http://hair-restoration-info.com/eve/forums?a=albumtopi...1017123&f=2566060861

BRAD LIMMER, MD/jac

Always good to see the thoughts behind the mask.

Excellent information Dr. Limmer. Thank you for taking time to put your perspective on this forum; it can only help to better educate prospective patients and those who may be finished with hair transplantation but stay here to help others. Getting this kind of input from an actual physician as experienced and dedicated as you is truly a blessing for all of us. Thanks again!

These are the best immediate post-op pics I have seen from the Limmer clinic.

The scar is great.

I am glad that my comments and the comments of others have prompted a response from the Limmer clinic--- in an effort to dispel preconceived notions held by many.

My personal feelings on clinics offering a real option for patient results is 3000+ grafts.
Any clinic should be able to offer 3-4000 grafts using the formula of strip width the Limmers posted and still keep scarring to a minimum.

I disagree slightly with the transplanted density, but 40 fu's cm/2 will still offer a tremendous cosmetic difference to a patient and set them up nicely for a second pass.

This is the type of information myself and others have been looking for from the Limmer clinic and I am glad that the photos are impressive.

Thank You Jessica,
J

dude

that was one of the best ie cleanest scars ive seen.

if the doctor is achieving this goal above average
hats off

Jessica,

Thanks for posting the link.

Post op results look clean, and I agree with B Spot on the scar.

I'm also glad to hear that you do larger sessions when needed on patients.

I'm also in agreement with B Spot on the 40 fu's sq cm. Though this will offer a cosmetic difference, clearly more density would help decrease the see-through effect. Of course, this will depend on other variables such as how many hairs per graft, hair/skin color, and hair texture.

I hope to see this particular result grown out and more like this in the future.

Falc

Falceros:

There are many variables that come into play as you noted. One not mentioned is that of original follicular unit density along the frontal hairline and top of scalp. The most dense area on the scalp is typically in the donor area and for the vast majority of men, ranges from 85-95 fu per sq cm. The frontal and top of the scalp is almost always less dense, often by around 10%. This puts many men at a fu density of 80-85 in the typical frontal/top of scalp. Remember, everyone is different and there is a vast range.

Bringing into play the 50% rule (50% of normal density can look like normal density) a 40 fu/sq cm pass comes right up to that. So there will be a significant change in one pass. Obviously, greater densities can be achieved; it is the approach to achieving these higher densities where the differences exist.

Our approach has been modified and developed through years from not only our own experience, but that of other physicians (especially many of the Coalition members). Based upon patient results (ours and other physicians), along with research data we have arrived at our approach. For many, one pass at 40 grafts/sq cm can be enough. But I always discuss a second pass 9-12 months later, especially true in the younger patients.

There are so many things that factor into our reasoning/approach to transplantation that it is difficult to express them all. Weighing the pros/cons of each method along with evaluating ours and other physicians results is how we determined our approach. I look forward to more discussion, patient education and making hair loss patients happy.

Brad Limmer, MD/jac

Jessica, yes that is correct, based on the 50% rule.

However, one would like to see a slightly higher density performed on patients who require 55-70 fu's in the hairline.

Obviously if we base every patient on NW5-6, then yes, your transplanting at 35-40 is right on target.

Given that hairline work is being done at higher density's (using 1 hair grafts) it would be nice to see some 55+ density's in the hairline if you have them.

Thanks,
J

Jessica,

Good points.

I agree with B Spot's last statement though. I'll also add that if a patient has the available donor hair and the area that needs coverage isn't as large, why not shoot for more density assuming the patient wants it? Whereas 40% may be enough, considering lighting, surely 60-75% of original density will make even more of a difference and look better in brighter more obtrusive lights.

The point is, I think desired density should depend on the individual, not be based on a general rule for the clinic. Hair characteristics will play a major role into whether or not 40 fu/sqcm is enough. Just some food for thought.

Falc

the B-spot / falceros:

I think we are closer together in our thoughts than you or some might believe (and all only want patients to get good results). Each case is looked at from an individual perspective and many times what is done (as far as coverage & graft #) has to do with what the patient wants. Some patients want a big area covered which necessitates lower densities, while other have small areas and can be planted at higher densities.

I personally spoke with Ron Shapiro today and as I expected Ron’s and my approach are very similar. While we all do some things a little different (because of our own personal perspective) much is quite similar. Whether this be views on donor harvest size, graft placement densities or stick/place methods of graft insertion.

Hopefully Ron will follow up with a post regarding these topics/discussion. He notes he has wanted to, but as I can a test to, it takes time. I would actually like all top physicians in our field to get together and better clarify what is the norm and what is the exception. The pendulum of approach to transplantation swings back and forth and I would suspect the physicians like Ron and myself fall in a category I would call “Cautiously Aggressive”.

Thank you for your input and hope this dialogue has helped.

BRAD LIMMER, MD/jac