Forum member's opinion (pic attachment)

[Severn]

I had partial information on another thread but I wanted to add a pic to get some forum members opinions based off their past experiences.

 

I'm 49 and only want work done in the top and crown. I had 3 scalp reductions done in 1996 with only 400 mini grafts added. My scalp laxity seems ok and was confirmed by Dr. Arocha and Barerra. Dr. Arocha said my hair "makes me a HT surgeons dream."

 

I have temple loss but am not interested in any hairline work. My hairloss has been neglible for the last 14 years so I can consider myself stabilized for the most part.

 

The reason I'm more interested in the top and back is because of the scalp reductions. I don't have a normal "horseshoe" pattern crown. I have a widened scar running down the center of my head that branches off in the back in the shape of an upsidedown "V".

 

The consultations I've gotten so far are as follows:

 

Dr. Arocha - 3500

Dr. Barerra - 1500(*cost = $12,000 @ $8 per graft!)

Dr. Limmer - 1500 (via pics)

Dr. Shapiro - 2500-3000 (via pics by consultant)

Dr. Wong - 2500-3000 (via pics)

Dr. Cooley- 1500-2000 (pics)

Dr. Rahal - 2500(pics)(*cost=$8421 w/discounts)

 

Money isn't the *most* important factor of course but Rahal definitely came in as the cheapest after discounts. On the other end of the scale is Dr. Arocha suggesting 3500 but telling he would basically "give me a full head of hair."

 

I'm still waiting on Dr. Feller but I have the impression he's pretty busy and backed up. All these guys are the top of their field and I have a feeling it would take a magnifying glass to tell the difference in each other's work.

 

What do you guys think based off the attachments?

 

Top Down View

 

Back View

 

Side View

[Severn]

I had partial information on another thread but I wanted to add a pic to get some forum members opinions based off their past experiences.

 

I'm 49 and only want work done in the top and crown. I had 3 scalp reductions done in 1996 with only 400 mini grafts added. My scalp laxity seems ok and was confirmed by Dr. Arocha and Barerra. Dr. Arocha said my hair "makes me a HT surgeons dream."

 

I have temple loss but am not interested in any hairline work. My hairloss has been neglible for the last 14 years so I can consider myself stabilized for the most part.

 

The reason I'm more interested in the top and back is because of the scalp reductions. I don't have a normal "horseshoe" pattern crown. I have a widened scar running down the center of my head that branches off in the back in the shape of an upsidedown "V".

 

The consultations I've gotten so far are as follows:

 

Dr. Arocha - 3500

Dr. Barerra - 1500(*cost = $12,000 @ $8 per graft!)

Dr. Limmer - 1500 (via pics)

Dr. Shapiro - 2500-3000 (via pics by consultant)

Dr. Wong - 2500-3000 (via pics)

Dr. Cooley- 1500-2000 (pics)

Dr. Rahal - 2500(pics)(*cost=$8421 w/discounts)

 

Money isn't the *most* important factor of course but Rahal definitely came in as the cheapest after discounts. On the other end of the scale is Dr. Arocha suggesting 3500 but telling he would basically "give me a full head of hair."

 

I'm still waiting on Dr. Feller but I have the impression he's pretty busy and backed up. All these guys are the top of their field and I have a feeling it would take a magnifying glass to tell the difference in each other's work.

 

What do you guys think based off the attachments?

 

Top Down View

 

Back View

 

Side View

[thanatopsis_awry]

2500-3000, and it's not even close, IMO. Dr. Arocha's 3500 certainly wouldn't hurt, though lol...

 

You're in a tremendous spot to get a near-total restoration in one pass here; take advantage of this!

[Severn]

Thanks thanatopis. Much appreciated.

 

One of them I talked to seemed to suggest 3500 was overkill and I would gain no cosmetic benefits from it. But he wasn't attacking Dr. Arocha's analysis. He was just stating his opinion. However, I am still undecided.

 

I guess there is merit to save donor grafts *just in case* I need a little hairline work in the future. But if my hairline stays relatively stable, I'm fine with it.

 

I've seen a few older guys(50+) who have zero hair loss with the hairline of a 15 year old. It looks downright wierd, lol.

[Severn]

Question:

 

I've read about the face swelling after the procedure. I assume since the work would be done to the top and back, the face won't swell? Even so, I wonder how much the head will swell. I want to at least be able to get a cap on.

