*HUGE* discrepencies in analysis (i.e. graft quotes), clinic to clinic.

[thanatopsis_awry]

There are clinics that are known as "conservative" and others that are "aggressive"; specifically, I'm thinking of graft quotes, and am not taking into account extremes like Armani or Dr. Hack recommending 200 grafts for a NW4. But, what do these labels really imply about a clinic -- there either is an optimal route for a patient, or there isn't, right, and graft quotes should be roughly equivolent place to place? Financial reasons, and perhaps patient preference notwithstanding(a patient places a premium, e.g. on not shaving down, or limiting work to a particular area).

 

http://www.hairlosshelp.com/forums/messageview.cfm?catid=5&threadid=75880

 

This is a recent example where 3 clinics (though, I am thinking of one in particular) where they gave quotes 50%+ (!!!) less than what the patient ended up getting. What's the deal? Is there logic to going about things so "conservatively" in cases like this, that gives it pro's as opposed to the obvious con's.

 

I'm not saying this to bash any clinic, and I wasn't seeking out an example with the ones mentioned in the link. At the same time, based off my own initial thoughts and the reaction in that thread, I think it's in everyone's interest -- especially the clinics -- to shed some light onto this.

[its752]

thanatopsis_awry, You've got to be thankful that you found Dr. Feller, and not do what so many others have done unknowingly by getting a smaller substandard session! Hopefully the industry will continue to gradually get better by following the techniques and bigger session sizes, when appropriate, of the top clinics now operating--thank god!!!! Until then, the top clinics will continue to get the increase in patient business and satisfaction.

[Bill - Seemiller]

Thanatopsis,

 

In my opinion, there is something to be said about the level of skill it takes to perform larger densely packed sessions of ultra refined follicular unit hair transplantation.

 

At the same time, there are philosophical differences between physicians that are then further refined when taking the patient into account. Some of these philosophy differences include when to perform a larger session and when to perform a smaller one.

 

I do not think it is fair to call smaller sessions substandard generally speaking. Clearly cases can be made for smaller sessions depending on the patient.

 

At the same time, for those with higher levels of hair loss, larger densely packed hair transplant sessions are more attractive to the patient typically speaking.

 

It would be interesting to see a debate between physician's with varying philosophies over some of these points.

 

Bill

[MrJobi]

I think generally speaking ( not including fraudulent docs, etc) it really depends on the doctors strategy. Some take a more aggressive approach while others are more conservative.. Hard to say who is right in every case.. The main point is for the patient to feel comfortable with the decision made. They should be an active part of that.

[the B spot]

I believe there is "What is right for the patient"

 

What is right for the patient is doing 2800-4000 (or more) grafts on a NW4-5 with, unless the patient has a tight scalp or extremely low donor.

 

Forcing a patient into additional, uneeded surgeries is NOT conservative. It is just behind the times.

 

Of course, it may be that we push for too MANY grafts for some patients.

 

Additionally, it is always subjective on how to treat diffuse thinners, lower level NW's coupled with relevant ages. Here is where the conservative tag should fit and fit nicely.

 

But, forcing NW's 4-5-6 who are going to need 3-4-5-6-7K+ grafts to endure 1500-1800 grafts a session for 3-4 surgeries that can be accomplished in 2 sessions for less cost and less down time are not really debateable, IMHO. (except for extenuating circumstances)

 

We have seen that 3-4K grafts at once grow and H&W have proven that 6-7K grafts grow.

 

Bigger is not always better, but sticking the "conservative" tag on a estimate of 1500-1800 grafts for a patient who can obviously use 3K+ grafts is passe and outdated.

 

There is a right way to approach hairloss and that is to assess donor both long and short term, assess patients needs and wants, assess the patients financial situation, strategize for today and tomorrow and go forward with an informed patient.

 

Hope this helps out,

Jason

[richie48]

hey thenap

 

Just for clarification I'm not trying to provoke anything here or clinic bash , so i won't disclose any clinics .

