Pat I agree hair count info is useful it helps empower the end customer. As hair count is more comparable then graft count(given the variance discussed in thread), it is not a reach to think more records will be kept (again its not rocket science its a spread sheet). Your food label comment made sense, ironically I shop at my local farmers market co-op no labels but taste and quality second to none. I do think as a patient of H&W I would like to have a complete detailed break down, I read this forum almost everyday why not get more numbers to compare accurately across the board.... a coalition standard. My reality is I flew out of the country to see Dr.Hasson for I found his product quality to be second to none. Wanted to put a positive note for my HT Doctor, I do not work for H&W at all, but I did have a good experience all around with my HT so far, Dr.Hasson was honest and straight forward. But yes numbers can help keep alot so I finish as i started; I agree Pat.

Spoon,

Basically, a patient's one hair grafts are going to be the same size with a certain percentage of them being finer in caliber. Despite the two different size of ones, they are inserted into the same size incisions. We purposely pick out the finest ones to place at the very front points. The regular size ones are then place just behind the fine 1 hair grafts. Here's a break down of the blade sizes based on average caliber hairs: 1 hair grafts-.7mm, 2 hair grafts-.8mm, 3 hair grafts-.9mm, 4 hair grafts-1.0mm. There's slight variation to these sizes depending on how strong, curly, or fine the hairs are. We've gone as small as .65mm for ones on one patient, and as high as .8mm in another patient. As the doctor begin making incisions, we test by inserting a graft into the appropriate size incisions to make sure the grafts fit.

Experienced techs can tell the different size incisions and know where differnt size grafts should be placed. More importantly, the doctor directs us to where he wants the grafts placed.

First, in reference to my employ at H&W. Hey, it's an old horse, why beat it? Anyone with a cool head about them and has been around for a while knows that when I started out I was just one guy with a website and a little trigger happy on my new digicam. The rest is history, (and a history that allows me to sleep well I might add). Even back then people were at times questioning my relationship with H&W but the fact remains that as I shared my results as they were happening so I had no idea what the final outcome would be. That's the beauty of how our patients post. You see the immediate post-op and the subsequent development as close to real time as can be found without a 24 hour webcam in their living rooms, bedrooms etc.

To Landen specifically,

I wish I knew why you feel so passionate about your points that honestly do not have any merit. You specifically implied that our ability to get large sessions were ripping patients off. I then broke down the fee structure that is shared by most of the top clinics to show how it actually saves money for the patient. Your rebuttal was simply, what appeared to me anyway, a "yeah well" response that is based on your feeling about this subject without having actually spent any time in our clinic and most likely having never seen one of our patients that have received one of these big sessions.

I present to you these examples...





I dare say that if this was not 5200 "complete" grafts but rather a bunch of ones and twos then this patient would have a result that would be much thinner in appearance. You can see that with the 2600 FUE and 400 minis he simply did not have any respectable coverage not to mention density. Yes, they added to the final outcome but this is hardly a mere doubling of what he already had (add up the previous two procedures). No, this is the result of having a big session and giving the patient what he was originally hoping for WITHOUT cutting corners. To put this into simple and understandable English...we do not divide bigger grafts into smaller grafts to inflate graft counts, rip anyone off, or to give false impressions that other clinics are useless.

With regards to the "dangers" of these large sessions. I say again, these large sessions are not packing 5000 grafts into a hairline. If a NW6 comes to us and wants us to do the best job that we know how for him AND IF he is a candidate for a big session then THIS is where it is in his best interest to get such a session. 5000 grafts will do wonders for a NW6 and if he were for some reason to progress further into a NW7 then he WILL have more grafts to spare if that need does indeed arise. You said earlier in this thread "Hey lets just wipe out all of this patient's donor in one sitting...". Impossible to do, simple as that. You, and everyone for that matter, need to understand that if a patient is a candidate for a 5000 graft session it is not so at the expense of future work. Being able to get more in the future is inclusive in being a candidate for a big procedure. You could say that being a candidate for a future session is by definition a patient that has excellent donor laxity AND donor density that not only suits the session in the here and now but also for more sessions should the patient need it. In our experience patients have an average of 6500 to 8500 grafts total. That is an average and with averages being what they are it means that indeed there are patients that can be limited to less than 6500 total as well as those that are limited to more than 8500 (yours truly for one). Those that have less than 6500 available will instead have a first go with perhaps 2500 grafts. This number is strictly for argument's sake but you get the gist of it. We do not want anyone to think that we get 5000 grafts for every patient. Quite the contrary, 5000 grafts is the exception rather than the rule as the, again, average sized session in our clinic is 3500 on the low end and 4500 on the high end.

