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Most consumers and patients take for granted that “board certification” implies some level of expertise and qualification of a doctor. What does it ultimately mean to you? Why do we even bother with it? Is it to advertise achievement reflecting doctors’ credentials?

In the United States there are 24 approved medical specialty boards that are overseen by The American Board of Medical Specialties (ABMS), a not-for-profit organization. Certification by an ABMS Member Board has long been considered the gold standard in physician credentialing. To be ABMS board certified means that the physician has undergone formal educational and clinical training with adequate supervised activities a medical institution AFTER earning their medical degree. After this training, they must successfully pass a level of competence through written and oral examinations.

Hair transplant surgery is not a part of the ABMS so there really is not a board certified hair transplant surgeon in the traditional sense the public thinks of. This is mainly because there is no formal supervised training or credentialing in hair transplant surgery. There is no curriculum and no oversight. There is no place to formally learn to become a hair transplant surgeon. To date, the only way to learn how to perform hair transplant surgery is to read a book, attend a seminar, or become an apprentice to a doctor in the private practice of hair transplantation. We know of doctors who never performed a hair transplant surgery but only attended a seminar and within a week set up shop proclaiming that they were experts at Follicular Unit Transplants. If there was truly a board or some sort of governing body, the physicians who learn the field through an overnight effort would have been discredited and alienated from his/her peers. But this is not what happens because hair transplant surgery is not considered mainstream surgery and anyone with a medical degree (even straight out of medical school with no training) can legally perform it. Unfortunately, a license to practice any or all specialties of medicine comes after 4 years of medical school and an internship and with that completed, a doctor could proclaim themselves even a neurosurgeon; however, no hospital would allow this overnight sensation to practice neurosurgery.

Recognizing the need to become part of the mainstream, in the mid 1990’s the American Board of Hair Restoration Surgery was formed to independently certify hair transplant surgeons. The Board requires recommendations for other doctors and 100 hair transplant surgeries to qualify to take the Board’s examination. But the board can not certify adequate supervised training, as there is none. It is also powerless in its structure to monitor any doctor’s training or enforce any form of discipline. Why? Because there is no place for a physician to train to become a hair transplant surgeon. There is no education/training center. There is no residency. There is no fellowship in the traditional sense. Thus, the term “board certified” hair transplant surgeon is NOT the same nor does it hold the same value as “board certified” in the common sense that we think of a board certified plastic surgeon or neurosurgeon. In fact, states like California forbid doctors to use the term ‘certification’ unless it reflects the American Board of Medical Specialties’ endorsement, which is not the case today, nor should it be. The reality of this training process is that this is a one surgery field. Today, I know personally of doctors who started doing FUE after only attending one ISHRS meeting. When I spoke to the doctors about their results from the FUE they were doing in the first 6 months and they admitted to me privately, that they had very significant failures in their initial treated patient population.

This is why many hair transplant surgeons are not board certified in hair transplant surgery. Drs. Rassman, Pak, and Kim are not board certified in hair transplant surgery mainly because they felt that it had little significance to their practice or credibility. Since Dr. Rassman is widely regarded as one of the pioneers of modern day follicular unit transplantation (from the early 1990s) and even the innovator who started the FUE technique in 2002, his reputation stands on its own without a certification. When Dr. Rassman started performing hair transplant surgeries in 1991, the standard was ‘plugs’. He visited doctors who had great reputations in the hair transplant field and watched what they did. He figured out that the techniques that were used did not meet his standards and he refused to adopt that technique. He learned the details of how it was done by others over a period of a year and then he pioneered (a risky move) what eventually became the standard for hair transplantation across the world.

Dr. Pak was part of the original research team (working as an engineer) that developed FUE instrumentation from the mid-90’s (that eventually ended up in a U.S. Pat. No. 6,572,625 licensed to Restoration Robotics for the Artas® Robot) and has been trained exclusively by Dr. Rassman as a hair transplant surgeon. Dr Pak’s hair transplant surgery education was in the traditional sense of a fellowship or apprenticeship by working one on one with a mentor, Dr. Rassman, for more than a year. For that matter many well respected physicians have gotten their start from Dr. Rassman in the 1990’s and 2000’s. To this day, Dr. Rassman receives several emails a month from physicians requesting private fellowship training. In fact, we even found on multiple occasion, doctors from a foreign country that display photos of Dr. Rassman standing next to themselves to advertise to their patients that they were trained under him. These pictures were taken at conferences.

