HELP! -- needing your advice on making a final surgeon decision

[CIT_Girl]

That's something I have always wondered about, but it's difficult to assess because most post-HT photos are taken from the front or sides (and the few that are taken from the back are usually for the purpose of showing the scar itself, not the surrounding hair).

Would you say this misalignment is commonly noticeable, or generally only in men who keep their post-HT hair very short?

It is definitely more noticeable on short hair where the scar is visible anyway. I think having some length to the hair puts weight on it, helping it to appear that it is all growing in at the same angle.

[gmonasco]

Taking out a strip of tissue and then stretching the scalp back together is somewhat akin to removing a chunk of patterned wallpaper and then trying to pull the pieces above and below back together- you will never get it to match up exactly as before.

That's something I have always wondered about, but it's difficult to assess because most post-HT photos are taken from the front or sides (and the few that are taken from the back are usually for the purpose of showing the scar itself, not the surrounding hair).

Would you say this misalignment is commonly noticeable, or generally only in men who keep their post-HT hair very short?

[CIT_Girl]

Maybe there's some hope that such might not be the case forever. With medical and surgical techniques improving all the time, perhaps someday even FUT strip scars may be rendered nearly undetectable.

This could certainly be the case eventually as strip scars have certainly improved with the more advanced closure techniques available today- however, we're still certainly not at a point where a patient can be guaranteed a paper-thin scar or one that will not stretch over time.

Another problem with strip surgery is that it results in misaligned hair growth angles around the scar, which can draw even more attention to it. Taking out a strip of tissue and then stretching the scalp back together is somewhat akin to removing a chunk of patterned wallpaper and then trying to pull the pieces above and below back together- you will never get it to match up exactly as before.

Have you encountered any cases in which patients didn't shave or cut their hair short, and didn't experience significant additional post-transplant hair loss, yet nonetheless were dismayed by their scars and/or could not completely conceal them?

I've seen this with patients who had very thin hair in their donor region and/or those who had very poorly executed procedures that left extremely wide scars. However, in general, if you go to a top surgeon, have decent donor coverage, and plan to keep your hair a little longer for the rest of your life, it shouldn't be a major concern. The only scenario I can think of where the scar would be visible would be if you one day lost your hair due to cancer or another medical reason (and at that point, I don't think a strip scar would be a major concern).

[gmonasco]

Frankly, I would say a lot of them are individuals who simply weren't properly educated about what they were getting into. If they were told to expect a scar, they were led to believe that it would be paper-thin and not warned that healing is unpredictable and many will stretch out over time.

Have you encountered any cases in which patients didn't shave or cut their hair short, and didn't experience significant additional post-transplant hair loss, yet nonetheless were dismayed by their scars and/or could not completely conceal them?

[gmonasco]

The bottom line is that any prospective patients needs to be sure that he will be comfortable having a strip scar and needs to understand that it will be there for the rest of his life.

Maybe there's some hope that such might not be the case forever. With medical and surgical techniques improving all the time, perhaps someday even FUT strip scars may be rendered nearly undetectable.

[Laserboy20]

Thank you all for your input.

GMONASCO: Thank you for your suggestion that I should meet any potential surgeon in person before scheduling a surgery. If I do go with Dr. Hasson, I think that a pre-surgery trip up to Vancouver to meet with him in person is a great idea. Thanks also for your recommendation of seeing multiple surgeons for the purpose of establishing a norm for the direction that surgery should take. That's another great piece of advice, and I appreciate it.

CIT_GIRL: Thank you for your input on the wisdom of using the non-tangibles (rapport, feelings of comfort when seeing results of former patients, etc.) to make a final surgeon selection. That's great advice. And thank you also for bringing closer attention to the issue of scarring. You have made me realize that I have indeed been downplaying the scarring issue in my mind because I know that I'll never shave my oddly-shaped head. However, I was planning to continue to wear my hair short (perhaps even as short as 1/2 inch in the back), so I need to think about this scarring issue more carefully, because I am hearing you clearly say that this kind of short length might not be cosmetically possible for me -- especially with my fine hair. Therefore, perhaps I will indeed look into FUE -- and your very own Dr. Cole. Thank you for drawing this to my attention.

SCARMAN: Thank you for your unequivocal recommendation of Dr. Hasson. It does seem to me that he has an amazing track record, and the fact that you are validating that perception is quite valuable. My gratitude to you for taking the time to read and to comment on my situation.

At minimum, I will schedule an in-person consultation with Dr. Hasson, I will schedule more consultations with IAHRS-certified surgeons in my area for comparison purposes, I will research further about how scarring affects people similar to me, and I will explore FUE. Thanks to all three of you!!

[CIT_Girl]

That's interesting. In your experience, are such cases primarily men who wanted to keep their hair quite short even after their transplants and weren't aware their scars would be visible under those conditions, or men whose hair loss continued post-transplant to the point that they wanted to shave their heads?