There is also the issue of how numbers are achieved for those patients that do not need a lot of coverage but rather need a smaller area with more density. Over the past four and a half years of speaking with patients of other clinics since I signed on to this very site as a "noob" WAY before I became professionally involved in this industry I found that the #1 complaint was the lack of density from their respective procedures. Even today you see people posting on this and other forums saying this. What do they wind up doing? You see where this is going, they go right back into the chair to do it all over again. What Dr. Hasson and Dr. Wong have done is recognize this problem and address it with larger numbers RELATIVE to the patient's donor area supply. While one clinic may hit a NW4 with 1500 grafts we'll hit it with 3000, again, IF it makes sense with the final donor supply in mind. This is of course just an example so please, anyone reading this do not expect a standard of 3000 if you are a NW4. Always keep in mind the phrase "relative to the individual patient's donor supply".

With regards to the future, your arguments have been echoed by other clinics for a few years now but the FACT of the matter is simple. If the grafts don't grow then there would be gaps in the scalp showing where the grafts did not take. We do not see this and if we did we would scale back to examine what may be the cause. To imply anything else would be to say that we are being less than honest and that simply is not acceptable. I reiterate that almost five years ago when I had my first session with Dr. Wong 3000 grafts was considered to be ludicrous. "It won't grow. The blood supply will be compromised. The donor area will be used up". Now, these same clinics are doing the exact same thing. Why is this? Landen, I'm very curious as to what your answer will be regarding this.

With regards to Dr. Shapiro and his excellent staff. They are top notch and no one should think otherwise. There are simply two different approaches here that in the end will result in a happy patient. Some patients prefer one approach over the other and I will not argue if their view does not align with ours however when the disagreement reaches the point of accusations of negative assumptions because details are not understood then they need to take a moment, step back, and realize that if we were not delivering what we promised then the well over one hundred patients that have documented online in one way or the other would be screaming for our heads and not their elation which has fortunately been the case.

quote:

Originally posted by Landen:
They mean nothing because you have different people with different characteristics.

I hate to break the news to you, but hundreds of H&W patients with all sorts of characteristics post thousands of pics and they all seem to grow incredibly well. Some slower, some more quickly, but they all seem to grow. That's why I went to them; that's why so many others do. Quality speaks for itself, and rather loudly.

quote:

The results don't speak for themselves. Take any of the top docs let them cut a huge strip out of the donor harvesting a bunch of grafts, let the techs insert them and you will have the same result in the same patient.

And I can perform open heart surgery. Gimme a scalpel and a few nurses. C'mere, lemme fix your heart for you. Do you actually believe your own words?

The rest of your comments are so preposterous, it's hard to reply intelligently.

quote:

Originally posted by Landen:
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 there's even less than nothing wrong with just staying bald!!! DON'T GET A HT, and call it a friggin day! I'll try to make this very simple, since you seem to be missing the obvious point:

Donor grafts = finite.
Ethical doctor = figures out where to place these finite grafts so no run out.

quote:

Originally posted by Landen:
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. . . . This is once again where the domination of the forums marketing tactic comes into play.

. . . 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.

