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Hair density- how to justify?


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Hi there. This is my first question on this forum, so forgive me if it's something old, but I've done my homework but still can't find a satisfactory answer to my concern.

 

I've looked at before and after photos of many patients, and wonder how as patients we are sure that the doctors are implanting the agreed-upon amount of hair. Is that something that the patients have to take on faith? Let's say given the area and the amount of grafts, we come up with 60 grafts/ cm2, so should we expect to see 60 incisions (or at least close to that number)?

 

I know that some of you will say many grafts are transplanted without a mark, so how are we to determine if that is the case? As far as I'm aware, no clinic agrees to tape the whole procedure (or have a friend of the patient tape the whole procedure) and hand it to the patient as a souvenir. Why not?

 

Again, sorry if this post seems cynical. Just wondering if anyone feels the same way. Thanks for your time.

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I've heard of some clinics providing clickers to patients and calling out the incisions to they can keep track. However, in my opinion, if a patient has researched and chosen a physician with a reputation for skill, ethics and patient care, they should feel confident in trusting them to perform the agree upon surgery.

 

More often than not, I hear about patients receiving slightly more than the agree upon grafts at no extra charge.

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It comes down to trusting your gut. You chose the doc for a reason so there shouldn't be a reason to question the basics. I'm not saying not to question the doctor but if you make the decision to go to someone there must be a valid reason and hopefully ethics is one of them. Keep in mind however that density estimates don't always match up with reality in that a doctor truly does not know what density is possible (assuming higher densities) for each patient until the procedure is actually being performed. It has to do with the integrity of the skin tissue overall because if incisions are made too close to their neighbor the tissue in between can disintegrate thereby making the incision much larger.

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good topic. take a look at final results of those that had high density placement. if there is low density or uneven density, then something is not right.

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Yes, I understand the idea of trust and ethics, but I also like to have some kind of verification, maybe just for the peace of mind (or am I a weirdo for thinking like this?). But look at all the people who are supposedly very ethical and later found out to be not so ethical (most recent: Bill Cosby). Ethics is a very funny issue. Who would have thought those CEOs could take away money from their poor employees and stockholders, right?

 

There's a video on YouTube about a doctor in India performing 100 grafts/cm2, possibly a record. You can clearly see 100 of them, so that's what I expect of other post-op pictures and videos as well.

 

Do you guys know of any clinic/ HT doctors who actually tape the procedure to give to patient later? I know that there are excerpts on YouTube, so maybe there are videos of full procedures somewhere.

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You're not a weirdo for asking about this but you would be in the minority if you were insistent on verification of such details. Regardless, there is nothing wrong with having a friend in the OR to count for you or to even record the procedure but just keep in mind that this will make some doctors nervous and some will flat out refuse to allow any recordings for reasons mentioned earlier.

 

Let me pose some hypotheticals to you.

 

1.) Are you going to sit through a couple of hours of footage and count each and every incision made? What will you do if you are promised 60 per cm2 and some areas come up short with regards to the number of incisions?

 

2.) What will you do to verify that all the grafts grew, even if you are able to confirm each incision? Are you going to shave down the recipient area, measure off each individual centimeter and then count each follicular unit growing? How will you account for any hairs in telogen that you can't see?

 

3.) What kind of compensation will you be seeking if the measurements come up a few grafts short? Ask for a refund of 95 dollars because 19 grafts were missing?

 

I hope you see my point. Again, you have to eventually just trust that things are being done the way you were told they would be done and judge your result by the final aesthetic and not be happy or unhappy based on whether or not every "t" was crossed and every "i" was dotted. If you do that then you will be setting yourself and your clinic up for failure.

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Thanks, JoeTillman for your insights and hypotheticals. Let me clear it up a little bit, I don't plan to sit through the whole video of the procedure, unless the result doesn't come out as expected. The taping of the procedure is intended to be a preventive measure to encourage the doctors to be more diligent with their work. Think of it as a transparency measure. Right now I believe that we are giving doctors too much leeway and little responsibility. Let's say the true amount of grafts needed is 4,000. What then prevents the doctors from saying you need 5,000? Surely nobody is going to count the 1,000 "phantom" grafts. Surely the patients will be very grateful when the doctors say they transplant 5,231 grafts for the price of 5,000. That might not be a gross overestimate, but that's easily $4,000- $5,000 of the patient's hard-earned money for nothing.

