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allan

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Dr. Feller,

 

I agree that the ideal location of the scar is not up for debate. I also have the text book you are referring to and am enjoying it very much.

 

The point of my post was simply that appearances can be deceiving. Just as Balody's scar "appears" low in the referenced picture, Richie's "appears" high in one of his pictures posted in comparison on this thread. I have posted a few images below for your reference.

 

The first picture, seemingly based on the camera angle, the scar "appears" too high, but in looking at the scar from the side angle, it appears normal. In comparing it to other pictures on his blog, the scar looks normal.

 

168-1-1.jpg173-3.jpg

 

Now if you compare the picture you referenced of Balody's scar to this one below, you will notice it looks much different. Whereas it "appears" low in the picture you referenced, this one appears perfectly normal.

 

9251000773_010.jpg

 

I do appreciate however, you taking the time to post this detailed information.

 

Bill

010.jpg

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  • Senior Member

Hey Dr Feller ,hope you and your staff are well

 

As requested , more photos of my scar and donor .

 

Bill , below I have posted 12 pics of my scar from all differing angles and different lighting , i have been as honest and as transparent as i can be .

 

You will see that in all the shots my scar looks to be in the exact position show by Dr Feller earlier in this thread , to be the most optimum for the best healing with mininum scar stretch , i have even put my scar next to the diamgram used from the teaching manual published by Unger and Shiparo using Moore's and Gray's text book of anatomy to show you .

 

My scar has also been scutinised in person by atleast 8 people at our Manchester show case less than two weeks ago , these people ranged from veterans to newbies but most had similar knowledge to yourself on were a scar should roughly be located and certainly showed knowledge of what would be concidered a low scar or a high scar , all these people commented at how neat and healthy and perfectly placed my scar was .

 

Balody was invited to this show case but unfortunitally couldn't make it ,which is a shame as many menbers of the ht "club" could have verified the hight of his scar and put this topic to bed once and for all .

 

Billorus have you ever met Balody to inspect his scar or are you only defending the hight from the photos from his blog ?

 

I only ask this due to the fact most of the pics on balody's blog show the scar looking very low , even the pic you have shown above has got bolody with a very tilted forward head with the scar looking very close to the nape of his neck , clearly out of the optimun zone shown demonstated by Dr feller in his above post .

 

here are my pictures ;

 

PB040164.jpgPB040163.jpg

 

PB110196.jpgPB110198-1.jpgPB110197.jpg

 

166-1.jpg168-1-1.jpg167-1.jpg

173-3.jpgDSC00016.jpgDSC00025.jpg

scarplacement.jpgscarcomp.jpg168-1-1.jpg

 

You can quiet clearly see from the photos above , what is a low area regards the medical infomation supplied by Dr Feller and which scar is right were it should be and within the lighter shaded area , as explain by Dr Feller in his above post .

 

You can also clearly see from the variety of my pics I have posted , that some do look a little higher then others ,however the most accurate are my side profile shots , were my scar can be seen clearly falling into the safe zone .

 

Perhaps Balody may be willing to supply more photos ,which would also help to clarify things ?

 

I hope that clears up any confusion

richie

2100 crown grafts

Dr Feller

nov 2007

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  • Senior Member

My Norton scar is well below the hump....hence it has given me the right hump.They obviously haven't read any manuals on hair transplants.

---

Former patient and representative for Hasson & Wong.

 

Dr. Victor Hasson and Dr. Jerry Wong are esteemed members of the Coalition of Independent Hair Restoration Physicians.

 

My opinions are my own and do not necessarily reflect the opinions of Hasson & Wong.

 

 

My Hair Loss Website - Hair Transplant with Dr. Hasson

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Richie,

 

I appreciate your post, but I'm not sure exactly why you felt the need to post all your scar pictures when I've already stated in plain black and white that your scar looks perfectly normal. icon_smile.gif

 

Once again, the purpose of my post is that LOOKS can be DECEIVING. And by this, I am referring to the APPEARANCE of your scar looking high and the APPEARANCE of Balody's scar looking low.

