Body hair for transplant? Which type is best?*

[didi]

yes dr woods comes across as very defensive, its a bad sign..
I mean ffs if in 2013 we have to spend 30k and get such crappy result then im speechless..

If I was this patient I would be pushing for refund, shave it off and maybe get smp till something better coms along.


Why he used body hair only? No FUE?
My understanding is its last resort and patient seems to have virgin donor.


imho its unethical to perform such surgery on patient who clearly isn't good candidate


body hair is overhyped by some doctors in industry

[John P. Cole, MD]

There are a few salient points anytime one contemplates body hair.
1. It looks like body hair when it grows.
2. The typical good yield is 40 to 60%.
3. The hair will grow about 1/10 th of a millimeter per day faster on the scalp than on the body, but still 1/10th of a millimeter per day slower than scalp hair.
4. As a result, after a month body hair will be shorter than scalp hair that are both grafted in the same place.
5. If you graft body hair at densities greater than 36 grafts per sq cm, the yield may drop from let's say 60% to 4 or 5%.
6. Body hair may not last more than one or two or three cycles before it goes away.
7. Beard hair acts more like scalp hair. It grows fast. It covers well. Still a 60% yield is about average.
8. Beard hair grows like beard hair meaning it may be coarser and wavy like beard hair. This can be a stark difference between scalp and beard hair when scalp hair is fine.
9. Body hair may turn white long before scalp hair.
10. Some people have alot of body hair done and they are disappointed with the results.
11. Body hair can in some instances rescue a bad hair transplant.
12. For this reason, do a small test of BHT to determine yield, quality, and acceptance. If you do a large session and it does not grow, you will be out a ton of money and time. You will be very depressed.
13. Body hair may not grow at all especially in scars.
14. Anagen hairs will grow better with a higher yield than telogen hairs so wet shave body hair 3 days before a procedure to identify anagen hair and wet shave beard hair 1 day before because beard grows faster than the rest of the body hair.

I don't like this result at all. Recognize that 90% of patients with nearly good results like this are happy. Ray is certainly happy or he would not have posted the video/photos. Ray is correct, the patient would look better with the hair cropped shorter, however. One needs a good aesthetic sense to get great results. I'm not salivating over this particular result.

Some patients prefer body hair. If you plan to shave your head, it does not hurt to try a test session of BHT to see how it grows, what the yield is, and what it looks like. Only then should you jump off the cliff for a 2000 graft session. Scalp hair is far more consistent and better looking so i'd start with this. If the patient plans to shave his head, i think a small trial of BHT and scalp is a good option. If they don't like either, stop right then and there. 2000 grafts is far above a trial. Sometimes 2000 or 5000 or 10,000 BHT do not grow at all or only 4 to 5%. Don't take such a risk. Set the bar low and do a small trial first.

Gillenator, what the heck do you know about BHT? Probably what you read and that's a thimble full at best.

[topcat]

I think what is most important here is Dr. Woods just shows it and it is what it is and with that patients can make an informed choice. He does not hide or try and bury it. Nor does he e-mail patients or posters to say this or that so that he can polish his image as a good guy. In fact he goes out of his way to be politically incorrect and truthful about this industry so he is often in my opinion unfairly portrayed as a bad guy.

Others should take note that honesty is always the best policy. I am speaking most recently on the exposed e-mail from one rep of which there are plenty more and the buried necrosis case for which one forum had to gall to ban me as it was bad for his business when I brought it up.

[didi]

I agree with dr Cole, he is realistic about bht, you always say like it is..no fluff

I mean, if you see this particular patient in the street you would think something is not queite right? Nobody goes to have HT expecting such poor result.


