Dr. Feller,
Thank you for your input. It is interesting and quite educational to the patient to hear a discussion of the various HT philosophies.

It would even be more educational to hear from a doctor who still believes that placing 3 and 4 hair fu's is the best way to go.

I do agree with Bushy that if a clinic takes more time and effort to distribute the harvested follicles more diffusely by creating more grafts and incisions then they should be compensated for this work.

I also think Dr. Feller makes an excellent point that essentially hair restoration surgery at its best is more about artfully creating the optimal illusion of both density and naturalness - rather than copying nature literally.

Many have probably observed that even pure follicular unit grafting does not necessarily look perfectly natural when the density is below 30 or 40 FUs per sq cm for the reasons Dr. Feller pointed out. Transplanted hairs that are growing at full terminal thickness, yet are distributed in thin densities are not optimal in naturalness.

Thus I believe a compelling argument can be made that distributing a given number of hair follicles using larger numbers of grafts that are more refined than the standard follicular unit graft may indeed achieve the optimal look of fullness and naturalness.

Such an approach is certainly more labor and skill intensive. Thus the work required to achieve this higher level of refinement would need to be reflected in the price.

That is why I applaud pricing plans in which the cost per graft diminishes as the graft count increases. Such price plans enable patients to achieve more refinement for a given budget.

With regards to splitting the grafts up, would the additional scar tissue surrounding the grafts somewhat limit the proximity of their distribution in the recipient? So basically I'm asking, can you plant them as Dr. Feller suggested without sqeezing them into slits that are too small or in some other way compromising the yield?

Once again the problem of language blurs the dialog.
Ugly,
1. When you refer to "splitting up the graft" you must define what you mean.

In my clinic we do not divide up grafts-ever.

We don't just look at a 4 hair grouping and say, hmmmm, I think we'll cut that in half, because at this point it is NOT yet a "graft", it is just an area of strip that is in the process of dissection.

Don't confuse a "close grouping" of follicles with a "graft".

Sure, there are some patients with follicles so close to each other that you simply can't split them any further down than 3 or 4 hair grafts, but they are quite rare.

2. The smaller the incision the less scar you will produce, so there are no "excess scaring" issues when planting many smaller follicular units.

In fact, it is beneficial to have the smaller units because their ability to transport nutrients and wastes across the graft (to and from the surrounding dermis) is ENHANCED compared to the larger 3-4 graft variety.

3. You should never be squeezing grafts into slits. If you are, the slit is simply too small.

Should Dr. Feller, or any other TOP surgeon want to be considered with the "rest", then by all means, continue to use the "rest" as a comparision. The initial pricing for 2000-2500 grafts essentially guarantees the time of the surgeon and staff for the day. Many clinics have great pricing for additional grafts after that. I am also not declaring that anyone is being ripped off.
Bushy, I understand your point, but both lawyers would more than likely charge a flat rate for the motion, and then hand any research, etc.. off to their staff. The lawyer that continued to provide better representation could then charge more, while the other guy continues to screw people (I see an interesting corrollary here =) I am saying that Dr.s should not make any money, nor am I saying that I would not pay a premium for a top doctors services. I am saying we better start understanding pricing for graft, versus density achieved, versus what the patient understands is actually happening.
That is my point, which I am directing to the membership here, not at specific clinics, nor as a statement of truth, just a topic to be recognized and debated.
Your argument regarding Dr. Hasson and his using 4-6 hair grafts is flawed from the standpoint that Dr. Hasson has an ETHICAL RESPONSIBILITY to provide the BEST hairtransplant his abilities will allow him. The same goes for any other doctor. IMO, there is no choice anymore to use these pluggy grafts, and any doctor that does is violating the Hippocratic Oath. That is my point, because you and many others still act like doctors have a choice to provide us with the best. I do not. I consider it a responsibility, especially if a clinic or particular doctor is considered a leader in the field.
Again, I am not aiming this at you in particular, or anyone else, just looking at things from a different angle.

quote:

Originally posted by the B spot:
. . . what the patient understands is actually happening.

This is the only reason I am in favor of Pat's hair count theory; Not because I believe it will make any difference, but because in an increasingly competitive industry patient information, fiscal transparency and global standards are a good thing.

My point is quite simple: It has been stated that H&W, Feller, or any others who may subdivide 4-hair grafts (or >4) are somehow ripping off patients by charging for two grafts instead of one. My point was simply that, to the contrary, they are doing this for the patient's benefit (as described by Dr. Feller) and, consequently, are completely justified in charging for these extra grafts (if, indeed, they do).

In any event, there are so relatively few of these larger grafts that I doubt the final surgery price would be significantly effected. Take my surgeries, for example. 4,000 grafts x .02 (app. 2% of grafts are 4 or larger) = 80 grafts; x $2.50 = $200; = insignificant.

We are actually on the same page then, Bushy.
The only difference of opinion we have is that hair counts will not make a difference. You don't, I think it will.
Good Discussion All.

quote:

Originally posted by the B spot:
We are actually on the same page then, Bushy.
The only difference of opinion we have is that hair counts will not make a difference. You don't, I think it will.
Good Discussion All.

Isn't it great to be able to have a hearty debate without throwing mud? Thanks for engaging.