Dr Rahal Patient - 2084 Grafts - 7 Months

[NEWHAIRPLEASE]

Once again, thanks for your input but your response was anecotal evidence and your own personal biases. Whilst your opinion is appreciated, these are not what im looking for. Im after a medical vindication of the approach taken here on this patient being in the the long term interests of the patient vs a conservative approach.

 

For me, it is precisely your argument that you want to enjoy hair today and not worry etc that concerns me. Say for example in 20 years time significant dangers are found with long term finesteride use, if a dense packed forehead is being supported by a drug that was to cease to be in circulation, all of a sudden aggresive hair restoration would start to look an inadvisable practice. Now I know this is unlikely, but the recall of a drug is certainly not without historical precedent. With this in mind it is simply my belief that ones donor must be used with extreme caution. In that context, I am asking sincerely if there is any evidence that the approach on this patient and others like him is viable in the long term both medically and aesthetically? Hopefully you can see how your post did not answer my questions. Thanks again.

 

ManinSpace

There is no such thing as " medical vindication" as you are defining it!! Everything that you want to throw out as factors for receiving a hair transplant ARE IN FACT FACTORS that have to be in place to have a hair transplant!! Example, most doctors will ask men if they are taking Preventative meds before hoping into the surgical chair!! I had 7 or more consults with coalition doctors before eventually happily settling with Dr Rahal, EVERYONE asked if I were on finasteride and rogaine!! Also, you have to consider age, miniaturization at its current state and then do your best assessment given ALL of the variables..as for comparing Armani to Rahal, well there is NO COMPARISON!!! Its not even close....Capelli is right, if you want the perfect answer, it would be nice to have a crystal ball!! Unfortunately that only works in movies so we have to do our best with the variables we are given!!

[ManinSpace]

Once again Capelli thanks for the extensive response.

 

By extensive I did not mean that as in an offensive sense, so forgive my poor selection of words, I simply meant your loss was apparent and is far enough on the way that had you not addressed it with a HT and meds then there is reason to suspect from the level of miniaturisation and diffusion that appeared to be occuring in your pre op pictures that it would continue through at least 1 more NW scale in your lifetime. I did not mean any offense I can assure you so my apologies on that.

 

I have only consulted with 2 Drs as I have researched for around a year and these were the 2 whom fulfilled all my criteria. Having consulted with them I was satisfied with both proposals but i have decided to put the breaks on and am delaying my procedure. As stated, I have a good head of hair, I am regrowing much more than anticipated on meds and am happy enough to recede as I get older, so im now thinking that I dont need to address this with such haste, it is my opinion that the longer you can go without having a HT the better as for me, it is a last resort.

 

I fear because of my responses to you my concerns are taking over the thread so i wonder now if you and I should stop discussing this?. You keep telling me things I know and presuppose i do not understand the things you say, but I think it is you who is not quite understanding me. My questions remain totally unsatisfied so if anyone else feels they can address them it would be appreciated. I dont mean that in a rude sense Cappelli, its just we have both made our points and are going around in circles.

 

I hope that doesnt appear rude, everything you say is valid and are interesting points of discussion, but they are not answering my specific points. You assume i am a conservative charecter but this is not true, i am happy to change tact, indeed i would love to, if i see evidence that it is totally viable in the long term to do so. Admittedly the conservative argument is easier to make, I want to hear how valid the aggressive argument is and so far all ive got is 'pack it and see'. I remain convinced there is more to it than that, but if it really is as simple as that then that is certainly not satisfactory for me.

 

One final thing, I need to be clear im not accusing Dr Rahal of any impropriety or not operating a duty of care, I have no reason to suspect this, Im simply asking how he is doing so. You say 'the doctor plans for the future' but that is a little abstract, im asking for something more procedurally concrete, how is it planned for, what is the protocol?! How much donor is sufficient contigency? How does donor density affect the decision to dense pack? The effect of Hair characteristics? Whats the maximum you could lose on top without being compromised by a heavily harvested donor from a dense packing in the hairline etc?. How do you balance a densely packed frontal region of 75 fus per cm with an area behind that will likely thin as you age particularly into old age into something less than that? What will the aesthic appearence be of a denspe packed linear frontal hairline and thinning and possibly emergence of a bald spot on the crown? What happens if the recession continues in the lateral temple region and they seperate from the rest of the hair and there is not enough donor to address this and the top? I feel these are all vastly important considerations and there must be more to it than hope fot the best and it varies for each patient. Of course it does, but there must be some be some basic procedural considerations? Thanks again

[Capelli11]

I concur that we have both made our points and I will push back to you again in that your questions are all for the HT doctor so I would again advise you to have a phone consultation with Dr. Rahal so that you can get his perspective and this will literally put your questions to rest. Would you be willing to do that? It is best to speak with as many doctors as you can as I have learned sooo much from speaking and meeting them even if I didn't end up using them...in the end it made me more educated and allowed me to understand the HT process better. We all have had your questions and at the end of the day you have to go with the dr that suites your needs and gives you the best answers that you agree with.

