Why so many different survival rates for scar grafting?

[John P. Cole, MD]

on the subject of repair work, there is a thing called operation restore. This is a fund that helps patients get repair work. It is an off shoot of the ISHRS and they are quite proud of themselves for setting it up.

I donated 4500.00 to it last year. A number of physicians also contribute up to 2000.00 to this fund. There are physicians who do the repair work for patients in operation restore. I think the fund pays for your hotel and travel, while many of the doctors donate their time in exchange for the right to market your photos. i'm personally not involved because I do the work for free many times and did it for free before there was an operation restore. Also, i have no desire to use patient misfortune to promote operation restore, the ISHRS, or myself. This is how the fund got off the ground. One doctor treated a child that was a burn victim and then posted the child's photos all over the place. I was happy to see the youngster get a more normal look, but hated to see the child become the poster boy for hair restoration surgery even if done under the banner of a non-profit organization.

What bothers me about repair work and patient cost is that the repair work is much more costly than doing it right the first time. If someone needs repair work and they are worried about cost, it is best to find a physician who will work with them inside their budget. That is what i've always tried to do.

Of course, repair work can be challenging. It is not always easy to do this. It often takes many procedures. Goals can sometimes not be achieved because one is often limited to sources that do not have high yields. This includes body hair. I once had a patient who needed quite a bit of work and he had 500 beard hair and 500 scalp hair grafts. He needed much more. He spent his budget getting the first bit of work and then he was demoralized because he was out of money. That is where the physician just needs to kick in and do more work on the house to help the patient get over the hump.

I gave about 80,000.00 to charity last year. Making money to give to charity is not always the easiest thing to do, but giving one's time is easy.

[ejj]

Dr Cole ,

Thank you for taking the time to reply, with such a detailed account , its very much appreciated .

I myself am undergoing repair using beard hair grafted into strip scars , so its of huge interest personally .

Am unsure re operation restore as i thought it was solely for accident victims , and not applicable to hair transplant failures/ repairs , please feel free to correct me if im mistaken .


Again thanks for the reply , all the very best

ejj

[John P. Cole, MD]

I'm not sure if operation restore is only for "accident victims". I'll do some snooping. I can't imagine why they would not consider repair work part of operation restore, but I would guess that perhaps the hierarchy at the ISHRS might consider bad ideas and bad work acceptable results. In other words, I've heard them say for years, what are you patients complaining about? It's just plugs, mini-grafts, pitted grafts, ridging and strip scars so why are you upset about them?

I had one yesterday. He was 19 when the largest TV advertiser got ahold of him. He had absolutely no hair loss what so ever and still doesn't. What he did have was grafts in his temple recessions like woman though. I took out about 300 grafts. Of course they told him they'd done 2400, but he did not have more than 300. I rotated them all to his strip scar. The chief medical officer of this group told me that he should not be blamed for what happened in his group prior to his arrival in 2001. Of course, this one happened under his watch so next time I see him, i'll let him know that it does not appear that much has changed with the group. At least they are working on hair multiplication. Maybe that will make up for their prior sins.

Dr. Bisanga started in the hair transplant field in my office, and I set him up in his first clinic. He is capable. You should be in good hands ejj. He eats a little too much, but he is a good hair transplant surgeon. You'll be fine.

[gillenator]

FUE seems to be the way to go for adding hair grafts to an existing suture line scar instead of cutting out the old scar only to have a "wait and see" hopeful attitude. The nice thing about FUE to the scar area, you can always add more later if you want. Survival rate will vary on the quality of the grafts and the amount of scar tissue in the area.

From what I have observed, that really depends on the individual patient. If the wider strip scar was more attributed to incompetence, and the patient has the scalp elasticity to "reclose" then removing some of the scar tissue and then utilizing Acell, PRP, etc, can make a dramatic improvement. Not on all, but some..

The problem with scar revisions is yes sometimes the wider scar is due to a healing issue and not incompetence. Cutting again can potentially make the new scar worse than the first one. And also, the blood flow is compromised everytime more cuts into the tissue are done. The less blood flow, the more scarring is left which any way you look at it will compromise yield.