Dude, I don't mean to be getting personal, but you are bordering on delusional. We have all heard the old "payed marketer/shill" accusations. They are so old Adam must have used them. H&W patients document their hair loss before, during and after. If the docs sucked their business would long have closed. The succeed because their work is the best out there. I was one hour away from a Bosley surgery when I discovered THIS WEBSITE. I then spent 5 months researching, inquiring and investigating. I chose H&W because they were simply, in my opinion, the best. They did not pay me to go there. They did not bribe me. Jotronic did not threaten to kill my next of kin if I did not go there. My pictures are not doctored. I am not a Martian. I AM A REAL PERSON WHO GOT A REALLY SPECTACULAR SURGERY BY A VERY REAL SURGICAL WIZARD NAMED VICTOR HASSON. AND I'M REALLY EXCITED AND LOVE SHOWING OFF MY NEW HAIR.

H&W took off because they are incredible. The best marketing plan is only as good as the product behind it.

Hi Joe, H&W definitely produce spectacular results. I am however curious. You say H&W do not break down bigger grafts into smaller grafts to inflate graft counts... Was that Clintonesque speach meaning you do break down larger grafts but for valid reasons, or that you simply don't break down larger grafts ? If at least one of your techs didn't ever leave 4 haired fu's intact, was she eroneously cutting grafts she shouldn't have or is that standard policy?

Keep in mind that if you do break them down, I'm not being critical. Based on your resuls, maybe that's a better philosophy (lots of smaller grafts densly packed). It could be the preferred method of the future. Sorry, but as B-Spot says, until you give hair counts that perception is going to exist. Based on the pictures you have shown, you say that if this patient had received only one's and two's it would not look as dense. Well, I don't know about that. That's a heck of a lot of grafts.

Based on my knowledge and what Janna said, you must use differing blades for 3 and 4 hair fu's. You would, therefore need to count them in order for the doctor to make the proper sized incisions. Doctors make the incisions during the long and tedious graft trimming process. It is at this time that the techs are calling out numbers that the doctor is using as a guide for incision making.

Again, thanks for your input. I think as patients become better informed their their thirst for knowledge of such details increases. Oh, and how many incisions are actually made with a pool queue at your clinic? Just kidding

Gorpy,

I had to laugh out loud when I read your post. Sheesh, NO we don't break down grafts save for the rare occasion when a few singles might be needed for a hairline or if a graft is just so big that no matter how you place it the result will be pluggy. All clinics do this and it is usually when the patient has pasty white boy skin with dark, really coarse hair. Yes, I did inhale and no I did not know a thing about Al and the monks.

Regarding blade sizes, yes, you are correct but it's there's more to it than techs just calling out the numbers and blades are made based on this. The different sized grafts are actually laid out next to each as Dr. Hasson or Dr. Wong match them up with the raw blades so they know how to cut the width and the length.

quote:

Originally posted by Gorpy:
Hi Joe, H&W definitely produce spectacular results. I am however curious. You say H&W do not break down bigger grafts into smaller grafts to inflate graft counts... Was that Clintonesque speach meaning you do break down larger grafts but for valid reasons, or that you simply don't break down larger grafts ? If at least one of your techs didn't ever leave 4 haired fu's intact, was she eroneously cutting grafts she shouldn't have or is that standard policy?

Keep in mind that if you do break them down, I'm not being critical. Based on your resuls, maybe that's a better philosophy (lots of smaller grafts densly packed). It could be the preferred method of the future. Sorry, but as B-Spot says, until you give hair counts that perception is going to exist. Based on the pictures you have shown, you say that if this patient had received only one's and two's it would not look as dense. Well, I don't know about that. That's a heck of a lot of grafts.

Based on my knowledge and what Janna said, you must use differing blades for 3 and 4 hair fu's. You would, therefore need to count them in order for the doctor to make the proper sized incisions. Doctors make the incisions during the long and tedious graft trimming process. It is at this time that the techs are calling out numbers that the doctor is using as a guide for incision making.

