Over at the other forum, no disrespect to Pat and this forum but it took me forever to figure it out over there and i havent even tried here yet, anyway this is a duplicate post i put up over there.

Check them out and form your own opinion on my first surgery with Dr. Ron Shapiro, when i look at them now i think he did me VERY well, ive come along way so far and ive got a way to go but hey thats why im here posting and sharing instead of drinking and joking with my other friends, today i went to Shapiros clinic to get these pics and met Dr Haber & Dr. Paul Rose, they all checked out my surgery from Dr. Hasson and commented that the work was excellent and i was going to look great, Dr. Shapiro also commented that i had more donor left, F@CK YEAH today was a good day!!!!!!!.

Im trying to share this so that anyone with recession as bad as mine was can have hope of letting it grow out and not having to shave to a #1 every 2 frickin days.

Another thing is yeah i know im one UGLY MOFO but soon my hair might cover my face hahahaha, and it hasnt effected my success much because i got a great woman, make good money and overall not depressed about this shit, i just have the power to change it now and im gonna use it.

Thanks for following so far and i will try to update my progress, oh yeah my girl took out my staples yesterday, yeah it stung like a beotch

Sincerely, Mudpuppy

Mud, after looking at your pre-first HT, I have to admit that your donar area looked like crap. I mean that in the nicest way. I just never would have guessed that you could get that many grafts out of it. I can see why Shapiro went conservative with you initially. Man! If you can get 5000k grafts out of that, I must have over 10k left!

hey mudpuppy, would love to see your pics bro. i had two surgeries from shapiro myself and waiting on results from my second procedure. In a few months ill probably post some pics too. just wondering if i could get a link to this other forum somehow?

Hey Gorpy, When i first started researching i thought i was going to have great donor because i always had long hair and real thick in back, i started shaving to a #1 or #2 approx. 8 years ago, i never looked at my donor area much until those pictures From Shapiros or a straight side view either, it seems to just creep up on you, needless to say i was humbled and quite bummed when i left my consultation at Shapiros, since taking Propecia for a year and letting it grow out a bit the Doc feels my donor is good and i might have more donor left, so far i have used 5820 graphs, Doctor Shapiro says i might reach 8000 in total, i am only taking that as maybe and im happy i can reach my goals with my plan of 1 more strip and then some small FUE's, also realize that in those consult pics i shaved to the scalp and then spent 2 weeks in the sun on a Tropical island, i dont know if it bleached out my hair or lightened it.

Tropicoo, go to hairlosshelp.com, do a search on "my Shapiro pics are updated on my profile" the click on my website under neath my little Mudpuppy with the Blunt.

I will start to work on my pictures to post on this site

I wanted to post mudpuppy's photo on the HTN so people could see the reason we were conservative with him. When he arrived at our office he had extemely short hair which influenced our evaluation. It looked as if he occiputal area might drop and his lateral donor above the ear was so thin we worried that even with a fine scar it may show.

I am glad that with propecia and with letting his hair grow it looks like he will have more donor than his initial evaluation indicated. If I had seen him at the 7 month point I would most likely have estimated about 2500-2700 for his second session by the way his donor looked to me now. I hope these photo explain to a small degree why we we were more conservative with him intially

Here is mudpuppy's album
mudpuppy album showing inital potential poor donor

As it turned out Victor(Hasson) was able to get 3200 instead of the 2500-2700 I might have done) And he did a great great job. He and Jerry(Wong) do wonderful work. Victor,Jerry and I are friends and I respect thier work tremendously. I never have an issue when patients elect to go to them becuase I know they will get great work.

On another note I want to appologize for not posting as much. I have been so busy lecturing, writing, and talkng to my patients that I have not really spent alot of time on the internet. It has led to some misconceptions about my current approach which has changed alot in the last 2 years. Even my web site is over 9 years old and is out of date. For example I have done a number of cases greater than 4000 FU and have been creating 1 pass densities of 50+ for years. But I vary my approach tremendously depending on the individual. My numbers can range from 1500 over 4000 and my denisties can range from 25 to over 50 in one pass...depending on the situation and patient. Sometimes the more the better but sometimes it may not be the best choice. Over the next few months I plan on posting and sharing more how and why I approach diffent patients. I hope that patients and visitors to the forums find it helpful. I have been told I am a good teacher and have a knack for putting things in perspective . I hope that I can contribute here. The only problem is that I am so compulsive about getting things right that I can spend hours and hours on a page of text..and not finish it...Writing does not come easy to me...talking does.......However I have decided that if I am going to contribute I cannot worry about it being written perfectly. Better to contribute some even if it is not written well than not contribute at all.