Hopefully scar revisions are being done with closer scrutiny verses a wait and see what happens approach.

[topcat]

Since I am a patient of Dr. Bisanga I would describe him as more than capable. In my opinion he stands out as the best but of course I am a patient so many others will debate this statement. What I can tell you about him through my own experience is that he is a very soft spoken, down to earth, and a kind hearted person. This is also evident in everyone that works at BHR. He seems to employ those that are similar to himself and those same traits in those that work there are what make it a complete clinic as one person alone does not make a clinic.

Actually I was a little shocked at how down to earth he happened to be. I have worked for years in customer service and hospitality. When someone ever asked me what occupational group represented the worst in customers without a doubt it was always doctors. They were the most arrogant, the cheapest and always treated the service staff like shit.

As far as Acell is concerned the debate will end when substantial photographic evidence is presented. At this point is simply does not exist.

[northeastguy]

Thanks Dr Cole for the detailed information I was looking for. It helps quite a bit and hopefully this information has helped others who had similar questions. I think we are all looking forward to seeing those photos. Being someone ready to pull the trigger on my strip scars, this information has eased my mind quite a bit. Obviously, I don't want to waist 800 grafts if only 30% grow. Especially when I could use them else ware.
In regards to strip scar revisions, I like the Idea a Physician has brought to my attention about revising only small sections at a time. If a scar was 16cm in length.... a 4cm section would be revised and 6 months or so allowed to pass before revising another section. Obviously this allows the existing and old scaring to minimize the tension to the revised area. I was told this does not completely prevent stretch-back but does decrease it substantially. Hell, a 3mm scar is a hell of a lot better than a 6mm scar. Dr Cole, have you had any experience with this?

.... I see the horrible scarring issue that ejj is dealing with and I wonder why there isn't some sort of guideline or test designed to spot patients who are prone to scarring issues like his. Obviously if a "test" area was done and he knew the pending results, he never would have gone down this road. I doubt any of us would have gone down this road..... Strip harvesting anyway. ejj your results so far look great, your obviously in the right hands. best of continued luck with your scar grafting.

[gillenator]

topcat,

Anyone who feels the way that you do about Dr. Bisanga many times state that they feel their doc is "the best". I would wholeheartedly agree that he is one of the best and also have always agreed that talent is not enough. Ethical characther is vitally important especially in this field.

[gillenator]

northeastguy,

It's in the preliminary consultation with "every patient" that the doctor review that patient's medical history which IMHO, should always include the area of healing from past and present wounds/lacerations. It's in the physical examination that the doctor can potentially look through the individual's scalp, test laxity, etc. That does not imply that this will prevent scarring but should the doctor discover something that could compound the healing process or discover then that the patient has past issues with healing including keloiding, other decisions in the patient's best interest can be made. This includes a change to FUE or even "no surgery".

They also can review current and past medical conditions, past surgery, medications, etc.

To this day I still hear about patients undergoing HT surgery and never asked about their medications or medical history.

[topcat]

Gillenator I think every time I state my opinion people take it a little too personal. Regardless of what many think I ended up at BHR because I knew they were the best from my own research. Over the years I have personally told some doctors that I would never consider them in fact one doctor on this site’s list I let know that I would not use if they were the last clinic on earth. I have been around too long and I’m too mature to be desperate. I’m also too honest and principled to come to these forums and simple make shit up.

Dr. Bisanga does what most will not and cannot do. He works long hours extracting FUE’s with very small hand punches. The is very tedious work but he has conditioned both his hands and his mind to be able to do it day in and day out while achieving exceptionally high yields along with beautiful end results.

Most doctors that have tried it have said to themselves screw this shit. I’m certainly not going to be busting my ass doing this day in and day out so they go back to doing strip and just rely on bullshit when asked by their patients. Oh FUE that results in low yield, white dotting, blah, blah blah. They leave out the important fact that it only applies to them. While others try to achieve the same yield with a basterized version of FUE using drills, in my opinion it is not the same and they end up giving FUE a bad name.

