quote:

They also happen to do the best results in one session. Forget numbers just look at results. Show me shapiro's best result and I'll show you 10 better from H&W.

Yes throw 1,000,000 men into battle and more are gonna live. But the ones that are lost can't be replaced and the ones that live could have been strategically placed in other areas to fight the battle better. These are your results.

You could show alot of results. I could also show you comparison photos after comparison: in one photo an APPLE and in the other photo an ORANGE. Two words: hair characteristics. This determines the outcome.

And if you want to forget about characteristics and focus on numbers then any of the top docs are capable of throwing another 1000 or so grafts on the head in one pass. To do this day in and day out is simple. Hire some extra techs, get a few more microscopes, and encourage their patients to flood the hell out of the hair loss forums with their comments and photos to keep the business coming through the door. It is domination with strength in numbers not necessarily better results than any other capable clinic.

quote:

Well you can always continue to walk around with your infinitely "natural" results (AKA bald) and go with that. Whatever floats your boat pal

You seem quite hostile. Don't let your emotions get the best of you it is simply a matter of different philosophy and it is up to the consumer to decide what is best for them. But to do this they need to see both sides of the story. There are TWO sides to every story.

They have good and bad results like every other top doc. The difference is the presence of patients on the forums. It is quite bizzarre behavior that you don't see from other docs. For some reason they have motivation to hang around the forums, almost to the point of policing them as I see you are sort of doing to an extent. Other docs like to stay low key and that is a good thing if they don't want to get involve in the mudslinging for no good reason that goes on. This is once again where the domination of the forums marketing tactic comes into play.

On the forums I have seen them go on to silence their own( fellow recipient of transplant from their clinic) when they come to the board and are not satisfied with their result. The matter is quickly swept under the rug. Results posted are oooed and aaaaaawed if they are one of their own. Good results from other top docs are not necessarily criticized in all cases but there is always that belittling jab thrown in here and there so it doesn't shine like it rightfully should. From a sociological perspective it would be described as gang-like.

Jotronic catapaulted his clinic into the spotlight. He came along in early times of this industry, an industry with a dark history, and showed off his results. With his internet savvy, he became the orinal dominant presence on the forums and marketed his clinic to the top. It's none of my business but they owe him alot for what he did for them from a marketing stand point. Had Jotronic gone to any of the other top docs they could have done the same for him in terms of fixing his bad transplant as he is blessed with great elasticity in his donor that allowed for multiple strip procedures to get him to where he is now. Had Jotronic gone to another top doc they would have been the beneficiary of all of Jotronics marketing genious, the average Joe that got saved by his clinic. His clinic took off from his dominant presence on the forums. Had Jotronic poor elasticity in his donor, it would not have had such a happy ending and would not have been as lucrative for both parties involved.

Well hummmm, this kind of discussion is the reason I come back to this forum. I had a rather "small" procedure of 2650 grafts about 7 months ago. I don't think I am going to see the kind of density I am looking for BUT, I had quite a bit of native hair in the area transplanted. So it stands to reason that perhaps a conservative approach was the way to go. I DREAD another surgery, so understand the reason for a larger one pass surgery. Was I a good canidate for one, probably not. At the end of the day, I am interested in a fantasic result not $4,000.00 one way or another. This will affect how I look and feel for the rest of my life. I really see and understand both sides of the equation. I do appreciate all the interst and passiion this subject seems to generate as it has made me a better patient/consumer of this type or surgery.

Cheers

Sorry for the typing errors!

Landen, you seem like a very intellegent person and bring a lot of thought to the table. I am still watching and observing. I think most would agree to get to your reseults as fast as possible with as little procedures as possible is the best route. A couple thoughts I have about mega sessions, when you have a very long scar, sometimes hairloss goes down along the side, above the ear, I wonder would the scar be visable. Maybe I am wrong and it wouldnt be an issue. Also going a little more conservative gives the industry time to make its advancements, if you did 2 procedures over 3 years the industry could change remarkably and has. I have seen amazing results from both clinics. And in the future I will go back to Shapiro, because they are 15 minutes from my home and they treated me awesome I also would recommend DR Rose to anyone. I would also goto many docs on here. This whole debate is very interesting, and obviosly emotional. I am out on this and will wait and watch over time and see what takes place.

