good surgeon recommendations

[Pat - Community Publisher]

Gorpy,

 

Congratulations on contributing over 1,000 useful posts over the past two plus years on this community. You've helped a great deal of people and now you are rightfully a "Follicular Salvation Club Member".

 

Amen to more hair and patient education.

 

Pat

[thanatopsis_awry]

So to shave or not to shave comes down to whether or not you want to sacrifice shaving your head (which some either can't due to work, or won't due to strong personal preference), as it relates to going into the HT under "ideal" conditions....not to say that shaving your head guarantees a "better" result than not shaving; but, all things being equal, would be nice to do.

[NervousNelly]

Mrjb,

 

I love ya guy but no need for the comment about our statements on the propecia thread. I certainly hope that oneday you don't have to think that you wished you had listened to some of us. I really hope that never happens to anyone.

 

 

NN

[finnari]

Look the guy is 50 and divorced. He wants to get layed right now. Not wait 8 months with a shaved scar filled head. After all when you take a woman home she expects at some point for you to take your hat off.

 

If he has had 6 transplants in his life most of his hair is transplanted. Why would this be subject to shock loss?

 

He just needs new work to make his existing stuff look natural.

[spoon]

"Fact" - you do not need to have your existing hair shaved to get a fantastic transplant result.

 

So if you don't want to shave, then don't shave. There are great doctors doing great transplants that don't require it.

 

Another "fact": a lot of what is presented as fact is actually opinion. Gorpy already dealt with this, as well as irresponsible statements.

[the B spot]

Hmmmm..... I believe a good result can be achieved without shaving.

 

However, I believe the most optimal setting for a transplant is to shave the recipient area.

 

I think transection is an issue regardless on incision orientation.... a doc either has the skill or does not have the skill to transplant high densities or in-between existing hair at a more than proficient level.

 

I believe the constant manipulation of the existing hair can contribute to greater shockloss (which CAN happen to transplanted hair BTW) in addition to forcing techs and doctors to search and search for places to make incisions or incisions to place grafts. I agree with Dr. Hasson on this. (that doesn't make him right, it just means I agree with him)

 

All things being equal though, I believe sessions 1200-1800 grafts shaven/unshaven are completely on par with one another-- that is to say the skill of the doc and the staff will provide the same result shaved or not shaved. I think going larger than 2000 grafts unshaven is asking for trouble-- no hard data on that, just a thought.

 

I think regardless of what anyone believes otherwise, it is more difficult to transplant a non-shaven patient over a shaven patient.

 

Shaven: Can readily see exit angle and better approximate root angulation, easier to make incisions, easier for techs to see grafts when implanting-- perhaps easier to see incision density and pattern?

 

Non-Shaven: more time consuming to check exit angulation, more time consuming to comb through and check incision density/pattern, more difficult to continually comb the existing hair when placing grafts, perhaps more difficult to make sure grafts are 100% seated properly?

 

In addition, while shaving down is a personal preference, my PERSONAL opinion is that I wish to make things as easy as possible for my doctor and staff.

 

I think that is really it--- do it or don't, but..... we only get a few shots at doing this, so make sure you choose wisely.

 

Take Care,

J

[Bill - Seemiller]

Interesting discussion everyone,

 

I have a tendency to agree with Joe and B Spot.

 

Many doctors do achieve outstanding results without shaving. However, I couldn't say it better myself so I will quote B Spot

 

"I believe the most optimal setting for a transplant is to shave the recipient area".

 

It is about minimizing risk...that's all!

 

But please...I am not debating that doctors who don't require shaving can't achieve an optimal result. But I think even the doctors that don't require shaving would admit that shaving the recipient area would provide a much more optimal setting for the transplant, therefore MINIMIZING risk of shockloss, transection, etc.

 

To read Dr. Hasson's point of view about shaving, see Pat's thread here:

 

http://hair-restoration-info.com/eve/forums/a/tpc/f/346...571041502#9571041502

 

Bill

[Bill - Seemiller]

P.S.