 

In ONE picture, your scar APPEARS high, but doesn't in your other pictures. Likewise, the picture you have selected of Balody's scar APPEARS low, while yhet other pictures show otherwise. Once again, see the below picture:

 

9251000773_010.jpg

 

You can his 3 month scar pictures from the side view by clicking here.

 

Another 2 month picture is below and the scar also appears normal

 

8781040773_039.jpg

 

In both of your pictures, it is quite difficult to see the Nuchal bump, and we must keep in mind that this bump is higher or lower in certain individuals.

 

Compare your scars to mine below:

 

3851075082_D686D66B53B3FF072BF5B0FE6AA8A1DF.JPG

 

According to some of the pictures displayed, mine is right in the middle between both of yours icon_wink.gif. And I'm also sure if I tilt my head up or down, the scar will appear higher or lower than it really is.

 

I believe both you and Balody are in great shape!

 

Best wishes,

 

Bill

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Thanks for replying Bill

 

I apologise to balody in advance for using his pictures , but you did direct me to them , so for the purpose of this dicussion I have posted them here .

 

Also Dr Feller asked me to supply him with some more photos to back up his point , so I obliged .

 

Thankyou for directing me to balody's side pictures , however after looking at these pictures they only confirm my origional opinion regards balody's scar position being very low .

 

The two pictures you chose to post have balody with his head tilted very far foward , which is even harder to accuratly see the scar , if anything leaving you wondering and seeking further clarification with his other pictures .

 

The following side pictures clearly show were it falls with regards his "bump" , as Dr Feller has already stated earlier

 

Above or on the bump- GOOD.

Below the bump- BAD.

Pretty simple.

 

balscarpic8.jpg In this pic you can clearly see how low the scar is , even how low it falls regards his crown loss and "bump"

 

balscarline6.jpg In this pic , which you directed me too , you can clearly see the scar , lower than his "bump"

 

balscarlines4.jpg On this pics i have produced a yellow line to show the position of my own scar to directly compare it to balody's

 

balscarline2.jpg Again i have produced the yellow line to show were my own scar would fall in relation to balody's lower than his "bump" scar , his scar also appears extreamly close to his ear in this shot .

 

If I am proved wrong by seeing this in person at one of the next Manchester meets ,or even the London or Birmingham meets , were balody is invited and I take some of my own photographs to rule out any mis-interpretation , then i shall publically apologise and offer to buy him a beer , but based on the evidence you have shown me , I still believe the scar to be very low , my concerns go out to balody as , I believe the lower the scar the more suseptable they are to stretching .

 

I origionally accepted the mis-interpreted picture theory but the more I look , the more the evidence suggests balody's scar to be low .

 

Again I apologise to balody in advance , but I was directed to these pictures and as a resulr of our debate I moved them from your blog to this post .

 

What do you think Bill ?

 

richie

2100 crown grafts

Dr Feller

nov 2007

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Richie,

 

Thanks for pointing these out.

 

The scar does appear to be a bit lower than normal in several of these pictures. Perhaps it is, I can't be sure. It is interesting however, that some pictures show a higher scar and others show a lower one. Some can be written off as the angle of the head while others may be more revealing.

 

Nonetheless, I suppose only Balody or Dr. Farjo can really attest to it and if it is indeed lower (as it appears to be in several of the pictures), the reason for it.

 

I also know that some surgeons occasionally take hair lower on the sides to get more of the fine hair for the hairline.

 

The good news is, his scar is healing very nicely and there are no signs of scar stretching.

 

Bill

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Bill,

As you and everyone knows on this site Richie has both here and apparently on other sites has continuosly had digs at Farjo.Concerned for Balody, well come on do me a favour.

I am not sure what his long term aims are but it's likely i will retire in a couple of years and he is doing his chances of applying for a position no good at all with his continual harrassment.

 

Mick

Patient coordinator for Dr. Bessam Farjo who is an esteemed member of the Coalition of Independent Hair Restoration Physicians

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dr feller,

i appreciate the knowledge you have as a dr at the top of his game,and your experience is valued on this site aswell as many others.

but could you refrain from using me as an example and stick to your own patients.i think it is highly unethical for a dr to "in effect" critisize another dr,s work on a public platform as you are doing here.

beleive me if i have any concerns with my proceedure(which i havent) i will go to my dr personally to air them.

