What is the optimal Ultra Refined Follicular Unit procedure?

[Bushy]

Originally posted by Jotronic:

Another one by Bushy. This is a patient that came back for #2 and now he's got well over 7000 grafts. What does he get in return? Complete coverage and not a hint of his former bald self and he's only at four months.

 

Bushy's hair transplant

 

Hey, I know that guy!

 

Joe, your post sent me to Domie's post, where I found a GREAT Mrjb comment:

 

Awesome

 

All the complaining people do about HT's , it's sad they don't recognize the AMAZING transformation one procedure can do by a qualified doc.. What a life changing experience.

 

JB

[the B spot]

Joe, first off let me say that your transformation and internet presence caused me to seriously consider hairtransplantation, where before after I had visited clinics, and decided against (for obvious reasons. I think that some people do not give you the credit you deserve for really pushing the amazing results achieved at H&W over the last 3-4 years. Let me tell you why I think this is important: It gave hairloss sufferers an entirely new perspectives and attainable goals, while at the same time forced out-dated doc's to raise the level of their game. I remember the outcry over H&W doing 3000+ sessions, and in speaking with Dr. Shapiro, he faced the same criticisms when he began doing 2000 to 2500 grafts on a regular basis. The fact that you get paid for what you do is a testament to hard work and a willingness to promote your skills, and those of the clinic you represent. I think what we have to remember is that no "rules" existed for this type of forum previously, and as your role expanded and you became employed with H&W, you did what any consultant or patient coordinator would do in your situation, and promoted your clinic on this forum. Absolutely fine, IMO. I remember when Pat decided to have anyone employed by a clinic declare that on every post, which is great as well. I just think that our involvement and expectations have grown and morphed, just as yours has. I think H&W is lucky to have recognized your abilities, and possessed the foresight to employ you. If H&W had simply posted a few HT and not the continuous stream of transformations, where would the HT industry be right now? The fact is, clinics would still be doing 3 and 4 smaller sessions, without the need to push the envelope, because as long as patients expected to go through 3 and 4 sessions, no pressing need to change would exist. I firmly believe this, and I see no reason why anyone else wouldn't either. With that said, with H&W pushing the envelope so far in excess of what anyone else is doing, H&W has an obligation to detail their practices and procedures, which is a naturally logical progression, given H&W's internet presence. My concerns are purely in the interests of the HT community, period. At this point in time, I regard Ron Shapiro and H&W as the preeminent HT surgeons in the industry. These are my opinions, and others may disagree, and that is fine, everyone is entitled. But when I speak with Matt Zupan or Dr. Shapiro, and I ask questions about the industry, they raised the same questions that Janna detailed about the long-term benefits of ultra-mega sessions, I feel it is important to ask and recieve proper information. I certainly do not agree with mudslinging or these pro/anti clinic posters that resort to calling our Coalition docotors inept, or stating that H&W is swindling patients. In addition, I hope H&W does not feel as if they do not have to justify their practices and procedures, regardless of results/success. Sharing detailed information is how we arrived at where we are today, and we need to take this to the next level, period.

With all of that said, I would like to see H&W post graft count, AND detailed individual follicular units (1,000 1's, 600 2's, etc...) That information will provide the entire industry with hard evidence that H&W is moving the same ratio of hair to graft as the rest of the industry, or it will show that H&W is moving less hair, as a result of their practices. In addition, I would like to see H&W post waste percentages for these larger sessions, (Say 4000+) and I would expect the same from every other clinic who performs these sessions as well. Waste is a by-product of the surgery, at every clinic, PERIOD. I think a good number would be in the 3 to 5% range, but I could be wrong. I think this is what Pat is talking about when he says H&W's practice of cutting grafts is neither a positive or a negative, because of the results H&W have produced, which cannot be ignored.

I think Pat is trying to give a perspective to us (members) and Docotors who are finding it difficult to move 8000+ hairs in one session, let alone 10-12,000, for 5500+ sesssions. At that point, we will have a definite understanding of what is being done to achieve these sessions, and why, as well as a solid comparision between clinics.

I hope these comments are well recieved and given careful thought, because I think they are important and needed to be written.

[Pat - Community Publisher]

Again, after the dazzling photos are seen and the warm fuzzies are exchanged, let's have hair counts. Those who don't like math can just look at the pictures or read the stories.

 

I'm going to again write to all physicians involved with this community and request that they supply their patients with not only graft counts but hair counts. Hair counts, along with graft counts, in my opinion provide a more accurate standard of measurement than graft counts alone. I will also ask all clinics to provide patients with the measurements of the donor strip removed. Many clinics are already providing this information.

 

Joe, as a long time patient advocate, I hope that you will be an advocate within Hasson and Wong for providing such hair counts and strip measurements. I think such detailed information will serve to enhance confidence in your clinic.