Misrepresentation in this industry are common. A series of website or “forums” or ‘Networks’ exist that define the best doctors in the world for its viewers. To get such endorsements, doctors must join that organization and pay a monthly fee in excess of over $1000/month. The implication is that if the doctor is not endorsed by that particular ‘forum’ that they are not amongst the “elite” and highly respected doctors in the world. The ‘forums’ or ‘networks’ collect these prospective patients and dole them out to the doctor so that the doctor might get there money back through professional fees. It becomes an interesting way to advertise through third party ‘endorsements’. To be as blunt as possible, these ‘forums’ or ‘networks’ are not neutral patient advocate sites but a subtle way for doctors to advertise by paying a membership fee. As I know most of the really great hair transplant surgeons world-wide, I know who is good, who is very good and who is not so good. The good and the bad surgeons may inevitably be endorsed by the website as long as the payment is made. I do not know them all. So you, the consumer, must be really careful if you accept the endorsements of these organizations without doing your research.

In the end the consumers (patients) are left not knowing what to believe. Board certification does not mean much if no one can enforce a certain standard of care or even oversee the training of surgeons. The Forum that endorse doctors do it for their profit, so they should not be trusted without really doing your own research. Sadly many great hair transplant surgeons are intermingled with the sleazy opportunistic ones and the entire profession is dragged through the mud as a whole but the consumer who do not get what they paid for, what they expected and end up blaming the ‘sourcing’ for their doctors.

Tags: hair transplant, surgery, surgeon, board certified

 

We are announcing a summer discount program for hair transplants as follows:

· Follicular Unit Extraction (FUE), reduced from $8/graft to $6/graft (minimum 1,000 grafts)

· Strip surgery reduced from $6 to $5/graft (minimum fee $3,000)

These fees will apply for any surgery performed before August 31, 2014.

In addition, we want to invite you to visit us and see the amazing results of Scalp Micro Pigmentation(SMP) on previous hair transplant patients who wanted a fuller look or wanted to address their scars (see scalpmicropigment.com). During your free consultation, ask to observe one of our SMP procedures so you can see, for yourself, the value of this process. At our Open House Events you can meet many patients who have already had hair transplants and Scalp Micro Pigmentation – our Summer events are Thursday July 10th from 4-7 PM and Saturday August 9, 2014 from 11AM to 2PM.

Please visit us at our open house: July 10th between 4 and 7 PM.
5757 WIlshire blvd.
Prom. 2
Los Angeles, CA

Or Call us at:
(800) New-Hair

Tags: summer sale, FUE, strip surgery, hairloss, hair loss

 

Hi,

This is the 6th month after my hair transplant was done. After 2 months my transplanted hair shed out, then after 4 months I noticed there was new hair that started growing. At the 6 month mark, the weak hair started falling out. Is this shock loss after the fact? Is this normal or there is any other issue? Can you please give me your suggestion.

Thanks

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It does sound like it might be shock loss, perhaps somewhat delayed for the first round of it. The progressive hair loss that occurs in all of balding men can get accelerated by a hair transplant surgery.

I usually prescribe finasteride (Propecia) for my patients to minimize this impact. Were you on this medication? If not, you should consider going on it to slow down the acceleration of the hair loss that yet still may come. As always, if you have questions or concerns with your surgical procedure, you should follow up with your surgeon to get his/her take.

Tags: hair transplant, hairloss, hair loss, shock loss

 

If hair cloning is a viable option in the future (perhaps in 15-20 years since I know the time line keeps moving every year) would you expect to see a large number of people elect to have a hair transplant for the sole reason of increasing overall hair density? If the amount of available donor hair was no obstacle, could someone thicken their existing hair?

Obviously, I would be satisfied just having decent hair coverage, and would elect to have a hair transplant in the future if I am a decent candidate, but I also don’t want previous hair loss remedies I’ve tried to affect any potential ‘cure’ in the future either.

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I’ve always believed that hair transplant candidates should go ahead and get their hair now while they are young enough to enjoy it. To be bluntly honest, there’s no point in waiting until you are an old man for what may never come about (hair cloning).