So yes I do give Dr. Bisanga a lot of credit for sticking with something that is very hard to do and not caving in while others around him make more money working less. And to top it all off he is a good man.

[John P. Cole, MD]

Yes, i agree. Dr. Bisanga is very capable. He did not invent FUE or sit down and figure it out. He learned it from me in 2003. FUE has evolved significantly since then. Since then Dr. Bisanga has been quite critical of FUE. I really don't think you can be pro-Strip and anti-FUE, which is what DR. Bisanga is. Dr. Bisanga worked in my office from 1999 to 2003. He was a very good surgery assistant during that time. I gave him his first opportunity to do surgery in 2003 working in our office in Cyprus. Dr. Bisanga subsequently took staff and patients from this clinic to open his own office. In short, he was nothing short of dishonest. Personally, I could care less, but he has no right to market himself as someone who developed FUE or someone who figured out hair transplant surgery as is suggested. Dr. Bisanga is very capable, but he has not advanced a single aspect of hair transplant surgery. What he is does is limited to what he learned by 2003. Beyond then he is simply stuck in the mud, which is common to most hair transplant surgeons In other words, he learned some good techniques, but he has not grown beyond those. If he has, i'd love to know what they are. Still 2003 technology is better than 1958.

[ejj]

I have a freind who is self employed , he has a manager who worked for him for over ten years , the manager left to set himself up in buisness , the same buisness , its interesting to hear the points of view of both , my freind states he left him to set up on his own and took clients with him , the guy who left states that he wanted to go on his own as he had fresh ideas and felt restrained within the company , naturally his clients developed over time wanted to follow , i think this is what happens in buisness generally and all to often people forget hair transplantation is just that ..... buisness ..

Being a victim of over eight procedures ranging from .4mm plugs in 1990 with Drs who were ` stuck ` in the mud , i often wonder how any Dr can swear an oath , treat ill people in hospital , experience illness even death during there career and still ... think that 120 4.mm plugs cored into a twenty year olds ever so slightly receding hairline can possibly ever look good is beyond me !

Going forward i experienced ` mini grafts` ` choi ` implanter , even bizzarre methods of multiplication ,plucking , regeneration etc before having a procedure with Dr Bisanga of 1032 beard grafts into my horrific scarring , so I have growth and there is improvement so i think Dr Bisanga has advanced the area of repair with beard hair significantly , i think there are only a handful of Drs who can do this ( Dr Cole included )

That said i like the fact Dr Cole is fue only and has some outstanding results

regards

ejj

[topcat]

Where exactly have you read it posted that someone else has taken credit for inventing FUE other than Dr. Woods. I have been around for a very, very long time and I know who has stated what. Everyone starts somewhere does MHR ring a bell. Some become better than those that have helped in their training that is just a fact of life. I am very familiar with the history of this industry and who has worked where. Who has become better and moved on as we all can relate to working for employers that are not the ideal. You seem to be a bitter and angry and it comes out in your posting. I have spoken to many people over the years including employees and many patients from the various clinics so I think I might know just a little bit. Many of these doctors are extremely arrogant and that is why they have such a hard time attracting and keeping quality people to make up their team. Humbleness is something that most often cannot be learned but is a human trait one develops at a very early age.

It is very well known that Dr. Woods invented FUE and most doctors with any integrity still call the procedure what it is FUE and not some new acronym to call it their own. Here is some posting history but it is only a taste. The history of this industry cannot be erased.

(2003 patient consultant)
If I were Woods, I would put away my paranoia and make a sincere effort to work with the best strip docs out there. They all acknowledge the benefits of FUE but these are some damn smart guys and they don't need to shell out the cost of a couple of years of medical school to learn one procedure. The biggest thing that Woods has to offer is his experience, not the technique, as there is more than one way to skin a cat and these guys are smart enough to figure it out on their own. It's already being done by Feller, Jones, Cole, and soon enough Hasson & Wong. These guys are working together to advance the field.


