advice from personal physicians?

[HtQuestions]

As I'm sorting through all of this, has anyone asked their regular personal doctors for advice or referrals on hair transplants? I assume some doctors would probably disapprove of cosmetic surgery in general, but I wonder if their advice has been of use to anyone, or whether anyone has asked. They would probably know less than someone who specializes in it, but otoh their judgment would (probably) not be as subject to bias and self-interest. (One little thing I've noticed is that the clinics that don't specialize in "FUE" or do little of it tend to be more explicit about the downsides of FUE, but that gets challenged by the clinics that do; so it seems like it's going to take some time to come to an informed judgement about all of this!)

[Danielkiwi]

Thats a good point HT questions. I have asked this question to my childhood physician in my home country and my current physician in america...childhood physician is adamant that i should not do it at all. Infact, he was really pissed off when i told him i had started to take propecia..he had not even heard about it but as soon as i told him that it blocks DHT, he said immediately not to take it as it would cause ED issues ..THe GP in america is fine with Propecia but tells me to proceed with caution with respect to HT's..he says that he has seen a lot of people who have been buthered with dolls hairline..i suspect that he has seen a lot of old style transplants..

 

As far as FUE is concerned, i have the same thoughts as you..I notice that a lot of doctors recommended on this forum are not comfortable doing FUE and hence try to avoid doing these...i think it is cost effective for them to do FUT and dont want to deal with FUE...I highly recommend you to look beyond the recommended doctors and keep your eyes open..guys like Dr. Bisanga, Dr. Umar and Dr. Keser are doing awesome work and seem to be confident of their work..i am going to be consulting Dr. Bisanga soon and will keep you posted...Are there any doctors you are considering?

[HtQuestions]

Danielkiwi,

 

Thanks for your comments. I too had a doctor who thought even propecia was a bad idea! Weighing risks and benefits vary depending on the person, but I can't say that going bald is a good thing, so some (at least very small) risks seem justified. A good idea based on what you say would be to ask if one's doctor is familar with the new techniques--I assume younger doctors might be better at judging something like this. But the doctor may be reacting to the general character and trustworthiness of hair transplant clinics (not the techniques)--and that's important by itself (regardless of the techniques).

 

I've been looking at some of the doctors who belong to this forum's list and who are frequently mentioned here, Shapiro, Feller, Lindsey, and Hasson. I briefly looked at another "media-comfortable" doctor but there was too much hype and I disliked his California-like (or in this case, Florida) spa emphasis, and his getting testimonials from people who got special benefits from him. Also, I've ruled out doctors that push the laser light (i.e. low level heat) business. I thought one prominent doctor overstated the case for FUE in some videos, or at least didn't present the drawbacks honestly.

 

The big problem is finding doctors who specialize in and do a lot of ht work, but who are also trustworthy and reasonably priced despite the self-promotion and marketing (and of course there's a lot of money involved). Maybe I'm hypercautious, but I was concerned that the doctors listed on any forum or website are paying dues or fees or ads (maybe someone could explain how that all works, here or on other sites--who pays for what), but at this point I think if one gets enough (non-consultant) patient reviews and starts to evaluate that, that's helpful, and it is also helpful to hear what the doctors themselves have to say and how they explain it.

 

I would very much like some sign that a doctor I already trust recommends some of these clinics--or at least see that they receive some recommendations from doctors outside the hair transplant specialty who are known and respected. I wish this subarea were more like other areas of medicine in terms of tone, trustworthiness, analysis, etc., not that some of the same problems aren't everywhere.

Edited August 9, 2010 by HtQuestions

[Blake Bloxham]

HTQuestions,

 

While I applaud your dedication to research and transparency (this community prides itself on a similar attitude), you bring up a few issues I'd like to address.

 

First, I've personally discussed the hair transplant procedure (follicular unit transplantation) with my family physician (I've known him my whole life and he's a good friend) and he had nothing negative to say from a medical standpoint. Additionally, remember that many of the physicians performing hair transplantation are still involved with other areas of medicine and practiced in various fields before becoming full-time hair transplant surgeons. To me, this indicates that these physicians are ethical professionals who have interacted with various areas of mainstream medicine and feel safe practicing hair transplantation. Furthermore, I've noticed several transplant patients on our community are physicians themselves.

