Northern's Procedure with Dr. True and Dr. Dorin

Robert_ · November 12, 2004

November 10, 2004

It was a day of change for Ron Sachetti, the third winner of the "Win a Free Hair Transplant Essay Contest." Ron wrote a very compelling essay in July that got a response from everyone that read it. His story was all-too-familiar to all of us that have been in his shoes. Ron is recently divorced with two children. It was very obvious that the welfare and happiness of his children came first and finding the money and time to concentrate on his own hair loss affliction had proven to be impossible.

Dr. Robert True and Dr. Robert Dorin of New York, NY answered the call to come forth and benevolently offer their services to Ron free of charge. Dr. True was thoroughly involved in the selection of the candidates. "Ron's case intrigued me. There was just so much good that we could do for him. It will be a pleasure in helping all that I can."

I met up with Ron at True & Dorin Medical Group in Manhattan early Wednesday morning. We shook hands and sat and talked for a while in the waiting area. "I still cannot really believe it. I know that I am here, but it still hasn't really sunk in yet."

As the time to go into the back and get started approached, I couldn't help but to get as excited for Ron as he was for himself.

First thing, some preliminary "before" pictures were taken of Ron from several angles. While I was snapping some of my own for documentation, he showed me his license picture that was taken about a year ago. The difference was astounding. He had lost a great deal of hair in just the last year alone.

"I'm pretty sure the divorce had something to do with that," he told me.

That again reassured me that we had selected the right person.

After the pictures, we were invited back to the consultation office. Here, we sat in comfortable chairs and met Dr. Robert Dorin. Dr. Dorin answered many of Ron's initial questions and asked him what his expectations were. They talked about the hairline placement and how the grafts that were harvested would be distributed. Then, Dr. Dorin took out the marker and went to work mapping out an initial plan for Ron. There was no silence at all during this as he was repeatedly asking Ron what he thought of this and that and if he had any questions.

As this was taking place, Dr. True joined us. It was apparent from the very beginning that both physicians took this imperative part of the procedure very seriously. The real treat for me was watching as both methodically looked over Ron's donor area and bald areas, conversing back and forth about the absolute best way to treat his case. There was absolutely no indication at any time that Ron was treated any differently than that of a paying patient. He was always told about any decisions that were made, his input was always heard, and everything was thoroughly explained.

After the pre-operation consultation, a few more pictures were snapped of the outlines showing where Ron's new "mop" was going to lie.

"Now let's go get some hair!" Dr. True enthusiastically exclaimed after that, signaling the start of the fun. There was no doubt that he and Dr. Dorin were as excited as Ron and even myself.

In the operating room, Ron was laid back on the reclining chair and preparations began on the donor area. While Dr. Dorin was doing that, Dr. True and I looked on while he explained some key facets of the experience that he likes to provide for his patients.

"One part of the procedure that I was particularly concerned about a few years ago was that patients would tell me that the most discomfort that they felt came from the administration of anesthesia. This concerned me a great deal because I truly want this process to be as pleasant and pain-free as I could possibly make it. After searching several different methods, I came across a breakthrough that was being utilized in the dental field."

He explained that the pain of the administration of anesthesia from syringe injection, the traditional method, can never be fully controlled by the human hand. In that, the pressure on the surrounding tissue is what causes the pain, not the needle itself. Even the steadiest human hand administering the anesthesia is fallible in that it will never be able to provide the consistent rate and pressure that is needed to produce a truly painless result.

The answer came in the form of a microprocessor controlled anesthesia-delivery machine called "CompuMed," or more affectionately named: the "Wand."

The Wand has been approved by the FDA as a local anesthesia delivery device and has served successfully in applications in dentistry. The microprocessor monitors and adjusts the infusion pressure while delivering anesthetic solution at a controlled flow rate. The result? Painless anesthesia delivery and no more needle scares. I returned my attention to Ron while Dr. Dorin and one of the techs used the Wand on the donor area.

"How are you doing Ron?" I asked.

"Thumbs up the whole way!" he told me.

Once Dr. True saw how interested I was in this method, he produced a triple-blind study that he performed when considering the Wand. Once reading through it and seeing it in action, I knew that this was definitely a great answer to those that are needle-shy or have lower pain thresholds.

After the anesthesia, Ron was ready to roll over onto his stomach. I watched anxiously at a very safe distance (in a full smock; decked out like I thought I should be there or something) while Dr. True and Dr. Dorin began the painstaking process of removing the strip of donor hair. Ron was awake the entire time though now comfortably sedated. It is truly fascinating to watch two of the leading physicians in the industry work so diligently and expertly at carefully excising the strip and suturing the area into a tight scar. Dr. True and Dr. Dorin use a double stitch method of sealing the area. One set of dissolvable sutures in the scar and another set of removable stitches over that.

"The true test is not stitching the area too tightly. If it is closed up too tightly the scar can actually heal larger. Of course, too loosely has its own obvious drawbacks" he told me.

I was able to take a peek at the area right after the sutures were in. The result was nothing short of beautiful.

While the physicians were diligently working sealing Ron's donor area, I took the opportunity to sneak back to the where the technicians were separating the naturally-growing follicular units in another room. No less than five technicians were peering into microscopes the entire time while I tiptoed around at a safe distance. Thankfully, I was able to snap off a few photos of them working but I didn't dare interfere with them with my mundane conversation during such an important process.

Watching all this toiling had me needing a quick break so I headed to the break room in the office. After pouring myself a cup of coffee I noticed a wall of certificates that intrigued me. Upon closer inspection, I realized that they were not either Dr. True or Dr. Dorin's accomplishments that were proudly displayed, but those of the technicians themselves. Each had passed a rigorous training program that Dr. True had personally put into place.