 

It would also be good to get other feedback on this thread...

 

SPEX: Perhaps you can comment on this thread as you have been in the business for many years and work closely with Dr. Feller?! It would be appreciated to help ManinSpace get a better understanding.

[NEWHAIRPLEASE]

Maninspace

I truly believe you are wanting answers,however, all of the questions you asked in your last paragraph, IM SURE Dr Rahal has them all answered before he proceeds with a surgery...In Fact, I know he does...personal experience...Yes, I am partial to Dr Rahal...I think that is obvious...BUT IT IS FOR GOOD REASON...you say Capellis answer is abstract..well, really its not....Its actually obvious...You say you have had two consults...are you asking these questions on your consults?? Are you getting the answers you are looking for?? The truth is, anything can happen...you can go from no hair loss at 40 to a Norwood 7 at 45...its unlikely, but possible...unfortunately thats the best we have with hair loss..again, we don't have a crystal ball....Dr Rahal has done this a LONG time and has been very successful at it...I know he hits the ball a lot more than he misses...in fact, honestly, Ive never seen him miss...until he does, I will trust his judgment!!

[ManinSpace]

I apprecite your input and shall cease asking the same questions. I still feel maybe im not explaining myself very well as i dont seem to be understood but i dont know how else to word it.

 

Edited to say i dont really disagree with anything either Capelli or new hair say, its just that almost all of it was taken as read. I sincerely appreciate your attempts to understand and help.

Edited February 20, 2012 by ManinSpace

[NEWHAIRPLEASE]

I apprecite your input and shall cease asking the same questions

 

Maninspace

This is not the message I got from your post via my email...Not sure if you deleted it or edited it or whatever....

Listen, certainly not trying to argue with you...not trying to " not " answer your questions!! Questions to the patient are extremely important!! I asked questions for 1 and 1/2 years...I guess we are just not doing a good job of answering it!! BUT, the reality is, we can't predict the future, all we can do is try our best!! I know Dr Rahal would NEVER, NEVER, give someone a hairline he thought was gonna look stupid or bad 10, 20,30 years down the road...we obviously can't answer the questions right, so if I were you, I would get a consult with Dr Rahal...Im sure he can do a far better job explaining it....I had a consult with a coalition doctor on here before I chose Dr Rahal...it was Dr Konior...Dr Konior is great!!! He told me something I will never forget..and Im paraphrasing here...he said...having a hair transplant is like flying in an airplane, eventually, you are just gonna have to trust the pilot...and thats what I did....DONT stop asking questions, get the answers you are looking for...you may just have to go a little higher to get them...good luck!!

[Capelli11]

I 100% agree with NHP...Maninspace you need to consult with Dr. Rahal and we would enjoy seeing if he answers your questions because at the end of the day the doctor is going to have to answer your questions...not anyone on a hair network thread. Please come back when you have spoken to Dr. Rahal.

[ManinSpace]

New hair indeed i deleted my message as in the time i wrote it i had two new messages and i felt the discussion had been exhausted.

 

Once again, i understand all that, your telling me stuff i already know. I do appreciate it and i am sure Dr Rahal is fantastic, i think ive been clear that i am trying to remain neutral, im just wanting to know in the same way that some drs can explain their conservtism in general, non case specific terms I would like a general understanding of a more aggresive dr in the same way. Im perfectly aware that HTs are largely case specific, but there are fundamentals that each dr goes through whether conservative or aggressive, i have seen the conservative case, i would like to hear the more aggressive case (im not really comforatable with this word aggresive by the way, i feel it is a little emotive but i mean it in a neutral but descriptive way) I have no doubt that if i were to speak to Rahal in person he could tell me why he thinks he can be more aggressive on me but I already know im a good candiate for this kind of proceure, i am also on meds and have good family history, so im actually less interested in my specific case and more the general attitudes and approaches of Drs like Rahal. I persist with doing this in the forum as it is the discussion that interests me, the dialectical method so to speak that you get within a public forum.

 

Thanks again, saw your avatar new hair, to me, Seinfeld is the best show in history by the way.

[NEWHAIRPLEASE]

New hair indeed i deleted my message as in the time i wrote it i had two new messages and i felt the discussion had been exhausted.