[Leeson]

You know, for 3 scalp reductions, you don't look that bad at all. As for Barrera, I'm kinda shocked he's charging that high, placing himself above the HWs, Fellers, Rahals, Shapiros. Pretty arrogant. Unless he's trying FUE, but I've never heard of him attempting this delicate art.

I would think, for decent density, you should stick with the upper suggestions. 2500-3000 sounds right.

[thanatopsis_awry]

Re: 3500....I see where the "overkill" remark is coming from...BUT, I totally disagree that there would be "no cosmetic benefits from it". Make no mistake about it, even 3k will likely *not* be giving you *true density* on par with your pre-MPB self. IMO, it will strike a great balance between the "illusion of density" and true density and leave you very satisfied. What would an extra 500 or 1000 do? It will assuredly give you greater true density. What does this practically mean? You will be able to pull off a denser look in a wider array of circumstances, regardless of "style" or how "wet" or "dry" your hair is. What that is worth, over the backdrop of stockpiling another ~500 grafts is your call.

 

Your age, pattern, and pretty excellent stabilization of hairloss sets you up nicely to really blast the area; so, while I think ~3k is a great #, I can understand 3500, too, in that any future loss will still be able to me targeted with an ample number of grafts.

 

As for swelling....I'm not positive on how facial swelling is effected by non-hairline work, but either way, I'd be shocked if you weren't able to at least be able to put a cap on.

[Severn]

Originally posted by Leeson:

You know, for 3 scalp reductions, you don't look that bad at all. As for Barrera, I'm kinda shocked he's charging that high, placing himself above the HWs, Fellers, Rahals, Shapiros. Pretty arrogant. Unless he's trying FUE, but I've never heard of him attempting this delicate art.

I would think, for decent density, you should stick with the upper suggestions. 2500-3000 sounds right.

 

Thanks Leeson. However, I admit the flash is actually making it look a little better than it is. Without the flash, the area is very uneven and the scar is quite visible.

 

As far as Dr Barerra's pricing, that $12,000 is AFTER the discount. They are running a special right now where they won't charge you the $2,000 fee for "operation room prep". The normal price for 1500 grafts is $14,000 according to the good doctor.

 

And that is an EXCELLENT explanation thanotopsis of what is considered adequate. I'm a little easier to please than others here. I just want adequate coverage. I don't need it to be thick enough to where you can't see the scalp even if wet. I see some guys on the forums talking about their disaster of a transplant and then they provide pics. I look at it and think: "Geez, I would have no problem with that at all." I guess that's because at 49 years old, I'm not a chick magnet anymore. My main goal is not looking like a freak lol.

Thanks again for the help. The consultants I've talked to have all provided great info, but it *is* their job to sell their clinic. I'm not implying that they would give false information, but you guys here on the forum really help balance out the decision making process.

[El Nino]

Originally posted by Severn:

Question:

 

I've read about the face swelling after the procedure. I assume since the work would be done to the top and back, the face won't swell? Even so, I wonder how much the head will swell. I want to at least be able to get a cap on.

 

Hi Severn,

 

I had a crown only transplant and my face never swelled at all. The area between my donor and recipient area did a bit, but only for a couple of days. And I had no problem wearing a cap.

[Severn]

El Nino:

 

Thanks! Thats just the info I was after. I've also seen pics of those huge staples running around the back and side of the head. I assume you could adequately still cover that up with longer hair or a low fitting cap? I'd prefer not to look like Frankenstein for 2 weeks if I can avoid it lol.

 

I also won't be buzzing my hair pre op like a lot of guys do. I can pretty much just wear a cap everywhere including work for months on out until my growth comes back.

[El Nino]

I had sutures and they were easily hidden with my hair.

 

Some of the Doctors insist on shaving the recipient area, Dr. Rahal is one of them. If you can wear a cap at work, then it shouldn't be a problem.

[Severn]

Originally posted by El Nino:

I had sutures and they were easily hidden with my hair.

 

Some of the Doctors insist on shaving the recipient area, Dr. Rahal is one of them. If you can wear a cap at work, then it shouldn't be a problem.

 

I really prefer not shaving, but some of the better docs claim it prevents the danger of transection. However, SMG said I could probably get away without shaving. H&W prefers it but said if I put my foot down, they would do it without shaving. Dr. Arocha said he "likes a challenge" and said he has no problem not shaving.

 

So the whole shaving vs. not shaving is a debate I'm not sure what to make of. It could be that the main reason is it makes the procedure go quicker. Or it could really be a danger of transection. I don't know tbh.