 

Additionally, I understand how certain promotional techniques and marketing methods in the field of elective surgery can be disheartening. However, I think one of the strongest foundations of our hair restoration community is the stance it takes in recommending ethical physicians who dismiss these "smoke and mirror" marketing campaigns and stick with proven methods and impressive results. If you would like to see how we ensure that only the most ethical, dedicated hair restoration surgeons are recommended on this community - click here. In my opinion, all of our recommended physicians are dedicated to transparency, efficient techniques, quality results, and patient safety.

 

If there is anything I can personally do to address some of your concerns or answer any difficult questions, don't hesitate to reply in this thread or send a private message. Thanks!

Edited August 9, 2010 by Future_HT_Doc

[NotUrAvg]

It doesn't hurt to ask your primary care physician, but don't be surprised if you get a blank stare in return, or their personal opinion (Which may not be based on anything tangible). I'm sure there will be a lot of variability in outside physician knowledge of HT. There is minimal overlap between hair transplant and general medicine, and there is probably zero exposure to HT medicine in medical school. But it would be excellent to consult with your primary care physician regarding medical therapy as they will be more comfortable speaking towards the systemic side effects. Remember that internists and family practice docs (and Danielkiwi's pediatrician), are used to treating sick people. It is not typical for them to put healthy people at a potential risk for a cosmetic benefit. So some physicians may not understand why a healthy person would take on a potentially harmful intervention for their appearance. It is hard to escape bias, even if it's meant to be harmless.

[jacksonbrowne]

What happens when you listen to your PCP? You con yourself into thinking the Kia you paid Lexus money for is better than the real thing because the brochure was prettier, salesman slicker, and at your mechanics uninformed opinion. Oh, and the coffee probably tasted better.

 

My mom's boss did an HT last year after getting a referral to Robert Leonard from his PCP. Guy also visited 2 other local outfits with Mark DiStefano being head and shoulders above Bosley or Leonard.

 

Guy actually referred to Leonard as 'the Lexus of HT's' and DiStefano as Toyota. Clearly glamor and glitz won over actual results.He told me in no uncertain terms not to consider anyone but Leonard. I threwup in my mouth a little at his suggestion.

 

The reality? You spend $15,000 for an unknown number of grafts, far less than the 3000 from a first rate clinic. Your new hair looks oddly spaced and pluggy and you have no clue what a trychophytic closure or transection rate means.

 

To add insult to injury, you rave about the 2 weeks of FREE low level laser therapy, and are DYING for another round with the SAME doc after seeing him on the 11 o'clock news demonstrating some new cutting edge whizbang machine called NeoGraft.

 

(promotional link removed)

 

If I do get a HT, i'll be sure to wear a hat around this guy at ALL times because I don't want to make this guy cry.

 

Caveat emptor

Edited August 10, 2010 by jacksonbrowne
shortening and color commentary

[HtQuestions]

noturaverage,

You put it very well--there is some (illegitimate) bias among pcps against cosmetic procedures. I would add that the gravitas and responsibility that attracts a lot of people to being doctors in the first place also would lead them to look down on elective cosmetic surgery as frivolous. Of course, most doctors are a little too serious about mere health. I mean, the things that good looks helps along are certainly worth some expense and risks, otherwise why get out of bed, but that's not usually their thinking. (They seem to be a tad overly severe about drinking also!)

 

jacksonbrowne,

Thank you for that link. Seems like good advice on that site -- though I'd never be tempted to be influenced by yellow page ads, hair stylists, or tv infomercials. I agree that pcp's are also susceptible to salesmanship and glitz (or for that matter, free notepads and coffemugs). Still, if it were an exceptionally good and trusted pcp (whom you could ask the basis for his recommendations), or if we were taking a survey of many doctors, couldn't it provide some indication at least of what might be a bad practice (they might know more about what bad doctors are like, or at least what doctors violate customary practices, which is generally a bad sign). At any rate, it would help if there some official training standards in ht with some supervision of doctors by doctors (the way there are for other specialties). But since it's purely cosmetic and no life and death is at stake, it's probably not considered to be worth setting up official standards. (As an example, I think it was a great mistake to allow attorneys to advertise -- there is value in the honor and strictness of professional feelings and supervision and restraining crasser sentiments and practices.)

