This is my Quality of grafts

Dr HM,

While your grafts here look good, I think you will have an uphill battle convincing people microscope disection is not a safer method. Patients are really fearful of transection of even one graft. If microscopes help save grafts, they should be used.

It still comes down to careful trimming by the techs, the unsung heroes of a quality HT.

Dear Friends

I know what all of you saying as for the quality and latest technology for the furthering of the hair resortion.
This is our quality of grafts made especially for the front hair line that is visible.
Behing first three rows of hair line or what I call a transition zone we start putting twos and three hair gafts and as we go deep we start putting 4's and 5's.

Please do comment on these grafts that is made by one most trained and especially designated tech to dissect these grafts.

I would like all of you to compare these loop magnification disseected grafts with the worlds top 20 reccomended surgeons Microscope dissected grafts and tell me how much difference is there.

One more thing, with Microscope the yeild as in grafts are increase but the yield as in number of hair does not significantly. As all we do we make the 4s and 5s into 1,s and 2s......
anyway,

I still fail to understand that practically if the results can be compared and standard of work is good as been told, then why should the latest technology be the only reason to disqualify the person.

I do see your point, my point is with microscope All I would be doing dissecting 500 to 1000 grafts for front hair line, as I need and believe that i can produce denser effect with some hidden 4s and 5s. This is more beneficial for the patient. As we all charge per graft, its value for the money. DONT YOU THINK SO.

Humayun

Dear NB

I am not here to convince people that microscope is not the way forward. I am here to say that is not the only way just in my case.
I will like to use microscope as well but I have tried and seen but I could not see a practical reason in my hands.
If I show you the amount of waste we do for the 1000 graft dissection you would see that our waste have less than 1% of transection, I will not put it as zero for there is nothing like zero or 100% in medical term.
I am here just to tell people that YESI agree that microscope is good and YES every graft should be saved.
All I am saying is that in my case as I do not use 100% of fine 1s and 2s FU, I do not need a very very high magnification.
But YES may be just to be a part I would invest on a microscope which is not that big a money anyway.
I am pretty sure that it will not drastically increase the outcome.
May beI am wrong.

Lets see. but I still feel that it was unfair on behalf of this forum to vote against me, keeping in mind tha I am giving a reasonablly good results in a world where we all have heard and trust me I have seen very horibble results.

90% of people in this part of the world would not be able to pay for the hair transplant in USA, second they will not get a VISA in the first place.

I hope my point of view should be taken on board.

Humayun

Doc,

I understand what you are saying and I agree that it might not be a drastic difference in your case if you are just using 500 or so 1 and 2's. Possibly that in itself is somewhat of an issue. Do you think that with a microscope you would still only choose to have this many grafts for the hairline or do you limit this number due to the loop use? Moreover, I certainly respect saving the patient money by using larger grafts but many will be very concerned about any chance of it looking pluggy. I know that when done correctly it can be very beneficial.

Here is the number one dilemna. A standard has been set that states that the physician and clinic must use a microscope. Your work might be as good and even possibly better than most but it does not meet the standard. What is to happen? Do we make 1 exception? This is the challenge.

There are european cars that get great gas mileage but they don't meet US standards. I would love to get my hands on one, but I can't unfortunately. It looks to me like you might have no choice unfortunately. If you believe the cost is not a big deal I guess I would suggest that you buy one. Likely it will be worth the investment as it appears to me like you believe being a recommended doc on this site will increase your business. Good luck.

By the way--yes the grafts do look as good as they get.

Dr. Mohmand,

I appreciate that you are taking the time to continue to post.

I do not feel that anybody here is voting against you. In fact, just about everyone is stating that your results look good.

But where there is call to question is whether or not your results would be EVEN BETTER with the more powerful technology.

Let me ask you this question point blank: In your opinion, which TOOL is better and makes dissection of the grafts easier, 2.5 loops or microscopes? I'm talking about tools alone, not the skill of the technician to work with a particular tool.

Let's say your technicians DO the same quality of work with the loops as a microscope. There is still less room for error and use of microscopes would make it easier for your technicians to dissect the grafts.

Even if you feel that patient results would be the same, why not spend the money to invest in microscopes at the very least for the sake of your technicians?

Let me say that I am personally disappointed because I believe you are the BEST in your area and provide a very good service. Therefore I encourage you to purchase microscopes and begin to use them as a primary part of your practice and then we can reconsider you for recommendation.

