What is the optimal Ultra Refined Follicular Unit procedure?

[Guest Rickmonius]

Originally posted by Bushy:

Originally posted by Rickmonius:

Hey Landen, there is definitely a need for a skeptical voice here. I, for one, as a newbie considering a HT, appreciate it. I think you would help your own credibilty a lot if you would not allow yourself to be sucked into personal attack fests.

 

Rickmonius, a sceptical voice is always welcome, and encouraged. I may have missed it, but can you show me where Landed got "sucked into personal attack fests?"

 

Welcome to the boards. I hope you are able to find the kind of real information that I did here, and look beyond personal attacks.

Sorry Bushy, I guess my post reads a little one sided. I wanted him to stick around but to drop the personal attacks. That's all. Your four month shots are awesome. I just wish I had your donor area!

[Bushy]

Originally posted by Rickmonius:

Sorry Bushy, I guess my post reads a little one sided. I wanted him to stick around but to drop the personal attacks. That's all. Your four month shots are awesome. I just wish I had your donor area!

No problem at all, Rick. I understand your intentions.

 

Thanks for the compliments. I just can't wait to be able to stop using Dermmatch. It will be 15 years since I woke up in the morning, brushed my hair back, and walked out the door!

 

What's your donor area like?

[Guest Rickmonius]

Bushy, I really don't want to hijack this great thread. I'm not opposed to sharing my info with this forum I just hate it when a good thread makes a left turn. PM is on it's way.

[Guest Landen]

You sure are putting in some long hours for the clinic today aren't you. I see that you are over on the other site bashing the Armani clinic. You even have your photoshop software in high gear.

[Bushy]

Originally posted by Landen:

You sure are putting in some long hours for the clinic today aren't you. I see that you are over on the other site bashing the Armani clinic. You even have your photoshop software in high gear.

 

Sheesh, I thought you were leaving?

[Guest Landen]

Sheesh, I thought you were done shilling for the day?

[Bushy]

Originally posted by Landen:

Sheesh, I thought you were done shilling for the day?

LOL I'll grant you that you're quite funny.

[Dr. Victor Hasson]

Strangely enough, no one has thought to ask me what my opinion is on the relevance of hair counts. I agree that if the marketplace demands hair counts so that we will be comparing apples to apples that this may indeed be a good idea. However, since individual hair characteristics vary so greatly (i.e. shaft diameter, curl, color etc.)we may wind up comparing some very large apples to some very small apples - which ultimately defeats the point of trying to compare apples to apples.

 

In the past our FU grafts were categorized according to the number of hairs per graft. The necessity for classifying the multi-hair FU grafts was no longer important once we started placing all multi-hair grafts in the same size recipient site (in an individual patient). At the time I felt that multi-hair FU grafts of varying sizes should be mixed randomly in the area behind the hairline. My further experience has confirmed this and I will continue this practice.

 

In every single case the exact dimensions of the donor strip is measured and noted in the operative record. It will be of little inconvenience for us to reclassify our multi-hair FU grafts.

 

In the final analysis, I believe that contrary to what others in the Coalition may feel, that it is all about results, regardless of individual hair counts or characteristics.

 

We live in a very competitive society and other physicians performing hair transplants will endeavor to find fault with us no matter what we do. If anyone has a better method of measuring the end point, or more importantly, the level of satsifaction of our patients than by cosmetic result, I would be very happy to hear their suggestions. We do try to provide very detailed and clear photographs of our patients before and after their procedures. We had hoped that this would satisfy the most skeptical of our critics. Apparently we were mistaken.

 

We will in the future provide patients with graft counts, hair counts, strip dimensions and anything else you would like us to measure. I am sure that there will still be those who remain unsatisfied. Fortunately our patients are intelligent individuals who have managed to sift through endless marketing and hype and still find their way to us. We do not expect this to stop anytime soon. Hopefully our patients will continue to post their photos and share their experiences with all who care to learn. In the end it will be the patients who benefit.

 

Victor Hasson MD

[troy]

Well I was debating if I should watch the springer show or read the forums tonight, i guess its the forums, thanks for the entertainment

[Pat - Community Publisher]

Note - I was in the process of writing a reply before I read Dr. Hasson's above post. So my original post, written prior to reading Dr. Hasson's post, is shown at the bottom.

 

First, I'd like to commend Dr. Hasson and his staff for operating in the transparent and accountable world of the Internet over the past several years. H & W have shaken up the status quo and many clinics unfortunately have responded defensively, while patients have typically recognized the advancement and embraced it.

 

They have done a great deal to raise the bar and they have shared their results on and offline repeatedly. H & W have also led the way in sharing honest photos online, including immediate post op photos. Their willingness to provide their patients and this community with both hair and graft counts as well as donor strip measurements is in keeping with their long time commitment to patient education and empowerment.

 

I look forward to more physicians providing similar surgical details to their patients.

 

Those clinics that are truly outstanding look better the harder we look. So better and more detailed information will serve them and potential patients better yet.

 

Kudos to H & W and to all clinics who can operate in the transparent and demanding Internet environment.

