+ Reply to Thread
Page 2 of 3 FirstFirst 1 2 3 LastLast
Results 11 to 20 of 29
  1. #11
    Senior Member
    Join Date
    Dec 2008
    Location
    Atlanta, GA, New York, NY
    Posts
    379

    Default

    Tracy C, you seem well tuned to hair loss and treatments. I've been seeking answers you have for years without success. Thanks. You know that many people have perceptions about hair loss and hair treatment that lacks scientifically conclusive data. Stressed is not more right or wrong that you are so the more appropriate path is to simply state your perspectives without challenging someone whom you cannot conclusively adversely confront.

    Mandg, you are 30 and very potentially going to a class 6. No one can say for sure without evaluating the mid-scalp for miniaturization, but i'd say it is likely. How long will it take you to get there? I don't know. Look for a family history. In the abscense, it is impossible to tell. Hair loss goes in stages. It accelerates. Stabilizes. Stalls. Accelerates. No one knows if the stall is due to medication. We certainly like to think it is medication. No one likes to waste their money or take unnecessary risks.

    How many grafts?

    Look, treatment is very individual. The things you need to look at are hair density, follicular density, hair diameter, curl/wave, area of loss (present and potential), desired personal goals, and trichoimetric surface area. Here's the tricky part. Find someone who can give you this information. Good luck!

    Patient donor capacity determines potential results. It's not magic. If you don't have the proper size and number of bricks, you can't build the house that someone with more substantial building elements can achieve.

    Currently, your mid-scap looks good. I can't say when you will loose it, but i suspect it will happen. perhaps not, but it is probable. thus, be careful with what you do in the crown and be careful how low you build your hairline.

    If your trichometery is greater than 90, I think you can be much more aggressive than if it is 60 to 70. A trichometry of 90 suggests higher diameter, higher follicular density, and hair hair density. The number of grafts in the front depends on the hairline location you desire. Lower spells more grafts. Crowns always eat up more grafts because the hair grows in 360 degrees back there, which means there is less shingling affect in the crown area. One always needs more hair in the vertex to make it look full.

    Let me give you an example. A patient with a hair diameter of 82 and trichometer of 92 had 1400 grafts in the frontal area. The resulting trichometery showed a 62% to 76% loss in the front and top respectively compared to the donor area, yet the patient looked totally full. in other words, the 50% loss rule does not apply. What applies is individual characteristics. Only someone who evaluates these variables and understands them can give you an interpretation of what you can expect based on your donor area, recipient area, goals, and anticipated hair loss.

    I'm really not sure where you are headed, but it could be significant. Therefore, i would certainly encourage you to either do nothing or to seek medication or FUE. I'd steer clear of a strip procedure simply because your situation can get a whole bunch worse over time and only God knows for sure where you are headed.

    The photos suggest you might be worse off or better off. Hard to give a recommendation based on them. Don't be upset. Poor photo quality is very common and even with good photos it can be hard to tell.

  2. #12
    Senior Member
    Join Date
    Sep 2011
    Location
    Ohio
    Posts
    3,125

    Default

    Quote Originally Posted by drcole View Post
    Tracy C, you seem well tuned to hair loss and treatments.
    I pay attention.

    I realize you likely do not have the time to spend enough time here to see what StressedToTheBald has been doing in this forum. He has been doing more harm than good and I am not the only person who knows that.

  3. #13
    Senior Member
    Join Date
    Dec 2008
    Location
    Atlanta, GA, New York, NY
    Posts
    379

    Default

    Tracy C, I spent a good bit of time tending forums at one time. I am the first to admit that I don't spend much time there any longer. What I can tell you is that I have skimmed here and there the past few days. I think i will tag along for a bit of time because there are multiple perspectives valuable to the decision making process.

    There is no such thing as not having time. There is not making the time. I stopped making time for forums because i found them distasteful because so many people can be quite rude. I'm going to make a bit of time now only to voice a different perspective. I certainly hope to avoid hurting anyone because at the end of the day no one is necessarily wrong.


    Now, let's take stressed. He seems to be concerned about medication. What's wrong with that? Do you know that class action lawyers are starting to snoop about finasteride? Their radar comes on for a reason. I'm not saying it's right or wrong. I'm just saying that Columbus was sure the world was not flat. Don't condemn a guy just because he may sound off irrational fear that stirs petulance. He may turn out to be right. No one knows for sure at this point. I can honestly say that i have no idea whether the vast majority of my patients have responded positively to propecia. i can say that about 1 in 1000 had a noticeable response. How do you measure that risk to reward?