I think your point No.2 is a little ridiculous, as no one would be that meticulous in measuring the density, not even me. Again, this comes back to my previous paragraph. We only do it if the HT turns out to be a failure. And as far as I know, even the top doctors have failed at some procedures.

Your point about doctors feeling nervous when taped is also a little strange. I might consider the possibility that they have "tricks" that give better results and that they don't want the public to know. But to think that they get nervous and mess up their work because they are being taped? Those pros who have supposedly done thousands of procedures over years or decades?

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The taping of the procedure is intended to be a preventive measure to encourage the doctors to be more diligent with their work.

 

I fully understand and I think that the reasoning is sound. However, by saying this to a top doc you will effectively be questioning his abilities to do the best job possible without oversight and this may be ego bruising to some. Some are fine with it but others are not.This isn't conjecture, this is life.

 

Let's say the true amount of grafts needed is 4,000. What then prevents the doctors from saying you need 5,000? Surely nobody is going to count the 1,000 "phantom" grafts. Surely the patients will be very grateful when the doctors say they transplant 5,231 grafts for the price of 5,000. That might not be a gross overestimate, but that's easily $4,000- $5,000 of the patient's hard-earned money for nothing.

 

You are asking about docs overcharging for grafts not placed? It's a fair question but again, it comes down to trust justifying your choice. I personally think the fear of being charged for "phantom grafts" should be low on your list of priorities. Reputable clinics just aren't going to charge 25% more than what should actually be charged. They don't need to do this because they're making enough money as it is. This is something I could imagine seeing in a clinic with a low or non-existent reputation but not a top clinic.

 

Regardless, if you find a clinic you like and they OK a recording of your procedure then more power to you.

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Thanks again for giving a good answer, JoeTillman. I do think that I'm in the minority for fussing the probably unnecessary stuff :). I guess I don't have the level of trust that you place in those reputable clinics. True, they don't need to overcharge because they are making enough money as it is, but think about it, an extra few grands with almost zero risk of getting caught (for now, that is) is pretty lucrative. I don't know about you, but if I can earn 25% more of what I'm earning right now, I will be happy. Sure, that might sound unethical, but if everyone is doing it, then it's not unethical anymore, it becomes the norm. I would just be a fool for not taking that extra 25%..

 

One good thing about this business is that we can go to different doctors to get different estimates, and if all the estimates are pretty consistent, then there's a lower probability of being overcharged. In a competitive market, I would expect the price to be competitive. The only exception I can think about is that all the clinics agree that they will inflate the estimates by a fixed amount (25% for example). I hope this is an unlikely case.

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I was told fue yield matched fut yield in terms of docs capabilities. I was told very high density but from appearance got less then half that. Where do I stand? Went for a repair procedure and still waiting for concerns to be addressed, no substantial growth at month 5, nor appearance of higher density yet. If I was originally given a high density 3000 graft estimate that did not appear on my scalp yet or doesnt after repair growth period, what's a person do? That is the estimate I paid for, also to factor in travel and hotel costs i paid for, for my repair procedure, which also included financial loss from time off at work.

 

ProspectivePatient, thats interesting point. Ive heard a few folks are turning to international fue where prices are thousands cheaper. The doc makes less per procedure versus those making over $7 per graft. They dont have to worry about docs and their 'gaurantees' when something goes downhill as much (monetarily). Some docs that have gaurantees may try to have patient wait it out and suffer, in hopes of a repair procedure versus refunds, or etc. some guys told me trying to get refunds for poor growth is extremely hard when the prices are so high versus when prices are low. The monetary stakes are high for some docs and some docs upfront may say money is no matter to patients when you ask for a refund, but if it wasnt they should just refund instead of having the patient wait out, only to come back later and say well we can do another procedure. So, some folks I spoke with are turning to locations like Turkey, where some well yielding docs are offering 1 euro per graft, which becomes added financial security to a patient. For like 90% of the population, that are middle class, they do look for affordability. If a clinic charging 1 euro turns out results like clinics charging $7 per graft or higher, i think they would travel to have more security and peace of mind afterwards.