All Woods has to do is say, "Hey, let's put the past behind us. You strip docs that are the best of the best recognize what I've done, now let's work together to truly bring about real change in this industry. If we lead the way, then the rest will have to follow". Then, he needs to cut the price of his mentoring to maybe 50K tops. Actually, that may still be too much but you get the idea. If he were to have a healthy attitude like this then he would have LOADS of docs just lining up to learn. Not to mention he could learn a thing or two from the other docs. I think that Dr. Woods is a very paranoid individual and he should not let the experiences of the past dictate the future.


(2002 from Dr. Woods)
Dear Dr ,

As you know, we accepted your invitation some months ago to address the ISHRS on October 12th. However there were "problems" as you well know and the invitation was not followed through. Perhaps it is better that you give a public explanation regarding this matter.
We were very disappointed with this missed opportunity, but have since made other arrangements.


Message to the forum

Dr Campbell and I will be holding an introductory seminar on October 12th. (this date was put aside after the original invitation). We are looking for expressions of interest from doctors interested in joining a "woods technique" training program.
From the very start it was our intention to end strip excision and other forms of harmful surgery worldwide. However, simply having a vastly superior procedure guarentees nothing.


We are directly challenging a multibillion dollar industry. People who run it do not always act in the public interest.
It was our strategy to create worldwide interest . We needed a critical mass and overwhelming public opinion to force a change. We are not there yet and still need support.


However , we have come so far because we have proved the undeniable superiority of our technique and offered future hope to millions. We have not played into the hands of those who would relegate our technique to obscurity. Revealing our technique too soon and to the wrong people would be like revealing a "water engine" to an oil company.


Now, the time is drawing near. We need people to become active. If you know a doctor who you think could be a woods technique surgeon, tell them about the seminar. We need good people. NO PRIOR HT EXPERIENCE NECCESSARY(LOL).


We expect there will be those who will see one procedure and then self proclaim they are "expert pioneers" offering an "improved" version. If done incorrectly, the damage to the donor area will be the same as strip. We intend to protect the public from these unscrupulous opportunists.


We thank you all for you support.
( I liked the Julius Caesar invited to the forum analogy (LOL) )


Dr Woods and Dr Campbell

2001
Reply from Drs Woods and Campbell


From our own experience and from the word of clients and from Farrel and Spencer it was clear that the hair transplantation industry did not want the changes we were proposing. I am on record for saying to journalists as early as 1996 and to Spencer Kobran 2 years ago that we wanted to make strip excision surgery obsolete and that the individual removal of follicles via 1mm microsurgical incisions would replace it.


Doctors in this industry have tried to misrepresent and discredit us. We decided not to reveal our technique to doctors who were hostile to our commitment to changes in this industry because we felt that they would further misrepresent our cause.
We believed that doctors would say, "yes we have seen and are familiar with the Woods technique and it is inferior"
We have been accused of being paranoid but we have been right, as doctors who have never seen our technique have made similar comments.
As I made clear to Farrel and Spencer our intention was to create a frenzy of interest. To advertise in American magazines and create a "pressure cooker" effect......the public would be convinced by living indisputable truth and evidence, that our approach was the end point in hair transplantation surgery.
It is our belief that this would not come from the doctors in this industry. However once the public became aware of the truth they would force a change.
We thank all our clients who have told of their experiences and spread the word. We thank all the posters who have not actually seen us but have the ability to do thorough research. Your intelligent clear thinking has maintained a high level of debate and prevented the hijacking of our achievement, future hopes and principles.


We hope to establish an international clinic and training facility based on the following unshakeable foundation principles-


1. That everyone is a candidate for the WoodsTechnique and strip excision is definitely not done
No Biopsy or test procedure is required.
2. The entire procedure is to be preformed only by a doctor fully trained and accredited in our technique by Doctors Woods and Campbell
No one else touches the patient’s head
Absolutely no assistants
3. The entire procedure adheres strictly to microsurgical cosmetic principles, which defines our technique.
4. There will be no routine legal disclaimer or waiver.
5. The doctor must be responsible for the removal of and the placement of each and every follicle,ensuring a virtually perfect result each and every time.