 

Gorpy....welcome to the "Follicular Salvation Club" my friend!

 

Thanks for all your contributions to our community! Wouldn't be the same without you!

 

Bill

[the B spot]

Yes, Welcome to the club Gorpy!!!!!!!

[nobuzz4me]

Is it not possible to get a close cut but not buzzed to make it easy on both parties. Maybe 1/2 inch or so? Seems to me that docs should give a discount or something if you buzz down since that makes it "easier" for them. Charge extra for longer hair in the recipient if it is that much more work for the doc and the techs.

 

The doc works for the patient, not the other way around. Now having said that, I agree that shaving gives you the best chance for a great result, no guarantees though. Hell, I may even get buzzed my next round just to experience it

[Gorpy]

Thanks guys!

[MrJobi]

Welcome to the Club

 

You get a week with Hairforce one and a lap dance!

[Jotronic]

Bspot and Bill nailed it perfectly. Well said, indeed. Bill, thanks for the link. I have copied and pasted it here so that no one has to leave this thread.

 

As a note, there really hasn't been any rebuttal that describes why shaving is NOT the best route to take while there are numerous reasons to support shaving.

 

Can anyone imagine all these grafts placed while trying to comb through and manipulate the hair the below patient had? Does it not stand to reason that a clean slate so to speak allows for much better visualization of the recipient area? I fail to see how this is debatable.

 

Nobuzz4me, you are correct that when you choose a doctor and pay your your hard earned money they are working for you but you hired said doctor for their expertise in delivering what you want, the best results possible, based on what you have learned from your research. If you choose a doctor and know what is required to get the results you want then you acknowledge that certain steps are taken to get that result and by choosing that doctor you are accepting their methods. It's the same thing for anything else that you choose to spend your money on. Make sense?

 

 

 

From Dr. Hasson....

 

Bezane,

 

The question you ask about shaving is a good one and one that I would like to address.

 

When you ask if it is necessary to shave the pre-existing hair before surgery- the answer is- "it depends".

 

Depends on what? It depends on the quality of the result that you are looking for. Some patients (and doctors) will be satisfied with a less than optimal result while others will want to achieve the very best result possible. For this long term gain a patient may have to endure some inconvenience including buzzing of the recipient area.

 

There are multiple technical factors that come into play during the creation of recipient sites and the subsequent graft placement. These include:

 

1.) When thinning areas are shaved down the "thinning process" takes on a different meaning. With the use of magnification it will be seen that some follicular bundles are absent (and there are wider spaces between remaining bundles) and that some bundles are significantly miniaturized. It will then be possible to place new recipient sites in the place of absent bundles and alongside miniaturized bundles to recreate the density. This can also be done in a uniform manner so that if the pre-existing hair eventually disappears, due to progression of hairloss, the transplant can still look reasonably natural. If the recipient site is not shaved the surgeon must part through the hair again and again looking for any empty spaces and trying to fill the spaces as best as possible. This is not really as exact a process but much more hit or miss.

 

2.) The hair exits the scalp at an exact angle. The only way to precisely match that angle is to buzz the recipient hair down (in a way similar to how ALL doctors need to shave the donor hair when taking out the donor strip).

 

3.) Transection of existing hair below the skin surface is possible if the incisions are not made exactly parallel to the surrounding bundles. We often see this as a "halo" type effect when performing repair procedures.

 

4.) When inserting grafts the technicians can easily identify the recipient sites and ensure that all sites are filled. This can be achieved with no trauma to the pre-existing hair.

 

5.) When hair is buzzed no manipulation of the pre-existing hair is required at all. When the hair is not shaved it needs to be combed through (hundreds of times) by the physician who makes the recipients sites and again by the technician who places the grafts into the sites. This repetitive trauma of combing through the hair again and again will result in "hair shock", a shedding of the existing hair. When this hair falls out in 2 to 3 weeks there will be a 2 to 3 month wait before it returns. Whereas if the hair were buzzed it would grow from day one 1 and keep growing. A number 3 buzz cut often will look good at 10 to 14 days post operatively and blend in with the recipient site well.