Upon my later inquiry, Dr. True explained, "The technicians are such a vital part of the process. No matter how good I or Dr. Dorin may be, they are the ones that we rely on to get the process done. I know that I never have to wonder if what they are doing is right. They have all been with me for 5...10 years or more. They know this procedure and how to get it done with the best results possible. I have to say that I am infinitely proud of the team that I am fortunate enough to have."

Soon after, Ron was ready for the graft incisions to be made. Dr. True methodically made the incisions while Dr. Dorin looked on and counted.

"I know that you have heard a lot about the different types of incisions that are practiced" he told me, "I really believe that while classification is important, it can really be an oversimplification of what is needed. No one slit technique is going to give the refined, truly natural look of the patient's hair."

He pointed to the scruff at Ron's forelock that he had left long (Dr. True didn't shave the recipient area at all). "Do you see how the hair exits the scalp in this manner? Now look here...as the slope of the head descends on the side, the angle of the hair as it exits the scalp differs. This is extremely important to keep in mind. One can make a truly beautiful hair transplant, but if the angles of the hair that are being implanted don't match the patients existing hair characteristics, it will never look as natural as possible."

I had to say that I was impressed. Not only from the professionalism and the excruciating attention-to-detail that I was witnessing, but also from the graft count that had come in: just shy of 2,700 grafts. Not bad at all for writing an essay!

I was able to snap a few pictures of the grafts at an extremely safe distance (using the zoom on my camera) while they were in the fluid. Ron's 2,700 new best friends were on their way to their new home at a new address on his scalp.

Graft placement was another long and arduous experience. As Ron (and I) sat comfortably and watched television, the doctors and technicians swarmed his head placing grafts. As much as we discuss the importance of this aspect of the procedure on the forums, there really is nothing like being there and realizing the time, skill, and effort it takes to accomplish it with accuracy that the procedure demands.

While grafts were being placed, I got treated to another bit of information. Dr. True and Dr. Dorin are marching into the future by performing FUE trials. One of their most recent patients came in for a follow-up and was gracious enough to let me meet him and see his progress. He was only a couple of months post-op but his head was shaved down. There was no hiding the recipient or donor areas with this guy's haircut. Close inspection of the donor area revealed absolutely nothing visible to the eye. I would say that his hair had been shaved with a #1 guard only days before. There was no evidence of the scarring from extraction at six inches away and believe me, I looked. The patient then proudly directed me to his recipient area. "I am already seeing them push through in some areas! I can feel the fuzz where there was none before."

Dr. True told me that this particular patient had received 800 grafts in two sessions. Then, he answered the most pressing question that I had regarding the extraction: "How big of an extraction tool did you use?"

He smiled at me because I think he knew that it was coming.

"I alternated between a .75mm and a 1mm extraction tool" he answered.

"Can I ask what determines your decision between the two while in surgery?" I pressed further.

"Sure, you see when extracting the follicular units with FUE, its important to keep tabs on the different angles at which the follicles lie at the different areas of the scalp. You see, where at one area where a .75 mm tool would be very beneficial and I am more confident that there is little risk of transection, a 1mm tool wouldn't be as prudent. This same philosophy is reversed for other areas. It is important to be flexible for the absolute best results."

I was convinced. He took out pre-op picture of the patient.

"You see how I outline the areas where I want to extract from? Look at how that lines goes under that spot." He was pointing at the top line of a box that was stenciled on the donor area of the patient's scalp.

"In a lot of early studies of FUE, I took notice of a rather careless practice that I was seeing that disturbed me greatly. I couldn't believe that I was seeing follicular units being extracted from the area so high up that the hairs may not even be permanent; they are still subject to fall out in time from the balding pattern that the patient may be subject to. This is why something so mundane as mapping out where the follicular units are going to come from is so important. Also, every patient's thinning pattern is unique, so it is very time consuming to ensure that it is the ??sweet spot" that we are getting our grafts from."

I thanked the patient profusely for letting me meet him and discuss his case with him. His progress will certainly be interesting to follow as well as Dr. True and Dr. Dorin' other trials with FUE.

It was getting down to the wire for Ron by this time. I re-donned my scrubs and headed back to see what was going on. The technicians were finishing up the apex and forelock of the grafts and the coverage was looking great. Dr. Dorin looked on intently. I asked Ron how his long day had been so far.

"Great. Nothing short of great. I really haven't felt anything at all. Any time I did, I just told them and I was given some more anesthesia."

After everything was said and done, Ron looked at the finished product. He was beaming. Heck, I was beaming. I knew the feeling of looking at yourself knowing that in a few short months the clock would be rolled back profoundly and a new person would be looking back at you in the mirror. He shook my hand and smiled again.

In these pictures, you can see that the approach that was used was to re-establish Ron's hairline to frame his face. This was done utilizing a fairly dense amount of coverage and as you move back, the coverage is slightly decreased. The crown was important to Ron. He really wanted some hair back there. Dr. True and Dr. Dorin obliged by "sprinkling" the crown with follicular units giving great care to Ron's naturally-occurring "whorl." The result is an ingenious use of 2,700 grafts in a session that can only be described as top-notch.

I want to take this time once again to thank Dr. Robert True and Dr. Robert Dorin for their participation in this truly life-changing event. For the rest of his life, Ron is going to look back on this day as a day that started a new era. In a few short months, he will be able to return to the dating scene with his confidence restored and a fresh outlook on his appearance. This day was not about hair in the traditional sense. This day was about the benevolence of two industry-leading physicians taking the time to give the gift of confidence to someone that they had never even met. One day out of these doctor's schedules will enable Ron to return to Nova Scotia able to look forward to each day without the embarrassment of an unfortunate condition and without the shadow of a baseball cap. I was thrilled to be a part of it and bring the story back to post.

-Robert

Robert_ · November 12, 2004