 

However, looking at your blog is a good approximation of my situation. with your 2800 grafts, that would be in the range of what I'm looking for and your results were outstanding. After seeing your pics, I might have to give more consideration to Rahal since his prices are a good bit lower than the others. However, I think the others are willing to price match now.

 

If I got results anywhere near what you have, I would be ecstatic. Your results are astoundingly good.

[TC17]

You have got to be kidding me. Barrera's regular price is $14,000 for 1,500 grafts? I would literally piss myself if a doctor quoted me that much for a hair transplant.

 

My advice for you is going to be different from the other people who have so far chimed in. I don't think you necessarily need to pick one of the doctors who quoted you the most grafts because I'm not sure that the result will be better with a higher number. Rather, I think you should go with the doctor that you feel gives the best results, regardless of their graft estimate. It appears as though you've been doing a great deal of research, so pick the doctor that you are most comfortable with, and trust that he/she will be able to deliver the results you desire.

[El Nino]

Thanks Severn. Good luck with your research.

[thanatopsis_awry]

You've narrowed it down to three excellent docs, Severn; and it's no surprise to me that they quoted you similiar #s, and also that those #s were in the higher range.

 

Also, actual graft #s are the 'sine qua non' of getting a quality HT for all practical purposes....choosing the best graft # is indispensible to getting the best result, and finding yourself happy at the end of the long, winding road.

 

Going by "feelings" and "trusting" that a doctor will "be able to deliver..regardless of their graft estimate" the goods that you have in mind is a sure-fire way to end up at a destination you don't want, and wishing you could do a do-over. I've seen it happen countless times and it will continue to happen (unfortunately). Don't let that person be you -- and it seems you won't be!

 

A doctor could puportedly have the most supreme skills in the world, but if he is quoting and delivering inferior graft numbers that aren't in sync with the patient he's doing his skills almost as much of a disservice as he is doing the patient. Thankfully, in actuality, this hypoethical doesn't carry much weight since the best docs have been those who have pioneered their practices into offering patients the most flexibility and choice -- graft #s included.

 

Maybe there is a method to the madness in quoting Severn 1500, when juxtaposed to the service being offered by SMG, H+W, Rahal, and Arocha -- I'd love to know it....

[Severn]

Thanks thanatopsis. I actually deleted my post before yours because I felt it might be unfairly targetting a miscommunication between myself and the good doctor's consultant.

 

This forum has been hugely informative in just the little time I've been here. I'm sure there are lots of very very rich men who decide on a HT but don't do the research. Then end up at some place like Bosley because they don't know any better. All the money in the world won't save you if you don't have the research backing up your decision.

 

But agreed, so far it's hard to decide between H&W, SMG and maybe Rahal. If quality were a horserace, it would probably be a photo finish beween the three.

[Severn]

Maybe there is a method to the madness in quoting Severn 1500, when juxtaposed to the service being offered by SMG, H+W, Rahal, and Arocha -- I'd love to know it....

 

After talking to some of them, I get the strong feeling at least *one* of the 1500 quotes was because they were not set up to do large sessions. The woman on the phone told me I could come back a very short period of time afterwards and do another 1500 after the first session.

[Mr. GQ]

you are a good guy Severn. polite too. either of the three you can't go wrong. good luck to you with whoever you choose.

when you say H&W, who do you consider H or W for crown work? i'd actually consider W rather than H based on my research. so do the search on crown work by typing actual words in the search box, have a look and make your own decision. for big bald area and megasession it would be H. for perfect hairline SMG or Rahal. all of them are capable of doing it all however now it's all up to you.

 

my 2 cents

[Severn]

Thanks Mr. GQ!

 

If I go H&W, it would be Dr. Wong as he's the one that has been dealing with my estimates through the consultants. The rest of your post about hairlines vs. crown work was also very informative.

 

Is it ok for a 50 year old dude to say "you guys rock?" Well I'm gonna's say it anyway. You guys rock!

[Ron J]

Severn,

 

you have a very interesting case. Where were your scalp reductions performed: in the crown or midscalp area? I'm curious because the concern w/them is that they'll stretch back. If they were in the mid scalp, have they not stretched at all? If they were in the crown, are any of the dr.'s concerned about scar tissue limiting yield?

 

 

Re Surgery--

 

I think your in a solid spot to get a great transformation, as it appears it is ONLY your crown that needs work done. Your right to not allow money to be a determinging factor. This is PERMANENT cosmetic surgery that will be on the top of your head for the rest of your life, & just like virtually anything else, THE best are charging more money because their work dictates such.