Best wishes,

Bill (Falceros)

I do not mind buying a microscope, at the end of the day only patients have to pay for the cost. As we all know technitians are paid for in hours........so YES I do feel that there is a room to improve with a microscope. YES I do think that with Microscope i would be able to cut more grafts and much finer and least wastage.
But what I want is that by suspending my membership, actually you would in a way let so many people in this part of the world lose an oppertunity to get a decent job done and there will be more horror stories of hair transplant.
I thought that, if instead of my suspension, if Pat's second option would have been considered it was a positive way of encoaging Doctors like myself to improve, a critique rther than criticism.
Anyway, I always look ahead and try to rise as much as I can.

My membership was not given to me as a favour. I haveeen an active part of ISHRS since 2002, and speaking on 6 occasions out of 7. I am a faculty member of Orlando Live Surgery Workshop since 2004, I have been speaking at ESHRS forum. It was at one of these meetings that Pat met me and ask me if I woud like to Join this forum because he was convinced that my work is of standard and this forum does not have a doctor from this part of the world. I took me 1 year to decide to join. Look now, what happens to me.
These clients who come to me are not fom USA, they are mainly from Pakstan. DOnt you think this form should be giving them an oppertunity to get the may be not the best of the world but a safe doctor?
anyway
The topics that I have spoken on over the last 7 years covers
1) Ethnic problems in HT
2) FUE in South east asians
3) Scar repairs with HT
4) non scalp hair transplant ( Webinar)
5) Cosmetic Closure of Donor area (tricophytic scar closure)
6) Role of curvature of Hair shaft in naturalness of HT (published in ESHRS journal).
7) Placement of Lower mature hair line.

I knwo what this forum is saying and I do not disagree with all of you. What I am saying that thee is always a better way of dealing with people who care about the profession and always a way to ask some ne to improve by tll him to improv and giving him time to change........dont you all think I have a point here.

Anyway, If you all still believe that that is the only way forward and the only criterion then I would simply withdraw my point of view.

I thought it was a bit tooo harsh of this forum.

I'm just wondering how much magnification is needed, and how much more the human eye can discern under that magnification.
I remember in the 70s and 80s that stereo equipment companies were promoting lower and lower harmonic distortion (Yamaha at .05% TDH, etc, when the human ear cannot tell the difference below .1% TDH).
Are we talking real differences, or just marketing?

Dr. Mohmand,

I understand how discouraging it is to lose your status of recommendation based on what MAY appear as trivial.

However, by your own admittance,

"YES I do think that with Microscope i would be able to cut more grafts and much finer and least wastage."

We recommend physicians based on a high level of standards and you have met most of them. For your reference, I have copied our recommendation criterial below:

-----------

1. A demonstrated proficiency and commitment to performing high quality follicular unit hair transplantation using grafts that are microscopically prepared.

2. Dedication to doing follicular unit hair transplantation exclusively or at least as the main specialty of the clinic.

3. Excellent patient results demonstrating a high level of artistry and naturalness throughout, as well as excellent growth rates.

4. A reputation for high ethics and quality amongst colleagues and former patients.

5. Extensive experience performing hair transplantation.

6. Medical training, depth of background, board certifications, honors and credentials are also considered.

7. Excellent value - as determined by quality and pricing taken together.

8. Mastery and control of the orientation and direction of the transplanted grafts to achieve a completely natural appearance.

-----------

If you purchase microscopes and feel that you have to increase the price to seeking patients to compensate, I feel that this is perfectly acceptable. If you look at criteria number 7, it stands to reason that the quality of using microscopes outweighs in value the increase in price, especially given the very low rate you currently charge. Perhaps increasing your price and purchasing microscopes is the best way to go.

I can tell that you are upset by our decision, but know that our decision was made with a heavy heart. Pat and I still feel that your results are the best in that area by far and would love to recommend you once again. We realize now that there is no physician in that area that we recommend and makes it difficult for seeking patients. But if you are willing to purchase microscopes for each of your cutters (as you stated), I strongly encourage you to do just that and we can talk to you again about recommending you on our network.

Feel free to add your thoughts.

Falc

I feel dr. Mohmand does phenomenal work and should not be suspended.

I almost feel this is going to be injustice.

I know that it would be a huge financial outlay. Possibly there would be a consideration if you were to buy 1-2 and slowly add more over time? I don't think that in good faith we can state that because it is a poorer nation that it doesn't have to live up to the recommended standards, but nothing states that every cutter has to have one. The larger grafts could be prepared with the loop and the finer ones done with the microscope.

Just a thought.

I must say that his work looks very good and those grafts look good too. And he sounds intelligent and appears to have good credentials and considers his patients best interests.