 

Bezane, all these factors are relatively unimportant if you are trying to place to 2 or 3 hundred grafts into recipient sites however if you wish to have the ultra refined type of result that Pat Hennessey advocates, the difference will be night and day.

 

I apologize if what I've said in any way contradicts what others have told you but I feel you should hear this from the doctors who basically developed the process you know as "ultra refined follicular grafting".

 

I have attached photos of a patient who has undergone a mega (mega mega) session into a large area of thinning scalp- before and ten days after surgery. Hopefully my reasoning will be self explanatory.

 

Sincerely,

 

Victor Hasson MD

 

 

[Gorpy]

While this is nice of you to post this, it only addresses transection in one spot, point 2. That is exactly where I was saying there was contention. Some say you can only see the exact exit angle by buzzing the hair others say that's wrong. Who's right? It's just differing opinions, not facts.

[Jotronic]

Gorpy,

 

"it only addresses transection in one spot, point 2. "

 

Please clarify.

[Gorpy]

See my comments after the bullet points.

 

The question you ask about shaving is a good one and one that I would like to address.

 

When you ask if it is necessary to shave the pre-existing hair before surgery- the answer is- "it depends".

 

Depends on what? It depends on the quality of the result that you are looking for. Some patients (and doctors) will be satisfied with a less than optimal result while others will want to achieve the very best result possible. For this long term gain a patient may have to endure some inconvenience including buzzing of the recipient area.

 

"?? This is just the doctor's feeling, like many others, that his method is the best. Nothing new here.

 

There are multiple technical factors that come into play during the creation of recipient sites and the subsequent graft placement. These include:

 

1.) When thinning areas are shaved down the "thinning process" takes on a different meaning. With the use of magnification it will be seen that some follicular bundles are absent (and there are wider spaces between remaining bundles) and that some bundles are significantly miniaturized. It will then be possible to place new recipient sites in the place of absent bundles and alongside miniaturized bundles to recreate the density. This can also be done in a uniform manner so that if the pre-existing hair eventually disappears, due to progression of hairloss, the transplant can still look reasonably natural. If the recipient site is not shaved the surgeon must part through the hair again and again looking for any empty spaces and trying to fill the spaces as best as possible. This is not really as exact a process but much more hit or miss.

 

"?? This addresses placing grafts next to miniaturized bundles so that when they eventually die, some transplanted hair will be there. The claim is that it is easier if the hair is buzzed. It's not about transaction, but about identifying miniaturized bundles.

 

2.) The hair exits the scalp at an exact angle. The only way to precisely match that angle is to buzz the recipient hair down (in a way similar to how ALL doctors need to shave the donor hair when taking out the donor strip).

 

"?? This is the point I made that all doctors do not agree with this statement. This is the opinion of Dr. Hasson.

 

3.) Transection of existing hair below the skin surface is possible if the incisions are not made exactly parallel to the surrounding bundles. We often see this as a "halo" type effect when performing repair procedures.

 

"?? This point is obvious and is related to point 2, IF a transaction were to occur. What is a bit cryptic is the "halo" reference. Typically the halo effect refers to the old type plugs where the central hairs in the plug would be starved for blood and die, leaving a halo of hair. This has nothing to do with transaction or modern transplants.

"?? If by the "halo" effect the doctor means that someone stuck a huge blade in an area and destroyed several surrounding follicles ??“ well that just doesn't happen with the coalition doctors so it is a moot point.

 

4.) When inserting grafts the technicians can easily identify the recipient sites and ensure that all sites are filled. This can be achieved with no trauma to the pre-existing hair.

 

"?? This is about techs finding the recipient sites and not causing trauma.

