Let's Discuss Texas Area Doctors

[Leeson]

This is a hair loss forum? I thought I've been in an AA support group all this time. I did notice everyone seem to keep going on and on about their hair.

[Speegs]

I've tried to upload photos and it says mine are to big, how do I downsize the KB to format the forum?

[Bill - Seemiller]

Speegs,

 

To attach photos to this discussion thread, they have to be less than 300K. You can use just about any image editing program to do this. Windows should have one built-in, or you can download your own. Personally, I like Irfanview which used to be free, but they just recently started charging for their product. It's cheap though, and a good purchase for anyone doing a number of photo edits and resizing.

 

Best wishes,

 

Bill

[HairDew]

Speegs,

 

Or you can use Google's Picasa, its FREE

Of course it's not Photoshop but its great if you only need some basic functionality (resize, crop etc)

 

http://picasa.google.com/

[HairDew]

And to stay on topic, I think Dr. Arocha does a very solid work and at this time he's climbing on the ladder. It will take some time for him to be on the same level as other elite docs (meaning get accepted here just as other docs, not his skills) but hey...you know what, we all have to start somewhere.

 

On a side note, roscopeeco, I agree with Dakota3, there other EQUALLY GREAT doctors he mentioned who I would go to with my eyes closed.

[Ron J]

Originally posted by Speegs:

I appreciate your opinion but i am looking for medical facts and opinions and not simply thumbs up enthusiasm from posters...For instance this is the opinion Dr. Limmer emailed to me, and he is a member of this forum and coalition:

 

"While many patients can do fine with 50+ grafts sq. cm you increase the possibility of poor growth, prolong/permanent pinkness (neovascularization) and ridging (scar tissue formation beneath the grafted zone). Also, for many 40 grafts/cm2 is reasonable and decreases the risk of post op shock loss of existing hair.

Finally, with less risk you can always go back and do an additional pass if needed.

Those are not just my opinion, but also plain fact born out of seeing what happens with higher and higher densities of planting Complications might not always occur, but when they do it is a problem. So I try to avoid this happening.

Brad Limmer, MD/jac"

 

So, wait, where are these " facts" (i.e. demonstrable cases of adverse outcomes from megasessions) then out of the thousands of cases we see routinely cranked by the likes of: Rahal, H&W, & Feller?

 

If anything, I would be more inclined to believe the risks of having ADDITIONAL invasive surgery are greater than that of dense packing in a SINGLE session; such as:

-additional scarring to the scalp (recipient area). When the incisions are made the surrounding tissue is also scarred.

-possible permanent shock loss of patients' finite grafts.

-additional trauma to the donor area.

Not to mention exhausting additional unnecessary down time (assume 1 yr for every surgery to reach it's maturation) for the patient -AND- money.

 

 

Since the dr. is touting these as common " facts" associated w/dense packing & megasessions; I'd like to see what cases he's reffering to from the dr.'s who are known for their great work in this area.

[Speegs]

Originally posted by HairDew:

Speegs,

 

Or you can use Google's Picasa, its FREE

Of course it's not Photoshop but its great if you only need some basic functionality (resize, crop etc)

 

http://picasa.google.com/

Where's the resize function on this, i only have cropping ability on the tool bar.

[Bill - Seemiller]

Ron and Speegs,

 

Ironically, Dr. Limmer's message isn't disputing the viablity of megasessions and in fact, isn't referencing them at all. Instead, he's referring to hair growth survival rates in regards to dense packing.

 

Leading surgeons in the field, including those you mentioned recognize that vascularity plays a major deciding role in how much hair should be packed together in a single session. How much a surgeon is willing to dense pack in a single session will also vary from patient to patient.

 

This topic was discussed at last year's annual ISHRS scientfic meeting in Montreal.

 

You can read more on this topc by visiting the Highlights of the 2008 Annual ISHRS Scientific Meeting in Montreal. I've copied that section below for your reference:

 

Dense Packing Complications

 

Large session high density hair transplants are desirable to patients since it typically limits the number of subsequent surgeries needed. And though a handful of leading hair restoration physicians have taken on this challenge when appropriate for the patient, some complications have been cited in a panel discussion led by Dr. William Parsley. Dr. Ron Shapiro and Dr. Michael Beehner shared their experience and expertise on this subject.