 

im sure you understand,

cheers

paul

2381 fut Dr Bessam Farjo

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2000+ fut Dr Bessam Farjo

 

My Hair Loss Website - Hair Transplant with Dr. Bessam Farjo

 

challenge the unchallenged.

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Hey Mick

 

Thankyou for taking time to reply , much appreciated , and thanks for your kind offer to take your place as patient coordinator at Farjo, however I will have to decline , as tempting as it is hahahaha .

 

Its a shame that since this debate has been very helpful to many that you have actually chosen instead of finally coming forward to explain and help clarify your patients scar position and getting involved in the debate, which would have helped you. You have chosen instead to have a little dig at me , rather than make any attempt to back up your clinics result with any information which i think may have helped to stem any confusion .

 

With all due respect , may I make a suggestion that you, yourself , try to be a little more interactive on the forum and responsible for your clinic before you retire and not leave these questions surrounding your patients for others to answer , this only leads to speculation .

 

I have seen on another forum that balody has now stated his scar is below the bump , so at least we are finally getting some clarity .

 

I look forward to anymore information .

 

your sincerly

richie

2100 crown grafts

Dr Feller

nov 2007

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Mick,

 

I am very disappointed with your post on this thread.

 

In my opinion, you would have been much better off addressing either the content of the thread or posting impressive patient photo albums that display a multitude of quality scars indicative of the quality of work that Dr. Farjo regularly performs.

 

Remember that all physicians are open to constructive criticism as outlined in the Coalition membership standards under the "physician accountability" section. See below:

 

-------------

 

Membership in the Coalition requires members to maintain a high degree of patient satisfaction. Members care for their patients knowing that their patients are free to post their experiences on the popular Hair Restoration Discussion Forum. On this open forum patients are free to critique physicians and to hold them accountable for their actions. This forum is run and moderated by hair restoration patients.

 

-------------

 

It's hard to tell whether or not Balody's scar is normal or low by the pictures as some appear normal whereas others show the scar as below the occipital bump. The great advantage that you have is that you can obtain proper permission from Balody and then discuss the actual placement of the scar and Dr. Farjo's reasons. If it is low, I suspect Dr. Farjo did it with good reason.

 

But an honest explanation is more powerful than accusation. Instead of questioning posters motives, I highly encourage you to combat criticism with the truth, explanation, and evidence.

 

I also strongly encourage you to gather a great multitude of impressive scar pictures and present them in a new photo album and continue to show the world that Dr. Farjo does high quality work.

 

Best wishes,

 

Bill

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Bill,this started as allans thread about allans norton scar,not my scar or dr farjos work.

stupidly i responded to allan(dont worry i dont think ill bother in the future)and richie jumped in with both feet as usual making up blatant lies as to what i posted and then supposedly edited.now,yet again we(me and the farjos) find ourself in the dock being cross examined by richie,feller and now you.

im getting sick of it.

if richie is that happy with dr feller that he has to let everyone who will listen know on a daily basis then hey thats his perogitive,im glad he has the time.

i just wish he and all the other "back slappers"

would leave me out of it,end of the day i too am happy with both my proceedures and would even consider a third with dr farjo if all the factors were right.the scar is fine and my hair is improving by the day.

now i wish everybody would stop being"concerned" icon_rolleyes.gifand concentrate on their own experiences.

2381 fut Dr Bessam Farjo

2201 fut Dr Bessam Farjo

2000+ fut Dr Bessam Farjo

 

My Hair Loss Website - Hair Transplant with Dr. Bessam Farjo

 

challenge the unchallenged.

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Balody,

 

I am not cross examining you, only addressing the content of this thread. You have posted your photos on a public forum which means that they are open for discussion/criticism. That's the advantage and disadvantage of posting photos openly.

 

Try not to take personal offense. In my opinion, nobody is attacking you....and I most certainly am not.

 

This is a discussion about scar placement and some of your photos appear ambiguous, hence the discussion. I cannot tell with certainty based on the photos presented whether or not your scar is a little low or on the occipital bump. This is not a criticism, only a question.

