On the day I visited Dr. Rassman and his staff were performing a large megasession of 4,000 plus follicular unit grafts. The patient had extremely high laxity in his donor area, which enabled Dr. Rassman to remove a very large donor strip that was 29 cm long by 2.1 cm wide.

He used a single blade to remove this strip, while minimizing follicle transection and he then did a trichophytic closure to minimize any visible scarring. The technicians then trimmed this strip carefully into 4,185 one, two, three and four hair follicular unit grafts, which were then placed across the top of the patient’s entire balding area. The entire procedure, including lunch, took only seven hours.

Given Dr. Rassman's long standing reputation for doing high quality megasessions of follicular unit grafting, both the quality of the work and the speed in which it was completed were not surprising.

To read all the highlights from my visit to NHI go to http://hair-restoration-info.com/eve/forums?a=tpc&s=569...021078082#2021078082

Pat...

There is no taking away from Dr. Ra$$mans credentials, he is certainly a well qualified surgeon with state of the art facilities. I am sure he used this patient, with a high degree of scalp laxity, to promote the fact that he can do a megasession. Makes you wonder what a surgeon like Feller or H&W could have harvested from this individual, in my opinion it may have approached 6000 grafts. The only objection I ever had with him was his outlandish fees, for instance using his $10 per graft this procedure probably set back the patient $40,000, way too high in my opinion.

sorry but I have to comment on your assumptions:

how do you know that Dr Rassman planned a 4000 graft surgery to coincide with Pat's visit? You know, certain things are booked months in advance.

Also, who do you know the patient wanted to get the max number of grafts in one shot? I can't see why another capable doctor can't get as many grafts as H & W if the patient wanted and was willing to take the risk.

As far as the price: it's a ridiculous attack. If it's too expensive for you, don't go there. In fact, go to a surgeon that charges $2 a graft. The price is quoted upfront, and its your choice.

quote:

Originally posted by Cousin_It:
Pat...

There is no taking away from Dr. Ra$$mans credentials, he is certainly a well qualified surgeon with state of the art facilities. I am sure he used this patient, with a high degree of scalp laxity, to promote the fact that he can do a megasession. Makes you wonder what a surgeon like Feller or H&W could have harvested from this individual, in my opinion it may have approached 6000 grafts. The only objection I ever had with him was his outlandish fees, for instance using his $10 per graft this procedure probably set back the patient $40,000, way too high in my opinion.

Cousin,

Fee issues aside, no physician can produce more folicles from the same strip than another. However, they can produce different graft counts, even while ultimately relocating the same number of hairs.

If I take 12 inch pizza and cut it into more slices are your really going to think you're getting a bigger pizza?

That is why my signature says "Count Hairs Not Grafts".

There are no magic wands - only scalpels. Take out a bigger strip you increase not only the size of the session but the risk of visible scarring in the donor area.

To imply that Dr. Rassman and his staff yeild less viable follicles than other clinics is not fair or accurate in my opinion.

since John said it above already, i'll second his suggestion that everyone stop bitching about Rassman's prices. given his contributions to this field of medicine, it seems ridiculous that he isn't a member of the coalition already, and if you spend any amount of time reading his blog, you'll soon realize that he was among the ethical vanguard in hair restoration. if you don't want to pay his fees, you don't have to go there. it's that simple. the coalition's goal, i would hope, is not to establish some kind of price fix based on what its members want to pay, but to point people in the direction of the most capable surgeons. everyone can make up his or her own decision given all the relative criteria, price being one.

Pat,

Perhaps I did not make myself clear in my previous statement. You are correct that from a donor strip of x amount, all surgeons should be able to extract the same amount of grafts. My point was, due to favorable scalp laxity, the surgeons I have mentioned would have opted for a larger donor strip thereby resulting in a higher graft count. Since the area to be covered was quite extensive, it would have been in the patients best interests to have a higher density implanted. I myself, had implanted 3700+ grafts in an area half his size in which I had existing follicles, by no means balding. In my opinion this would be far more advantageous to the patient in ultimate appearance and would reduce the likelihood of additional surgery to "fill in" for additional density at a later time. I am sure you will agree with my elaboration of my previous statement now. Thank you for pointing this out so I could clarify.

quote:

surgeons I have mentioned would have opted for a larger donor strip thereby resulting in a higher graft count

Cousin, how can you sight unseen speculate that other physicians would have gone beyond 2 cm wide? Frankly, the idea of going beyond 2 cm wide in one session with virtually any patient makes the staples in my current donor closure want to snap out and fly across the room (and I did three weeks of donor massages and my donor strip averaged only 0.8 cm wide).