 

One debated complication is graft survival at higher densities. Previous studies have been done on graft survival rates that indicate graft survival decreases when density increases. Whereas just about anyone can transplant higher densities, growth yield is debatable.

 

The introduction of smaller blades to make recipient incisions has convinced many leading surgeons that higher densities may produce adequate growth yield, but not in all cases. Dr. Beehner believes that the staff's experience and ability to trim and place grafts safely into recipient sites plays major role in graft survival at higher densities. Dr. Ron Shapiro agrees but also believes that more scientific study is needed.

 

Other complications include increased risk of necrosis, "shock loss" to existing hairs, abnormal distribution of hair in the event the patient loses more hair, and using an abundance of a finite donor source in a concentrated area.

 

Most surgeons will agree that cases exist where extreme dense packing is suitable. But in many patients, lower density hair transplants are appropriate.

 

Best wishes,

 

Bill

[Speegs]

Originally posted by Bill - Associate Publisher:

Ron and Speegs,

 

Ironically, Dr. Limmer's message isn't disputing the viablity of megasessions and in fact, isn't referencing them at all. Instead, he's referring to hair growth survival rates in regards to dense packing.

 

Leading surgeons in the field, including those you mentioned recognize that vascularity plays a major deciding role in how much hair should be packed together in a single session. How much a surgeon is willing to dense pack in a single session will also vary from patient to patient.

 

This topic was discussed at last year's annual ISHRS scientfic meeting in Montreal.

 

You can read more on this topc by visiting the Highlights of the 2008 Annual ISHRS Scientific Meeting in Montreal. I've copied that section below for your reference:

 

Dense Packing Complications

 

Large session high density hair transplants are desirable to patients since it typically limits the number of subsequent surgeries needed. And though a handful of leading hair restoration physicians have taken on this challenge when appropriate for the patient, some complications have been cited in a panel discussion led by Dr. William Parsley. Dr. Ron Shapiro and Dr. Michael Beehner shared their experience and expertise on this subject.

 

One debated complication is graft survival at higher densities. Previous studies have been done on graft survival rates that indicate graft survival decreases when density increases. Whereas just about anyone can transplant higher densities, growth yield is debatable.

 

The introduction of smaller blades to make recipient incisions has convinced many leading surgeons that higher densities may produce adequate growth yield, but not in all cases. Dr. Beehner believes that the staff's experience and ability to trim and place grafts safely into recipient sites plays major role in graft survival at higher densities. Dr. Ron Shapiro agrees but also believes that more scientific study is needed.

 

Other complications include increased risk of necrosis, "shock loss" to existing hairs, abnormal distribution of hair in the event the patient loses more hair, and using an abundance of a finite donor source in a concentrated area.

 

Most surgeons will agree that cases exist where extreme dense packing is suitable. But in many patients, lower density hair transplants are appropriate.

 

Best wishes,

 

Bill

So Dr. McGrath and Dr. Limmer are somewhat vindicated by this study. Both men are recommended by the ISHRS as well.

[Ron J]

The irony is so dense it could cause complications.

 

I routinely see Ultra Refined results from Coalition Members: Rahal, H&W, & Feller that include both mega sessions -AND- dense packing at 50+ grafts cm/2. But, I have yet to see any of the complications arise from these good dr.'s that Dr. Limmer states as clear medical facts. I just wonder if Dr. Limmer has personally experienced these complications; has seen them from any of the dr.'s I mentioned above, or he can't dense pack as they do w/out resulting in such complications?

[Speegs]

Originally posted by Ron J:

The irony is so dense it could cause complications.

 

I routinely see Ultra Refined results from Coalition Members: Rahal, H&W, & Feller that include both mega sessions -AND- dense packing at 50+ grafts cm/2. But, I have yet to see any of the complications arise from these good dr.'s that Dr. Limmer states as clear medical facts. I just wonder if Dr. Limmer has personally experienced these complications; has seen them from any of the dr.'s I mentioned above, or he can't dense pack as they do w/out resulting in such complications?