Researchers are making great strides with hair cloning, but I have no idea how many years it’s going to be before anything reliably safe and effective is commercially available. If reliable hair cloning ever does come about to allow for unlimited donor hair, I could see possibly more people having their existing hair thickened.

I obviously can’t know what the future holds, but I don’t see how moving hair from the back of the head into the top/front of the head would prevent any possible future treatment.

Tags: hair cloning, hair transplant, hairloss, hair loss, hair loss treatment

 

Pakistan’s prime minister has gotten a hair transplant a few years ago. His results are amazing. However, even with the hair transplant sometimes he looks like he has no hair in the frontal zone and sometimes he looks like he has a lot of hair in the frontal zone.

Here is a picture under the sunlight where his front zone looks empty. Photo

If Nawaz went for another procedure, is there any possibility he can get a result where even if he stood under the sun, his hair transplant results would show a fuller appearance in the frontal zone? Please give your advise.

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Nawaz SharifNawaz Sharif could fill up the frontal area with another procedure and get some more hair on the top of his head, but as has a Norwood class 7 balding pattern with what appears to be fine hair, I doubt that he will ever look completely full.

In our practice, we have performed hair transplants on people with fine and average weight hair. Those with fine hair, never really look full although I have done upwards of 9000 grafts on these people; however, with an average weight hair we have succeed in getting good coverage with a good styling technique to enhance the distribution of the transplants with about 9,000+ grafts. Many Asian class 7 pattern patients will not have the density to move that high number of grafts, so even with a better hair thickness, the ability to extract and move 9000 grafts may not be possible if the density is typical of most Asians.

Of course, one other way you can give the appearance of fullness would be through the use of Scalp MicroPigmentation (SMP).

Tags: narwaz, hairloss, hair loss, hair transplant

 

Dr. Russell Knudsen (from Australia) wrote in informative article in this months “Hair Transplant Forum International”. Clearly, the ability to harvest the donor area with FUE will be more restrictive in individuals who have more extensive balding patterns (Class 5, 6 and 7 patterns of balding). The donor area around the sides and back of the head reflect 25% of the original total hair count on the head (I call it my 25% rule). If one targets somewhere between half or 2/3rds of the follicular units found in the donor area, as the maximum safe yield for FUE over time, then for Caucasians with average hair density (100,000 hairs on their head or 50,000 follicular units in the permanent zone) might be able to safely harvest as much as between 6,250 (half) or 8,250 (2/3rds) from the 12,500 follicular units in the permanent zone (25% rule).

In those individuals with higher densities than 100,000 hairs on their head, the harvestable follicular unit numbers may safely go higher, while in the typical Asian, for example with lower hair densities (80,000 hairs on their head or 40,000 follicular units), the donor area would contain only 10,000 follicular units. With half of the Asian’s 10,000 follicular units harvested, that leaves 5,000 follicular units behind (this reflects a calculation of 25% of the birth hair follicular unit numbers which are permanent). I believe that extracting between one out of every two follicular units from the permanent zone may be pushing the limit on people with low density hair.

There may be reasonable limits for a typical Asian based upon hair density (we calculate hair density on every patient undergoing hair transplant surgery). To complicate matters, Asian follicular unit hair counts average less than two hairs per follicular unit, so to get out an average of two hair FUE grafts, it takes more follicular units to yield an average of two hair FUE grafts. Asians (or Caucasians with low hair density) who have a high number of FUEs will, in my opinion, be thin looking around the back and sides of the head. I have seen some Asians with significant track marks from the punch scars created by FUE, particularly when the harvesting numbers are high and the remaining donor hair is significantly lessened.

Many doctors are taking hair from the non-permanent area to give the patient the benefits of more hair in the transplant; however, this may spell disaster for the patient who develops more extensive balding (suggested by Dr. Knudsen). Hair taken from the non-permanent area will be lost with aging and/or advancement of the balding patterns. Over zealous FUE beyond the permanent zone, has long term consequences for some patients and they must be warned. I have seen some patients who’s balding had accelerated from multiple FUE procedures and have loss hair in areas where FUE grafts were taken while leaving visible scars.