 

5.) When hair is buzzed no manipulation of the pre-existing hair is required at all. When the hair is not shaved it needs to be combed through (hundreds of times) by the physician who makes the recipients sites and again by the technician who places the grafts into the sites. This repetitive trauma of combing through the hair again and again will result in "hair shock", a shedding of the existing hair. When this hair falls out in 2 to 3 weeks there will be a 2 to 3 month wait before it returns. Whereas if the hair were buzzed it would grow from day one 1 and keep growing. A number 3 buzz cut often will look good at 10 to 14 days post operatively and blend in with the recipient site well.

 

"?? This is about how the techs find the recipient sites and the trauma they could cause.

 

Bezane, all these factors are relatively unimportant if you are trying to place to 2 or 3 hundred grafts into recipient sites however if you wish to have the ultra refined type of result that Pat Hennessey advocates, the difference will be night and day.

 

I apologize if what I've said in any way contradicts what others have told you but I feel you should hear this from the doctors who basically developed the process you know as "ultra refined follicular grafting".

 

"?? More salesmanship

 

 

I have attached photos of a patient who has undergone a mega (mega mega) session into a large area of thinning scalp- before and ten days after surgery. Hopefully my reasoning will be self explanatory.

 

Sincerely,

 

Victor Hasson MD"

[Jotronic]

Gorpy,

 

Thanks for clarifying.

 

What you call salesmanship is a lot more than what I've read to the contrary. Not one rebuttal that has raised an argument against any of the points made. None, save for "it's just an opinion" and references to conversations you've had with Dr. Keene. Please expound on these conversations if they offer anything to the contrary.

 

Lets address some of your statements.

 

Point one: Dr. Hasson clearly states that not only are the miniaturized hairs visible the absent spaces are as well so it is more than a point about miniaturization alone. When the grafts are placed in easily defined spaces (either next to miniaturized hairs or healthy hairs) the end result (if the miniaturized hairs fall out) is one of more uniformity. This is only one part of the whole story as transection does indeed come into play as noted in point #3.

 

Point 2: Yes, it is an opinion based on observation of both shaved and unshaved patients.

 

Point 3: The Halo effect, in this context, refers to the areas of a patient's scalp where there was concentrated transection of numerous hairs in relatively the same area. It creates a small "patch" so to speak where it is obvious that DHT was not the culprit but rather the incision instrument and method was. You do not see patches like I've mentioned from anything other than transection.

 

Point 4: Of course it's about not causing trauma. That is one of the issues we try to avoid with shaving. As stated in the previous post, when the hair is manipulated excessively it can cause shock. Imagine, for even a 3000 graft session the hair is manipulated thousands of times. You do know that this can cause shock, right?

 

Point 5: Ditto to point 4. Look, shaving the scalp is not only about not causing transection. It's about not causing undue shock to the native hair. It's about having the cleanest area to work in possible and about hitting every area possible with a new hair(s).

 

I reiterate,this does not mean that every result from a non-shave clinic is going to have issues but it does mean that there are more limitations to a procedure when the hair is not shaved. How anyone can think that shaving is not beneficial is beyond me. I'm not aware of any special loupes that allow technicians and doctors to see through hair down to the scalp and the exit point. Imagine 3000 slits less than 1mm in size covered by a matte of hair that is several inches long. Again, three THOUSAND, and then tell me that it is just as easy as having all the hair in the region at 2mm in length. I don't think anyone in good conscience and with any degree of common sense can do so. This reminds me of the scene in The Holy Grail where King Arther cut's off the legs of the Black Knight.

 

King Arther: " I've cut your legs off."

 

Black Knight: "No you haven't" (legs, laying on the ground, blood spewing).

 

I of course say the last few lines in jest but you get the point (especially if you've seen the movie). It's a classic from my college days.

[Gorpy]

Joe, you have not really made any valid points here. You just keep repeating the same thing.

 

Point one: I already stated what point one is about and you just repeated what I said. Yes, the "gaps" are more easily identified, but that has nothing to do with transection.

 

Point two: Point two - the point of contention.