 

So can we count on hair counts in the future?

[the B spot]

Pat, what do you think about waste percentage? I for one, would like to know if donor waste increases drastically with session size. If a 3000 graft procedure produces 75 wasted grafts, does that mean a 6000 graft procedure produces 150 wasted grafts, or is it 300 wasted grafts? I am well aware of the fact that donor waste is a necessary evil, but if donor waste goes up exponentially as session size increases, it is yet another variable to consider. Like you said, it is all about the math. =)

[troy]

Joe I am enjoying reading this debate, I have a question for you. I am trying to get an understanding of this. Lets say in my situation I have thinning but still a fair amount of hair. If I was a candidate and would have went with a 4000 procedure and dense packed everything. lets say down the road I did loose more hair and had to have another HT, how would that be any different than if I had a smaller session and went back? would it be a different game plan in graft placement? If you had a mega session and were a norwood 4 heading towards a norwood 6, what would be the difference in a game plan? if your going to try to give them the best final results? I guess if you are going bald and going to loose more hair and assess that, what difference does it make?

[Guest Landen]

Jotronic,

 

You represent and debate the opinion of your clinic. It is not fact that you debate or represent. It is one philosophy, may even be a fallacy. Forget about the comb over and fuzzy overhead pictures. I don't see apples to apples. I see apples to oranges. Pat has a valid point, and I agree with it.

 

 

Bushy,

 

You are on every H&W thread aren't you.

 

The last that I heard is that you had some kind of business partnership with H&W, "non hair transplant" whatever that is supposed to mean. You have no credibility because of your business association. So, what you have to say means nothing to me or anyone else interested in the subject matter. You should disclose your current/ previous business involvement. and quit posting as if you are just merely a patient of the clinic. You have posted about this involvement and your golf outings with them in the past.

 

Take note people. As consumers you need to be informed.

[Janna]

As I write this an alert came up on my screen with B-spot's latest posting, which has a very valid point, and I'd like to thank him for his calm, well thought out input.

 

Mainly, I want to apologize to the H&W Group for any offense taken by my comments and concerns to Pat's posting. Given the data I saw on the forum, I questioned their technique and made certain assumptions to their graft and hair count. I should not have jumped into the assumptions without asking the questions first. It's human nature to question or assume when you don't have the answers. We've come to rely much on the internet for answers. I used to wonder how H&W were able to accomplish such a large session in one day. By visiting their clinic I was able to see that it just took the old fashion hard work and long hours.

 

In reference to the "two piles", which still has me stumped has a simple remedy to this concern by providing the hair count. One cannot get too upset by the thirsty man wanting a glass of water.

 

B-Spot, I'm not sure about the waste percentage being a factor. It would be hard to calculate if it increases as session size increases. It's also hard to measure exactly what the percentage might be as this data would be provided by the individual tech cutting the grafts, and no tech wants to believe there are any waste. Realistically, I believe you are right to estimate 3-5% percent waste per session.

[Pat - Community Publisher]

B Spot,

 

I do not think that the percentage of waste necessarily increases with larger sessions. Some might argue that more trimming to create more refined grafts could result in some follicles being trimmed away, especially those follicles in their telogin resting phase (when they are not in the hair growing stage and are thus less visible).

 

However, clinics that are doing careful microscopic dissection take great care to minimize waste by recognizing even the hair follicles in the telogen resting phase and including them in the grafts.

 

Also, while I think detailed hair counts will enhance the overall picture, I would not say "It is all about the math." Photos, personal accounts and hair counts (and donor strip sizes) together will paint a fuller picture of both a patient's surgery and result.

[Bushy]

Originally posted by Landen:

. . . .

Bushy,

 

You are on every H&W thread aren't you.

 

The last that I heard is that you had some kind of business partnership with H&W, "non hair transplant" whatever that is supposed to mean. You have no credibility because of your business association. So, what you have to say means nothing to me or anyone else interested in the subject matter. You should disclose your current/ previous business involvement. and quit posting as if you are just merely a patient of the clinic. You have posted about this involvement and your golf outings with them in the past.

 

Take note people. As consumers you need to be informed.

 

Landen, I first started posting on this site in the morning of my scheduled Bosley surgery sometime back in July of 2003. I believe I have established my credibility since then. My surgeries have been an open book to all. I even disclosed that between late 2004 and mid 2005 I provided professional services, unrelated to hair transplantation, to H&W. Pat and the moderator of another forum at which I post were made fully aware of this. That is old news. If I washed H&W's windows for 6 months 2 years ago, that would have no bearing on my posts, pictures and credibility.

 

Oh, and please get your attack stories right: I never wrote anything about any golf outings, because there were none -- I don't even play golf. Are you confusing me with another poster whose veracity, credibility and candor offended you?