In his part of the world, the microscopes may be relatively much more expensive than in the USA. I'm guessing your average pakistani earns 1/10th of what an american earns, and his prices probably refelct this. Microscopes will increase his overhead but may not improve his results much if at all, so it may be in the best interest of his patients to continue with his current methods, but this disqualifies him from the coalition on a technicality.

My advice for the doctor is that his work appears excellent and that will advertise for itself. There are many internet formus that discuss hair loss and hair transplantation.

quote:

but this disqualifies him from the coalition on a technicality.

quote:

My advice for the doctor is that his work appears excellent and that will advertise for itself. There are many internet formus that discuss hair loss and hair transplantation.

He can still post here on this forum right? Since his work is obviously good and serves a much needed niche market I would value his continued postings of results and general forum participation.

The users on this forum are actually as valid and valuable a resource for recommendation as the forum coalition. In the end, it's the patient makes the choice for what's best for him/her. His exclusion from the coalition for this technicality may be acceptable for some, all considering.
.

Finally cat is out from bag!!!
Hi,
I think this network strongly recommends those doctors who are meeting established standard of ultra refined follicualr hair transplant and using microscope in their practice for betterment of patients.
By using loop one is violating basic requirements of ultra refined technique or let me put an other way
-With loop magnification ,can we do ultra refined follicular hair transplant.
Though uptill now results of Dr.Mohmand are not bad but we can not say excellent as well.
However in future continuous patients reporting is required to consider him good coalition doc.
Till now evidences are sufficient to remove him from coalition doc....

Well Falc

Fair enough that one really has to use the microscope, but I personally, am not convinced. Obviously cause i might be biased, I think as a clinician and Doctor first. I personally think, microscope is a toll to make more grafts with what we have in other words we are making naturally occuring pairs into two grafts and then charge them for two as well. YES we give a very bright name ULTRA FINE.....looks and feels good like Faheem said. I would like him to show me excellent results from his standard if mine is good. I never claim I am perfect, but as a clinicians I have to also see if the results will be changed significantly, YES grafts will all be single hairs or maximum double hair. The results will be same. After all the yeild of hair and grafts are two different things.
Apart from doing and achieving excellence in one treatment I need to protect my clients from extra burden as well.
Using microscoe will not increase the amount of money as in investment point of view. All I would do is make more number of single and double hair grafts rather that naturally present 3 and 4 hair grafts as well, so what happens we charge more.
Please take my point of view we are here to protect consumers in every way, not only in terms of equipment.
TELL ME HOW MANY OF YOU HAVE SEEN BAD RESULTS FROM EXCLUSIVELY DONE FU HAIR TRANSPLANT.

I would like to see the results in asian patient, not caucasians, better than that with microscope.

I will post my patient close up with loop magnification in a day or two........

In the mean while please comment. Dear NN, the whole life is full of exceptions. As far as doctors in USA, I feel apart from five or six of the doctors and Ron Shiparo is obviously oneof them, I am equivalent to most if not better.
I feel proud o my work and I will show you some others as well. Till you are convinced that i can be a member based on my outcome and not equipment.

Dont take me wrong, I protect patients more than I protect others. They are my assests, I am because of them.

Regards

HM

well i have seen dr mohammad's work several times and i am convinced that no dought he is a excellent doc and doing great job...u can never match the human skills with technology...i think he should stay here on this forum...i strongly recommend him to be a coalition surgeon...

Microscopes are not simply used to "cut grafts down" as is being pointed out....

Microscopes allow technicians to actually cut grafts into actual follicular units and trim them properly-----

5-6 hair grafts may seem to be one follicular unit or even a follicular family under loupes, but once examined under a microscope turn into 2-3 hair grafts or a 4 hair and a 2 hair graft, etc....

Of course, it is fine to leave some groups together---almost all docs do this for some patients--- but trimming them down as much as possible before implantation using a microscope is best.

Another aspect is when the donor strip is cut amongst the techs under a microscope you can help avoid some transection there as well.

Microscopes are a FUNDAMENTAL part of doing hair transplantation--- the benefits to the patient AND the benefits to the technicians far outweigh any cost to the clinic.

Here is an excerpt from a study conducted by Dr. Bernstien--- comparing loupes to microscopes.

41 patients studied. Microscopic dissection produced, on the average, 10 % more follicular units than loop dissection. The average number of hairs per implant was 2.28 with the microscope, and 2.14 with loop dissection. The average total number of hairs generated by the microscope was 17 % greater than with the loops.

http://www.newhair.com/resources/mp-1998-dissecting.asp
(for the entire article)

Please note this is in 1998--- 10 years ago.
It has been proven that with smaller instrumentation and dense packing ultra-refined grafts DO grow.