 

I do realize that this is Allan's thread so perhaps this discussion should have taken place on another thread.

 

Sorry if you are taking it personally.

 

Bill

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Hey Allen,

 

Sorry to see another victim of Hartley, me too!

this pr1ck is a staff doctor working in an a&e ward, he holds the most basic qualifications permitted by law, I have a wealth of information for this clinic and if you need any help in your legal action PM me.

regards

Nortonvictim

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I don't agree that there is one certain place to take grafts from. My hair loss goes very far down the back of my head. If you were to take hair from the bump in the back and above then you'd be taking out bare skin. I had my HT done before I lost hair down the back. I do have a scar that's just above the bump and later lost hair past that area, so I now have a scar showing across my bald area in the back of my head. The scars on the sides are showing too because I lost hair down the sides as well. I would much rather have lower scars because I'd be able to hide them better. I can post pictures if you like.

Al

Forum Moderator

(formerly BeHappy)

I am a forum moderator for hairrestorationnetwork.com. I am not a Dr. and I do not work for any particular Dr. My opinions are my own and may not reflect the opinions of other moderators or the owner of this site. I am also a hair transplant patient and repair patient. You can view some of my repair journey here.

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Behappy excellent chip in with this.Balody's scar is fine and in the correct spot and when we see him for a review i will take as many photo's as neccessary to show.though why on earth he was bought in to this i dont know, for what possible reason?

I have seen dozens of people over the years who have dipped down so far at the back as you have.I have even seen people whose scars have shown through and these were taken in what was deemed to be a safe area.Contrary to other opinion there is no exact right or wrong and good a bad.Your physician will have to look at your individual circumstances and plan accordingly.Just look around at people of the older generation and see what has happened at the back.Who is to say that wont be some of us in a couple of decades?

 

Mick

Patient coordinator for Dr. Bessam Farjo who is an esteemed member of the Coalition of Independent Hair Restoration Physicians

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Mick

Throwing the textbook out the window and ignoring good surgical practice is probably not a good thing to be advocating on a forum designed to accurately educate the public.

It would not serve you very well in a court of law either.

 

As I wrote in the beginning of my post, the issue of anatomy and scar placement is not up for debate as it is established medical reality and is not open to interpretation.

 

Your post smacks of medical advice, incorrect advice at that, and since you are not a doctor you should not be commenting on such matters on a public forum until you have a license to practice medicine.

 

Your doctor knows he is welcome to come on here and proffer his medical opinion on the subject, but I very much doubt he will write anything that contradicts the textbook. If, however, that is his intention, then I wait with great anticipation for his rebuttal. That's what these forums are all about.

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Alan,

 

I am using Mick's handle because I don't have my own due to time constraints in keeping track of threads here.

 

There was no need for your harsh and dismissive note to Mick. As I understand, this is a public forum as opposed to a scientific conference and he has as much right as anyone to give his opinion. Granted he is not medically qualified, but then he was not pretending to be nor was he giving any medical advice. To the contrary, he was correctly suggesting to ??BeHappy' and others that they SHOULD seek the advice of their examining doctor on the best place to get donor hair from in their particular case.

 

I go back to your highlighted text from Unger & Shapiro's textbook. I disagree with your dogmatic conclusion that everything above the notch is "good" and everything below is "bad". Here is the text you highlighted again: The anatomic difference between the 2 areas largely determines the widths of tissue amenable to surgical removal. Generally speaking, where 5 layers exist, wide excisions are possible; where 3 layers exist, the width of tissue amenable to removal is relatively restricted. My interpretation is that where 5 layers exist you can excise wider areas while you need to be more conservative comparatively where 3 layers exist. Nothing there about absolute good or bad. I agree however that very low incisions where there is no galea layer support are far more likely to end up in wider scars. But there are so many other factors in scar healing anyway such as skin elasticity, wound tension, width of the strip, healing characteristics of the patient, type and size of suture, surgical and closure technique, etc.