 

You, on the other hand, originally surfaced on this forum (as revealed by a quick author search) back in late 2002, complaining of poor growth 7 and 9 months after your HT surgery. You don't appear to have revealed who your doc was. Then you disappeared from the forums and have sprung up again several months ago, You have taken a rather irrational, antagonistic, hostile and most discourteous approach. Are you bitter for some reason?

 

Here are a few examples of your attitude:

 

Example 1 (August 26, 2006): "Today's hair transplant patients are tomorrow's hair transplant repair patients. I guarantee it!"

 

Example 2 (September 07, 2006): "An informed decision? That kind of terminology is used by greasy lawyers and quack doctors."

 

Example 3 (September 02, 2006, in response to my tricho scar video posting): "The video is of poor quality. The hair is too long. And I can still see the scar. Tone down the hype!"

 

Example 4 (August 30, 2006, in response to a post by Dr. Feller): "Giving this guy advice to go to "just about any cosmetic surgeon in the UK" is the most absurd advice I have ever heard of coming from a doctor. You can't be serious."

 

Wherefrom springs your credibility?

[the B spot]

Pat, I agree, but it is a valid question, one which seems to not have much bearing here, so if everyone is fine, then I am Ok, especially if you feel as if this is a non-issue.

In regards to my math comment, please let me clarify. I assume and fully expect that the proper ethical considerations and maximum artistic ability be applied to every HT, regardless of session, regardless of physician. I was in no way debating results, only wanting to know the practices and procedures of how the results are achieved. I am in TOTAL agreeance that photos, personal accounts, hair and graft counts, in conjunction with strip size will greatly enhance the knowledge presented to this community. I look forward to both old and new patients documenting these so we can truly understand where Hairtransplantation is today, and where it might go.

[Pat - Community Publisher]

To all forum members,

 

I have sent the below email request to all the leading clinics that have patients posting on our forum. I'm asking that they provide hair counts and donor strip sizes to their patients so that this valuable information can be included in their posts.

 

I ask all members of this forum to make an effort to also provide hair counts in their forum posts and in their weblogs. I know that some do not currently have this information. But your clinics may make this info available to you on request. If you do obtain this information please update your posting signatures and weblogs with this info.

 

I suggest that those who get future surgeries request this information on their day of surgery.

 

I appreciate your help in advance in making such detailed information the standard of accurate measurement on this forum.

 

Let's count hairs not just grafts.

 

All the best to all, Pat

 

 

Email sent to leading physicians Thursday afternoon:

 

Dear leading physician,

 

As follicular unit sessions have grown in size and refinement both physicians and patients have been asking - what size sessions are safe and cost effective?

 

During the ISHRS meeting in San Diego Dr. Ron Shapiro and Dr. Jerry Wong will be debating this issue. But this issue has been hotly debated on our discussion for months, if not years.

 

Most patients would like to restore their hair in as few surgeries as possible ??“ all things being equal. But concerns about growth rates, hair counts per graft and the potential for increased donor scarring are hotly debated.

 

Right now a topic on our forum entitled "What is the optimal Ultra Refined Follicular Unit Procedure?" already has over fifty replies and over 1,000 views during the past two days. In this topic, patients have been supportive of my request that physicians and patients post not just their graft counts but also their hair counts and ideally the size of the donor area removed.

 

I believe that hair counts by graft (i.e. 400 one hair grafts, 725 two hair grafts . . . etc.) provide patients with more accurate and detailed information about their surgery, which they can then share online. This also enables potential patients to make "Apples to Apples" comparisons between various surgical sessions and techniques.

 

I ask that you please supply all your patients with both their hair count by graft size and the size of their donor area removed, in case they care to share their surgical results online. In any case, I expect that patients will appreciate such info even if they choose not to share it.

 

Let's commit to hair counts as the standard of measurement on our discussion forum so that we can have a fair and level playing field for all clinics, techniques and patients.

 

Please reply and let me know if you are willing to provide such information to your patients.

 

Onwards and Upwards,

 

Pat Hennessey

[Bushy]

I like it, Pat. Sounds like a fair and logical approach.

[Guest Landen]

Bushy,

 

You have had a relationship with H&W above and beyond that of a normal doctor and patient. Say good bye to your credibility. I know this and have known this, but you have continued to post and interject yourself where there is debate with the subject matter involved, unknowing to the majority of posters. That is quite scandalous not to have that in your signature.

 

"Professional services" huh. That goes above and beyond normal doctor patient relationship. Put this "professional services business relationship with H&W" in your signature when you are commenting on other doctor's results, or might I say when you are belittling other doctor's results. It should also be there in your signature when you post your own results, photoshop does wonders don't it.

 

As far as my short brief posting history. All I can say is I have been honest, can't say the same for you. And no I'm not bitter, I'm a true consumer advocate.