Didn't dr woods claim that body hair takes on characteristics of head hair? sorry but Not in this case


bht was a big hit 10 years ago but it never really took off..woods hyped it up and everyone thought that donor issue is solved

hope dr cole gets in touch with dr nigam and start doubling donor

[John P. Cole, MD]

didi, anyone over hyping BHT today is a fool. The one absolute distasteful thing I can say about Dr. Woods is that he never told us that sometimes BHT does not grow well. He made it sound like a panacea. Then in 2003 patients began ringing my hook off about BHT. It was a result of his limited disclosure about only the great results with BHT. When I told them that BHT was not proven and I could not guarantee healing or growth, they still wanted to pursue it. My first case of about 200 thigh hair into a 2.5 cm strip scar done by CZ grew like crazy. How one makes a 2.5 cm wide scar in the first place is beyond me, but the story i got was that on his scar revision, CZ tried to get as many grafts a possible and turned a thinner scar into a disaster. You just don't do that unless your only goal is to make more money. So, we grafted the scar and it did well. Then we did another case that was larger and it did well. then we had a mix of success and failure. Now, I would tell anyone thinking about BHT that they need a trial first. Had Ray been more forthright from the beginning we'd have told everyone that they needed a trial first. Then later on even patients with good leg hair growth at first began to loose hair later on in life. At least Ray never advocated leg hair.

Frankly, I don't see many good aesthetic results coming out of this clinic even when it grows well. Yes, he cares about the patient, yes he seems honest and caring, but he needs someone to teach him how to build a hairline that looks good. It is so easy, but some just never seem to get a grasp on how to do it.

This is a patchy body hair result that is common with BHT. Perhaps he was a lucky one that got the 40 to 60% yield, but that's about all he got and it does not look natural at all.

Hey, the ISHRS is putting on a workshop in October called beautiful brows. The only problem is the result they are showing as "the model" looks like a transplant. Oh yeah! I want to walk around looking like i had a transplant on my face for the rest of my life. Last year a guy presented one case after another of his eyebrow results in the Bahamans. They all looked like a transplant. No aesthetic sense at all. Guess what. He's giving the same talk this year. Sometimes I just think hair transplant docs only see hair and they don't see what it looks like. Why else would anyone put plugs on a guys head for over 20 years?

[gillenator]

What's the matter Dr. Cole? Is what I say "bad for business?" And yet you send me a PM last week wanting to be friends again and because I did not reply, you time and time again show your true colors. Zebras never lose their stripes.

And those of us who have character do not make grandiose statements that they are the best at this and that, nor do they take pot shots at their colleagues as you do repeatedly. You were rightfully called out on that too by another forum member remember?

You see a true professional does not have to disrespect others in order to make a point. The very best are humble individuals. They do not have to repeatedly come on a public forum insulting their colleagues and others in order to gain market share.

[John P. Cole, MD]

Dr. Nigam invited me to his clinic. I'm going to go. I don't like walking into that drug resistant tuberculosis infested place, but i'm going. If he has something, I'm going to catch on to it and hopefully not catch "it". If not, he better wish he'd not invited me. We asked Dr. Gho too, but he never responded. All I care about is a better result for my patients. If they have something, I want it. I don't care what it costs.

[didi]

Dr Cole

great stuff..

I know how it went with dr gho, sad state of affairs, he kinda chicken out when he heard you coming...

This dr nigam seems like a real deal but of course I want you to 'grill' him and see if he can double hair or not.

[John P. Cole, MD]

Gillenator, I stand by my comment on BHT toward you. If you don't know a subject especially one that produces terrible results at times, you should refrain from comment.

That does not change the way I feel about you. I always liked you and frankly no matter what you say to me, I will always like you. You got under my skin in a good way long ago. I will never forget the chili you made me at your house with your wife years back. That creeps up in my mind every time I read something you post.

Now, about body hair, I'm very caustic because I'm the guy with the most bad experience doing BHT. I made guys very unhappy about their BHT result. They spent tons of money on it and i worked many 12 hours days with my head bent over like a contortionist trying to get the hair out. I even had a guy pass wind in my face getting pubic hair out. You try that sometime.

You know who fixed up your ragged hairline, but you never give that guy credit. Time to bury the hatchet. We both have the same agenda and that is to help out guys with hair loss. You are a great guy. I love you to death. You don't sugar coat the poison berry and neither do I. I really do miss you.

Now on body hair, be careful. It can work miracles and it can really mess a guy up financially and mentally. Remember, when you spend 10s of thousands of dollars and don't get any growth, you can become very depressed.

Ok, let's go fishing together sometime and put this all behind us. I gave you the name Gillenator for a reason and that's because you are awesome.