 

The other thing is that the text you quote is in the basic science/anatomy section of the book. It was written by the late Dr Gerry Seery, a wonderful Irish gentleman and surgeon and perhaps more known for reductions. I don't mean to sound funny when I say, the reason why patients seek our services is to have lifelong hair on their heads. If we can achieve that with as acceptable a donor scar as possible then even better.

 

With this in mind I refer you to a more relevant section in Unger's book entitled ??Donor Harvesting' (Chapter 10) where the balance of good permanent donor hair and cosmetically acceptable scar is addressed. In the text and amongst our colleagues in the field, safe donor area (SDA) refers to donor hair that will not fall out in the future rather than area of the scalp for best looking scar. Don't get me wrong, we all want least visible scars but not at the expense of risking losing the transplanted hair in the future due to continuing hair loss. Here are some relevant extracts I chose from this chapter:

"?? A physical examination of the patient's recipient and potential donor areas is essential. This examination is in fact, the basis of a scientific approach to the individual patient.

"?? Every donor region has specific characteristics that allow the informed hair restoration surgeon to customize an approach to the individual patient.

"?? Dr (Tom) Alt suggested that a horizontal line be drawn from a point 2cms superior to the reflection of the skin of the external ear and the scalp. He chose the point at which this horizontal line intersects the midline of the occiput as the superior border of the SDA at that location.

"?? In addition, he counselled that at least 2.5cms of unharvested permanent hair should be left superior to the most superior donor areas to provide adequate long term camouflage of scar lines.

"?? There is no substitute for taking a careful history of the extent of baldness in family members and for carefully examining a prospective patient's scalp for evidence of areas of future thinning.

"?? The younger the patient, the wiser it is to keep within the borders suggested by Alt.

 

This Chapter of the book also deals with methods of estimating the size of the recipient area and the required donor tissue (page 311). For anyone interested, there is a detailed description here of my method for the above under a section titled ??The Farjo Method'. I first presented this in Paris back in 1998. I have not photocopied pages and put them on as you did because I have not sought the publishers' permission to do that.

 

Here are some examples of donor hair at the back dipping or will potentially dip very low:

donor1.jpg

 

donor2.jpg

 

donor3.jpg

 

donor4.jpg

 

donor5.jpg

 

Alan, you seem keen to preach science and ??good practice' and give advice to doctors and lay people alike on a public forum. Surely the proper platform to do this for your colleagues is in a scientific or medical conference/workshop. For any theory, claim or argument to carry weight and gain credibility it needs to be scrutinised and debated amongst your equally qualified and knowledgeable colleagues. As much a lay person may or may not know in a forum like this, their information has to be limited and sometimes biased.

 

There is a statement on your bio on your own website re the ISHRS. It says that you are committee member, instructor, lecturer, and contributor to the International Society of Hair Restoration Surgery since 1993. I was therefore surprised to note that since you joined the ISHRS you have actually only attended 2 Annual Scientific Meetings with the last one being 6 years ago! In my position as President of the International Society of Hair Restoration Surgery (ISHRS), I urge you to come to meetings and hear all points of view. It's a great arena for you to argue your convictions so other doctors can hear them. If you are right then the others will benefit and learn from you, but if you are wrong then you would hopefully have learned something new yourself that will benefit your patients and practice.

 

Regards

Bessam Farjo

Patient coordinator for Dr. Bessam Farjo who is an esteemed member of the Coalition of Independent Hair Restoration Physicians

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  • Senior Member

That makes sense, and from the picture above it seems this guy would not be a candidate if the surgeon didn't go below that point. I figured my scar to be below that point and told Dr. Cooley prior to my consult that I thought my previous scar was too low. To my pleasure, he said it was right at that lower borderline and he was able to combine two procedures into one scar.

 

BTW, I've got an MBA if anyone wants to talk business..... icon_cool.gif

100? 'mini' grapfts by Latham's Hair Clinic - 1991 (Removed 50 plugs by Cooley 3/08.)

2750 FU 3/20/08 by Dr. Cooley

 

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Bessam,

 

Bravo for posting a compelling presentation on donor strip harvesting. I'm in agreement with you that hair transplant surgery is not black and white and can't always be broken down into simple categories of "good" and "bad".

