Is this unhappy patient being reasonable? Robert Haber, MD

[Dr. Robert Haber]

62 year old man 9 months after small HT due to limited finances to enhance frontal density. Fewer than 1200 grafts used in the frontal region, and at his return visit recently, he was very angry about the "complete failure" of the surgery. The photos demonstrate increased density consistent with the size of the session, but the patient refused to believe me, or that further growth and improvement was likely. I'm hopeful he will return in a few months with a better outlook!

[voxman]

I think his next trip should be to the eye doctor. Looks like a reasonable use of the 1200 grafts to me.

[Questionmark]

I don`t know what he did expect, but for 1200 grafts on the area this is exactly what a good transplant should look like. I also appreciate the exact same conditions in before and after pictures.

[LondonHT]

The pictures all look the same to me! So i cant tell.

[BUSA]

he got exactly wat 1200 grafts will give u. either way 1200 grafts aint gonna do much so wat does he expect? some ppl just have unrealistic expectations.

 

they watch a Bosley commercial and assume 1200 grafts will give them a full head of hair. smh.....

[TomCruise]

62 year old man 9 months after small HT due to limited finances to enhance frontal density. Fewer than 1200 grafts used in the frontal region, and at his return visit recently, he was very angry about the "complete failure" of the surgery. The photos demonstrate increased density consistent with the size of the session, but the patient refused to believe me, or that further growth and improvement was likely. I'm hopeful he will return in a few months with a better outlook!

 

I can hardly tell the difference between the before and afters. Part of being a responsible doctor is appropriately counseling a patient as to what to expect and whether a procedure will make an appreciable difference, even if he is constrained by so-called financial limitations.

[hairthere]

There is certainly a change, albeit a very subtle one. I agree with Tom Cruise that it's important for surgeons to manage a patient's expectations to avoid such post-op issues. This is certainly refined work though and it appears quite natural.

 

Dr. Haber, If the client is still unhappy at 12 months how will you handle it?

[Ali Emre Karadeniz]

There is no doubt about Dr. Haber's experience and skill in hair surgery.

This is obviously a very natural result and I congratulate him for it.

 

The problem encountered is a typical situation where a treatment plan is formulated according to the patients budget. Even if a patient initially accepts a modest result with a modest graft number such as 1200 grafts, he is always going to feel frustrated and even angry that the doctor offered him a suboptimal plan that was designed to the patients budget; put it the other way, designed to take an amount of money that the patient is prepared to pay.

 

I refrain from this approach, as the danger of the patient feeling robbed, instead of being treated is too great, even if the result is the best that could have been achieved.

 

On the other hand, the patient made a mistake of deciding on a treatment that is tailored to his budget; he should have looked for a clinic that is prepared to do the optimal treatment for the budget he has, or else he should wait until he has the necessary funds to have the best treatment offered by his doctor.

[BUSA]

I can hardly tell the difference between the before and afters. Part of being a responsible doctor is appropriately counseling a patient as to what to expect and whether a procedure will make an appreciable difference, even if he is constrained by so-called financial limitations.

and wat part of his post indicated that he didn't advise him wat to expect? ur making Assumptions based on nothing.

 

or are ur assuming he told the patient 1200 grafts was going to magically restore all his lost hair? maybe u shud ask questions before u insinuate that the doctor somehow didn't explain wat 1200 grafts wud or wudnt do....

Edited February 1, 2015 by BUSA

[BUSA]

do u have behind the scenes information that no one else has as far as the patient being on a budget or that he offered him a suboptimal plan? cause 1200 grafts is surely plenty of grafts for some ppl's expectations of adding a little density to the front.

 

some patients expectations are simply different from the doctors or anyone's for that matter.

 

it may not have been about money. somthn tells me a guy in his 60's can probably afford more then 1200 grafts and money may have not been the underlying problem.

 

expectations cud hav been the issue vs. money and thats the patients problem not the doctor as long as he explained to him wat 1200 grafts wud likely accomplish which imo he probably did.

 

a doctor can explain to the patient till he's blue in the face but some ppl just assume 1200 grafts must be a lot and therefore they don't require any more grafts and therefore no need to spend any extra money.

 

There is no doubt about Dr. Haber's experience and skill in hair surgery.

This is obviously a very natural result and I congratulate him for it.