[gillenator]

Well at least you're coming clean on some points. Yet trust me, I am not the only one who finds your grandiose spirited comments distasteful and unprofessional. There are ways to effectively communicate without attempting to make yourself look good at the expense of insulting your colleagues or me. If you have a beef about or with one of your colleagues then give specific names and examples. Ranting without specific cases and actual facts only shows a hidden agenda. I have often told you in the past that you tend to be your own biggest opponent.

And you do not have to attempt to discredit me regarding my commentaries. If you think I don't know what I am talking about, simply quit reading my posts. It's really that simple. The real truth is just maybe that my comments are not good for your FUE business. Your comment towards me was a potshot and uncalled for. My posts speak for themselves and do not need your approval or disapproval. Yes I do participate to help others who suffer from hairloss but as an independent advocate and not under the control/direction of any employer who might want to dictate what I say to patients in order to gain market share.

My opinions are based on countless observations over the past 34 years now, and yes also from what I read including some of the good things you have said from a clinical/research standpoint. And if you want to think otherwise, that's your entitled opinion. Just have a little class when you express yourself. Don't worry, I am not angry or anything. I just don't allow anyone to take pot shots at me. And I do not have any problem admitting if I am wrong about something either. I am human just like you.

I do see you as one of the more passionate doctors and want to personally thank you for that as you have made some awesome contributions to HT surgery. I remember when you went to see Dr. Woods a decade ago and wanted to start doing FUE in North America. Many criticized you at the time but you felt at the time it was a better option than strip.

I do not necessarily agree with that opinion along with many other of your colleagues who also offer both methods. But I suppose you might again think I do not know what I am talking about. Results are what count and patient satisfaction whether strip or FUE. You yourself have stated that FUE is not for everyone. You can think whatever you like.

Anyway I wish you well. Hope that your children are doing well and read that one of your daughters is becoming quite the violinist. She must take after her daddy although you never could sing a note on key! Just kidding.

Peace....

[garethbale]

Dr. Nigam invited me to his clinic. I'm going to go. I don't like walking into that drug resistant tuberculosis infested place, but i'm going. If he has something, I'm going to catch on to it and hopefully not catch "it". If not, he better wish he'd not invited me. We asked Dr. Gho too, but he never responded. All I care about is a better result for my patients. If they have something, I want it. I don't care what it costs.

I appreciate this Dr Cole, and I understand your skepticism. However, I would not expect an IAHRS surgeon to comment so disrespectfully, particularly as Dr Nigam might read the comment. You are obviously highly regarded in your field so a degree of professionalism is important.

[StinkySmurf]

Dr. Nigam invited me to his clinic. I'm going to go. I don't like walking into that drug resistant tuberculosis infested place, but i'm going. If he has something, I'm going to catch on to it and hopefully not catch "it". If not, he better wish he'd not invited me. We asked Dr. Gho too, but he never responded. All I care about is a better result for my patients. If they have something, I want it. I don't care what it costs.

Wow! I can't wait to hear what you think Dr. Cole!

[gillenator]

Doc,

Forgot to clarify one thing that you stated. When you stated that I had my "ragged hairline" fixed, I presume that you meant fixed by "you" when you did my third HT procedure in 2004. I want you to know that you did a very nice procedure on me although Drs. Patrick Mwamba and Chris Bisanga did the majority of the work. My point is that I liked and still appreciate the work that was done on me. So thank you for that.

That procedure however was for the purposes of adding density and coverage and only about 400 of the 2400 grafts went towards any part of my frontal hairline. About 17% of the total grafts. To clarify, and speaking for myself as a patient, the ragged hairline that you referred to was done by Dr. Ron Shapiro. It was not ragged. It was very good. You even applauded the work at the time. And I was perfectly happy with his work which you also knew.

In fact, Dr. Shapiro did my fourth and last procedure in 2006 and was happy with that one too!

Just wanted you to know my because we have not seen each other since 2004 is it? Almost 10 years now...take care.

[PayDay]

I think Dr. Cole should be very skeptical of Dr. Nigam's claims. Personally, I think it's sad to see so many young guys potentially being taken advantage of by someone with zero credibility in the field of medicine or science.