 

In my opinion, you have made a clear and valid argument based on your medical expertise for occasionally removing the donor strip below the occipital bump, while still recognizing what is optimal generally speaking.

 

In my opinion, as sited above, the text book seems to do a great job at defining and explaining general principles (as Dr. Feller rightfully pointed out) and teaching physicians how to adapt these techniques to cater to each patient (as demonstrated by Dr. Bessam Farjo).

 

This should address concerns made by a few patient members.

 

I trust that between educational posts and presenting compelling patient results online, slowly but surely, you will win over even your harshest critics.

 

Best wishes,

 

Bill

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Bill- I don't think the argument was whether it was ever proper under certain circumstances to go below the bump to take a strip. The question is why did Doc farjo do it if there was no reason to? He never gave a reason why he took Balodys strip so low.

 

doc farjo- You posted more pictures in this posting than you have in a year. But they're supposed to be before/after photos, not just before photos icon_wink.gif

 

Bruce

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Bruce,

 

I notice that you never responded to my private message I sent you over a week ago. Please read and respond.

 

I also think you need to go back and read not only the argument in this thread, but another thread entitled "scar city" by Dr. Feller. Defending the logic and reasoning (generally speaking) behind harvesting the strip below the occipital bump was the key component in understanding specific incidents. Physicians and patients may agree or disagree which is in their right, but a compelling argument has now been made for both sides.

 

I'm honestly not sure why people have trouble applying general principles to specific situations. Now that we see evidence that it can be acceptable in specific cases, is there a reason to hold Dr. Farjo's feet to the fire and make Balody's scar a public spectacle?

 

Balody's scar is not stretching and shows no evidence of problems. Therefore, there is no reason to make his scar an exhibition.

 

If you are interested in seeing before/after pictures from the Farjo Clinic, Mick McHugh has posted a number in the "hair transplant patient photo albums" section.

 

Regards,

 

Bill

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  • Senior Member

this makes sense as i have a patch (almost square in shape) of thinner hair under my bald crown.(like picture 2)

i suspect in later years this would go(im hoping fin will keep it going).

also at my consultation it was explained to me that i could be heading towards a nw7 like my mothers father,even though my dads still got all his hair at 60 icon_mad.gif

bruceman,dr farjo rarely posts on here,he leaves that side of things to mick mchugh.he has come on here basically because he was "called out" by dr feller,which i found to be very unprofessional.i like fellers work(who doesnt?)and i had a lot of time for him,but the aggressive way he is conducting himself on here and other forums lately leaves a bad taste in my mouth.

just my opinion.

2381 fut Dr Bessam Farjo

2201 fut Dr Bessam Farjo

2000+ fut Dr Bessam Farjo

 

My Hair Loss Website - Hair Transplant with Dr. Bessam Farjo

 

challenge the unchallenged.

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Dr. Farjo,

Your response and references refer to the EXCEPTIONS, not the rule. Both Balody and Allan fall well within normal donor scalp parameters. In fact, they both have ideal donor characteristics from the photos. Therefore, there is no need to make the deviations you cited as they are clearly not the exceptions.

 

With the exception of very "deep diving" donor areas or prior donor scarring, there are no variables that would compel a surgeon to cut below the nuchal bump as you intimated in your post. Indeed, any variation in the group you mentioned would obligate the surgeon to work ABOVE the nuchal bump and would strengthen my position and that of the text that going below would be "bad".

 

I also have to disagree with your opinion that discussions like this should only be set in a rented meeting hall with other doctors and to the exclusion of the public. The public WANTS to know what we are doing and why. I can think of no better forum than the internet to do so.

 

I also disagree that I need the consideration and approval of a collective body to hypothesize and test the voracity of theories. All I need are the opinions of my closet and respected peers and my own power of thought, reasoning, and testing. If I or any other innovator did as you wrote, the HT field wouldn't be nearly as advanced. That's how innovation is stifled.

 

I am happy to have anything I do scrutinized, that's why I post so many photos of my work so often. I just don't wait for my peers to "approve" of something I do before I consider it to "carry weight". I suggest that my peers spend more time doing the same rather than worrying about what I'm doing and trying to regulate it in one form or another. If what I am doing works, and works consistently, that's all the approval I need. No nod and a wink from a collective of other doctors who have no idea what I'm doing required.

