What are average results?

[Atomic]

This is a continuation of a thread from "Taking the plunge" the failure conmtinues.

 

We were discussing average results. What I believe are average results are different than what others believe.

Maybe we can define just what Poor, Average, Good & excellent results are.

 

What if Doctors posted ALl of thier results one after another without selecting which one's they post? Just recently Dr. Rose's office accidentally posted some Poor results as I'm sure everone will agree.

For the most part, most all poor or average results are posted by patients not clinics.

Unless by accident. And since all people don't post thier results on this forum, we really half to rely on what the clinics are posting.

 

Are we really able to judge what an average result is if we are recieving cheery picked results from clinics?

 

I need to leave it here for now but look foward to hearing other comments on this subject.

[Bill - Seemiller]

Atomic,

 

Thanks for creating a new thread to discuss this. I'm going to paste what I wrote in the other thread below since it's related to this topic:

 

A note about determining poor, average, and excellent results in general, unrelated to the above:

 

Unit of measurement for gauging a result is everything. For instance, if you evenly distribute 3000 grafts over a level 5A on the Norwood scale, most would argue that even with maximum growth that the result is below average. That's because our standard unit of measurement is our expectations of what we'd like to see achieved. In most cases, this unit of measurement is unrealistic since all of us would like to achieve a full head of hair. But as we know, this isn't realistic to expect with hair transplant surgery.

 

However, if the unit of measurement changes to what can realistically be expected for that degree of baldness with only 3000 grafts, the result changes to excellent (assuming hair growth yield is optimal and it looks natural).

 

If we're talking strictly about growth yield and naturalness, then we'd gauge a result simply based on measuring the percentage of growth and eyeballing a result based on our expectations. But if you take into consideration the number of grafts/hairs, area of baldness to be covered, position and placement of the grafts, hair characteristics, scalp/hair color ratio, and density, then there's a lot more to evaluate.

 

Best wishes,

 

Bill

 

P.S. P.S. What you're saying about Dr. Rose's "results" is irrelevant, because the "after" photo they provided was only a progress picture a few months out from surgery. Dr. Rose didn't know how many months off hand, but it wasn't a mature result picture.

[Maxxy]

An average result will be impossible to define on a broad scale as every patient is different in terms of loss, goal, hair characteristics, amount of grafts and whole host of other factors.

 

The only way to gauge an average result on a broad scale would be by graft surival, most top clinics will hope to achive at least a 90% survival rate, so in my opinion this would be an average/good result.

[thanatopsis_awry]

What would be seperating an "average" (or sub-average) result from a "good" (or great) one?

 

If it is yield, which I think makes good sense, what is causing this gross variability in growth?

 

Esteemed clinics within the Coalition have extremely strong protocol, and I can't imagine that misteps in their day2day operation could account for anything approximating the type of widescale "average" results you hint at, as to be defined as cases approximating (TTP, *assuming* for the sake of example, his 10month pics to be defined as a HT with an "average" result).

 

Then is it physiology that is chiefly to account for the variability of yield?

 

I don't believe that the disparity between Dr. vs. Patient results is that vast. Sure, a Dr. will rarely if ever post a case of BAD yield; and a patient will. But it is the *rarity* when we see a patient result differ that vastly from that which his Dr. would normally post on his own.

[Ventuoguy]

Thanatopsis- ABSOLUTELY missteps in day 2 day operation can spoil a result. How much difference in the simple act of taking a graft out of a petrie dish and installing it in a recipient site does it take to destroy the follicle. There would be not that much difference in the handling-certainly nothing perceptible to an untrained observer. Is the tech taking the graft by the teensy weensy bit of tissue surrounding it or is she(or he, theoretically) grabbing the follicle itself and applying too much pressure on the forceps, etc. My theory is that a combination of poorly created recipient sites (too small/big and too short/long) along with graft dessication/storing at room temperature, long delays between harvest and implantation and improper handling are all factors. TTP's result is less than average, but not horrible. Goodness-there have been displays of MUCH worse results than his on this site and others! Let's face it-there are going to be factors that are ethereal and hard to define that contribute to failure. I also happen to think that some failures occur because of blood flow compromise in the recipient zone. Trauma to microvasculature that nourishes the scalp from dull blades/needles that tear the flesh instead of neatly cleaving it probably are a factor as well in my opinion. A good surgeon meticulously preserves blood flow to the area he is operating on. Good blood flow brings oxygen and other nutrients, antibiotics that fight infection, white blood cells that fight infection and proteins and clotting factors that start the inflammatory/healing process. There was a failure on here a few months back in which the surgeon transplanted all around a central forelock tuft of hair remaining natively. The grafts grew but the native hair fell out leaving scalp that in my opinion looked like it was compromised by the trauma and disrupted blood flow from the grafts completely surrounding it. I happen to feel that result was direct result of less than optimal planning by the surgeon.