To my knowledge Dr Campbell and myself are the only cosmetic surgeons in the world who operate without routine legal disclaimers and waivers
For all the people out there who want to make a difference. We ask that you be vocal and spread the word and be part of this fight.


We want everyone to know that it was through the journalistic integrity and courage of Farrel Manne that the truth is told. Farrel had the 'sheer guts' to present us on his website despite opposition.


As far as Spencer is concerned. Approximately 2 years ago we contacted Spencer Kobran and told him of our achievement - He appeared to be fascinated and told us that we would be on his radio programme. With great excitement our entire staff was informed and we anxiously waited to tell of our achievement and our vision for change to the American public. However within a week Spencer called me to state that it would be impossible to interview me on his radio programme . We have never since been asked to be on Spencer’s radio programme. We gladly would have done so at any time.


We offered to fly to New York to show him hundreds of case studies never before seen by anyone else - I even offered for him to come to Australia to observe a procedure. Spencer told us not to come to New York and he declined our invitation to come to Australia. Our American patients have actively pursued trying to go on to Spencers show. It was due to Spencer himself that he refused to have our patients on his show.

Three days ago was the FIRST TIME we were ever asked to write a statement for Spencers website.


We are now very pleased to provide the above statement to Spencer .
Dr Ray Woods and Dr Angela Campbell

[topcat]

The problem with many in this industry is that they forget history. They have become blinded by money and boosting their own egos. These young guys that come to these forums don’t know jack shit about what is going on. They refuse to research the past and prefer to look at all the pretty pictures of present day. So if you wonder why I have been posting for 14 years, you now have your answer.

I have had my share of time working for a-holes and when employees get together they talk about how the boss is such an a-hole. It’s not unusual for them to often leave in groups as people tend to view social proof when making their own decisions. Get a clue already.

So I know very well to not only research the doctor but know who is working for him and how happy they are in their line of work. People that treat their employees like shit often treat others like shit, it's not rocket science people it's common sense.

[topcat]

Do you recognize this quote from 2002 that was posted to another forum under the name Dr. Cole. Either way it doesn’t matter to you see yourself and your arrogance?

I will say that there are many things occurring in Europe that do not occur in the USA due to more stringent control by the state medical boards in the USA and due to legal requirements. I know that Dr. Bisanga is doing hair transplant surgery. I also know that in the USA he was not a licensed physician and therefore did not practice hair transplant surgery. He never designed a hair line, he never made the recipient area, he never planned a donor extraction, and he never harvested from a donor area. He cut and placed grafts. He cut them the way he was instructed to cut them and he placed them where and how he was instructed to place them. He did not design any of my hairlines as Lee suggests he did and he did not control the result. He was a technician. Nothing more.

http://www.************.com/forums/m...VIEWTMP=Linear

[northeastguy]

I have worked in the Healthcare field since 95. I have worked directly with MD's for most of all of it. Some doctors are liked, some are not. It's that simple. Their personality, for my sake is not a number one requirement. Or as we call it Bedside manner. To be honest, most that have great bedside manor are making up for weakness in other vital requirements. I worked at a facility that employed a neurointerventionalist that was highly recruited by most of the major hospitals in Boston. He was the best and he knew it. He was not known for being a friendly guy. Often treated his staff like crap. To be honest, he was extremely difficult to understand..........However, if I ever had an inoperable Brain aneurism, please take me to him.

.... My point, although it would be nice to be buddies and share a few laughs with the Physician doing my transplant....my number one priority is the outcome. Plain and simple. All the other stuff to me is fluff. I want the best available to do it and I don't think we need to travel overseas to have that done. Dr. Shapiro, Dr Cole, Dr Rahal, Dr Hasson......Hell it's like comparing Sandy Koufax and Bob Gibson for Christ sake. I'd be happy with either. I do have issues with other aspects of the industry. But that is for another day.