[Bushy]

Originally posted by Landen:

Bushy,

 

You have had a relationship with H&W above and beyond that of a normal doctor and patient. Say good bye to your credibility. I know this and have known this, but you have continued to post and interject yourself where there is debate with the subject matter involved, unknowing to the majority of posters. That is quite scandalous not to have that in your signature.

 

"Professional services" huh. That goes above and beyond normal doctor patient relationship. Put this "professional services business relationship with H&W" in your signature when you are commenting on other doctor's results, or might I say when you are belittling other doctor's results. It should also be there in your signature when you post your own results, photoshop does wonders don't it.

 

As far as my short brief posting history. All I can say is I have been honest, can't say the same for you. And no I'm not bitter, I'm a true consumer advocate.

 

Landen, where are your pictures? Who performed your surgery? And for which "consumers" do you advocate? Pat, the owner and publisher of this site, knows the full scope and extent of my past professional relationship with H&W (which has long since ceased), during which my signature did, in fact, state it.

 

You show me where I "belittled" other doctors' results, and I'll give you $100.

 

And now you're accusing me of fixing my pictures with Photoshop? Jees, you're funny. Are you sure I'm not Dr. Hasson himself incognito? i think he and I kinda look alike . . .

 

How many posters on this and other forums have you met in person? Can you name them? I have met about two dozen, and I can name them. They've looked at me up close, under lights, and even run their fingers through my hair.

 

Where do you live? I hereby invite you to meet with me any time in the Greater New York City area. Then you can inspect me up close and take a full set of digital pictures with the camera of your choice, and post them here for all to see. And take a video of my http://www.youtube.com/watch?v=JM9j0PjRv1w

[Guest Landen]

It is unfair to the consumers on this site when people are posting and have reason to have bias for a doc beyond a normal doctor and patient relationship. Consumers need to make an informed decision.

 

 

I said what I have to say on the subject matter.

 

I am not going to have a debate with PAST, PRESENT, and FUTURE employees/business partners of H&W. They get paid to do this and I don't!

[Bushy]

Originally posted by Landen:

I am not going to have a debate with PAST, PRESENT, and FUTURE employees/business partners of H&W. They get paid to do this and I don't!

 

Hi. My name is Landen. I'm all bark and no bite. I accuse everyone whose opinion differs from my own of being a fraud.

 

Pat asks for a "friendly debate" so I accuse posters of being paid shills and of manipulating photos, and I accuse doctors of defrauding their patients. I'm a real nice guy, you see.

 

I am extraordinarily opinionated on the subject of hair transplantation (heck, I even tell highly regarded surgeons how ridiculous they are), but I have yet to post a single picture or anything whatsoever about my hair transplant history. I don't need to do that stuff -- I'm much better than all of you losers! My name is Landen!

[Guest 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.

[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.

[Guest Landen]

Rickmonius,

 

Those are the greasy tactics they use to humiliate and silence. I am fully aware of it and I know when they are sucking me into the attacks, manipulating and deceiving.

 

I continued only for the benefit of the truth to be heard.

 

 

To the others,

 

I am done posting on this thread as I will not continue to debate and subject myself to the attacks at the hands of past, present, and future employees/business partners of H&W!

[Bushy]

Originally posted by Landen:

I am done posting on this thread as I will not continue to debate and subject myself to the attacks at the hands of past, present, and future employees/business partners of H&W!

 

Landen, it's too bad you didn't just stick to the points and engage in a "friendly debate." As Rickmonius said, your skeptical voice would have been welcome.

[Pat - Community Publisher]

Landen, I can appreciate your interest in full disclosure in signatures. I have certainly been a stickler for this over the past two years in particular. Bushy did work in the past for Hasson and Wong as an attorney. At that time, at my request, he did state this in his signature, while he was employed by them.

 

But he was paid to be a legal advocate in court and not an advocate online. So I think it is not necessary for him to have such a disclaimer in his current posts.

 

Bushy and Landen, I appreciate both of your contributions. But let's get back to the issues of interest to all of us - sessions sizes and hair counts.

 

So who's on board for presenting hair counts and donor strip measurements? Can I have show of replies?

[MMA fighter]

Landen vs. The Lawyer............

 

landen wins by tko in the 3rd round

 

 

Just kidding guys

[Bushy]

Thank you for clarifying that, Pat.

 

Now back on subject: I'm for hair counts. It may be tedious for the clinics to do it, and in my opinion the count won't make a big difference in the end, but for the sake of industry uniformity I vote in favor.

[Bushy]

Originally posted by MMA fighter:

Landen vs. The Lawyer............

 

landen wins by tko in the 3rd round

 

 

Just kidding guys

 

Wait, I thought I thought "no mas" meant you lost!

[Janna]

Pat, I believe you know my vote on this.

 

I don't see this as a tedious task for the clinic as the clinics all have the graft count already. It's just one more column of numbers with basic math thrown in.