It would appear the some doctors are simply ultra protective of grafts and donor supply and do not want anything left to chance as dense packing over 50cm2 can cause. It also seems that for many 40cm2 will be dense enough for a satisfying illusion so they don't want to waste further donor hair piling on to little cosmetic effect.

 

i'm still weighing the two camps but i certainly see and appreciate Dr. McGrath and Dr. Limmer's concerns.

 

What it really seems to boil down to on an unspoken level is patience, megasessions provide a little bit of an instant gratification allure and the more conservative density procedures make you wait a little longer to see a result, of course some people can be satisfied by a less than 2000 graft job and some may require another 1000 to 1500 a year later, where its argued that scalp elascticity returns and a competent doctor can return to the donor sight and reopen in without cutting a new scar into the back of your head.

 

It certainly is seductive to dense pack but the question is whether or not less is more in this instance, the jury is still out in my opinion, thus i am still weighing the pros and cons of the dense packing argument before any one touches my head with a scalpel.

[the B spot]

I just want to point out that mega-sessions and density are two different issues.

 

For mega-sessions, the issues are the time grafts are outside the body, handling of grafts, donor tension, and future progression.

 

For density, the issues are graft survival, proximity, scarring/ridging and future loss behind the high density transplant.

 

Additionally, densities are not all the same--50 fu's of 1+2 hair grafts is not the same of 50 fu's of 1+2+3 hair grafts, so do not be so quick to discount 40-45 fu's in a given sq cm--look at the graft and hair count to determine the actual density.

 

You must look at the patient's hair characteristics as well... patients with thick, coarse hair when transplanted at 45--look like 65, other when transplanted at 45 look like 35 all due to hair characteristics.

 

All things considered, Dr, Shapiro does 40-50 on a regular basis, and occasionally will exceed that for a select few patients. However, we have seen that in almost every patient, the need to "selectively tweek" a hairline or temples results in a 2nd HT--almost ALWAYS--based on that, there is no need to push a higher density--we can then use a minimum # of grafts to truly make a result spectacular, without being beholden to specific # of grafts.

(If we do 50 first time, then add 10-15-20 in areas that the patient and Dr. Shapiro feel necessary, the result is great, without doing too much in a given area)--ie--the patient would notice no difference btw 65 or 80--so 65 will meet the patients goals.

 

There are other schools of thought on this, but our results are proven. We want to maximize every graft, use the minimum # of grafts to attain the desired result, while always keeping an eye on future loss.

 

On another note--I want to point out that a particular doctors methods are exactly that his or her methods---no one is forcing anyone here to go to a particular clinic--for those doing research the ultimate test is seeing patients in person--that will erase any doubts as to whether a doctor is for you or not for you.

 

Additionally, while cost is a factor, it is not the only factor--if you narrow your decision to 2-3 doctors, then weigh cost vs travel vs comfortability.

 

Take Care,

Jason

[Speegs]

Originally posted by the B spot:

I just want to point out that mega-sessions and density are two different issues.

 

For mega-sessions, the issues are the time grafts are outside the body, handling of grafts, donor tension, and future progression.

 

For density, the issues are graft survival, proximity, scarring/ridging and future loss behind the high density transplant.

 

Additionally, densities are not all the same--50 fu's of 1+2 hair grafts is not the same of 50 fu's of 1+2+3 hair grafts, so do not be so quick to discount 40-45 fu's in a given sq cm--look at the graft and hair count to determine the actual density.

 

You must look at the patient's hair characteristics as well... patients with thick, coarse hair when transplanted at 45--look like 65, other when transplanted at 45 look like 35 all due to hair characteristics.

 

All things considered, Dr, Shapiro does 40-50 on a regular basis, and occasionally will exceed that for a select few patients. However, we have seen that in almost every patient, the need to "selectively tweek" a hairline or temples results in a 2nd HT--almost ALWAYS--based on that, there is no need to push a higher density--we can then use a minimum # of grafts to truly make a result spectacular, without being beholden to specific # of grafts.