 

One very important factor to take note is that the crown is a unique beast in that it requires more grafts per sq cm than any other area on the head. I have heard that this is due to it's unique angulation & the way the eyes perceive it as opposed to the flatter surface areas of the hairline, mid scalp. Either way, look at any ht blog and you'll see that the crown exhausts significantly more grafts to create an adequate illusion of density.

 

In spite of what others are alluding, there is a direct causal relation to the total # of grafts used & the over all result. As thana' stated, even the best surgeons in the world can't create some masterful illusion w/out the proper tools, namely grafts. And you'll be wise to note that this is demonstrably true by looking at those dr.'s work who consistently produce the best results & noting the significant # of grafts used, case by case. This is even truer do to the fact that your having surgery in the crown. I would go w/the 2,500-3K # for sure.

 

Best of luck.

[TC17]

Severn,

 

Were you given any reason for the conservative approach of SMG and some of the other clinics? At 50 years old and with what appears to only be crown balding, you would think that you would be a perfect candidate to fill in the entire area reasonably thick. I am very interested to hear the rationale supporting the conservative approach with a patient your age. (assuming of course that the physicians also consider it conservative as well)

[Severn]

Ron J:

 

The scalp reductions were performed in the top and crown. They were cut out in a triangular pattern. The result is the bottom part of the balding crown was pulled up much higher than that of a normal horsehoe pattern would do.

 

And yes, it has stretched back out. But oddly enough, mostly towards the left side. The flash makes it look like it's sort of an oval. But in acuality, my hair in the middle of my head runs in a straight verticle line where the hair all to the right is dense, and greatly thinned to the left side of the scar. I assume a scalp reduction is just like a face lift. Eventually it will stretch back out again. Which in my case is good I guess. The stretching returned a lot of laxity back to my scalp.

 

I know the scalp requires more grafts, however since my back crown has been reduced in size from the scalp reductions, there will be less to fill. I actually *could* get away with no implants to the top vertex above the crown since the hair to the right of my part actually covers is up very well and doesn't even look like a "combover". I can't do that trick with the back crown though.

 

T17:

 

SMG actually suggested the same number of grafts as H&W. The consultant called me back and clarified that he wanted to make sure he conserved some grafts for the future in case my front eventually disappeared and I needed more work. If I heavily filled in all the top vertex and crown, he said I would have less to work with in the future. I see where he is coming from.

 

And as I mentioned, the other conservative approaches of 1500 seemed to be just because that was the limit their clinic could handle in one day. They appeared to not be able to do large sessions because of staff availability. One of these clinics has made claims against megasessions saying they are unwise. However, that same clinic told me I could do 1500, then return a short period of time later and do 1500 more. That kind of told me they didn't have the staff to do 3000 in one day.

[Severn]

Here is an attached pic that shows a more unflattering image of the top that demonstrates the odd pattern loss. Obviously I don't walk around with it looking like this but this is with the hair fully spread apart.

 

Non flash top

 

 

This is the same pic photo shopped to what I remember it looked like 14 years ago after the last reduction.

 

Post scalp reduction 1996 (photoshopped)

 

I was also an excellent responder to finisteride and this is a photoshopped pic of what I looked like about 4 months after taking propecia and about 7 months after the reductions. The propecia lost its effectiveness after about five years though. But that is very common from what I read.

 

Propecia 4 months (photoshopped)

[thanatopsis_awry]

I certainly hope it wasn't Limmer's clinic saying these things....

 

Lemme get this straight: by one of the two clinics, you get recommended 1500 grafts.....are told megasessions are unwise (lol)....and you are then also told that you could return for *another* 1500 to reach 3k a "short period of time later"....I do wonder what their definition of a "short period of time later" is, among many things -- you basically would be waiting a good year.

 

You are 49, have the textbook definition of stabilized loss and a good pattern to boot form-fitted to be carpet-bombed by hair....yet you are recommended 1500, and not just that, but are counseled by a physician with claims against "megasessions" while also telling you that you could simply return a "short period of time later" to reach that magic 3k number...lol....amazing....

[Severn]

No, let me clarify.

 

I read a thread where someone on here claimed that the doctor told them that megasessions were bad for safety reasons. This same clinic yesterday told me 1500, and that I could return shortly afterwards for 1500 more. I will call them back to find out what "a short period of time" really means.