Let's keep in mind that details, some of which are subtle, differentiate the doctors from each other. I call them style and technique differences. That doesn't mean one style is necessarily better than the other.

If one doctor's technique is to use smaller fu's neatly placed close together, that doesn't mean you are getting ripped off. If it creates fantastic results, you are ultimately the winner.

There are other style and technique differences such as:

- Some docs fade into the hairline with less density to high density. Others will produce a harder, yet still natural looking hairline.

- Hairline design differences obviously exist with all of the doctors.

- Exclusive use of lateral slit compared to a combination of lateral and sagital.

- Dense forlock spreading out to thinner sides, compared to a more even distribution.

- Tendencies to go with a higher hairline vs. a lower hairline that frames the face.

- Dense packing vs. less dense packing.

- Donar strip closure techniques.

- And obviously, huge megasessions vs. multiple smaller sessions.

When I viewed Pats' pictures from H&W I was astounded over the amount of donor tissue that was removed and also how some was taken from above the ear.

The reason for my surprise is that it has always been my understanding that you do not want to remove tissue above the posterior occipt bone in the skull, due to the fact that this hair may very likely fall out. This has always been a rule of thumb because the hair located below this bone is genetically programmed differently in most patients, which ensures the growth and success of the transplant.

If you transplant hair that has the DNA to miniaturize it will eventually fall out.

Well, I take a day off from the forum and WHOA!!!!
Anyway, let me take a moment to remind each of us, that we are debating two different philosophy's, and a question of what appears to be inflated graft counts over actual hair transplanted.
Let's start with this--- an industry standard of graft breakdown is 65% 1 an 2 hair grafts, 26% 3's and 6% 4's. Even if a patient is slightly skewed one way or the other, these numbers are typically constant.
1000 grafts
650 1's and 2's
260 3's
60 4's
If we multiply the hair moved here using estimates for 1's and 2's this is what we come up with
325 1's = 325 hairs
325 2's = 650 hairs
260 3's = 780 hairs
60 4's = 240 hairs
total = 1995 hairs for a 1000 graft procedure
Using these estimates please note the actual HAIR to GRAFT ratio is nearly double. I realize that these are estimates, but they represent a industry average which can change slightly from patient to patient.
Using this estimate we can say that a 3000 graft procedure should produce roughly 6000 hairs. We can estimate 200 to 300 grafts either way for physiological make-up, but either way a ballpark number of actual hairs is able to be estimated. This takes us to some very interesting questions---- What are actual hair counts versus graft counts? Does waste percentage increase if many naturally occurring follicular are being split at a higher than "normal" rate? Does pricing reflect naturally occurring follicular units?
3000 graft procedure producing roughly 6000 hairs costs:
2000 grafts = 9000
1000 grafts = 2500
total = 11500

a 6000 graft session with roughly 12,000 hairs would cost
2000 grafts = 9000
4000 grafts = 10000
total = 19000

This is great, but without hair counts how do we know that 12,000 hairs were moved? What if 8000 hairs were moved, roughly the equivalent of a 4000 graft session that costs 14,000, which is 5000 less? So the question is why pay for 6000 grafts, when you are getting a 4000 graft session turned into a 6000 graft session?
I think this is why we need to understand what is actually being done in these 4000 to 6000+ megasessions. (ie, 8000 1's and 2's versus, 12,000 naturally occurring FU's)
If we look at the information given we can come up with some solid answers. Pat detailed the fact that H&W does NOT keep track of hair count. I think that has to change, in order to put this issue to rest, permanently. Splitting grafts is a practice EVERY clinic employs, and that is a FACT. The question is how much, what is the benefit to the patient, and how much additional donor waste occurs as a result of blade trauma and technician fatigue?
This is an question that needs to be answered, in order for us to move forward and understand the nature of the industry at this time. If the hair counts moved in these mega-session prove to be spot on, I will gladly tip my hat to the genius of H&W, and they will have earned a heartfelt apology. If not, then I think we need to re-evaluate these graft sessions, and see what can be done to put things in proper order. I cannot argue with some of the results that H&W has shown over the years, but I can question philosophy and practices.
I hope this issue is resolved to the satisfaction of all the members of this forum, H&W patient or not.

quote:

Originally posted by Landen:

quote:

There is no danger of running out of donor hair if the grafts are positioned wisely. Good clinics do not pack 5000 grafts into a hairline. That's nuts. Proper distribution with the future in mind is key and insures that the future will not be bleak for the patient should they lose more hair.