I want to raise blood supply issues here as I have seen one patient already who had received 6700 FUE grafts in two sessions and lost more hair in the permanent zone than was removed by the surgeon during the FUE. I actually counted the grafts and the hairs on the head and had done density studies on him before another surgeon did surgery on him. When FUE numbers are pushed, this patient’s findings suggested vascular compromise may have occurred impacting the remaining hair in the donor area. I have heard, second hand, that at the last ISHRS meeting some cases of necrosis have appeared in the donor area when too many FUEs were done, possibly too close together. I don’t believe we really understanding the complications of large FUE sessions, or that doctors are not reporting their complications out of fear of professional ridicule and/or malpractice risks, all of which may become a factor in the long term future of this surgery. As we do many FUE cases in our practice, we are not anti-FUE; however, aggressive FUE megasessions in the wrong hands could be a problem.

In conclusion, “do FUE surgeries change donor area planning”, the answer is YES. FUE will impact long term planning and may impact strip surgery in future surgeries. Low density donor areas, resulting from FUE, make for less donor hair for a strip surgery, which will only make any scarring more visible as the hair is cut short.

 

Its pretty interesting to see that you are investigating this whole ACELL thing. I was kinda wondering one day if you would be one of the DOCs to have this Acell cross your mind. I just ran into this whole page doing a daily Google study on Acell and the usual Hair loss deal and saw that yeah you are thinking about it. Good to see.

Would it make sense to use Acell injections/Powder in the donor area after a strip or FUE procedure as well as Acell into the transplant area such as the frontal hairline area, etc? I have read that it helps the wounds heal faster and the scar feels better when healed With ACell then if healed naturally. IF you said that you saw that it had value in the scar area after a strip procedure. Would it then also have the same value in the transplanted area where it would cause the tiny pin holes after the hair follicle is grafted to heal faster and be less present? As well as help heal the tiny holes after a FUE procedure in the donor area where the follicle was removed. In theory In the long run, would it show almost no scaring anywhere after any type of transplant. Weather its a strip or fue?

I know all the hype is about cloning this and that and plucked hairs growing everywhere. but in the sense where it promotes rapid healing and helps the scar look/feel more natural or show almost no scarring at all. IS that not a great value to the whole hair transplant community?

There are a bunch of cases where grafts that were installed were driven into deep and look like indents after all is done and healed. Im speaking from my own experience from a procedure. Those little bastards are ugly so would that Acell bacon compound help that case as well?

So ACell alone without FRP or whatever they call it for faster healing and better cosmetic scar results seem like a very realistic and valuable thing

Things in life like this interest me. Especially When i read about things that come out like Acell and other medical devices that could potentially help people with hair loss and hair surgery

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ACellIt it generally thought that ACell will help the healing process deep in the wound and possibly reduce the superficial scarring, thereby making better wounds. There is circumstantial evidence for this in our practice, but this is more conjecture than science. I have not seen that ACell has helped the graft healing or made it grow better.

In our practice we have been using ACell for donor wound for over 3 years in most of our patients on a daily basis. Subjectively, the donor wound does look better with less tactile feel of a scar, so it may have some use in reducing keloid formation. Some patients came back for repeat surgeries and the old ACell scar seem to look better, but it was not a drastic improvement. Note that this is just a subjective observation from both the patient and doctor. ACell did not really have a reduction in the overall scar width and it does not make the scar any smaller in our observation. In one or two cases, the patient (who had prior non-ACell surgeries) thought it made the scarring worse. Even I (Dr. Rassman) had ACell put in my donor wound for strip surgery, but it made no difference in scarring compared to prior surgeries. ACell does not promote faster healing in our experience.

We also used ACell in many years ago in graft growth and even possible replication in recipient area. We submitted and applied for research approval with the medical board and conducted studies with Dr. Bernstein in New York. In the end, it didn’t work. The claims were false. To date, no one was able to replicate the claims of hair regeneration. Simply put, it was a publicity hype for the hair transplant world.