 

Of course, the latter part of my post has nothing to do with issue at hand. Your questions about me in particular have nothing to do with the issue, but since you asked I felt compelled to answer.

 

Bill,

I don't agree that Dr. Farjo made a compelling argument. His references were for the exceptions, not the rule, and therefore do not apply to either Allan or Balody. I drop below the nuchal line on occasion when I have no choice. I'm certainly not "dogmatic" about it, but there must be an obvious reason before doing so. Such obvious reasoning was not provided for Allan or Balody.

 

It is, of course, a doctors prerogative to begin his incisions wherever he likes. That is true. But any deviation from the text in any particular patient should be easily explained with specific reference made to the exceptions that required the departure from the text. That's what would be required in a courtroom. However, such has not yet been offered in either the case of Balody nor Allan.

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  • Senior Member

Going below is the EXCEPTION, and should be a fairly RARE exception at that.

 

Dr. Feller is 100% correct IMHO concerning the incision and final resting place of the scar on or above the "bump"

 

I cannot fathom how one would begin to defend going below unless repair work is necessary AND the patient has been informed about FUE--basically informing a patient fully about all options.

 

Nothing I have seen or heard has displaced the hard and fast rule about incisions and eventual scar placement.

 

In reading Dr. Farjo's post, his views seem to be at odds with the accepted posit of Dr's Unger and Shapiro, whereas Dr. Feller's views are in line with what is held as one of the "absolutes" of hair transplantation (exceptions aside)

 

I had thought Balody's scar was low, but I also stated he said it was fine, which is all I need to hear.

 

Dr. Farjo reserving the right to go below the "bump" is at direct odds with the generally accepted norm is why I am concerned AND Dr. Farjo himself acknowledged this a patient community subject to open debate.

 

I however, am NOT a Doctor, but the textual argument is relevant here.

 

Jason

Go Cubs!

 

6721 transplanted grafts

13,906 hairs

Performed by Dr. Ron Shapiro

 

Dr. Ron Shapiro and Dr. Paul Shapiro are members of the Coalition of Independent Hair Restoration Physicians.

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I don't agree that Dr. Farjo made a compelling argument. His references were for the exceptions, not the rule, and therefore do not apply to either Allan or Balody.

 

Dr. Feller,

 

In my opinion, this is highly presumptuous since you are basing your analysis of Balody's case solely on pictures viewable on an online forum community whereas Dr. Farjo's analysis is based on an indepth in person evaluation.

 

Though a specific explanation for Balody's scar placement has not been given, the principles Dr. Farjo bulleted above (in Shapiro and Unger's book) convey the importance of customizing an approach to the individual patient based on a physical examination of the patient's donor and recipient sites.

 

It is clear by balody's pictures that the scar is pencil thin and shows no evidence of stretching. In my opinion, THIS is the most important thing to consider.

 

I do not believe ANYONE is arguing that harvesting tissue below the occipital bump is the norm, nor optimal to provide a thin, fine scar, only that it CAN be appropriate in certain cases. Therefore, in my opinion, his argument is valid and compelling, given that your "Scar City" thread only discussed the "rule" and not the "exceptions".

 

Jason,

 

I cannot fathom how one would begin to defend going below unless repair work is necessary AND the patient has been informed about FUE--basically informing a patient fully about all options.

 

I think you should read Dr. Farjo's post again and reconsider your absolute statements. Though I agree that placement on or above the occiptial bump is optimal, his post clearly shows evidence of cases where lower excisions can be appropriate. I suspect that many surgeons would agree with Dr. Farjo in that they reserve the right to adapt their technique on occasion to the unusual needs of some of their patients.

 

I particularly find it odd that after his post that includes a number of patient photos with extreme hair loss that you would use this as yet another opportunity to plug FUE, especially given its lack of online consistency. I agree with you on informing a patient of all the options, but good grief - FUE on a norwood 6 or 7? show me the compelling results and I'll start to advocate it more regularly as well.

 

Regards,

 

Bill

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