No there is a danger. A real danger as a matter of fact. You see as the years roll on the transplanted hair stays thick and strong as the unttransplanted hair recedes and miniaturizes. This is process goes unnoticed, and then the patient looks in the mirror and notices these grafts standing out more and more eventually to the point where it is blatantly obvious that it just doesn't look right. With the donor wiped out, good luck trying to fix it. That is poor surgical planning to exhaust donor reserves in one pass before the patient has COMPLETELY halted hair losss or you some how have a crystal ball and you can see the ultmate norwood level of the patient. It doesn't matter where the grafts are packed. In about 10 years we'll see who is right. 10 years isn't an eternity. There's something brown thrown against the walls, it sticking but it ain't mud.

That was a nice break down of price. In the end your clinic makes more and it was a smart financial strategy in the sense that a dollar today is worth more than a dollar tomorrow. Time value of money allows your clinic to reap the benefits of earned interest and you don't have to worry about if the patient has a chance to see the grown out result, not like what they see , and not come back. Whether the patient wants to rush to the point of completion or not, it just isn't in their best interest at times physically and financially.

You have been in this game a long time so anything that anyone says, you can come back and say something else. You have been playing this hair transplant game for a long time and your paid to do what you do. You have vested interest. I don't make money from showing the other side of the story and I don't represent any doctor. I speak for all the top docs that can produce good results. Don't drive the economics of the hair transplant industry by running up the graft nubers to a ridiculous level in one surgery. Things change NOT for the good sometimes. Sometimes things are forced to change because people have demanded what they THINK is right because this is what is forced onto them. Even the good conservative docs must reach a point and change for the bad to stay in business.

There is NOTHING wrong with a decent moderate size procedure. See how it looks on YOUR head with YOUR hair characteristics. See how YOUR yield turns out. See where YOUR hair loss is heading. See if different technologies come about that are less invasive.

And don't cut the grafts up, if what i read is correct. Leave them alone unless you need to make a few extra singles for the front.

With inflation at around 3%, it would almost 7 years for your time value of money to count. So unless your crappy results last you 7 years (scoff, ROLFMAO, LMAO, etc, etc) you lose. Clearly you're talking a little bit out of your field on a number of topics.

quote:

Originally posted by Landen:

quote:

Well you can always continue to walk around with your infinitely "natural" results (AKA bald) and go with that. Whatever floats your boat pal

You seem quite hostile. Don't let your emotions get the best of you it is simply a matter of different philosophy and it is up to the consumer to decide what is best for them. But to do this they need to see both sides of the story. There are TWO sides to every story.

They have good and bad results like every other top doc. The difference is the presence of patients on the forums. It is quite bizzarre behavior that you don't see from other docs. For some reason they have motivation to hang around the forums, almost to the point of policing them as I see you are sort of doing to an extent. Other docs like to stay low key and that is a good thing if they don't want to get involve in the mudslinging for no good reason that goes on. This is once again where the domination of the forums marketing tactic comes into play.

On the forums I have seen them go on to silence their own( fellow recipient of transplant from their clinic) when they come to the board and are not satisfied with their result. The matter is quickly swept under the rug. Results posted are oooed and aaaaaawed if they are one of their own. Good results from other top docs are not necessarily criticized in all cases but there is always that belittling jab thrown in here and there so it doesn't shine like it rightfully should. From a sociological perspective it would be described as gang-like.

Jotronic catapaulted his clinic into the spotlight. He came along in early times of this industry, an industry with a dark history, and showed off his results. With his internet savvy, he became the orinal dominant presence on the forums and marketed his clinic to the top. It's none of my business but they owe him alot for what he did for them from a marketing stand point. Had Jotronic gone to any of the other top docs they could have done the same for him in terms of fixing his bad transplant as he is blessed with great elasticity in his donor that allowed for multiple strip procedures to get him to where he is now. Had Jotronic gone to another top doc they would have been the beneficiary of all of Jotronics marketing genious, the average Joe that got saved by his clinic. His clinic took off from his dominant presence on the forums. Had Jotronic poor elasticity in his donor, it would not have had such a happy ending and would not have been as lucrative for both parties involved.