 

Point three: Without point two, this point doesn't exist. You seem to be stuck on this idea that a bunch of transection is occurring. Maybe by some bad doctors, but not by the good ones.

 

Point four: It only causes shock if you roughly brush through it. I'm sure that if you are trying to squeeze in a 5000 graft session in one day then that's what the techs have to do. Have you ever heard of gently moving the hair aside? No shock Joe.

 

Point five: We were talking about transection of hairs which is much more serious than temporary shock loss.

 

I don't believe I ever said that transplanting into longer hair is easy. In fact I think it is probably harder. But you're out there claiming that doctors are transecting grafts left and right and they are liars for saying that they are not. That's simply not true. I'm expecting an apology to this community for stating that.

 

I have a novel idea Joe. Have you ever tried to reach out to other doctors to get their opinions on issues? Instead of just regurgitating the H&W song and dance, you might actually learn something.

[Jotronic]

Gorpy,

 

"I have a novel idea Joe. Have you ever tried to reach out to other doctors to get their opinions on issues? Instead of just regurgitating the H&W song and dance, you might actually learn something."

 

Are you getting personal now? Gorpy, I thought we agreed to play nice. I think the difference between you and me (one of many) is that I actually question things that I learn. I don't say "I've had conversations with my Dr. so it must be so." I digress.

 

This is going no where except for a tit for tat debate. However, to address something that has been painfully obvious and stated several times, yes it is harder to place grafts with the hair longer which you and I are now in complete agreement on. So with something that is more difficult therein lies the issue of less variables being eliminated that can cause problems. Because of this, and by your own arguments, I'm sure you'll agree that when something is made more difficult problems can arise and even compound. THAT is what the whole point of shaving is about. Eliminating as many negative variables as possible to insure the finest result. What possible reason could anyone want to have even the slightest increase in transection, shock, trauma etc., etc.???

 

Your position is that there is no transection or shock with the hair left in it's natural state, as the patient wears it, because the hair is moved ever so gently out of the way. Find one doctor to come on here and say that this is absolutely true every time and that shaving won't decrease the probability of these problems, even a little. Find one doctor to come on here and say that it's not easier to find the spaces in between the grafts with the head shaved. Find one that will say that any elimination of negative variables, even a little bit, is a bad thing. The reason we do this is because we feel that even that little bit( at a minimum) of advantage is something that will improve the result for the patient and improving the procedure is what this is all about.

[chibbler1]

Well , I think I have really sparked a good debate between gorpy and jotronic on this topic...good information on both sides which I must weigh .

As a neutral party heres my take - it seems to me that in a large mega session (say 3000- 4000 grafts or so) that its best to shave otherwise (contrasting to not shaving) the cumulative losses through transection , misalignment ,shock loss etc. etc. might at best have a small impact on the eventual results , and at worst - depending on the effort of the technicians - be moderate and noticable .

For a smaller session , say 1500-2000 grafts it seems to me that if the technicians slowed the pace down , worked more carefully and used the same amount of time as the previously described mega session - that a top quality job could be done with only a very slight - at most - lack of quality in the finished product (compared to a shaved patient).

Getting back to my original posting , for me its really not an option to have a shaved head due to my work , previous scarring and a general wariness due to my past 6 procedures. So it comes down to this - Is it better to have an 1800 or so graft procedure done without the buzz cut to smooth out the hairline (previously had minis and there is some unnatural scarring there) and t fill in the crown area as much as possible or is it better to just leave it as it is ?

Again , if I was in the situation that most of the other posters have - I wouldnt even consider this - I would have just gone for a quality mega session and shaved my head - or just let myself go bald .

I would happily pay the 3000 graft price for a 2000 graft session done with the extra care and labor needed to get the top results from an unshaved head - too bad it doesnt really work that way but it kind of sounds like this might be in the scope of Dr. Keene in arizona - what do you think ?

Chibbler

[Gorpy]

chibbler1,

Yes, that is in the scope of Dr. Keene.