 

Pat

 

 

Below is the post I intended to post prior to Dr. Hasson's post:

 

 

Landen,

 

You made your points. But now you're making off topic personal attacks. This is a discussion forum not a boxing ring.

 

Personally, I think you went too far in your defamatory criticisms of H & W. I think Hasson and Wong actually offer patients excellent value when quality, quantity and price are all considered.

 

$2.50 for grafts beyond 2,000 grafts seems very fair to me, especially when you consider that most hair transplant clinics typically charge over $5 per graft. In fact it was tough price competition from H & W and other leading clinics that drove many clinics to lower their prices, including the national chains. But in my opinion, free is not cheap enough for most chain clinic work.

 

But these chain prices were often $8 to $10 per graft just a couple of years ago. And when they are dealing with non online savvy patients their prices are often still $8 per graft. But I've seen them drop their prices to half that when the patient started to price shop.

 

Just a few years ago many old school clinics charged $25 and up for those round plugs. So we've come a long way and H & W are working long and hard to earn each and every graft/hair transplanted.

 

A good debate with multiple view points is healthy. But I'd like to see us come away from this discussion with some "action points".

 

Can we all agree on the value of physicians and patients providing hair counts in addition to graft counts?

 

With graft and hair counts - along with photos, patient experiences, etc members of this community can then make their own adult decisions.

 

I expect that many will embrace large sessions of small grafts as the ultimate in naturalness and fullness. Perhaps having the donor follicles dispersed more evenly in more grafts is really the ultimate in refinement and naturalness. Many H & W patients certainly feel this way after their hair has grown in.

 

Other patients may choose to be follicular unit purists and object to any division of a follicular unit - even if the price per graft is lower. Others may even choose multi follicular unit grafting (MUG), even though this community has a clear bias in favor of ultra refined follicular unit grafting.

 

Let's discuss results and techniques with accurate hair and graft counts. I think this will enable a more objective apples to apples comparison across all techniques and clinics.

 

All the best to all of us.

 

Pat (aka Hairy Jerry Springer)

[Guest Landen]

Pat,

 

No problem. However there were no slams against the clinic. They do a good job at a decent price. This I agree with. Their patients don't need to bully the forums and bash other clinics and results. That's uncalled for in my opinion.

 

I agree hair counts, graft counts, and strip dimensions are necessary.

 

The points that I have been trying to drive home in this thread:

 

1) They are a top clinic, but they can't do magic. It is all about the hair characteristics. A person with fantastic hair characteristics will have an equally great result from any of the top docs.

 

2) Results mean nothing without information concerning graft counts, hair counts, and overall hair characteristics.

 

3) It is not necessary to bully and bash other results, posters, and doctors to lift your doctor/clinic up. And this behavior should not be enabled.

[Jotronic]

Pat,

 

That would be "Hairy Springer" Couldn't resist, sorry.

 

I think I need to express a very important point with regards to documenting hair counts.

 

We have always had all of this information on file although in a slightly different format. Hair counts, strip dimensions etc. are listed in each surgical chart. While we have always given this information to patients when they have asked for it (just did so today) we simply have not considered it a detail that was needed. While Dr. Hasson has stated that we will provide this for each patient from now on I do see a potential danger looming.

 

As a consultant I many times speak to patients that contact us inquiring about our services. More often than I'd like I will get a question regarding a specific patient in our gallery or on the forums such as the following... "I really like patient # 21's results or "HTbob's" results on the forums. If I get X number of grafts will I have results like his?" My answer is not only a resounding "NO" it is an explanation that each patient is different and as part of my efforts at educating patients in person and online I stress that even with the numbers of grafts being the same the result will not be in kind.

 

As most of you have learned, hair characteristics play the dominant role in the final results. Even when the message is repeated several times on the forums sometimes it just does not get driven home. Now we are adding individual hair counts as standard disclosure. I feel that hair counts may serve to exacerbate the situation and could potentially backfire because when you narrow counts down to hairs above and beyond grafts you are not alleviating the need to understand characteristics just as is needed when discussing grafts. Grafts or hairs, the final result is still limited in the end to the individuals characteristics.

 

I hope that if anyone starts to rely on individual hairs as reference for results that they keep this in mind.

[nikkop23]

I see that hair counts started going up on the truedorin website this very day. Bravo--isn't taking long for some coalition members.

[nikkop23]

is Landen just Mahair back in a new incarnation?

[John_in_NC]

Originally posted by nikkop23:

is Landen just Mahair back in a new incarnation?

 

Not sure, but he is miserable. It seems like he didn't get the results he expected (dare I say he didn't do his homework before choosing a doctor?) and is down on everyone else. Some people feel better by attempting to drag everyone else down.

 

As far as Mahair, I saw a picture of him on another forum: he is not butchered or deformed as he claims, it seems to be more mental. Instead of seeing an HT doctor he needs to see a psychiatrist to discuss his image problems.