  4. #14
    Senior Member
    Join Date
    Sep 2011
    Location
    Ohio
    Posts
    3,125

    Default

    Quote Originally Posted by drcole View Post
    I can honestly say that i have no idea whether the vast majority of my patients have responded positively to propecia. i can say that about 1 in 1000 had a noticeable response. How do you measure that risk to reward?
    I think at this time it would be very appropriate to ask you to describe what "noticeable response" means to you.

    I also think it would be very appropriate for the other doctors to share there numbers and assessments as you have here.

    What StressedToTheBald is doing is fear mongering. Fear mongering is not a good thing under any circumstance.

  5. #15
    Senior Member
    Join Date
    Dec 2008
    Location
    Atlanta, GA, New York, NY
    Posts
    379

    Default

    I wouldn't say it is fear mongering. i'd say it is a personal concern. He's not alone. Do you have any idea how many patients I see who refuse to take finasteride, minoxidil or any other prescriptions medication? Honestly, more of my patients refuse to take medications.

    Let's look at smoking. Fifty years ago 50% of people smoked. Americans became wealthy selling nicotine. then someone discovered a cause and effect to cigarettes. Now what is the world like?

    What is a noticeable response? More hair! How can you evaluate similar coverage? You can't. someone with fine hair and a low density can loose a very small degree of hair diameter and look significantly thinner, while someone with coarse, dense hair might loose much more hair diameter and still look full as a tick. Does it mean that someone is responding to finasteride because they look the same for 10 years? No, not really. Some people look the same for 40 years and then start loosing hair. Some stabilize off mediation for over 10 years and then accelerate off medication. you really don't know.

    Tracy C, i really like hearing your perspective because i have to admit that i make mistakes. Unless someone challenges me to re-evaluate my opinions, I might continue to make mistakes. Sometimes a challenge gives me a AHA moment. So....keep it up.

    I really don't know you well. I'm not sure if you know me. In North America there were three physicians who promoted FUE back in the early days of 2002-3. They included Robert Jones, Alan Feller, and myself. Between the three of us, i'd say that the vast majority of people who do a great deal of FUE learned from us. Over the years, i've probably done more FUE than anyone else and certainly more FUE grafts than anyone else. Over the past 10 years I've promoted FUE over strip surgery because i think FUE is far superior to strip surgery. There are many physicians who do not agree with me. Physicians are notorious for their sluggish acceptance to change, not that this is a bad thing. Despite adversity to FUE, i continued to promote it and improve it. Today over 22% of all hair restoration surgeries are done by FUE and the total percentage of FUE cases increases annually. In other words, adversity does not limit my interest in something that i consider superior. Adversity would similarly not limit my personal consideration of those things that i don't necessarily agree with. I simply continue to state those features that i feel one benefits from FUE.

    I'm not going to tell someone that he is wrong for having a strip procedure. I will simply state why i feel FUE is superior when properly performed. Similarly, i'll never put a gun to a patient's head to tell him that he needs to take propecia. If competitive blocking of 5 alpha-reductase worked so well, everyone would respond to decreasing DHT. the fact is that most don't have any noticeable response and you can't properly evaluate a lack of response. Gather all the opinions of all the doctors you know and challenge them to give a more positive response to finasteride. The best they can do is tell you that the 5 and 10- year data shows that over that time span you have more hair on medication than off. Now, how do you determine more hair? Any time you want, I'll send you a photo of hair. You count what you see and i'll tell you how wrong you were. You can't count hair in a photo. It's really absurd to state that a medication grew more hair. Wasn't that the response to laser treatment that was sent to the FDA. You can't count hair in a photo. it's impossible. It's ridiculous.

    I'll give you an example. Recently when the editor of the "Hair Transpalnt Forum", Bill Reed was in my office i told him i'd try my best to extract a single hair graft. Try as i may, every graft I thought might be a single turned out to be two hairs. Why did it do it? Because i wanted to show him that natural singles were rare. WhY show it was rare? Because most strip surgeons make 20% of their grafts single hair graft and that number simply does not exist. What's the point? if I'm looking at individual grafts with 6X loops and can't tell if a graft is one hair or two hairs, how can a photograph from a lower magnification do better? It can't. Thus, don't worry about the concerns about someone over medication especially when it really is almost impossible to note a positive response in most individuals. If you come across a large body of physicians who have seen a "positive response" to finasteride, i'd sure like to hear their commentary because in over 20 years of treating hair loss, i've not seen anything close to such a confirmatory response to any medical treatment.

