective patients. It provides a forum for discussion between people at all levels of experience, and hopefully guidance to the novice searching for solid information in a field where even the best known physicians cannot form a consensus.

The conflicting information I received in the late 80s and early 90s when researching my options was frustrating. Even now, well-renowned physicians differ significantly in their preferences. Access Dr. Walter Unger's web site (walterunger.com). He is referred to by some physicians as one of the "godfathers" of hair transplantation and, in certain cases, is still a proponent of scalp reductions and large 4mm plugs. I know Dr Shapiro - with a reputation as one of the best all follicular unit docs - is working with Unger on his latest book. Reconciliation in the book of these conflicting approaches should be interesting. I'm anxious to hear about your experience with advise given during consultations with Dr. Rose and any other physicians, including differing suggested approaches.