 

Future_HT_Doc,

I lean to being cautious on surgery and medicine in general. It's not as though I haven't on occasion made grievous mistakes in purchases, and I'd like not to do that this time. I actually did not notice that any patients were doctors themselves, so I have to pay closer attention--I certainly agree that would help a lot (especially if they were non-ht doctors, as I explain below, and assuming of course they are not also consultants of some sort etc.).

 

This is a good point:

remember that many of the physicians performing hair transplantation are still involved with other areas of medicine and practiced in various fields before becoming full-time hair transplant surgeons. To me, this indicates that these physicians are ethical professionals who have interacted with various areas of mainstream medicine and feel safe practicing hair transplantation

 

 

That makes a big difference I agree. The only caveat I have is that they still made a decision to get into the hair transplant field--not that that's a bad thing, but it's still a bias (especially considering what I assume are the monetary rewards versus the honor hit in choosing that field). It's not as unbiased as someone who never went into the field in the first place, i.e. you still have an (unwanted kind of) "selection bias" in the sample. For example, if you took only those doctors who practiced in other fields first and then went on to practice homeopathy (sorry for the bizarre example--just using it for dramatic purpose here--I'm NOT comparing ht to it!), that would be heavily skewing the opinions in favor of homeopathy, even though I admit you would be getting some bias improvement over restricting yourself to doctors who had always practiced in homeopathy and nothing else. (of course there's a reverse bias as well (the bias against cosmetic surgery by pcp's), but that's less of worry, since it's the known factor. the scary thing to me are all the unknowns especially in a field that I think had a known bad history.)

 

That's longwinded but the main point is I am trying to sift through and get some trustworthy, intelligent, informed, unbiased judgments, or as close as I can get to that. The marketing and the bad taste of many of the ads and websites are a problem with me, but I try not to overreact. For one thing, its partly a reflection of the customer base--e.g. you get somewhat tasteless viagra ads because a large part of the customer demographics is of a certain kind (aka horny old guys -- but also Bob Dole I guess), and that of course in no way means viagra isn't sound, effective, legitimate, etc. Then you have the past history of ht which probably colors my judgment: the bad hair plugs (associated for some reason in my mind with late night "hair club for men" type ads). But I know these aren't the surgical techniques commonly used now.

 

Nonetheless, it makes it harder for me to sort things through. It would be difficult for me but not as difficult to pick a good cardiac surgeon I think, though some of the same concerns apply (some doubtful marketing and hype by Dr. Jarvik etc.). (Some of the more popular kinds of plastic surgery start to show similar problems, I mean the marketing issues, more problematic motivations of some of the doctors and also the customers, clinics that are "mills," etc.)

 

(The bad taste or vulgarity of the ads or marketing issue is a hard thing to convey but it's really there, and there's not much that can reassure me on that point. But as I said, that's partly a reflection of the customer base, and I certainly don't want to go to a doctor who has only had a few hair transplant sessions, i.e. didn't get a steady stream of patients/customers.)

 

As far as how physicians are recommended here, it's a delicate matter, but as far as trying to get a handle on bias issues, it would help to know how the fees and commissions and ads work--transparency. Some of the same issues would apply to the Mayo Clinic or what have you, but my sense is that there's somewhat more marketing deals, hype, showiness, etc. in this area, more than I am comfortable with. I tried to articulate some of it, but it's still not clear to me. I might have a better perspective after I meet for a couple of consultations (but of course I have to pick the right doctors to have the consultations with!)