You don't see it from other docs because their results are shit. Your other "coalition" docs are totally unimpressive with the exception of one or two doctors. The rest of them use tools that look like someone's been poking your head with a pool queue, plant the hairline with *visible* gaps in the hair - a good example here is the woman who recently had her hairline done and has her picture posted on the photos section. There was no need for a non-fpb patient to conserve donour. Furthermore, her HT will be THIN and I said just that. This simply shows a pathetic doctor not willing to do right by his patient. This woman will NOT be able to wear her hair normally like she may have had the chance to, had she gone to a decent clinic.

Joe Tillman did not originall work for H&W when he posted his first photos. You clearly like to view things one way, and you'll clearly have more of these weak points to add because you argue with the logic of a woman, so I'm not going to bother offering any logic backwards, I'll just tell you where you're wrong.

ALL, we can muckrack back and forth and it really needs to stop, because the root of the issue is simply graft count versus hair count that is all. We can simply wait for H&W to begin detailing how much hair they move, OR, if H&W decides not to employ this practice, we can make legitimate assumptions based on Pat's observations. This is not a Shapiro/H&W battle, nor is it time to begin personal attacks on others. THIS IS A SERIOUS ISSUE THAT COULD HAVE A TREMENDOUS RIPPLE EFFECT THROUGHOUT THE INDUSTRY. Let's take a breath and RELAX, the information we desire will surface.

UGLY--- I understand your anger, and trust me, we have ALL been there. However, do not presume to cast the Coalition Doctors as "shit." In doing so, you are destroying the very foundation of what this forum is based on, which is free speech and a collective membership that allows laymen like you and me to critique doctors on a daily basis. As our membership has grown, we have seen several instances of poorly treated patients who have been offered remuneration as a result of the input of this Coalition. Another presumption would be that Pat does not hold these doctors to a higher standard, and in essence you are smearing his name, and what he has worked so hard to build. I would ask that we take the high road here, regardless of any presently falacious statements that have been made or will be made. TRUST ME when I say that this situation will resolve itself in due time, through due dillegence.

quote:

There are alot of excellent doctors turning out great results everyday that stay low profile and off the boards. It's all about marketing. Dominate the boards and keep the clinic busy and profit. Domination is the marketing tool. Naysayers are silenced, humiliated, and criticized. It's getting old.

Does the the tone of Mr. Ugly Man 4 Life's posts sound familiar to my above quote. This kind of forum bullying has been going on for too long. It needs to stop for the benefit of the consumer.

Spin % rates however you feel comfortable and create diversion. This isn't finance class at the university. This is real life where a dollar today is worth more than a dollar tomorrow. Ah yes, the debate tactic where we discredit by saying that one is talking outside his realm of knowledge.

quote:

Joe Tillman did not originall work for H&W when he posted his first photos

No one said he did but YOU! I merely said he showed off his results.

Landen, no prob, but I would ask that you stop the personal attacks at this point. Both you and Ugly seem like very intelligent people, your arguments are understood at this point, but I would hope that we could cool off a bit and wait. I am just as guilty as the next guy, but I would think that this topic is so important that we could keep it relaxed until we find out something definitive.
Just trying to keep it cool, although I know its hard sometimes

the B spot,

He is attacking. I am speaking.

Since my posting has caused such a heated debate, I thought this thread warranted another posting. One thing I did not mention before, when I visited H&W I only viewed Dr. Wong's surgery. His grafts were put into three piles. It was from Pat's posting which stated Dr. Hasson's case of 5100+gr. with just two piles of 1's and "others", and that there were past concerns brought up on the Forum that raised some concerns for me. I don't think anyone is purposely splitting FU's, or suggest that the doctors are dictating this. From an assistants point of view, there is some individual judgment when looking at 3 and 4 hair groupings as to whether they can be kept as 3's and 4's, or safely made into 1's and 2's. There is a natural tendency for assistants who will later plant into all the small, close incisions to cut the grafts to fit those microscopic size incisions unless the doctor makes the appropriate size incisions for the corresponding size of the grafts. I stated exactly why we keep a cutting log in my "comments". We also know what the hair count is and know right away if the patient has below average, average, or above average density. On occasion when a patient has very low density, we've restructured our fee to coincide with the hair count rather than the graft count.