(If we do 50 first time, then add 10-15-20 in areas that the patient and Dr. Shapiro feel necessary, the result is great, without doing too much in a given area)--ie--the patient would notice no difference btw 65 or 80--so 65 will meet the patients goals.

 

There are other schools of thought on this, but our results are proven. We want to maximize every graft, use the minimum # of grafts to attain the desired result, while always keeping an eye on future loss.

 

On another note--I want to point out that a particular doctors methods are exactly that his or her methods---no one is forcing anyone here to go to a particular clinic--for those doing research the ultimate test is seeing patients in person--that will erase any doubts as to whether a doctor is for you or not for you.

 

Additionally, while cost is a factor, it is not the only factor--if you narrow your decision to 2-3 doctors, then weigh cost vs travel vs comfortability.

 

Take Care,

Jason

You are correct to note megasessions and density are separate issues but when dense packing someone with mild to moderate hairloss they do seem to become twin concerns because typically dense packing calls upon a megasession which will require a third if not half of a patient's donor supply which is what 2500 grafts represent on me since I'm estimated to have a donor area that can yield 6000 to 7000.

 

So one must weigh carefully from many different voices what is safe and reasonable to do at one time. That doesn't discredit the value of megasessions and dense packing, but it does caution that they aren't infallible and risk free methods.

[thanatopsis_awry]

Densepacking by way of megasession doesn't even just have a high success rate and proven safety (in fact, those that densepack and do the biggest sessions are among the *most* consistent); this two-pronged attack, above all else, offers a *vast* number of patients the absolute best chance at achieving their goals for the absolte best price at their absolute best convenience.

 

As a personal reference, I was quoted session sizes ranges from 1300 to 2500 from several clinics. I would *not* be nearly as satisfied if I went this "conservative" route, and quite possibly would have been livid and extremely *dis*satisfied, and had to reconcile planning an immediate, subsequent surgery in an even more mentally exhausted state. Unfortunately, this type of hypoethetical situation happpens all too often to people; thankfully, it didn't happen to me, and I can thank megasession densepacking and the doctors I found from Coalition.

 

Every patient is different, and at the same time every option should be available to the patient to best fulfilll his express benefit -- this includes the ability and skill to perform various degrees of megasession work and densepack work, which for many is optimal.

[Speegs]

I've consulted now with 9 doctors.

 

Dr. Arocha 2500

Dr. Puig 1400-1600

Dr. McGrath 1500-1700

Dr. McClellan 1500-1600

Dr. Limmer 1500

Dr. Tykocinski 2500-3000 (via pictures)

Dr. Epstein 1800 (via pictures)

Dr. Keene 1500-1800 (via pictures)

Dr. Rahal 3000 (via pictures)

 

Six of these doctors are on this very forum and a seventh (McGrath) along with those six is certified by every reputable board and consumer group monitoring the industry today.

 

Four of those seven doctors are recommending less than 2000 grafts, the other three are recommending way more aggressive approaches. What's a man to do?

[thanatopsis_awry]

To beat a not-dead horse (), trust your eyes. Look at the results from the docs you're considering, and examine them. Judge them by the clarity of presentation, the angles, the style, etc. If you find a doctor who you trust can deliver you and your situation an equally good result as another (e.g. Epstein, Limmer, McGrath Vs. Rahal), and by using a markedly lower # of grafts, then by all means go to them.

 

~1500 grafts and 2500-3k is a world of difference to a relatively small, hairline-focused case. Just know that the basic issue here is *not* safety or the yield -- it's whether or not you will be satisfied with the hairline and the density from the procedure.

 

EDIT -- I'd def consult w/ SMG, H+W, and Feller if you have the time and any inclination!

[Dewayne]

Originally posted by Speegs:

I've consulted now with 9 doctors.

 

Dr. Arocha 2500

Dr. Puig 1400-1600

Dr. McGrath 1500-1700

Dr. McClellan 1500-1600

Dr. Limmer 1500

Dr. Tykocinski 2500-3000 (via pictures)

Dr. Epstein 1800 (via pictures)

Dr. Keene 1500-1800 (via pictures)

Dr. Rahal 3000 (via pictures)

 

Six of these doctors are on this very forum and a seventh (McGrath) along with those six is certified by every reputable board and consumer group monitoring the industry today.