 

Once again, i understand all that, your telling me stuff i already know. I do appreciate it and i am sure Dr Rahal is fantastic, i think ive been clear that i am trying to remain neutral, im just wanting to know in the same way that some drs can explain their conservtism in general, non case specific terms I would like a general understanding of a more aggresive dr in the same way. Im perfectly aware that HTs are largely case specific, but there are fundamentals that each dr goes through whether conservative or aggressive, i have seen the conservative case, i would like to hear the more aggressive case (im not really comforatable with this word aggresive by the way, i feel it is a little emotive but i mean it in a neutral but descriptive way) I have no doubt that if i were to speak to Rahal in person he could tell me why he thinks he can be more aggressive on me but I already know im a good candiate for this kind of proceure, i am also on meds and have good family history, so im actually less interested in my specific case and more the general attitudes and approaches of Drs like Rahal. I persist with doing this in the forum as it is the discussion that interests me, the dialectical method so to speak that you get within a public forum.

 

Thanks again, saw your avatar new hair, to me, Seinfeld is the best show in history by the way.

 

Ok..well good luck to you..

[orlhair1]

This is just my opinion, but I think the younger you are, the more conservative you should be with preserving grafts for the long run. The reality is that no doctor can predict with any real degree of certainty how far your hairloss will progress over 3 or 4 decades. Sure there are factors that may be indicators, but that is all they are. It is an educated guess. Meds are great, but they don't work as well for some as others and in a lot of cases they lose their effectiveness over time. That is the reality of hair transplants. You have to plan for the future and we all have a limited supply (if i recall right the average donor supply is between 4,000 and 8,000 grafts). Everyone needs to make their own decisions on their approach that they want to use with their limited supply of grafts, in consultation with the doctor they choose.

[NEWHAIRPLEASE]

This is just my opinion, but I think the younger you are, the more conservative you should be with preserving grafts for the long run. The reality is that no doctor can predict with any real degree of certainty how far your hairloss will progress over 3 or 4 decades. Sure there are factors that may be indicators, but that is all they are. It is an educated guess. Meds are great, but they don't work as well for some as others and in a lot of cases they lose their effectiveness over time. That is the reality of hair transplants. You have to plan for the future and we all have a limited supply (if i recall right the average donor supply is between 4,000 and 8,000 grafts). Everyone needs to make their own decisions on their approach that they want to use with their limited supply of grafts, in consultation with the doctor they choose.

 

Great post...I totally agree!!

[orlhair1]

One other thing I will add.......most people will care about their hair in their 40s, 50s, 60s and perhaps beyond, whether or not you think you will right now, so planning for the future is key.

[mattj]

It looks like the debate has run its course and I'm late to the game with my response, but I wanted to say a few things. ManinSpace, the answer might not satisfy you fully as you did have some very detailed and technical questions, but I hope my response does go some way to putting things into perspective.

 

The issue here is one of perception. The forums see patient results (and only a small proportion of them), but it's what you don't see which is at the heart of the matter.

 

Dr Rahal consults with hundreds of patients in a year that are not candidates; for reasons that include, but are not limited to: poor donor density, age, unfavourable family history, poor hair quality, unrealistic expectations - or a combination of the above.

 

So the patients whose results you see are those who were considered qualified for surgery.

 

Dr Rahal's patients want to restore their hair to a reasonable level that allows styling options and a more youthful look. He ensures that this can be done without running into supply issues in the future. He always looks at the worst case scenarios and works backwards as to what can be achieved safely in each patient. He doesn't always super pack the hairline to a high density, and patients are aware that in some cases the crown might have to be left in the future.

 

Dr Rahal's hairlines tend to be between 50-70 grafts per cm (but not always this high) and there isn't much difference between this and the cases where patients get a 40 graft per cm density and then go back for a second surgery to increase the density. (With more down time, while still using up more grafts and with possible transection risk).

 

I thought Capelli explained the main points very well. However, his 'live for today' comments are his own thoughts and they have nothing to do with Dr Rahal's judgement of his case. I actually think Capelli has shown here that he understands the decision he's made and is an educated patient. This is something that would have featured in Dr Rahal's assessment.

[ManinSpace]

Thanks for the response Matt J. I appreciate you outlining the areas that are the considerations for a candidate.

 

I guess I just dont understand how dr Rahal can dense pack NW3's like Cappelli into NW1's (i disagree with you cappelli in that i believe from your pictures your design looks distinctly NW1 to me) using up half a patients donor supply, increasing the surface area and still ensure that he has enough to last in the bank for another minimum 40 years of ageing (sorry dont know how old you are). Im not at all insinuating he cant, i just simply dont understand how he does it but other drs advise so strongly against this practise. Who knows, maybe they just cant do it as well.