Again, thanks for your input. I think as patients become better informed their their thirst for knowledge of such details increases. Oh, and how many incisions are actually made with a pool queue at your clinic? Just kidding

Wouldn't logically it be better for H&W to understate graft counts? So they lose a few hundred bucks per surgery but gain massive market share because their results look so fantastic for such small numbers. Hyping up the grafts and not provding the results is stupid and will lead to people speculating about yield problems - that's not a positive thing to differentiate yourself on, you're better off doing and saying nothing.

Speaking of wasting grafts, I was just browsing the forums and ran across Domie's thread. 4900 grafts in one session with Dr. Wong. At five months out I don't interpret his exhuberation much less his photos as representative of someone that had his grafts wasted or had low growth rates due to vascular damage, transection rates, or whatever else you can throw at it. This is a classic case of what I'm talking about. His donor is not depleted and if he loses more on top then he's got more if he needs it. You see, the density while of course is highest at the front decreases toward the back. If he needs more in the back then it won't need to be as much as he's already had. Just smaller touch ups.

Domie's Hair Transplant

Here's another one by Bushy. This is a patient that came back for #2 and now he's got well over 7000 grafts. What does he get in return? Complete coverage and not a hint of his former bald self and he's only at four months.

Bushy's hair transplant

quote:

Originally posted by Jotronic:
Another one by Bushy. This is a patient that came back for #2 and now he's got well over 7000 grafts. What does he get in return? Complete coverage and not a hint of his former bald self and he's only at four months.

Bushy's hair transplant

Hey, I know that guy!

Joe, your post sent me to Domie's post, where I found a GREAT Mrjb comment:

Awesome

All the complaining people do about HT's , it's sad they don't recognize the AMAZING transformation one procedure can do by a qualified doc.. What a life changing experience.

JB

Joe, first off let me say that your transformation and internet presence caused me to seriously consider hairtransplantation, where before after I had visited clinics, and decided against (for obvious reasons. I think that some people do not give you the credit you deserve for really pushing the amazing results achieved at H&W over the last 3-4 years. Let me tell you why I think this is important: It gave hairloss sufferers an entirely new perspectives and attainable goals, while at the same time forced out-dated doc's to raise the level of their game. I remember the outcry over H&W doing 3000+ sessions, and in speaking with Dr. Shapiro, he faced the same criticisms when he began doing 2000 to 2500 grafts on a regular basis. The fact that you get paid for what you do is a testament to hard work and a willingness to promote your skills, and those of the clinic you represent. I think what we have to remember is that no "rules" existed for this type of forum previously, and as your role expanded and you became employed with H&W, you did what any consultant or patient coordinator would do in your situation, and promoted your clinic on this forum. Absolutely fine, IMO. I remember when Pat decided to have anyone employed by a clinic declare that on every post, which is great as well. I just think that our involvement and expectations have grown and morphed, just as yours has. I think H&W is lucky to have recognized your abilities, and possessed the foresight to employ you. If H&W had simply posted a few HT and not the continuous stream of transformations, where would the HT industry be right now? The fact is, clinics would still be doing 3 and 4 smaller sessions, without the need to push the envelope, because as long as patients expected to go through 3 and 4 sessions, no pressing need to change would exist. I firmly believe this, and I see no reason why anyone else wouldn't either. With that said, with H&W pushing the envelope so far in excess of what anyone else is doing, H&W has an obligation to detail their practices and procedures, which is a naturally logical progression, given H&W's internet presence. My concerns are purely in the interests of the HT community, period. At this point in time, I regard Ron Shapiro and H&W as the preeminent HT surgeons in the industry. These are my opinions, and others may disagree, and that is fine, everyone is entitled. But when I speak with Matt Zupan or Dr. Shapiro, and I ask questions about the industry, they raised the same questions that Janna detailed about the long-term benefits of ultra-mega sessions, I feel it is important to ask and recieve proper information. I certainly do not agree with mudslinging or these pro/anti clinic posters that resort to calling our Coalition docotors inept, or stating that H&W is swindling patients. In addition, I hope H&W does not feel as if they do not have to justify their practices and procedures, regardless of results/success. Sharing detailed information is how we arrived at where we are today, and we need to take this to the next level, period.
With all of that said, I would like to see H&W post graft count, AND detailed individual follicular units (1,000 1's, 600 2's, etc...) That information will provide the entire industry with hard evidence that H&W is moving the same ratio of hair to graft as the rest of the industry, or it will show that H&W is moving less hair, as a result of their practices. In addition, I would like to see H&W post waste percentages for these larger sessions, (Say 4000+) and I would expect the same from every other clinic who performs these sessions as well. Waste is a by-product of the surgery, at every clinic, PERIOD. I think a good number would be in the 3 to 5% range, but I could be wrong. I think this is what Pat is talking about when he says H&W's practice of cutting grafts is neither a positive or a negative, because of the results H&W have produced, which cannot be ignored.
I think Pat is trying to give a perspective to us (members) and Docotors who are finding it difficult to move 8000+ hairs in one session, let alone 10-12,000, for 5500+ sesssions. At that point, we will have a definite understanding of what is being done to achieve these sessions, and why, as well as a solid comparision between clinics.
I hope these comments are well recieved and given careful thought, because I think they are important and needed to be written.