Hope to be in touch soon

Ron Shapiro

Doc,

Thanks for providing the particulars of Mudpuppy’s condition and insight into your thinking. As so often happens when all the facts are in, I agree with your assessment and judgment.

I know I have benefited greatly from your input and sound judgment, which has guided much of the philosophy and evolution of this community over the years. I know your active participation on this forum will elevate the level of discussion and will be much appreciated.

I do think people’s perception of your work, along with other members of the Coalition, is in need of updating – especially in regards to session sizes. So often there is a mismatch between the reality of a physician’s surgical work and people's perception of it on the forums.

Often this is due to clinics simply not participating on this and other forums. Thus their work is out of sight and out of mind. It reminds me of the proverbial question - "If a tree falls in the forest and no one hears it did it make a sound?" On this forum the question could be "If a surgeon does outstanding hair transplantation and no one sees it on the forum will anyone know it?"

Thus the few clinics who cultivate an active presence on the forums get most of the attention, discussion and ultimately patients.

I believe there are many very quiet gem in the rough clinics who are doing large sessions of outstanding ultra refined follicular grafting like you but who get little or no mention of their work on this and other forums.

Fortunately most of these gems are members of the Coalition and thus do get some amount of recognition for their work online.

But I'd like to see more information about all great clinics on our forum. I think this ultimately serves potential patients better, while giving great clinics the recognition they deserve.

I hope that your involvement in sharing your results and surgical philosophy will act as an example to your colleagues.

Ron

Try Dragon Naturally speaking Preferred voice recognition software (version 8.1+). With a bit of training - not much - you will be able to dictate into the textbox of forums and also use it in letters etc.. word,

It really is good technology. If you do not already use such software give it a try

sparky

Sparky, man that program is pretty cool! You just can't talk super fast, but it is usefull for the hands free approach!

Dr. Shapiro,

Many thanks for your kind words regarding the work that we perform at H&W. Coming from you we could not receive any better compliment.

All,

It is really rewarding to see a physician of the stature of Ron Shapiro starting to adopt our philosophy in hair restoration surgery. Hopefully other physicians will follow Dr. Shapiro's lead and that one day large sessions of ultra refined follicular unit transplantation will become the standard of care in our specialty.

I'm certain that Dr. Shapiro's continued involvement on these forums will provide much new insight and depth to the online discussions.

Victor Hasson MD

I will look into the Dragon technology. Sounds cool and it may work with the new Nextect software I am implementing at the clinic

Nice hearing from you Victor . I hear you are going on vacation soon. You work so hard you deserve it. Thanks for the compliment. But you and Jerry deserve yours as well.

I had a question for you if you dont mind answereing on the forum.

A 3000-4000 FU session is not that difficult to do at least for me and you .

But the 4500-5500-6000 sessions take more skill and technique and I think (or am curious)a specially qualified patient.

When you do a 4500-5500 session what qualifications do you require. Specificall with respect to the donor area. I am also curious about how long and wide a strip do you usually need. I know it varies with donor density.

The reason I asked was yesterday I did a patient who was a virgin (with respect to hair tranplants) and I felt he could use 4500+ FU. He fit my criteria for a larger session(i.e He was a type 5, no hair in the recipeint area to shock, had very very loose donor so I could take a wide strip without tension or much risk of a scar, his donor density was only average however ) So I took a strip that was about 1.8mm x28 cm wide ( usually a 1.0x25 gives me 2500 FU) and expected 4000+ but only got 3800 FU. Not a small session but I had thought I would get over 4000. The case of cource turned out great and he will look great but I was disapointed that I did not get over 4000FU this time.

I have been reluctant to take strips wider than 2.0 so the only patients Ihave gotten over 4000 FU with have been those with very above average density.

So I am curious about what the size of your strip is for the 4500-5000 cases. Is it the same I took but these patietns have very very good density (above average) or do you go wider sometimes if they are loose enough that you dont think the risk of tension is significant.

I hope you dont mind me asking on the forum but I think knowing your approach and thought in this area would be very enlightening to all both physician and potiential patients.

Take care Ron

It would be educational to know and maybe it would be of interest and educational when your patients that do these very large session post to get an idea of how thier particualr donor ranked compared to average and how much was needed.

Dr Shapiro,

Just curious....are you currently, or planning to in the future, incorporating the new closure methods?

Awesome to see both Shapiro and Hasson on the boards!