 

Joe,

It's hard to play nice when you make outrageous statements.

 

I don't simply state something "because my doctor said so". Although I do weigh things heavily, analyze various OPINIONS, question things, look for more information, add a dose of common sense and draw a conclusion. I think if you look back, my entire point was that there are varying OPINIONS on this among doctors, so you can't simply state it as FACT.

 

Dr. Hasson's post has been out quite some time now. So I, having a strong desire to get the best transplant available (which I did BTW), asked Dr. Keene about this directly. She stated in no uncertain terms that she CAN see the true exit angle without shaving and that she would NOT transect any follicles. There is much more technical detail involved and I won't even attempt to speak for Dr. Keene in detail. So in essence, what you have done is call Dr. Keene either ignorant or a liar by making your reckless statement about transection.

 

So here you have it ladies and gentlemen. A doctor who is very highly regarded by her peers, given multiple awards, vastly experienced, published, this years chairman of the International Society of Hair Restoration Surgeons' conference and a member of this coalition is said to be ignorant or a liar by Joe.

 

Uh let me think... who am I going to believe, Joe or Dr. Keene? Dang, it's a tough choice.

[NervousNelly]

Chibbler,

 

I think that Dr. Keene would be a good choice for you and yes I think you have figured things out well in the debate about shaving or not. Good luck.

 

NN

[Bill - Seemiller]

She stated in no uncertain terms that she CAN see the true exit angle without shaving and that she would NOT transect any follicles. There is much more technical detail involved and I won't even attempt to speak for Dr. Keene in detail. So in essence, what you have done is call Dr. Keene either ignorant or a liar by making your reckless statement about transection.

 

Gorpy,

 

I'm confused by this statement...

 

Joe isn't talking with Dr. Keene, he is talking with you. Nobody is here speaking for Dr. Keene are they? You say you are not, but then you accuse Joe of calling Dr. Keene a liar. Are you not then speaking for Dr. Keene? Isn't it one person's opinion against another's?

 

That being said...

 

Any chance that you can attempt to explain the technical detail of Dr. Keene's reasoning? I'm not asking for you to speak for her, but certainly you are stating you agree with her.

 

Without an explanation of your reasoning other than providing Dr. Keene's credntials in your last paragraph, Joe's statement referring to you of "I've had conversations with my Dr. so it must be so" is valid.

 

Regarding shaving...I have a tendency to agree with Joe. It simply makes more logical sense that the direction of the hair can be much more easily seen if the head is shaved, therefore making the conditions of surgery more optimal. Do you agree with this statement?

 

I am not suggesting that a physician can't achieve an excellent result without shaving....but I do believe shaving provides for an optimal environment and minimizes risk.

 

Bill

[Gorpy]

Bill,

Joe said ANY doctor who says XYZ is either lying or doesn't know any better.

 

Dr. Keene told me XYZ. That is indirectly saying she is either lying or doesn't know any better.

 

I'm not speaking for Dr. Keene. I'm just telling you what she told me in response to my question on this issue. That's different.

 

Sorry, I will not go into the technical detail of our discussions. I don't have permission to share that. Anyone reading this should feel free to ask her about it, although she is extremely busy.

(Keep in mind that if I attempted to get into the technical detail, I would probably make some mistakes, there would be follow-up questions that I couldn't answer, etc. See what I mean? It could become a mess if I tried it.)

 

If you look back at my original argument you can see that I am just saying that there are differing opinions on this among the doctors. So saying something is fact and anyone that says different is lying is not the right approach.

[Bill - Seemiller]

you can see that I am just saying that there are differing opinions on this among the doctors

 

I can agree with this.

 

Thanks for your clarification.

 

I suppose, however, since you aren't and can't speak for Dr. Keene and also can't and won't share the technical information, that there really isn't much more that can be said on the topic. I would love to hear Dr. Keene's thoughts on the issues directly, since you feel you cannot share them. It would add to the interesting discussion.

 

Bill