Again, after the dazzling photos are seen and the warm fuzzies are exchanged, let's have hair counts. Those who don't like math can just look at the pictures or read the stories.

I'm going to again write to all physicians involved with this community and request that they supply their patients with not only graft counts but hair counts. Hair counts, along with graft counts, in my opinion provide a more accurate standard of measurement than graft counts alone. I will also ask all clinics to provide patients with the measurements of the donor strip removed. Many clinics are already providing this information.

Joe, as a long time patient advocate, I hope that you will be an advocate within Hasson and Wong for providing such hair counts and strip measurements. I think such detailed information will serve to enhance confidence in your clinic.

So can we count on hair counts in the future?

Pat, what do you think about waste percentage? I for one, would like to know if donor waste increases drastically with session size. If a 3000 graft procedure produces 75 wasted grafts, does that mean a 6000 graft procedure produces 150 wasted grafts, or is it 300 wasted grafts? I am well aware of the fact that donor waste is a necessary evil, but if donor waste goes up exponentially as session size increases, it is yet another variable to consider. Like you said, it is all about the math. =)

Joe I am enjoying reading this debate, I have a question for you. I am trying to get an understanding of this. Lets say in my situation I have thinning but still a fair amount of hair. If I was a candidate and would have went with a 4000 procedure and dense packed everything. lets say down the road I did loose more hair and had to have another HT, how would that be any different than if I had a smaller session and went back? would it be a different game plan in graft placement? If you had a mega session and were a norwood 4 heading towards a norwood 6, what would be the difference in a game plan? if your going to try to give them the best final results? I guess if you are going bald and going to loose more hair and assess that, what difference does it make?

Jotronic,

You represent and debate the opinion of your clinic. It is not fact that you debate or represent. It is one philosophy, may even be a fallacy. Forget about the comb over and fuzzy overhead pictures. I don't see apples to apples. I see apples to oranges. Pat has a valid point, and I agree with it.


Bushy,

You are on every H&W thread aren't you.

The last that I heard is that you had some kind of business partnership with H&W, "non hair transplant" whatever that is supposed to mean. You have no credibility because of your business association. So, what you have to say means nothing to me or anyone else interested in the subject matter. You should disclose your current/ previous business involvement. and quit posting as if you are just merely a patient of the clinic. You have posted about this involvement and your golf outings with them in the past.

Take note people. As consumers you need to be informed.

As I write this an alert came up on my screen with B-spot's latest posting, which has a very valid point, and I'd like to thank him for his calm, well thought out input.

Mainly, I want to apologize to the H&W Group for any offense taken by my comments and concerns to Pat's posting. Given the data I saw on the forum, I questioned their technique and made certain assumptions to their graft and hair count. I should not have jumped into the assumptions without asking the questions first. It's human nature to question or assume when you don't have the answers. We've come to rely much on the internet for answers. I used to wonder how H&W were able to accomplish such a large session in one day. By visiting their clinic I was able to see that it just took the old fashion hard work and long hours.