[ScottishGuy]

When we talk about an average result, I assume we mean a typical result - the sort of result that most patients should expect to achieve.

 

I feel that it is up to the doctor to ensure that the patient's expectations are realistic. One way to do this is to show the patient result photos from other patients with similar hair characteristics, procedure size etc.

 

If a doc chooses to show superstar results rather than typical results at this stage, that would seem somewhat unethical, since the doc is contributing directly to unrealistic expectations - there is a high likelihood of the patient being disappointed in the end result.

 

I've often thought that the only way a prospective HT patient can truly judge a clinic (and determine what is 'average') is if they can see all the results for patients in a given month or year etc. Without that we have only the cherry picked pictures from the clinic, or a small number of patient blogs (many of which aren't updated).

 

In terms of assessing an HT, the result is highly subjective. However, yield is the one thing that can be measured (particularly when transplanting into bald areas).

 

If I was in the situation of having a result that lacks density, I'd want to know the yield of my result. If it is high, then I know the clinic did a good job in preserving the grafts, and I can feel re-assured about having a second procedure with them. If the yield is low, then I'd have serious questions about the competence of the clinic.

 

I'd highly commend any clinic that records and publishes yield figures. However, I doubt they'd ever do this because it could destroy the myth? of 90% average growth.

[kaounis]

I would say that an average result is one that needs a certain amount of styling or products, (volumisers, wax, mouses, etc.), to look fuller and sometimes even just to look natural, whereas a "great" result, looks fantastic and undetectable under any circumstance. IMHO.

 

Just a thought from the peanut gallery...

[thanatopsis_awry]

That's basically just an issue of density, however, or the quality of our donors; the latter is invariable and is what it is, and the former is what is to the extent that even perfect yield and flawless implanting leaves it totally variable and you could still have the very same density issues.

[John Malloy]

Would'nt any HT that does not look completely natural be a failure? I don't think any doc ever said to his prospective patient that this may or may not look natural. I think they usually say there are no guarentees of growth, but it will never look unnatural( which I feel is a complete lie). Anyway, why would anyone get a transplant expecting an artifical look?

[thanatopsis_awry]

Ya, I mean, there's a fine, subjective line between what we mean by "unnatural", and that which is simply different in some degree from our "naturally had" hair, pre-MPB.

 

The latter scenario is somewhat common, IMO, but is this really something that others would deem "unnatural", and not something that isn't quite often "naturally" remedied simply in the way we would choose to style and wear our hair anyways.

[John Malloy]

Thana,

I mean when someone looks at your hairline, and it's obvious that something is going on. That in my eyes is a complete failure? Do you agree?

[thanatopsis_awry]

Ya, I'd agree with that. A hairline should always be pleasing to the eye and not draw that type of negative attention ever.

[kaounis]

I personally can tell a transplanted hairline no matter how well the work is. That doesn't meen that everyone pays as much attention to such things as "we" do. A well done HT, is undetectable to about 95% of people. The other 5% are just harder to fool.

 

Just a thought from the peanut gallery...

[the B spot]

The "average" result should meet the patients expectations.

 

That would be natural, undetectable, and proper density, with a patient who understands what result can be achieved, and how successive procedures (if needed) will be required.

 

A poor result does not meet realistic or doctor provided patient expectations.

 

As John Malloy points out....a hairline can be thick, low, etc...but if it fails to look natural, it is a failure...regardless of whether every graft grew.

 

However, I want to point out that if a patient is happy with his or her results, then that is marker of a positive result.

 

There is no "one size fits all" marker for a successful HT other than naturalness and patient happiness.

 

Take Care,

Jason

[Bob C]

I don't have any new insight to add at this time. But I have to say that against my initial expectations (when reading the title of this thread) this is a VERY involved and thought provoking discussion.

[Julius]

I agree with ScottishGuy in that any ethical doctor should make sure a patient's expectations are realistic and show photos of average results. And that their clinics should also publish what their average yield is.

To try and answer your question by defining just what Poor, Average, Good & excellent results, let's take two patients (preferably identical twins suffering from mpb) with average donor density, hair thickness, similar hair/skin contrast and the same number of grafts to cover the same area. Considering both had the same surgeon the outcome of their results could possibly be classified according to such a system of classification.

Poor: pluggy looking, unnaturally low or irregularly shaped hairline, totally visible scalp, pitting, scarring in recipient area, wide and visible donor scar.

Average: small donor scar which is not visible at all once hair grown out, natural looking mature hairline, see-through though natural.

Good: minimal donor scar which is not visible at all once hair grown out, natural looking mature hairline, see-through in harsh light which may be mistaken for slight thinning as it is so natural.

Excellent: virtually indictable donor scar only visible once shaven right down, natural looking mature hairline, only slightly see-through when wet and in the harshest light like fluorescent where it may be mistaken for naturally thin hair as it is so natural. (Only top surgeons have this ability)