 

The point raised by you and Bill is a good one ,i had four consults and had four different aproaches .

 

I was advised 4000 grafts , 3000 grafts , 2000 and 500 grafts from four coalition doctors , all were supplied with the same infomation , background and photos and my personal goals .

 

I think hair surgery has to have alot more of a personal input because every patients goals and cases are so different ,this added to doctors different aproaches causes for such diverse opinions .

 

All newbies should be accutely aware of this

 

makes you think doesn't it ?

 

richie

[thanatopsis_awry]

Hmmm, interesting and good points made by all. I am w/ Bill that it would be interesting to see a physician or someone associated w/ a clinic who has differing view/philosophy.

 

I don't mean to bash smaller sessions, and as Mrjb said, there clearly are times where smaller sessions are most appropriate; but, I can't help but think that often times that "conservative" appelation is getting thrown out there when in fact it goes against Bspot's "what is right for the patient." The case in the linked thread *looks* to possibly be such a case; which is why I think it's important for such clinics to get out their philisophical reasoning when they seem to have a "conservative" approach...whether you end up agreeing with it or not, it is better than the peoples' reaction of "what were they smoking".

 

Cases like this do puzzle me, though, particularly when the clinic *has* showed the ability to perform sessions far larger than their prognosis. As mentioned, various esteemed, doctors can give varying opinion, as in Richie's case....all while supplied with the "same info, backround, photos, personal goals". Also, as in the case of Armani (imo), bigger clearly isn't always better.

[Bill - Seemiller]

I think what B Spot is hitting on is that there is clearly a time when performing a smaller session is evidence of a surgeon being behind the times. Surgeons who limit session sizes to a small number regardless of patient characteristics is a good example of this.

 

But there are also philosophical differences that have nothing to do with ability. This is why I feel it would be interesting to see a surgeon debate in particular instances.

 

This is yet another reason why a seeking hair transplant patient should spend a lot of time researching. Be aware not only of the varying abilities of surgeons, but of the varying philsophies. Only then can a seeking patient make an informed decision.

 

Bill

[TheHairLossCure]

One thing to be cautious about is a clinic low-balling graft requirements. Don't get me wrong, there are cases where patient need only 1,000-1,200 grafts, or whatever. On the other hand there are guys that need more ??“ a lot more ??“ and are told a lesser numbers so that "the price is right." This is tricky tactic as the doc can pull more grafts and tack on additional fees after the fact. That can leave a bad taste in your mouth!

 

Make sure your doc gives an honest opinion of what he thinks you need...not just the estimate that gets you in the chair. When you get multiple recommendations from different clinics you will begin to see what to watch for.

 

Second and third opinions are often important!

[chucky]

This can be very confusing to a newbie looking into hts,getting varying estimates and prices.

 

It would be great if a doctor could post on this thread and give their opinion on this.

[Dr. William Lindsey]

Your thread comments point a number of important issues:

 

1. Treatment plans need to be individualized for the patient and the doctor and patient have to communicate. I saw a man Friday who said he was advised to have 3000 grafts from a doctor nearby and I couldn't find room anywhere except the hairline for more than 1500. Anymore and the patient would certainly not see any improvement and would likely have damage to his still growing follicles.

 

2. Some doctors can provide mega-sessions and some can't. If you like the doctor who can't and like his work or track record, well you will need more than one case. But go with the doctor you have a raport with and some knowledge of what his philosophy is.

 

3. Some doctors are conservative and others overly optimistic when it comes to donor supply. For example, in late December we did a 3100 graft case on a patient who I really didn't think we would obtain more than 2000 grafts. We were up front with the patient and found his scalp to be more lax than expected allowing a larger strip to be harvested and with strict microscopic dissection of true follicular units we gave him a 50% bonus over what he and I expected.

 

So, there are lots of reasons for varying estimates; just make sure you have a doctor patient relationship and honest dialogue from the start.

 

William Lindsey www.lindseymedical.com