  6. #16
    Inactive
    Join Date
    Jan 2012
    Location
    Norwood 3-4
    Posts
    452

    Default

    Thank You Dr. Cole. I for one very much appreciate Your attention to details and having the opportunity to exchange thoughts here on the forum. If my situation changes at some point in the future, I'd be more than glad to sign up for live consultation at least.

  7. #17
    Moderator
    Join Date
    Mar 2009
    Posts
    943

    Default

    Dr. Cole, with all due respect, I think I can speak for many BTT users when I say that stressedtobebald has the right to voice his opinions and concerns, but he does not have the right to destroy every thread with his rhetoric. I also disagree with your assessment of Propecia as well as your assertion of “where there’s smoke there's fire” when it come to ambulance chasing attorneys. These people are predators who simply smell blood in the water. I think it’s best to educate the less informed as opposed to pandering to them.

  8. #18
    Senior Member
    Join Date
    Sep 2011
    Location
    Ohio
    Posts
    3,125

    Default

    Quote Originally Posted by Winston View Post
    Dr. Cole, with all due respect, I think I can speak for many BTT users when I say that stressedtobebald has the right to voice his opinions and concerns, but he does not have the right to destroy every thread with his rhetoric.
    Voicing concern is one thing - but fear mongering is something completely different. What StressedToTheBald has been doing is fear mongering. It is what it is.

  9. #19
    Moderator
    Join Date
    Mar 2009
    Posts
    943

    Default

    We’re not dealing with independent thinkers here. Fear mongering is like a cancer, that if not cut out early, only spreads.

  10. #20
    Senior Member
    Join Date
    Dec 2008
    Location
    Atlanta, GA, New York, NY
    Posts
    379

    Default

    You guys must be progressives. What happened to freedom of speech?

    I have prescribed propecia and avodart for years. I asked all of my patients to read the data reported by Merck prior to receiving prescription. Those who choose to fill the prescription have always done so following full disclosure.

    More recently, some people have reported that dht blockers can cause depression, irreversible impotence, and sterility. I don't think any of these reports have sound scientific studies to support their conclusions.

    I think the risk for high grade prostate tumors is very small and question whether finasteride might be beneficial in regard to prostate cancer.

    Someone may hijack every thread with concerns about medications. I'm sure that this can be annoying if you see it every day. I don't read every thread and have not spent much time perusing so i really don't know who is doing what. i think that suggests that others are doing the same thing from time to time so the only way you might get your opinion in front of that particular person is to replay your thoughts over and over.

    Now, let me say this in all frankness. The only person who can properly address the topic of medication side effects does not live on earth. These concerns do exist with a growing faction here on earth, however. The fact that many of us including myself do not necessarily agree with the newer side effects does not matter. It's an individual decision. I am told that in the UK that depression was added to the product labeling by Merck. Maybe it can cause depression. i've never had a patient complain of depression, but maybe it can cause depression.

    Today i had a patient ask for a prescription of finasteride. i suggested that he break generic proscar in quarters until the Merck patent expires. he was all for this. then i went through the list of issues put out by Merck and the newer stuff that is circulating, which i don't think is scientifically sound. The patient elected to not take the prescription. Others despite full disclosure do elect to take the prescription.

    I had another patient who was on propecia for 8 years. suddenly his hair started to fall out heavily again. Finasteride does not always work, it does not always work forever, and it very rarely produces significant hair regrowth. I do recommend it to anyone whose hair loss really bothers them but at the end of the day hair loss is a normal condition. If you do not like the side effect profile, you should have the right to make a choice one way or another. It's not as if you are going to die if you don't take it.

    someone may incite fear, but taking away someone's right to free speech is even worse in my opinion. People should have the opportunity to make their own decisions without fear of censorship.

    Ok, i hear your arguments on both sides. I've played a bit of the devil's advocate here. Let's talk about something more interesting if you like. Thanks for you opinions.

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

» IAHRS

hair transplant surgeons

» The Bald Truth

» Recent Threads

1800 graft repair case results by Dr. Lindsey
Yesterday 08:38 AM
Last Post By Dr. Lindsey
Yesterday 08:38 AM
Navigating the German Job Market as a Kenyan Citizen
11-04-2023 06:31 AM
Last Post By Keegan212
Yesterday 03:51 AM
DR HAKAN DOGANAY/ 4500 GRAFTS / Implanter Pen+FUE
03-26-2024 04:15 PM
Last Post By Hakan Doganay, MD
03-26-2024 04:15 PM
The Mane Event for Thursday, June 15th, 2023
06-15-2023 02:59 PM
Last Post By gisecit34
03-26-2024 08:05 AM