Frankly, I would say a lot of them are individuals who simply weren't properly educated about what they were getting into. If they were told to expect a scar, they were led to believe that it would be paper-thin and not warned that healing is unpredictable and many will stretch out over time. I'm sure there are those who were warned but, in their desire to restore their hair, overlooked the warnings only to later regret it. Then there are the patients who might have been okay with their scar at one point but, as they lost additional native hair, they no longer wanted to 'keep up' with the loss by having further procedures and just wanted to move on and shave their head- but cannot without revealing the tell-tale scar. Then there are a handful of very unfortunate cases where they were prepared for a scar but they went to disreputable surgeons who left them with truly awful scars that are difficult to conceal altogether.

The bottom line is that any prospective patients needs to be sure that he will be comfortable having a strip scar and needs to understand that it will be there for the rest of his life. There are plenty of men who will happily trade a scar on the back of their head for restored density up front- but there are many others who wind up emotionally devastated after the fact.

[scarman]

If you are going for the strip way, there is nothing like Hasson & Wong . No other surgeons have so many succefully document cases like them .

[gmonasco]

we see unhappy strip patients trying to conceal their scars multiple times a week at our clinic

That's interesting. In your experience, are such cases primarily men who wanted to keep their hair quite short even after their transplants and weren't aware their scars would be visible under those conditions, or men whose hair loss continued post-transplant to the point that they wanted to shave their heads?

[CIT_Girl]

Although it's imperative to 'do your research', I think that when you come down to the top handful of physicians in the world, you can expect great (and frankly highly similar) results regardless of which one you ultimately select. At this point, I think your decision should come down to personal preference- did you establish a better rapport with one over the other? Does one seem more accessible? Does one have a hair restoration philosophy or photo results more in line with your ideal?

Although I almost always advocate FUE over strip (we see unhappy strip patients trying to conceal their scars multiple times a week at our clinic), if your hair loss is stabilized and you genuinely have no desire to ever shave your head or wear your hair very short, I don't think it is necessary for you to consult with an FUE physician and throw more confusion into the mix. Similarly, I don't see the need for you to continue consulting with additional physicians unless you are not sure that either of the physicians you mentioned will be the right choice for you.

There is definitely a lot of information to absorb and it's definitely not an easy decision so best of luck with whatever/whoever you ultimately go with- keep us updated!!

[gmonasco]

I've faced the same dilemma. I think it's worthwhile to visit multiple hair restoration surgeons (even if they aren't ones whom you would consider engaging to perform a procedure on you) to ensure that there's a consistency of approach and you're not getting widely varying opinions on how to handle your case. And I wouldn't want to go with a doctor whom I hadn't had the chance to meet personally beforehand. But beyond that ... there's plenty enough information on the Internet to help one find reputable surgeons with established track records for excellence, so I'm unsure what value is to be had by traveling around to consult as many of them as possible, or what criteria one would use in choosing one over another.

[Laserboy20]

Hey guys -- After having reviewed the forums for several weeks, I'm a first-time poster. And I'm a 50-year-old stabilized NW5 who is looking to have my first HT in order to 1) reinforce my front hairline, and 2) get some coverage in my bald crown. I'm not expecting miracles -- I'd just like a little more fullness in front, and less of a bald spot on top. I'm a white man with lower scalp/hair color contrast, very fine hair, and decent native coverage. (See profile picture) I would look horrific with a shaved head, so I'm not too concerned with losing my shave-the-head option. ... Because I feel like I could spend years doing research on all of the transplant surgeons, my question is: When do you know that you're ready to make a final surgeon decision? I have had four consultations thusfar. I have had an in-person consultation with William Reed of La Jolla, California (recent winner of the Platinum Follicle Award), and a phone consultation with Hasson & Wong (very highly regarded on these Forums, obviously) as well as a phone consultation with Craig Ziering of Los Angeles (due to knowing a friend who had a good HT result with him). (My first trip was to Bosley several years ago, and of course, I am not considering them.) Although I had a good phone consultation with Dr. Zeiring, and although my friend's HT from him looks great, I've read some negative things about him and will thus probably eliminate him. Both Dr. Reed and Dr. Hasson seem to have great reputations, and after my consultation with Dr. Reed, I felt comfortable that he would be a very good choice. My phone consultation with Dr. Hasson was primarily through his assistant, but even so I felt like Dr. Hasson had a very good grasp of my situation and offered enlightening, sophisticated answers to all of my questions. So now I'm at the point of evaluating how much *more* research I should do. Would you recommend, for example, flying around the country to meet with, say, 10 more surgeons before making a decision? Should I consider FUE evaluations as well as strip evaluations? And at what point do you just bite the bullet and do it? I'm leaning toward Dr. Hasson because of his reputation, and I almost feel that I could schedule right now, but I keep reading that more research is better. My question is...HOW much more research? And what are your thoughts on the Hasson vs. Reed decision? ...I know that these questions might seem newbie-ish, but I could really use some guidance at this juncture, and I'd love to hear from anyone who'd like to offer their advice based upon the wisdom of their experience. I know that so many of you are total consumer experts in this field, and I'd love to hear what you have to say. Thanks so much in advance.