Edited August 10, 2010 by HtQuestions

[NotUrAvg]

HTQ, while you may be right that money is one of the largest motivating factors for doctors to go into the field of HT, I do not think it automatically brings their credibility into question, or serves as the sole motivating factor. In physician surveys, patient satisfaction ranks extremely high in influencing physicians into choosing specialties. I could imagine how rewarding it must feel to have a patient who returns after a year looking 10 years younger, and beaming with a new found self-confidence. I'm sure most if not all of the surgeons recommended here take great pride in doing good work. It's not so simple to generalize that serious, self respecting doctors with a sense of gravitas and responsibility would avoid the field of HT surgery. What helped me evaluate the ethos of my HT surgeon was to see where his time was invested. He did not seem to be a flashy self-marketer, but instead has numerous publications, writes books, is actively involved in research, organizes and speaks at conferences, and teaches fellows in his practice. For me, this displayed an enthusiasm for the science of HT, and made it clear that he had a strong intellectual investment in what he was doing. I felt I was getting my surgery done by an academician and surgeon and not a salesman.

 

One thing you can do is go to the ISHRS website (a very respected HT surgery society), and look at the their 2010 conference roster, and see who is speaking and about what topics. The HT world is very small, and it seems like most people know each other. The way I see it, if other respected HT doctors are going to let another surgeon lecture them, that surgeon must have some credibility. It also shows who is at the cutting edge of their field. The conference is targeted towards other surgeons and not at patients, so it gives insight into the world of HT surgery without the distracting marketing and advertisements. I agree with you, it's so difficult to sort through who are good doctors, and who are just good businessmen, but this website (HTN) and looking at patient results/testimonials is a good start. I think your cynicism will be a strong asset in choosing a good doctor.

Edited August 10, 2010 by NotUrAvg

[jacksonbrowne]

@NotUrAvg

At the risk of being abrasive, you've made some dangerous and very naive assumptions. You sound like your new, but a spoonful of medicine is often hard to swallow.

 

I'm glad you've found this place and heavily encourage you to read up, otherwise you'll end up like my mom's boss (true story).

 

 

One thing you can do is go to the ISHRS website (the most respected HT surgery society)

Most Respected? By who? Certainly not the AMA.

 

The HT world is very small, and it seems like most people know each other. The way I see it, if other respected HT doctors are going to let another surgeon lecture them, that surgeon must have some credibility.

Practically anyone can give presentations, workshops, whatever at these conferences including companies.

 

The ISHRS is not some fraternity of elite HT docs. Don't put docs on a pedestal. They can do wrong. The ISHRS is filled with lots of elite docs yes, but also sprinkled with bad docs too.

 

Reference Dr. Feller's excellent response (2nd one) with empahsis on points 1-5. After, reference Pat's reponse where he states that The ABHRS is NOT recognized by the AMA.

http://www.hairrestorationnetwork.com/eve/146331-what-does-mean-abhrs-board-certified.html

 

It also shows who is at the cutting edge of their field.

What does 'cutting edge' mean to you? NeoGraft machine is cutting edge.

 

The conference is targeted towards other surgeons and not at patients, so it gives insight into the world of HT surgery without the distracting marketing and advertisements. .

Actually many Docs use it for shameless plugs (pun intended) and get up on a soapbox. What about the marketing/advertisements by companies that sell products/tools/services to HT docs. What about the companies that sponsor these events?

Edited August 10, 2010 by Future_HT_Doc
info

[NotUrAvg]

@NotUrAvg

 

At the risk of being abrasive, you've made some dangerous and very naive assumptions. You sound like your new, but a spoonful of medicine is often hard to swallow. I'm glad you've found this place and heavily encourage you to read up, otherwise you'll end up like my mom's boss (true story). Most Respected? By who? Certainly not the AMA.

Jacksonbrowne, you have made a very thorough and passionate critique of my comment. You make some good points. I will be happy to address any concerns you have about my dangerous naievity. You are absolutely right, I am not an HT surgeon, so I am not qualified to say that the society is the most respected in the community. I was speaking out of place. The reason I mentioned the ISHRS was because I wasn't sure if HTQuestions resided in the US or not and this is the most credible international organization I know of. I am basing that statement on the fact that 100% of the Coalition of Indpendent Hair Restoration Physicians are all active members and are going to conferences. Here is a example of some of the top docs and how often they participate:

Wong - 14 conferences

Hasson - 8 conferences

Rahal - 8 conferences

Pathomvanich - 14 conferences

B Farjo - 17 conferences

N Farjo - 16 conferences

S. Lam - 5 conferences since 2004

Epstein - 14 conferences

Dorin - 4 conferences since 2003

True - 14 conferences

R Shapiro - 15 conferences

P Shapiro - 5 conferences since 2005

Cooley - 13 conferences

G Charles - 12 conferences

Rose - 14 conferences.

