Trying to choose between two surgeons--looking for advice

[fireman]

So I'm on track to go in for a transplant (I'm a NW5), but my dilemma is deciding between two different surgeons, each one with a different approach:

 

Surgeon A thinks I could yield a significant number of grafts in a single session due to my very high scalp laxity. However, I'm concerned that the surgeon uses staples to close the donor area (I need anywhere from 3-4,000 grafts for decent results) and that this will result in a noticeable scar and might use up the donor area, in case I need to go back for more some day. Also, I've only done an online consultation with this doc; he hasn't seen my hair in person.

 

I had a personal consultation with Surgeon B, who also thinks I have high scalp laxity. However, he was able to examine my scalp and is concerned that the area above my ears is not as dense as the back; thus he only wants to harvest from the back. Plus, his approach is conservative; he wants to do the first session of 1500, let the donor area heal and the transplants take before doing a second session about a year after the first. Also, he closes with sutures; he says this minimizes scarring and he would never use staples.

 

My questions: what's the conventional wisdom on a) single session vs. multiple sessions, b) staples vs. sutures c) and choosing a doc based on online consult vs. personal.

 

I should note that both docs have good reps; I'm really just trying to make an informed choice by weighing their different approaches. Hoping folks on the forum may have some pearls of wisdom to share. Thanks.

[orlhair1]

Different clinics have different approaches on how big of a session to do at once. They also have to factor in donor density and laxity. Everyone has their own thoughts on conservative vs. aggressive approaches. For 3-4000 grafts, if it were me I would lean toward one session. That is really pretty common these days with good surgeons. It sounds like you have good laxity, so that should not be a problem. As far as staples, they are a non issue. Dr. Shapiro used them for my surgery and I have to look really hard to find any evidence of a scar. Staples vs. suture are a matter of doctor preference, but a doctor who says they would never use them for the reasons explained to you, would make me question whether that doctor is right for you. I chose my surgeon through online/ phone consults with several clinics. In person would be nice, but just is not practical. I would not let that be the deciding factor. I had 5 or 6 consults with top clinics and you may want to do the same. Good luck with you research and decision.

[N-6]

I tend to favor a fairly conservative approach for my own head and I would make every effort to personally consult with surgeon A prior to committing to any procedure and to know what to reasonably expect before hand. I personally would not feel comfortable entering surgery with a certain set of expectations when the surgeon has not physically examined my hair in person. Maybe surgeon B saw something in person that wasn't revealed by the photographs you sent to surgeon A. This is matter of preference I suppose. As previously mentioned, staples versus sutures should be a non-issue as top doctors use both.

[fakeplstctrees]

Fireman,

You have a difficult decision to make, and it appears that you are going about it properly, researching first. If you require that many grafts, I think it would be nice to have it one and be done. But I'm not a doctor, and am not sure of how well suited you would be for a megasession. Also, this brings up the question of cost. It has been my understanding that the more grafts, the less expensive they become. Has the conservative doctor made mention of how he will charge you for two procedures, as opposed to one large one?

 

Another factor to consider is the time, emotions, and personal comfort you invest in each procedure. I personally had a procedure of 1500 grafts, and am not happy with the yield or density, so will have to undergo a second procedure. This procedure is not extremely uncomfortable, but it is no walk in the park either. Would you rather be vacationing in the Turks & Caicos Islands, or be stuck at home, sleeping in a recliner in moderate discomfort a second time?

 

Those are some pretty important factors to consider. As for the Suture or Staple issue, I have no opinion. You probably should meet with your surgeon in person before an operation, just my opinion. I do wish you the best results possible, and please keep us informed, I am particularly interested in the cost matter of having multiple procedures.

 

Cheers,

-Trees

[Bowser1982]

I would have to agree with everything Orlhair1 has said. 3,000 to 4,000 grafts can be done in one session by most top surgeons these days, especially if you have good laxity and donor density. I just had my surgery done by Dr. Rahal and I would highly recommend him as he is one of the best in his field. Always research as much as possible before you choose the right surgeon. I researched for about 6 months before I choose my doctor. Researching is key my friend and as i can see you are on the right track asking questions already.

[N-6]

The issue for Fireman is does he have 3-4K as supply for this HT in this first place. It doesn't matter that surgeons can crank out 3-4K in one session. Every patient is different. We're talking here about Fireman as a patient specifically, not patients in general.

 

Surgeon A somehow determined he had high scalp laxity without examining him (maybe on basis that this is Fireman's 1st HT?). Surgeon B examined him and thought it would be safe to just harvest the back and not the sides. It makes sense that by not using the sides, this would limit his available supply for this HT as Surgeon B alludes to. Maybe its not safe to harvest from the sides in your particular case because grafts from there will eventually fall out.

 

I would schedule a personal consult with Surgeon A to come up with a specific treatment plan after a close exam of your scalp including your sides. You definitely need to be on the same page with your surgeon even if its the day before your scheduled procedure. Maybe even consult with Surgeons C and D.

[Bowser1982]

well with the amount of pictures you send the surgeon, wet hair and none wet hair, your head in all angles, I would assume a good HT doctor could tell pretty close as to what he has in his donor and on the sides. Unless hes sending them poor quality pictures but i highly doubt a good surgeon wouldn't have said anything about his poor quality pictures in the first place. I do agree with you tho on how could the doctor judge his laxity from the pictures seems a bit odd. I would consult with as many surgeons as possible, maybe you can post some of these pictures you sent these surgeons, So we can see what they are seeing, But like i said researching is KEY because this isn't a race to the finish line.

Edited December 4, 2011 by Bowser1982

[orlhair1]

I had several online consults followed by multiple phone calls. All were very close in their recommendations and ideas. I used that plus my research to choose Dr. Shapiro. It was a close call....there are probably 4 or 5 surgeons that I would feel very comfortable with. I did happen to be in Minneapolis about 2 weeks before my surgery and had an in person consult which confirmed that the online was spot on. The reality for most people is that you can't have in person consults with the several top clinics unless you take a trip around the US and Canada. I old not let the online vs. in person influence your decision unless you are lucky enough to have in person consults with at least 5 top surgeons.

[N-6]

I agree with orlhair1 about online consults in general but in this case, there are two docs with what seems to be very divergent views on how to approach his case. One has only seen photos and states he can get a significant number of grafts while the other (after personally examining his scalp) says I can get only 1500. That seems to be a pretty big difference.

 

My online consult gave me a more conservative estimate than my actual in-person consult. Given the very differing views by docs on Fireman, if I were him I would arrange an in-person consult with surgeon A or another doc.

 

Good luck!

[fireman]

Wow, thanks for all the great, thoughtful replies. It sounds like it would be in my interest to seek a few more opinions from HT doctors. To answer a few questions from folks who replied, I supplied a video to Surgeon A--that's how he determined I had very good laxity. I would have to say my greatest concern right now is whether or not harvesting from the sides is an option; I think that's where I need further confirmation before proceeding.

As far as the price, well, there is a difference there. If I go the two-procedure route I'd definitely be spending more than a single session. However, price isn't as much of a concern (not that I love to spend money unnecessarily); what is most important is getting the best possible results. This is something I don't want to half-ass...

One other question: when the surgeon closes the donor area, does it pull up the back of the neck, creating an odd look? Or does the laxity make up for it? I'm just wondering if the pulling on the back of the head to close up the incision has any noticeable side effects on appearance.

[orlhair1]

Take some really good detailed photos of your sides to send to the surgeons you consult with. They will be able to give you sound advice with that. Good luck and let us know what you decide!