I don't agree that H&W are "ripping" patients off. Nor are we ripping patients off if we opt to do two sessions instead of one. Either way, I believe both fee structures are moderate considering the caliber of work. Whatever H&W comfort level may be, and whether they are equipped to handle such large session is up to the individual physician. My contention is if Dr. Shapiro has concerns he has not been able to put to rest at this juncture in regards to mega sessions that exceed 4500grafts on a routine basis, our clinic should not be viewed as less than stellar. Also, the misconception on the Forum that everyone is an ideal candidate for a mega session bothers me as there's bound to be disappointed patients. Even the patients who get exceptional work of 2000-3000 grafts feel insecure.

It's perfectly fine to have different techniques and beliefs as voiced by many on this Forum. I've gotten to know Dr. Wong in the last couple years from Conferences and my visit to his clinic, and I personally trust and respect him. I'm sure I'd say the same for Dr. Hasson if I got to know him as I know he has many happy and satisfied patients. The two clinic doctors get along very well and have mutual respect for one another.

quote:

Originally posted by Janna:
One thing I did not mention before, when I visited H&W I only viewed Dr. Wong's surgery. His grafts were put into three piles. It was from Pat's posting which stated Dr. Hasson's case of 5100+gr. with just two piles of 1's and "others" [stop quote]

[continue quote] There is a natural tendency for assistants who will later plant into all the small, close incisions to cut the grafts to fit those microscopic size incisions unless the doctor makes the appropriate size incisions for the corresponding size of the grafts.

Reading your post, I have some questions about "custom cut blades". Suppose you have a 3,000 graft surgery. How many different blade sizes are used for that surgery? If it's only a few different sizes, does that imply that a given patient has a very consistent graft size? Moving on, consider the 1's, 2's, 3's, and 4's. How different is the size of each type of graft (what variation in 10ths of a mm, for example?). Then, in the technique where the slits are made first and the grafts planted afterwards, how do the planters know which grafts to use in which slits? I don't mean in the hairline where there are singles (although this goes back to my first question, are all singles from a given patient the same size), I mean in the midscalp where you would have the multi-hair grafts.

Any clarification would be appreciated.

I agree that after all the showing and talking is done, it comes down to how many hairs are successfully relocated.

I like nutrition labels on the food I buy and I like the estimated vehicle MPG posted on the lot.

Photos are useful in demonstrating the artistry of a clinic. But ideally physicians and patients posting on this forum should provide hair counts for various size grafts. Measurements of the width and length of donor area removed would also be useful information.

More accurate and detailed information serves potential patients/consumers better so they can compare "Apples to Apples". Let's use consistent standards of measurement here on this forum.

Graft sizes are just not consistent enough across clinics (even those doing "follicular units") to be an accurate standard of measurement.

Some clinics even use grafts that contain "follicular unit families", which are two follicular units that are so close to each other that they are virtually a single follicular unit. Such follicular unit family grafts can range from 2 or 3 hairs to 5 or even 6. Should these grafts be counted with the same weight as one hair grafts that were created for the hairline? Do we want to compare oranges to apples or apples to apples?

Consumer demand created food ingredient labels and MPG stickers. If the members of this and other forums make hair counts, rather than only graft counts, a standard expectation then in time I suspect they will get them. As they say "ask and you shall receive". I know that I intend to request hair counts and donor strip sizes from all posters who present only total graft counts with out hair counts.

Those who don't like numbers can choose to ignore them if they like.

Accurate information is better information. I'm confident that all top clinics can provide such information if they choose to and can compete successfully on a level playing field.

Bottom line - Count the hairs on your head not the grafts on the tray.

All the best to all of us. Pat

I agree Pat that the hair count is usefull information. So I recently asked my doctor to provide that information as you can now see in my signature.

You don't see it from other docs because their results are shit. Your other "coalition" docs are totally unimpressive with the exception of one or two doctors.

I take offense to this as my doc is one of the coalition doctors and I had great results with him. Please don't use your anger as an excuse for ridiculous comments as this will not help your case.