 

Four of those seven doctors are recommending less than 2000 grafts, the other three are recommending way more aggressive approaches. What's a man to do?

 

The three best on that list all said >2500. Trust me, you'll wish you went with the larger number.

[Severn]

I met yesterday with Dr. Arocha and Dr. Alfonso Barrera. I'm just doing work in the crown area and Dr. Arocha recommended 3500 @ $4-5 per FU while Barrera recommended 1500 @ $8 per graft. The cost of both end up being about the same but I have a feeling with 1500 I might need a second session which would double the total price.

[TC17]

$8 per graft is obscene, period.

[Severn]

Yea, 8 bucks per graft does seem pretty high. He's mainly a cosmetic surgeon and was in a high end medical area of Houston. I assume the extra cost takes into account his rent and him using nurses instead of assistants. I'm not saying that's bad, but I can see where it would significantly add to the amount.

[Bill - Seemiller]

I do agree that the price of $8 is very high. It seems like recently there has been a trend of doctors charging more than I previously remember.

 

Frankly, especially in a tough economy, I wish all doctors would keep their prices reasonable to the average $4 to $5 per graft.

 

Though price shouldn't be the first consideration in selecting a doctor, I admit that if I was choosing between two excellent doctors and one was significantly less expensive, I'd go to the least expensive.

 

Best wishes,

 

Bill

[wylie]

One of those doctors you mentioned once butchered a young man in his early 20's in Cleveland back in the early 80's, I would guess he has been in the business long enough to have evolved into, perhaps, a first rate surgeon, but should his past work be taken into consideration, or just whether or not he is presently doing first rate work?

 

I wouldn't recommend anyone go near him based on what he once did, but perhaps he wishes to atone for his past, I dont know, I only know that someone has their life seriuosly messed up and took the time to document every step of it on his website.

 

You can consult about price and worry about location but if you choose a doctor based on either you are making a mistake. It can be part of the overall consideration but should be minor in the end, and Coalition doctors really should be at the top of your list, as this keep you from getting any unpleasant surprises that are difficult and expensive to repair, if they are not Coalition doctors your risk factor probably doubles. Good luck

[Speegs]

Originally posted by Bill - Associate Publisher:

I do agree that the price of $8 is very high. It seems like recently there has been a trend of doctors charging more than I previously remember.

 

Frankly, especially in a tough economy, I wish all doctors would keep their prices reasonable to the average $4 to $5 per graft.

 

Though price shouldn't be the first consideration in selecting a doctor, I admit that if I was choosing between two excellent doctors and one was significantly less expensive, I'd go to the least expensive.

 

Best wishes,

 

Bill

If they want to be competitive they either need to keep it at a flat rate of four bucks a graft or offer discounts for procedures over 2000 grafts.

 

Its my opinion that a surgery that is at least 2,500 shouldn't exceed the price tag of 10K and even then I wish it were more affordable.

[TC17]

What kills me is that the European doctors charge FAR less than their US counterparts. For example, Dr. Feriduni charges 8,450 Euros for 4000 grafts, and 3.95 Euros per graft for FUE. Dr. Devroye is also very close in price to Dr. Feriduni. The only thing that I can think of for the dramatic differences in price is that maybe the European doctors pay their assistants and techs far less than here in the US, or possibly lower insurance rates.

[Speegs]

Originally posted by TC17:

What kills me is that the European doctors charge FAR less than their US counterparts. For example, Dr. Feriduni charges 8,450 Euros for 4000 grafts, and 3.95 Euros per graft for FUE. Dr. Devroye is also very close in price to Dr. Feriduni. The only thing that I can think of for the dramatic differences in price is that maybe the European doctors pay their assistants and techs far less than here in the US, or possibly lower insurance rates.

With the exchange rate that really isn't any different depending on the dollar.

 

Edit: Oh wait, sorry only looked at price and not grafts.