We all hopefully have years ahead of us. Their is no contest that I'm aware of with an award for the most taxing session done in a patients first year. Let's be a little more lax and give the scalp a fighting chance to heal without visible donor scarring.

Hair restoration in my opinion should be more of marathon than a sprint.

Pat...

Based on your statement "This patient had exceptionally high donor laxity" the only conclusion one can draw is that the patient offered the raw materials for such a donor strip, why not take advantage of it.

Surgeons in this Coalition are supposed to offer the absolute best in hair transplantation, to take advantage of whatever a patient has to offer and maximize on it. Obviously scalp laxity of this degree should be taken advantage of. The bar has been raised by pioneers of the Coalition and it is up to the rest to try to meet it if they wish to retain thier status.

I for one do not wish to make a career of being a hair transplant patient. If at all possible I would prefer to have one procedure and be done with it. I do not relish the thought of multiple procedures, with ensuing recovery periods, when it could have been done in less. I cannot think of anyone who would.

Sorry if we do not agree on this point, and perhaps I am being too critical, but this is the way I feel.

quote:

Originally posted by Cousin_It:
Pat...

Based on your statement "This patient had exceptionally high donor laxity" the only conclusion one can draw is that the patient offered the raw materials for such a donor strip, why not take advantage of it.

Surgeons in this Coalition are supposed to offer the absolute best in hair transplantation, to take advantage of whatever a patient has to offer and maximize on it. Obviously scalp laxity of this degree should be taken advantage of. The bar has been raised by pioneers of the Coalition and it is up to the rest to try to meet it if they wish to retain thier status.

I for one do not wish to make a career of being a hair transplant patient. If at all possible I would prefer to have one procedure and be done with it. I do not relish the thought of multiple procedures, with ensuing recovery periods, when it could have been done in less. I cannot think of anyone who would.

Sorry if we do not agree on this point, and perhaps I am being too critical, but this is the way I feel.

Cousin,

You are making a stand on rather weak ground my friend. Lets consider a few points of information that you, I and everyone else here (other than Dr. Rassman, the patient and Pat) cannot know for sure.

1) Maybe the patient and the Dr. discussed a 4000 graft session for reasons only they could know, budget, donor scar stretching concerns, amount of coverage the patient wanted.

2) Maybe the patient is older and wants a diffuse look with all areas covered rather than dense packing in the front. I disagree with you in saying it is the docs responibility to "take advantage of the what the patient has to offer". Lets remember who is paying who, the patient and doc should work together to game plan a strategy but the patient should have the right to ask for what he wants not have the doc decide what he can do. Again, we have no knowledge of their game plan.

3) Maybe this patient wanted to keep a reserve in case something does not work to his satisfaction. If the doctor (even as good as he is) were to screw it up, it would be wise to have some left for repair if needed. Some people may not want to put "all their eggs in one basket".

4) When you say Coalition docs should offer the best in tranplantation, why base this on the number of grafts placed? 4000 is a very large session, it's not a race to see who can do the most grafts, quality vs quanity should apply and 4000 is nothing to sneeze at.


I agree with you that its a pain to go thru recovery of additional work but some may not mind the wait or additional sessions for many reasons. I think Pat for instance, has done four or five procedures of average 1500 a piece. To each there own

Buzz...

I welcome the opportunity to defend my stance on this issue. You make a number of arguments in your post, some valid, some not..

First you are probably right, due to cost constrainments this guy had to draw the line at 4000 grafts. Due to the high price Dr. Rassman charges it is unlikely most people would be able to afford his fees beyond this point.

Since he opted for full head coverage it is unlikely he wishes to return for followup transplants. If he was to do so he might risk temporary shock loss in the recipient areas if scheduled too soon, something I hope Dr. Rassman pointed out to him in their consultation.

As far as stretching issues, due to the high laxity of his scalp this would be unlikely. Patients with his degree take advantage of the condition to obtain as much as possible in their session, it is done everyday by the top surgeons.