Tags: acell, hair multiplication, hair cloning, hair transplant, wound healing

 

hi

i have two questions. i am planning on getting a transplant done. i have read on a couple transplant sites where the doctor has posted pictures of young patients under 35 saying “patients hair loss stabilized”. How exactly does the doctor know the hair loss has stabilized and no further loss will occur in a younger patient if he is on meds? is the doctor just pretending or assuming no more loss will occur?

my second question is about my own hair. My own hair under bright lights my hair looks terrible, thin and disgusting more so in the front. In pictures and normal light my hair is thicker and nobody can tell. so if I go for a procedure can I ask my doc doing the surgery to look at my hair under the harsh light and give me grafts according to the harsh lighting and so it looks thick under those lighting conditions?

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I am not sure what your doctor means by “stabilized”. In young men, the hair situation is progressive, so unfortunately stability is not the rule. After a hair transplant, some of the hair loss will increase (shock loss)… so a hair transplant is destabilizing. You should be on finasteride for a good few weeks before you get the hair transplant to help minimize this destabilization. You and your doctor should talk about the surgery that he plans on doing.

Your second question needs to be directed to your hair transplant surgeon, who should be sensitive to your desires for where the transplants will be done and in what quantity. Keep in mind that harsh lighting commonly makes hair look terrible, but your doctor should be able to create a Master Plan modified for your individual desires and your best interest.

Tags: hair transplant, hairloss, hair loss

 

Hi Doctor,

I underwent a FUE treatment 3 months ago, around 2000 grafts. i’m 38 and always had a good skin quality. All went well, but i remarked “yellow shadows” over the recipient area very early. My GP said it was all ok.

At 2 months post op i remarked i lost small 1cm hair, trapped in balls of dry sebum. Also had red pimples with pus for one week and itchy. Went to a dermatologist, he gave me antibiotics and a sebiprox shampoo. I had to stop the use of the shampoo because it made me lose a lot of hair very quickly. I still take antibiotics for 15 days now. No more red pustules, BUT still losing some hair trapped in sebum balls and recipient area still red and itchy.

You cannot see with natural eyes, but if you use a looking glass you can see that almost every pore that is hosting small hair is bathed into a yellow substance. Sebum i guess. I fear this will prevent the hair from growing and make it fall.

What should i do? the surgeon who operated on me said it was a skin problem not a follicle problem and told me to see the dermatologist! I dont know what to do! Thank you for your advice. I see some hair growing from the transplant and i dont want to lose them.

As it is nice to see and not infected can we exclude the terrible folliculis decalvans ?

Best Regards.

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Click the photo to enlarge:

 

I don’t want to just brush your question off, but I don’t and I can’t diagnose medical conditions via the web. I think you should listen to your surgeon and make an appointment to see a dermatologist… or you could see another hair transplant surgeon or even your primary care doctor. This isn’t something I would want to guess about just based on a photo.

Some patients get infections and some have bad skin issues. You may or may not have both. Usually, within a few days, the evidence of a hair transplant in the recipient area is gone. Good washing techniques are critical to that process. At two months, you should be washing your hair, but not with too much pressure. Leave the shampoo on for around 5 minutes before you wash it off.

Tags: hair transplant, infection, hairloss, hair loss, hair restoration

 

I had about 1200 grafts transplanted into my frontal third (an area i roughly estimate to be 10 square inches, which i figure the amount of hair transplanted to be about 20% of the original density).

My question regards dense packing. I’m looking to get 800 more grafts transplanted there, but the thing is i still have a considerable amount of native (miniaturized) hairs in the area. I realize I’m running the risk of damaging the native hairs but do I run as high of a risk involving the growth of the new grafts in two surgeries compared to one?

To sum all of that up, is there any benefit of having several surgeries instead of one large one in regards to the growth of grafts in dense packing?

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If you have significant miniaturization in an area that you’re looking to have transplanted, you do run the risk of surgical shock loss occurring that could wipe those hairs out. Finasteride may protect you from shock loss, but you should discuss this with your surgeon. You don’t want to end up having a hair restoration surgery that causes hair loss.

As for the transplanting question — I generally will perform the largest surgery reasonable to minimize the number of surgeries. Dense packing, something I originated in 1993, may not result in growth as well as traditional grafting spacing.

Although it has not been my experience, reports by doctors in our field with side-by-side comparisons on volunteer patient have shown a lesser growth rate when grafts are packed at greater than 60 grafts per square cm. This should also be discussed with your surgeon.

Tags: hairloss, hair loss, hair transplant, dense packing

 

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