I also agree with gillenator and find it extremely unprofessional and in poor taste for Dr. Cole to make many of the remarks that I have seen him make on this forum. If you really are the best at what you do, you don't have to shoot other people down to prove it. It's really kind of pathetic.

[John P. Cole, MD]

Allright, that's the Gillenator I know and love so much. Thanks for expressing your opinions boldly.

To be quite frank with you, I don't worry about my colleague's opinions about my commentary. I am really sick about the false and misleading rhetoric in this industry. I've had just about enough of it. With FUE on the cusp of breaking through as the gold standard, the last thing I want to see is to have it ruined by a docs who want to profit by it at the expense of patients. You are not gold standard when you let your assistant watch a robot harvest your patients' grafts in my very experienced FUE opinion.

Dr. Nigam seems to be a very nice guy, as are all the doctors from India, but he is stating that he is getting complete donor regrowth. If he is accurate, then we all need to know. If he is not, then we all need to know. I think that is as clear as I can state it. If I go there and the results are equivocal, I will say we need to give the technology more time, but it looks promising or it may not be so promising. If the results are amazing, I will make this clear and highly recommend him. If the results are poor, I will make that clear, as well. If they work, I will do my best to help him spread his technology. Yes, the tuberculosis stuff was a bit off the cuff poor taste, but the facts are the facts. I know of one girl who contracted TB there and it is drug resistant. She will die with the disease, and she was in India as a volunteer to the poor. It is very sad, actually. I still have two children at home so I worry about such a journey. So does my wife. Then again, I have never considered myself an IAHRS physician or anyone looking to be simply professional. I just tell it like I see it. Sometimes I'm wrong and then I apologize profusely. I know, the professional guy is what we like, but where has that gotten us? We have over 20 years of plugs, flaps, and scalp reductions. We have snake oils that grow hair. We have guaranteed pencil line thin strip scars. We have non-surgical FUE procedures. Now, we have follicle regeneration. Even with my own work on Acell I have some degree of skepticism. I think professionalism is done in the hair restoration industry. We need a very high degree of truth. We don't need to continue to turn our backs on what is being done. We need to look closely and make a very real assessment. Turning a blind eye is hardly the path I will ever pursue.

I guess here we go again with the thought that assistants control a top quality procedure, Gillenator. Dr. Mwamba and Dr. Bisanga were not physicians in the USA and they were not called doctor. They were very good assistants or surgery techs. Grafts can only go into recipient sites in the direction they are made. Only the physician can decide where to place the grafts of any given size by making sites that will accommodate them. In other words, a proper site for a one hair graft should not tolerate a 2 hair graft, etc. However, sometimes it does. This is why the physician has to make sure that the proper grafts are placed in the correct location. In a strip procedure, the technicians (assistants) generally cut and place the grafts. In FUE, the physician should be the one extracting grafts though in some clinics, assistants do this. If the physician has experience cutting and placing grafts, the physician will know what should be done at all levels and pass this expertise on to the assistants. In many clinics if not most, the physician has placed few grafts and cut even fewer. These physicians do not know what a graft should look like and they don't really know placing either. Gillenator, to suggest that my team did most of the work is a complete fabrication on many levels. First, they were taught exactly how I wanted the grafts cut and exactly where to place them long before they ever worked on your scalp or hairline. Furthermore, I personally placed a fair amount of those grafts myself. It was a long procedure and a difficult procedure, but as a team we got the job done. A hair transplant is always a team effort, but those teams have also produced some very bad results with other physician control. To suggest that your hairline was ragged is accurate, but Dr. S and his team were not the only people to work on you so who know's who were the culprits. What I do know is what I see. As stated, most patients with near good hairlines can't see the bad. The reason is simple. When you look in the mirror, the focal length is twice the distance to the mirror. Most can't see that well to zoom in on suboptimal work so 90% think near good is good when it is not. It is up to the physician to make sure the result is good by evaluating the results as they proceed. If you don't know what to look for, you have no idea if the job is good or bad. I know what to look for, which is why Drs. Bisanga and Mwamaba are good physicians today. They were taught the optimal basics. In an average to poor practice, yes the assistants control a procedure. In a high quality practice, the physician controls the procedure from start to finish.