As far as being older, the patient appears to be in his 40's, no an age in one would settle for accomplishing a thinning look , which I believe Pat may be able to verify. This can be attested to by the skin quality of his forehead, also note the sporadic full gray hairs which notes the gentlemen does not dye his hair, something someone in his age range is unlikely to do.

Due to his age, an age in which hair loss has stabilized, and stage of baldness there is not much more that can happen to him, so conserving for the future would be a moot point.

Finally, though 4000 grafts is a very respectable amount, it is inadequate in his case. Placing this many grafts in area of this size will only result in a thinning look, not exactly what one who opts for this procedure is after.

I am sure when his transplant matures he will be less than thrilled with the outcome and will eventually be forced to schedule another session in order to bring it up to his initial expectations.

All these thoughts, both yours and mine are pure speculation, not being privy to the consultation between the patient and Dr. Rassman. Perhaps Dr.Rassman advised him that the 4000 grafts would be sufficient, and not being informed the patient agreed. This is a likely scenario and one that can only be put to rest by interviewing the patient himself,no one else.

Cousin,
can you please post here how old are you? I am amazed at how you think that you're making sense. I'll just debunk one way too obvious point and leave it at that before knowing more:

quote:

Originally posted by Cousin_It:
First you are probably right, due to cost constrainments this guy had to draw the line at 4000 grafts. Due to the high price Dr. Rassman charges it is unlikely most people would be able to afford his fees beyond this point.

Let's assume that he isn't LOADED with cash--many people are--why did he go to Dr Rassman office? It' likely that he found him via the internet and lots of other great-but-cheaper doctors are one click away. In fact, why didn't he choose Dr. Rassman's partner who could have transplanted 8000 grafts with that price?
Maybe because he made the decision to go with the safer and proven option! Just like someone pays more for a Lexus when a Chrysler might have all the features and looks very good. Why do they do it? Because they want to and because they can!

Right on John, I think Cousins comments are clouded by his strong objection to his prices. That is fine to feel this way but to try to bring down his medical integrity for it makes no sense.

Its more than price of which I object. I happen to have a long time friend whom ended up with a nightmare of a transplant from this doctor a few years back. After a great deal of emotional turmoil he eventually had it repaired at another doctor, but had to endure it for over one year, wearing a hat everyday! I personally would never go to Dr. Rassman even if it was for free.

It is not that I object, Cousin, but I think it would be best if your friend presented some photos of his issues.

I just think that if you personally feel that way, that is perfectly acceptable, but I think it is something you should have shared earlier, not after several opposing viewpoints.

I just think the timing of your recent post is a little off.

I think some of your points were based on some speculation, but so are some of the other posts in this thread as well.

I can say that you have been doing a great job of really trying to educate others, so this thread has been a bit of a head-scratcher for me. Now that you have revealed your reasons/friends experiences, I understand.

I just think that we have ALL had our say, Pat is working on a resolution, so I think we should let this lie until we receive additional information.

Can we all agree to wrap it up with a agreement to disagree with Rassmans pricing/ disagree that pricing has no bearing on a Doc's practice?

It is the Yuletide season after all!!!!

To be perfectly honest, I wish my friend would post his experience in this forum. I will surely mention this to him when we speak again, but I sincerely doubt it. The only accomplishment to him would be to relive the trauma of his surgery and get a few comments of sympathy. I believe he has just put this away as a big mistake and continued on with his life. Today thankfully he looks very good due to the repair surgery.

You are correct in all parties making certain assumptions, I would be very interested in seeing what this guys transplant turns out like, after all itsn't that the "proof of the pudding" Maybe Pat can get some type of followup on him.

As far as I am concerned this thread is a non issue, but if someone posts again to come to the good doctors defense I will certainly post a followup.

Have a healthy and merry holiday!

Cousin,

Just wish you would have let us about your friend earlier, we may have reacted differently to your views. I am sorry he had a unsatifactory result, who did his repair work?

In the future, it would be great if Pat could get more patient info up front ie: age, patients expectations and desires, doctors game plan for the future if any. This would help curb speculation and assumptions.

Never the less, it is always educational to debate, all in good fun of course.