In fact the study points out the major reason for not having microscopes is they initially slow the staff down by as much as 25%--but once microscopes are used average cutters can improve drastically.

I hope this puts this dicussion to rest.

Jason

I think first and foremost we should be chosing based on results regardless of how they are achieved. A doctor using a microscope could be overcharging patients or could have a poor staff transecting grafts. A piece of gear will not overcome problems.

I know one of the very highly regarded Doctors on this Site, Dr. Beehner, has been producing excellent results throughout his career and for most of it (very possibly _still_) was a proponent of using micro grafts internally for greater density! Are we calling these double FUs now? Graft for graft I must say that his results look very dense. I'm not usre if he has migrated to using exclusively FU megasessions.

Isnt this argument similar to Pat's "Dividing a pizza into more pieces does not make the pizza bigger"? I know for a while he was defending some of the docs who were not getting uber-sessions and claimed that this was because they were not dissecting the grafts as small. That on average, their grafts had more hairs. Count hairs, not grafts! So there seems to be some debate as to what actually constitutes a FU. If didffernt clinics are getting more one's than others, then what consitututes a "FU" seems arbitrary.

So there seems to be a continuum. We've got doctors like H&W getting excellent results doing uber-sessions. When their average hair counts are examined, it seems that they are getting proportionally more 1's than (say) a doctors like Shapiro and Epstein, who are _also_ getting excellent results. Then youve got Dr Mohamand who is perhaps using primarily double FUs with specailly trimmed 1's for the hairline and getting excellent results.


I think everyone needs to chose based upon their needs. H&W are an excellent choice because of their consistency, dense packing, and large session sizes. Are you paying more per hair? Very possibly, but you know that going in.

Maybe a doctor like Shapiro who has stated he likes to use double FUs in some patients for additional density is abetter choice. His sessions may not be as large on average, but possibly the value is higher and the cost per hair is lower.

Then you've got Dr. Mohamand who is using morse double Fus, showing density and refined hairlines, coupled with large sessions. Possibly there is some graft wastage, but his cost per hair is the lowest.

On the other end of the spectrum, you've got FUE dos who are possibly wasting grafts, are considerably more expensive, but do so without a donor scar and an easier healing process for the patient.

This comes dwn to a fundamental argument that has not been answered for me: Density vs. graft size. On one hand doctors who trim lots of small skinny grafts claim they can more densely pack. On the other hand, doctors using double FUs claim they can get higher hair density. If its the same number of hairs, then why would double FUs provide greater density? But the pictures and some docs seem to support this notion. . .

You raise excellent points E----- points that have been routinely discussed and should continue to be as we move forward.

I do not want to confuse this topic with my only real point--- microscopes in the hands of conscientious Doctors and staff limit donor waste vs those who do not use them.

I will readily concede that the use of larger grafts in some patients provide excellent density. However, that type of decision should be on a patient to patient basis---a doctor should be able to switch between the two.

I will also concede that there is no "one method" or "approach" to achieve great results.

However, one thing that can separate these methods is artistry and skill of the individual doctors. It has been mentioned that Dr. Shapiro achieved great results using mini and micro grafts---but that is a testament to his skill and artistry--NOT necessarily the method---- but you have to note---he made the change to all follicular unit dissection and started doing sessions of 2000+ grafts because he could perfect the naturalness of the hairline and limit incision sizes and still get great yield. Now SMG (and others) routinely do sessions of 3000+ refined grafts.

Another point to consider is the hair vs graft debate you bring up.
At the end of the day the hair moved is the hair moved. BUT-- the orientation of hairs to existing native hair, density achieved in specific zones, and level of baldness all contribute to a "result"

Dr. Shapiro will use some DFU's in the frontal core to provide density -- ie think a 4-5 hair graft with all the individual hair exiting the scalp at almost the same point--- the theory is that the hair exits the scalp and "fans out" to cover more area --- say a 1.2mm incision is used---

Balance this out by a different approach where 2- 2hair grafts are placed together in the same area using 2 .7mm incisions for a total incision of 1.4mm---- If the incisions are orientated to create the shingling effect (Dr.s Hasson and Wong) the 2 hair grafts occupy a slightly larger surface area--but essentially cover the same space.

Each method is as refined as humanly possible and when coupled with the skills of Dr.'s like Dr. Shapiro, Dr. Hasson, and Dr. Wong the results are and can be amazing.

Take Care,
Jason