Dr. Shapiro,

Great to see you participating on the boards. Dr. Hasson is out of town at the moment but I'll be sure to point our your questions so he can respond when he returns.

J-69, Dr. Shapiro has been using a variation of the "Frechet"/Trico method, which of course is the closure method that allows hair to grow through the scar itself, in essence creating a "scarless" HT. How do I know this you ask? Because I had this method used on me!!!!!! Since I have to have all of the information possible about everything, this closure technique interested me greatly (as it does all of us!). Dr. Shapiro's associate Dr. Rose is also quite well known for the LEDGE closure method as well.

b-spot......how does your scar look, and how is your scalp elasticity?

thanx man

Looks great for only 4.5 months. Still a little pink, but that's normal. Keep getting the bumps from hairs pushing through the scar itself. As far as scalp elasticty, I do the Jotronics prescribed scalp exercises daily so my scalp is pretty loose. You have to understand that my strip was only 1.25 cm wide (although it was 27 cm long). That is not a wide strip at all, so I was in no danger of tightness. I think I might ask for a bump up to 1.4 or 1.5 this time in order to yield well over 3000 for #2.

thanx B....I never heard Jotronics prescription....what is it and how fast can one expect to yield results? Im going in for #2 in a lil over a month...shooting for 3000 more..

Go to http://www.hairtransplantmentor.com/
and click on scalp exercises----- They really seem to work for me, so I highly recommend them, especially if you are doing #2...

B,

You might want to lighten up on those exercises for a while. I don't want you doing them vigorously until six months post-op from HT #1. Let the donor area heal my friend then get busy.

Absolutely Joe! Mine are more of a "head rub" at this point, and I will gradually increase them as time goes on. Thanx for the warning

Ron,

Sorry for the delay but I just got back into the clinic recently.

-Regarding the patient dependent factors for harvesting 4000 plus fu sessions.

Firstly, I am surprised that a 25 x 1.0 strip usually yields 2500 FU in your experience. It is my experience that the average donor density is in fact less than 100 fu per cm2. The reason for this is that the FU density usually falls off progressively as one moves from the occipital to parietal and temporal scalp. There is often a 15% to 20% loss of density between these areas. My average strips for larger sessions vary between 30 cm and 34 cm in length extending anteriorly on both sides to above and in some cases in front of the anterior border of the ear. Perhaps because I am utilizing more temporal scalp for donor this is reducing my average yield per cm2. For most patients it is possible to harvest a 30 cm by 1.5 cm to 1.8cm strip to yield approximately 4000 grafts. For sessions that exceed 4000 fu a patient will need both greater than average density and laxity. It is not that uncommon for me to harvest strips reaching 2.5 cm in width. The secret here is that the strip width is not kept constant for it’s entire length. I divide each side of the strip into three separate sections corresponding to the different tensions along each side of the strip. The widest sections of the strip on each side are above the ear and posteriorly. Scalp has most tension in the area directly above the mastoid prominence on each side. Correspondingly I will taper the strip by as much as 30% or 40% in these areas. In this way I am able to close the wound with uniform tension throughout the length of the strip. Maintaining a uniform tension over the entire length of the strip is very important as increased tension above the mastoids will reduce the tensions in neighboring areas and the majority of the scalp tension will be borne in the areas of the wound above the mastoid resulting in wide or stretched scars.

-For those sessions which exceed 5000 fu.

In addition to high density and laxity the patient will often have a larger than average head enabling up to 4 or 5 centimeters in additional length for the strip.

As you are aware it is absolutely essential to maintain optimum conditions for graft storage and handling when performing these larger sessions. For this reason we do not recommend that clinics rush into these large megasessions. It has taken me approximately four years with an experienced team of twelve to fifteen surgical technicians to get to the level where I can confidently perform surgeries of 6000 or 7000 fu’s. The more often you perform these megasessions the easier they become. We perform sessions of 4000 fu on an almost daily basis and have performed hundreds of these size surgeries. Contrary to what other physicians may claim the yields from these surgeries are every bit as high as when we were performing 2000 fu sessions several years ago. The impact of these larger sessions on the patients is far greater and I believe the reduction in number of surgical procedures that a given patient needs to undergo are quite obvious.

Ron, I honestly believe that the combination of these megasessions with densely packed fu’s placed in lateral slit incisions is the way of the future. For me, it is really gratifying when a physician of your reputation starts to adopt techniques that we have pioneered. I hope that patients find this explanation useful in their hair transplant research.

Victor