 

The problem encountered is a typical situation where a treatment plan is formulated according to the patients budget. Even if a patient initially accepts a modest result with a modest graft number such as 1200 grafts, he is always going to feel frustrated and even angry that the doctor offered him a suboptimal plan that was designed to the patients budget; put it the other way, designed to take an amount of money that the patient is prepared to pay.

 

I refrain from this approach, as the danger of the patient feeling robbed, instead of being treated is too great, even if the result is the best that could have been achieved.

 

On the other hand, the patient made a mistake of deciding on a treatment that is tailored to his budget; he should have looked for a clinic that is prepared to do the optimal treatment for the budget he has, or else he should wait until he has the necessary funds to have the best treatment offered by his doctor.

[Ali Emre Karadeniz]

do u have behind the scenes information that no one else has as far as the patient being on a budget or that he offered him a suboptimal plan? cause 1200 is surely plenty of grafts for some ppl's expectations of adding a little density to the front.

 

some patients expectations are simply different from the doctors or anyone's for that matter.

 

it may not have been about money. somthn tells me a guy in his 60's can probably afford more then 1200 grafts and money may have not been the underlying problem.

 

expectations cud hav been the issue vs. money and thats the patients problem not the doctor as long as he explained to him wat 1200 grafts wud likely accomplish which imo he probably did.

 

a doctor can explain to the patient till he's blue in the face but some ppl just assume 1200 grafts must be a lot and therefore they don't require any more grafts and therefore no need to spend any extra money.

 

 

Dr. Haber mentioned in his post that the patient had limited finances, so that means he would have offered a higher number of grafts if the patient was prepared to pay for it.

 

There is no doubt that Dr. Haber must have explained in detail the patient what he should expect, as he is a very senior and respected hair surgeon and a member of ISHRS, that I adore.

 

What I am trying to say is that it may not be sufficient to lets say build a safe relationship between the patient and the doctor by just explaining what to expect, as the patient will always have in his mind that the doctor didn't do the ideal treatment he had in mind, but tailored it to the patients budget.

 

I would like to add that there may be some cultural differences between countries. A patient in the USA may tolerate better and/or may be expected to tolerate a treatment plan designed according to his budget, however a patient in Turkey would never accept this. He would feel insulted and not only that he would refuse the treatment, but he would also speak against the doctor when talking to other people. He would not see it as a natural result of his limited budget. I wish it were the other way round

[Dr. Robert Haber]

Thanks for all the comments. I conduct all consultations myself, and never proceed with surgery unless I am comfortable that the patient will be happy with the results I can provide. When a patient can't afford a large enough session to give benefit, I suggest putting money aside until the funds are sufficient to undergo a larger procedure. In this case, as the patient was an older gentleman and voiced very reasonable expectations during the consult, I thought 1200 grafts would make him happy. At 9 months, the growth is incomplete, and I remain confident that several months from now he will be happier. What if he's still unhappy in a few months? As its in my best interest to have happy patients, under such circumstance I will generally offer an appropriate number of complimentary grafts during a subsequent session.

[hairthere]

Patients really need to understand that they cannot judge their HT results until it has fully matured and that it takes at least 12 months.

[Torn]

Hard to tell any difference. Which are the before photos and which are after ?

[Questionmark]

Hard to tell any difference. Which are the before photos and which are after ?

 

It`s actually the usual pattern: Pic 1 Before, Pic 2 After, Pic 3 Before, Pic 4 After and so on... I also had problems at first sight, but again: Look carefully at the pictures; you will notice a difference (and it`s not only that the patient has a tan on the after pictures )

When distributing such a low amount of grafts over such a large area, this is what to expect exactly.

[wazaam]

This is a very subtle change if any.

 

This is a small amount of grafts over a large area. I can see how both parties could be a little frustrated over this result.

 

Very minimal if any cosmetic difference but this could be expected by the minimal amount of grafts over such a large area.

 

It appears there may have be a disconnect somewhere along the long between surgeon/patient.

[Torn]

It`s actually the usual pattern: Pic 1 Before, Pic 2 After, Pic 3 Before, Pic 4 After and so on... I also had problems at first sight, but again: Look carefully at the pictures; you will notice a difference (and it`s not only that the patient has a tan on the after pictures )

When distributing such a low amount of grafts over such a large area, this is what to expect exactly.

 

 

 

Thanks for clearing that up Q. The change is definitely very subtle though.