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Hey Sean. I'm sorry to hear that you are having the doubt. It really sucks to be unsure about something like this. However, you have chosen one of the top doctors, so let's hope it turns out alright. But wouldn't you feel much better if you had something to verify that the doctor had done everything in his power and ethics to help you?

 

I'm quite surprised that not many patients have voiced this concern. Probably they have it, but decide to "go with the flow" in fear of offending the doctors. I would be interested in seeing the full recording of procedures become a common practice. As patients we should demand what's fair. Come on, can some top doctors/ top clinics voluntarily provide this option to the patients? After all, you have nothing to hide from the patients, right?

 

I'm not a proponent of having this procedure in another country unless you are a citizen of that country. I think there are too many risks involved.

 

I support the fact that patients should wait close to 1 year before they can get a refund though, as it might take time for the HT to fully mature. Besides, I find your comment that 90% of the population is middle class to be an overestimate. Most people in order to have this kind of surgery done have to save up 1-4 months of his/her salary. Not a small amount..

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Keep this in mind, the techs are people too who have ethics and most believe a great deal in their work as well. If a doc and techs are colluding to short-change or over-charge patients, this will come out sooner or later as there are many techs involved. During my procedure, there were 6-8 techs involved and they all knew my graft count as the day went along, as they needed to tally the ones, twos, and threes. I was talking to the techs placing grafts at the end of the day, and they knew my exact graft count (probably because they got 500+ and they had to be there way late!).

 

Don't forget that a doc is risking his license by allowing any funny business in this regard. Medical boards are not fond of fraud. I wouldn't worry about the issue much in the U.S. but I wouldn't travel overseas and trust their laws would protect me in the same way.

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Thanks for your comment, hadenough2014. I think you have a good point, although I do believe that sooner or later some doctors will be exposed. The idea is when a patient goes for a HT, he shouldn't have to depend much on luck (to get a skilled and ethical doctor). Besides, as you've visited this thread Heartbroken and mental breakdown...that is what all i have to say - Page 10 - Forum By and for Hair Loss Patients, doctors can threaten to have legal action against patients who trash their work. I wonder what kind of legal actions he can impose on his employees. In the financial market, they actually have the whistle-blower rewards. I doubt that they have the same thing for medical market, especially when the evidence is quite subjective and excuses are many (patient doesn't have the right kind of skin, patient doesn't take good care of his grafts after procedure, etc..).

 

In the case that doctors do issue some kind of compensation for a failed procedure, the most a patient can ask for is 100% of the cost, which actually doesn't cover: travel expenses, loss of salary, psychological stress, loss of donor grafts, etc.. I would rather have some measure in place to protect ourselves than to put total trust in the doctors and hope for the best.

 

I hope this discussion becomes more popular and we get more comments, and I hope that patients begin to ask for a total recording of their procedures. We should realize that as customers we also have rights, and we should demand them..

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  • 3 weeks later...

It seems that people have run out of excuses to say about the possibility of doctors giving an overestimate for the amount of grafts. To a certain extent, I guess I should care more about the final result than the cost of a transplant, but I would prefer transparency in this issue. If no doctors or clinics are willing to provide the full recording of procedures, I think it's a pretty safe bet that overestimate is a real problem..

 

If you prospective patients out there are reading this, I would encourage you to either request full recording as a measure of protection. If not, it might be better to buzz your hair and live with it until further development in this medical practice. After all, I've heard that most of those who decide to buzz their hair are pretty happy with themselves, unlike many who undergo hair transplant surgeries. Be aware that one hair transplant procedure is typically not enough to keep you happy for long, so be prepared to shell out 20k and still be unhappy..

 

Good luck to all of you..

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