Though this doesn't equate with credibility, it shows that many doctors consider these conferences of some worth. Make of these stats what you will, but personally for me, I see a lot of 'elite' names who frequent these conferences and lecture at them, and that adds some credibility for me, but you obviously don't feel that way, and you are more than entitled to your opinion. Someone's decision should definitely NOT be based solely on this. My original point is this is just another source of facts not clouded by physician-to-patient marketing strategies to throw into the decision making process. It helps reveal who is involved on a more academic level. By the way, that AMA has no business dictating the activities of an international organization. The AMA has it's purpose, but they aren't qualified to speak about an international society in a very subspecialized field of medicine, and I would be more than happy to engage in a private discussion about the politics of the AMA with you. I was an active member for 4 years, and have attended numerous AMA conferences. What are you referencing btw when you say the AMA has issues with the ISHRS? And what experience do you have that gives you the impression that the AMA has credibility and authority in giving their opinion on such matters? You also said that I 'sounded like I'm new'. I'm not sure what that means and why that should place my opinion into question. I am definitely no expert. As far as I can tell, we both have the same number of posts, and both joined the forum at roughly the same time. I have been suffering from advanced MPB for 10 years, researching it for a little less than 10 years, and saved up for an HT for 4 years. And as far as I can tell, I've had more transplants than you have, so what exactly am I new at?

Practically anyone can give presentations, workshops, whatever at these conferences including companies.

Though there are companies advertising directly to physicians and staff, this is not material that will bias an individual who is on the website looking at who the keynote speakers are and what topics they are covering. You probably don't realize there is actually a very rigid peer review process involved in deciding who is speaking and what topics are discussed. I have attended and presented at many medical conferences in the US and internationally. Though I am not a member of the ISHRS, I do not think my opinion in this matter is naive.

The ISHRS is not some fraternity of elite HT docs. Don't put docs on a pedestal. They can do wrong. The ISHRS is filled with lots of elite docs yes, but also sprinkled with bad docs too.

I wholeheartedly agree. Anyone can probably become a member of the ISHRS. But not just anyone can lecture, run symposiums or present medical posters and papers. These professional organizations do their best to establish some set of standards, which doesn't exist in this unboarded speciality. Though they not perfect and are not free from politics, they provide more reliable information than watching a physician's ad on TV.

Reference Dr. Feller's excellent response (2nd one) with empahsis on points 1-5. After, reference Pat's reponse where he states that The ABHRS is NOT recognized by the AMA. </p> http://www.hairrestorationnetwork.com/eve/146331-what-does-mean-abhrs-board-certified.html

I do not know why you are bringing this up. I have never mentioned the ABHRS. The ABHRS is not the same thing as the ISHRS. These are two separate entities. According to the ISHRS website, Dr. Feller is an active member of the ISHRS and has attended a couple of conferences.

What does 'cutting edge' mean to you? NeoGraft machine is cutting edge.

You are absolutey right that I was ambiguous when I used the phrase 'cutting edge'. What I meant was that at these conferencs you weren't going to have antiquated surgeons advocating placing macrografts into the hairline. Those people practicing HT below community standards will be weeded out as presenters. You will have physicians who practice HT surgery with modern high standards. If you feel that the field of HT surgery is perfect and needs no advancement, that's fine. But there are going to be innovations on how to improve technique and that information is going to be shared through peer reviewed journals and at scientific conferences in the form of papers, posters, and lectures.

 

Actually many Docs use it for shameless plugs (pun intended) and get up on a soapbox. What about the marketing/advertisements by companies that sell products/tools/services to HT docs. What about the companies that sponsor these events?