[BUSA]

 

What if he's still unhappy in a few months? As its in my best interest to have happy patients, under such circumstance I will generally offer an appropriate number of complimentary grafts during a subsequent session.

how many complimentary grafts wud u be comfortable giving him under these circumstances?

[Dr. Robert Haber]

That would depend on my assessment of his growth. If his growth was excellent but he was still not satisfied, I'd probably offer 100-200 complimentary grafts. Again, not because anything went wrong, but because its better to have a happy patient.

 

I shared this case because its too easy to always show great results and happy patients. I wanted to share a case of an unhappy patient as a learning experience for all of us.

[BUSA]

ok thanx. and ur post is appreciated. SOME doctors will present both good and not so good work. thats what imo makes him or her more credible.

 

its like askn a carpenter to show me his not so good work and what he did to make it right. thats the guy I wud be more comfortable going to.

 

even the VERY best HT surgeons around the world have unhappy patients and ppl get their panties in a knot wen a reputable HT surgeon has a few cases where the patient didn't meet the usual expatiation and then ppl want to hang that HT surgeon by his balls as a result...:rolleyes:

 

there are so many variables to a HT not coming out successful and in the hands of a qualified and PROVEN surgeon I don't blame the HT surgeon at all. this isn't rocket science and we all know it. sure, there is obviously some skill, training and experience that is involved but wen a HT surgeon completes a HT its essentially the same as the last one that was successful.

 

there just isnt a lot of variables in the HT surgeons technique that wud result in numerous ppl having great results then a couple having poor results. the seldom poor results imo has nothing to do with a reputable HT surgeons skill on that particular day.

 

That would depend on my assessment of his growth. If his growth was excellent but he was still not satisfied, I'd probably offer 100-200 complimentary grafts. Again, not because anything went wrong, but because its better to have a happy patient.

 

I shared this case because its too easy to always show great results and happy patients. I wanted to share a case of an unhappy patient as a learning experience for all of us.

[JoeTillman]

A few observations/questions:

 

1. How did the patient express that this is a complete failure? Is he saying that nothing grew, the result did not grow enough or is he unhappy with the design and/or degree of lowering? The answer or answers can make all the difference on the legitimacy of his complaint.

 

2. I see residual redness still in the recipient area which tells me indeed that there is more growth to come.

 

3. The current situation is, in my opinion, a success based on the number of grafts, patient age and that he had "reasonable expectations" during the consultation. His hair also appears to be fine which further validates the result. His face is framed better and the inconsistency of density and overall hairline shape has been remedied.

 

4. The documentation is refreshingly consistent with not only lighting and angles but the damp nature of the hair as well. Damp and combed in the befores, damp and combed in the afters.

 

5. I commend you, Dr. Haber, for posting this case with the full disclosure that the patient is calling this a failure. In fact, I LOVE this about your post because this helps to show that not every success necessary need be super high density or massive coverage.

[Sparky]

1200 should make a lot of difference and tbh I had trouble telling what was before and what was after, I don't think 200 grafts will help this person to be happy, people aren't after subtle improvements, do you have any placement pictures?

[Dr. Robert Haber]

1200 grafts placed into an area of about 100cm2 would give only 12 grafts per cm2. Hardly enough to make a lot of difference, but enough to satisfy someone with modest expectations. I wouldn't place only 200 grafts. I would add 200 complimentary grafts to a second session, if he chose to have another procedure. I agree that the results are subtle at the present time, but I generally see additional density appear between 9 and 15 months.

[wazaam]

So if this patient isn't satisfied and decides not to pursue an additional procedure then how will you reconcile what the patient perceives to be a poor result?

 

2/3/15

"That would depend on my assessment of his growth. If his growth was excellent but he was still not satisfied, I'd probably offer 100-200 complimentary grafts. Again, not because anything went wrong, but because its better to have a happy patient."

 

2/5/15

"I wouldn't place only 200 grafts. I would add 200 complimentary grafts to a second session, if he chose to have another procedure."

 

It may be a little misleading stating that the option of 200 grafts is now only available if he elects to have an additional procedure? I don't think that 200 grafts for this gentleman will do much based on the images that were attached.

 

I commend you Dr Haber on being transparent and presenting these results. My personal opinion is that this is a poor result but as you mentioned it still has some time to thicken up so that could possibly change in time.

 

Look forward to updates.

[2youngforthis]

i agree all the pics look the same to me too. can you list which ones are before and after?