In reference to the "two piles", which still has me stumped has a simple remedy to this concern by providing the hair count. One cannot get too upset by the thirsty man wanting a glass of water.

B-Spot, I'm not sure about the waste percentage being a factor. It would be hard to calculate if it increases as session size increases. It's also hard to measure exactly what the percentage might be as this data would be provided by the individual tech cutting the grafts, and no tech wants to believe there are any waste. Realistically, I believe you are right to estimate 3-5% percent waste per session.

B Spot,

I do not think that the percentage of waste necessarily increases with larger sessions. Some might argue that more trimming to create more refined grafts could result in some follicles being trimmed away, especially those follicles in their telogin resting phase (when they are not in the hair growing stage and are thus less visible).

However, clinics that are doing careful microscopic dissection take great care to minimize waste by recognizing even the hair follicles in the telogen resting phase and including them in the grafts.

Also, while I think detailed hair counts will enhance the overall picture, I would not say "It is all about the math." Photos, personal accounts and hair counts (and donor strip sizes) together will paint a fuller picture of both a patient's surgery and result.

quote:

Originally posted by Landen:
. . . .
Bushy,

You are on every H&W thread aren't you.

The last that I heard is that you had some kind of business partnership with H&W, "non hair transplant" whatever that is supposed to mean. You have no credibility because of your business association. So, what you have to say means nothing to me or anyone else interested in the subject matter. You should disclose your current/ previous business involvement. and quit posting as if you are just merely a patient of the clinic. You have posted about this involvement and your golf outings with them in the past.

Take note people. As consumers you need to be informed.

Landen, I first started posting on this site in the morning of my scheduled Bosley surgery sometime back in July of 2003. I believe I have established my credibility since then. My surgeries have been an open book to all. I even disclosed that between late 2004 and mid 2005 I provided professional services, unrelated to hair transplantation, to H&W. Pat and the moderator of another forum at which I post were made fully aware of this. That is old news. If I washed H&W's windows for 6 months 2 years ago, that would have no bearing on my posts, pictures and credibility.

Oh, and please get your attack stories right: I never wrote anything about any golf outings, because there were none -- I don't even play golf. Are you confusing me with another poster whose veracity, credibility and candor offended you?

You, on the other hand, originally surfaced on this forum (as revealed by a quick author search) back in late 2002, complaining of poor growth 7 and 9 months after your HT surgery. You don't appear to have revealed who your doc was. Then you disappeared from the forums and have sprung up again several months ago, You have taken a rather irrational, antagonistic, hostile and most discourteous approach. Are you bitter for some reason?

Here are a few examples of your attitude:

Example 1 (August 26, 2006): "Today's hair transplant patients are tomorrow's hair transplant repair patients. I guarantee it!"

Example 2 (September 07, 2006): "An informed decision? That kind of terminology is used by greasy lawyers and quack doctors."

Example 3 (September 02, 2006, in response to my tricho scar video posting): "The video is of poor quality. The hair is too long. And I can still see the scar. Tone down the hype!"

Example 4 (August 30, 2006, in response to a post by Dr. Feller): "Giving this guy advice to go to "just about any cosmetic surgeon in the UK" is the most absurd advice I have ever heard of coming from a doctor. You can't be serious."

Wherefrom springs your credibility?

Pat, I agree, but it is a valid question, one which seems to not have much bearing here, so if everyone is fine, then I am Ok, especially if you feel as if this is a non-issue.
In regards to my math comment, please let me clarify. I assume and fully expect that the proper ethical considerations and maximum artistic ability be applied to every HT, regardless of session, regardless of physician. I was in no way debating results, only wanting to know the practices and procedures of how the results are achieved. I am in TOTAL agreeance that photos, personal accounts, hair and graft counts, in conjunction with strip size will greatly enhance the knowledge presented to this community. I look forward to both old and new patients documenting these so we can truly understand where Hairtransplantation is today, and where it might go.