That's an entirely separate topic. If you want to discuss how doctors are influenced by company advertisements then I invite you to begin a different post. It's a great topic and we probably share some of the same opinions. Also if you want to talk about the validity of HT conferences, and their purpose, I'd also be glad to discuss that too with you in private or another post. But this post is about trying your best to gather some information about HT doctors without their marketing getting in the way. Looking at physician participation in conferences/jourals/research provides some insight into their academic investment in the field, and how they interact and are perceived in their community by their peers. It sounds like your mother's boss's decision to get an HT had a strong impact on you, and i'm sorry for his bad experience, but I think we both have the same goal to try to help others in an open and respectful manner. This is a forum of adults, and I hope many of the users understand that our opinions are just opinions and we are not experts. Edited August 10, 2010 by NotUrAvg

[HtQuestions]

I have to say this is all very helpful, though I hope it stays friendly even if it gets heated.

 

Two points:

1. @noturavg, I don't mean to suggest the bias problem always reflects mercenary motives--and certainly conferences can be a good thing (assuming there is some substance there, good techniques being discussed or taught etc.) even if not without a few elements of self-promotion (how much of each is going on is one of those judgement calls). But there are other issues, broader self-love and the "mutual admiration society" and the "hopes and future allies society" that can bias judgments a lot even though they are also factors that help people take pride in themselves, work hard and work together. And even mercenary motives can produce great benefits, including good medical work. (But I do think there are some perhaps unsolvable problems particular to this field, because of the lower esteem with which the public holds it relative to other medical specializations and because of the other issues I mentioned in the previous post. One can think of the reverse, what (idealized) factors attract higher (I don't say the highest) caliber people: extreme difficulty of training or rare intelligence demanded, high honor or respect, extreme benefits thought to be conferred, such as saving lives, no menial or demeaning acts or selling required, etc.)

 

2. Thanks to jacksonbrowne for drawing attention to Pat's post, which makes a number of good points (here):

http://www.hairrestorationnetwork.com/eve/146331-what-does-mean-abhrs-board-certified.html#post2111238

 

About the IAHRS he says:

"This pseudo non profit group, which was cleverly crafted by the self proclaimed "patient advocate" Spencer Kobren, does not operate in a transparent manner and is not held publicly accountable by a patient based forum like the one. Frankly, this patient based forum community keeps all of us accountable - not just the doctors but me. If a physician does not consistently perform it will typically be public knowledge on this forum in short order. At that point the issue must be investigated and resolved. If the physician is found to not be meeting the standards for Coalition membership ( see Coalition Standards) then they will be promptly suspended."

I think it is a good sign if doctors can get removed from a group, since presumably that would be against the (lowest) interest of the group if they were paying dues or for ads etc. Now there could be a very cynical view of this, which I am NOT proposing! and won't even articulate, but some concerns that could arise would be alleviated by: familiarity with the posts of the patients here, which will take some more time for me to do, familiarity with how the acceptance or rejection of physicians into the group actually happens, and confidence that there aren't commissions or side benefits going from a few physicians to the group, or only minimal ones necessary to run the board and pay managers (or is this run by volunteer efforts? seems like an absurd amount of work!). (In an ideal world there would be a mixture of patients and doctors, not beholden to the doctors they are reviewing, reviewing complaints, and doctors setting in common minimum standards of practice (or some commonly accepted protocols).)

Edited August 11, 2010 by HtQuestions

[wb280]

One of the more in depth discussion threads i have come across However, i think we are leaning out of topic gentlemen. It might be beneficial to start a brand new thread as i am sure your discussion will garner quite a bit of mind provoking thoughts.

 

As for me, back to the original question, i feel your family doctor might not be suitable for recommendations. Look, someone who is not in that field might feel its dangerous and speak of untrue things which might dissuade u. Maybe u r a suitable candidate and u could ve gotten back that full head of hair but due to poor advice ( intention was good though ), u would continue to suffer the pain incurred by hair loss

 

As such, i feel forums are still your best bet when it comes to hair loss. You can derive real life examples of what went right and of cos what went wrong, and an abundant supply of Q&As. Just be careful to land yourself in the right forum. I have mentioned before that among all the hair loss forums, i found this to be the most fair and unbiased forum