[QUOTE]Originally posted by Cousin_It:
As far as stretching issues, due to the high laxity of his scalp this would be unlikely.


Cousin and everyone, I read a publication which you will find very interesting regarding scalp laxity and it relationship to potential scar stretching.

Look up Dr. Bernstein's website (bernsteinmedical.com) and pull up "under "Bernsteins publications" an article titled "Scalp Laxity Paradox".

It basically explains that a tight scalp is indicative of stronger connective tissue which binds the scalp to the submembrane or pericranium. Patients with this type of situation actually heal with a thinner scar than those with extreme or mushy laxity. The softer the laxity the less strength in the connective tissue which could lead to more stretching of the donor scar. Fascinating stuff.

Bernstein is one of the best in the world and this is one example why.

I just noticed this thread....sorry for a late response.

Here are my views on all that was written

1. Yes, Dr. Rassman's prices are high and I would personally warn patients that his pricing is are way above normal.

2. Sorry but posts such as "stop bitching about pricing" are ridiculous. Nobody is bitching...it IS a relevant issue regarding this doctor...but however, I agree that it's not relevant to his adequacy as a doctor

3. I believe there is no way to determine whether or not any other doctor in the world could have gotten more grafts than Dr. Rassman did out of this patient. Too many variables...and you know what? We can't prove or disprove it...it's only speculation. So the argument is self defeating...nobody wins, game over.

4. I believe Cousin_IT to be a new, but well researched honest helper of this forum and am personally glad to have him here. I'm certain he's not making up his friends experience just to prove a point. However, I will also state my opinion that his remarks about Dr. Rassman are more emotional than logical regarding this particular issue, and I'd further add, with some right to do so. I agree that if he posted that earlier, this discussion probably would have been different, but I think it's still a good discussion.

5. Nobuzz...interesting, I'll have to check out that article. Of course, without reading it, I only can add that Hasson and Wong among other docs have had patients doing scalp exercises for years, have yielded higher grafts as a result, and still maintained small, thin scars. Though this article may have merit, I have to add...the proof is in the pudding.

Hope this becomes a helpful and healthy part of the discussion

Falc

Falc,

Nice comments on the overall thread, I would never go to Rassman myself due to his prices since there are many other great options for less as you point out in other threads about him. Why throw away the money? I just would'nt slam his work based on that.


The article I mentioned on Bernsteins site is very interesting indeed you will find. It sort of indicates that scar stretching is kind of a heriditary issue and may not have as much to do with scalp tension as the underlying connective tissue or lack thereof. (There is a name for this condition) It sort of means a great doc could do a great closure job and this patient could still have problems do to this condition. After reading this I concluded that the H&W scalp exercises are probably good for some but not all need it, maybe like this Rassman patient?

Check it out.

I appreciate everyone’s valuable input regarding Dr. Rassman's involvement with our community. It's tough to come up with a solution that satisfies everyone but I think Dr. Rassman, his staff and I have come up with a solution that is close. Dr. Rassman has shown a great deal of flexibility in meeting the concerns expressed in this thread.

As many of you know, Dr. Rassman is a big believer in patient education and empowerment. His website at www.newhair.com and blog at www.baldingblog.com have been great in-depth and empowering patient resources, as is his book - "The Patient's Guide to Hair Restoration”.

His belief in patient education and open information is one of the reasons why he wants to participate in our community as a member of the Coalition.

To support our community and forum he now prominently promotes them on the New Hair Institute website and on this popular balding blog.

Dr. Rassman has also offered to give those visiting our community special deep discounts.

He is willing to reduce his normal surgical fee of $10 per graft down to $6 per graft for those who are willing to do surgery in his Los Angeles office on a "Standby" basis and be called less than ten days prior to surgery.

For those who would like to schedule surgery with him more than ten days in advance he is willing to reduce his fee down to $8 per graft for surgery in his Los Angeles office. After 2,000 grafts all additional grafts will be charged at half rate. Travel reimbursement credits up to 5% of fees paid will still apply.

To qualify for these special discounts patients must refer to the "Coalition Special" when they initially contact the New Hair Institute's office.

I think such flexibility and generosity on Dr. Rassman and his staff's part is very commendable.

Based on his generous offer and support for our forum and community I believe that Dr. Rassman should take his rightf