[troy]

Joe, that was pretty funny, hairy springer!! I have not put to much thought in hair characteristics. You always have great pictures, is it possible to post some examples of different results with the same graft count and different hair characteristics. thanks

[Janna]

Joe,

I don't know if this explanation will ease your concerns, but the fact that you provide the hair count and every other aspect of the surgery only gives the patient a broader understanding of what to expect. Hair count is only one piece of the puzzle. Certainly the characteristics of a given hair play a major role as this will dictate in many cases whether they have average density or not. When a patient comes into a clinic or has a remote consult, one of the first things you do is ascertain the type of hair they possess. Let's say the patient is Asian, most (not all) Asian hair, from my experience, have very strong hair caliber, but the density tends to be on the low side, which means the follicles mostly come in groupings of two's and one's. At completion of surgery if you state he received 3,000 grafts and leave it at that, it stands to reason he may expect similar results to someone else receiving 3,000 grafts. In instances such as this where the hair count plays a key role. Now, I believe you and your clinic educate your patients so the patient understands what they should realistically expect, but the hair count can only help in the explanation. I've never come across a case where the hair count became a negative factor. In the past, most patients didn't care about the hair count; it was indeed just about the results. However, with the new era of mega sessions and dense packing, the hair count and hair characteristic seems to have become a bigger piece of the puzzle.

[Pat - Community Publisher]

God,

 

I hope this "Hairy Springer" thing doesn't stick.

 

Well, be good to each other and take care out there.

[Bushy]

Originally posted by Janna:

In the past, most patients didn't care about the hair count; it was indeed just about the results. However, with the new era of mega sessions and dense packing, the hair count and hair characteristic seems to have become a bigger piece of the puzzle.

While I support keeping hair counts, I think it will make virtually no difference in the end of the day. When I look at a Bobman, for instance, do I really care if he had 9,000 hairs or 9,200? All I see is a NW6 who went to having a full head of hair!

[the B spot]

All, I obviously am on board for as much information we can gather, period. Regardless of what anyone anywhere thinks, or spins, each bit of information helps us put the puzzle together, in an effort to understand how the results we are seeing are being accomplished. I feel with this discussion, we are on the cusp of a new era of Hairtransplantation, an era of the FULLY informed patient, which is beginning to help seperate those who should be doing HT's and those that should not. The power of the internet and power of this Coalition is very telling, and I see no reason for us to back down from requiring clinics to meet our demands.

I think it is great that Dr. Hasson is taking the Pepsi challenge, and is going to provide us with these numbers. Again, I am excited to see where this goes.......

Happy Growing to ALL!!!!!!!!!!

[Janna]

Hi Bushy,

 

I absolutely agree with you that 9000 or 9200 hairs won't be much of a factor in the long run. It's really in cases where a patient receives 6000 hairs rather than 9000 hairs. One of my concerns in my original comment is when patients see results like Bobman's, they feel that is the norm when Bobman obviously had great density with the optimal hair characteristics for a HT. I'm also sure he had great hair count. It's really for the patients who have lower density that hair count becomes a bigger factor. This helps everyone in reaching a realistic goal.

[Guest Landen]

I absolutely agree with you that 9000 or 9200 hairs won't be much of a factor in the long run. It's really in cases where a patient receives 6000 hairs rather than 9000 hairs. One of my concerns in my original comment is when patients see results like Bobman's, they feel that is the norm when Bobman obviously had great density with the optimal hair characteristics for a HT. I'm also sure he had great hair count. It's really for the patients who have lower density that hair count becomes a bigger factor. This helps everyone in reaching a realistic goal.

 

 

Janna,

 

Well said. This is the point that I have been trying to make. Maybe they will listen to you.

[Midiman]

I'm actually in the process of getting my hair counts from Dr. Keene's office. Not to necessarily form expectations about my outcome, but rather to find out what my current donor area density can realistically provide me should I decide on another procedure in a year or two.

[Guest Landen]

While I support keeping hair counts, I think it will make virtually no difference in the end of the day. When I look at a Bobman, for instance, do I really care if he had 9,000 hairs or 9,200? All I see is a NW6 who went to having a full head of hair!

 

You are saying two different things here at the same time:

 

1) "while I support hair counts..."

 

You say that you support hair counts here.

 

 

2) "...do I really care if he 9,000 hairs or 9,200?"

 

You say that you don't support hair counts here.

 

 

This sounds like "double talking" to me.

[Pat - Community Publisher]

Support has been strong from both physicians and patients to provide hair counts and donor strip measurements in addition to graft counts, photos, etc.

 

I appreciate patients updating their weblogs and posting signatures with such hair count and strip info - if they can get this info.

 

I'm working with our data base programmer to reprogram our photo galleries so that clinics can provide the number of hairs per graft for each session. Clinics will soon be able to login into their online admin and add this additional info to any of the current 500 plus patient photos on our database.

 

We will also be requesting hair counts and donor strip sizes for all patient photos added to our photo galleries in the future.

 

With everyone's cooperation I believe we can establish a more detailed and accurate standard of measurement for surgeries that will be consistent across multiple techniques and clinics.

 

Thanks for everyone's support for this standard of measurement.

 

All the best to all, Pat