 

I would love to understand simply because I find Dr Rahals designs so eye catching.

 

Again, no offence meant, no impropriety suggested, just a very curious man in search of answers.

Edited February 21, 2012 by ManinSpace

[Gandolf]

This patient's hair looks almost just like mine, especially from the back. I hope I get as great a result when I have my procedure with Dr. Rahal. To everyone making a big deal about the placement of the hairline, it doesn't look to me like it was even lowered very much in the center, just in the corners. And 2084 grafts is just a fraction of his lifetime donor supply so I fail to understand all of the fear mongering here.

[Mickey85]

This patient's hair looks almost just like mine, especially from the back. I hope I get as great a result when I have my procedure with Dr. Rahal. To everyone making a big deal about the placement of the hairline, it doesn't look to me like it was even lowered very much in the center, just in the corners. And 2084 grafts is just a fraction of his lifetime donor supply so I fail to understand all of the fear mongering here.

 

Some people here think that HT's should be 'mature' hairlines and temples should not be closed... I fail to understand it also. This one consultant for a local HT surgeon told me "when you are 40, you will want a mature hairline" after I said I want my hairline straightened out and I thought "yeah I'm sure Brad Pitt is cursing that he has a juvenile hairline!"

[AdamAJ]

Some people here think that HT's should be 'mature' hairlines and temples should not be closed... I fail to understand it also. This one consultant for a local HT surgeon told me "when you are 40, you will want a mature hairline" after I said I want my hairline straightened out and I thought "yeah I'm sure Brad Pitt is cursing that he has a juvenile hairline!"

Yes but Brad Pitt has that hairline because of genetics obviously. It will most likely look weird on a guy who wasn't born with it. Bill Clinton is another one that kept his juvenile hairline.

[Mickey85]

Yes but Brad Pitt has that hairline because of genetics obviously. It will most likely look weird on a guy who wasn't born with it. Bill Clinton is another one that kept his juvenile hairline.

 

 

Of course However I do not believe it would look weird on a guy not born with it as most of us started off with juvenile hairlines. Some keep it, some don't. Whether or not it is transplanted doesn't necessarily make it look weird or not as long as it frames the face properly. Just my opinion anyway.

[chrisdav]

Getting a hairline like Brad Pitt should only ever be considered with someone who has minimal hair loss at the correct age and who isn't likely to loss much more with the right hair characteristics.

 

Hair transplants are an illusion of density so it will never be exactly same as someone who has never suffered any balding in their life.

 

Going off the subject, great result for the patient and money well spent.

[Mickey85]

Getting a hairline like Brad Pitt should only ever be considered with someone who has minimal hair loss at the correct age and who isn't likely to loss much more with the right hair characteristics.

 

Hair transplants are an illusion of density so it will never be exactly same as someone who has never suffered any balding in their life.

 

Going off the subject, great result for the patient and money well spent.

 

Oh of course, I never said an NW 4, 5, 6 or 7 should expect a Brad Pitt hairline.

[chrisdav]

I think we all would want a hairline like that Mickey in an ideal world

[Gandolf]

Matt,

 

Did you ever get any newer pictures of this patient or hear any updates? I'm just curious if he got any further improvement as these were only at the 7 month mark (even though they blow 99.9% of final results away).

[BlueSteel]

with any medical procedure there are risks benefits and alternatives

 

the OP made their decision; I have met Dr. Rahal before, he is an ethical surgeon that would have fully disclosed the patients risk/benefit/alternative profile. He did a scar revision for me.

 

There are many things about the patient we do not know ie: family history of hairloss / acceptance of "moderate to high risk" surgery etc and being committed to the HT process if further loss occurs.

 

I had a HT with 3000 to the front with Dr. Armani back in 2005. Finasteride lost its effectiveness in the temple zone and front in 2008 and I experienced side effects after about 10 years of use in ~2009. Obviously I stopped. This is just a picture timeline of what it looked like. I understand that forum users believe this is a "rare" occurrence and that the info put out by Merck states only ~5% of patients have side effects. If it happens to you however, it doesn't matter how many people do or don't have side effects. You have them, end of story.

 

from the age of 26 to 32 the appearance of my hair drastically has changed as I reflect on the pictures.

 

That being said, the doctor is there to guide and counsel patients and let the patient make the ultimate decision unless they are extremely poor candidates / have unrealistic expectations.

 

it sounds like the OP knows the risks and Dr. Rahal discussed these with him, there is nothing unethical about the surgery.

 

if the OP can't accept the fact that there IS A CHANCE, he could lose a substantial amount of hair behind the hair transplant, that is another matter.