Contemplating Dr Cole Fue Transplant - Opinions Please
- Thread starter macaroni
- Start date
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We have arfy's experience, which was not satisfactory at all, but of course every body has his story...
https://www.hairlosstalk.com/intera...geries-i-paid-36-000-with-zero-results.94382/
https://www.hairlosstalk.com/intera...geries-i-paid-36-000-with-zero-results.94382/
Cole has done my hair transplant 2.5 years ago and I'm going in on the 1st for 1000 graphs.
Arfy was a repair case. Cole addressed this on another forum. If you know Cole and judging by arfy attitude the out come was not a surprise. Don't expect a hug from Cole. He's a competitor. He has treated me great.
Best of luck!
Arfy was a repair case. Cole addressed this on another forum. If you know Cole and judging by arfy attitude the out come was not a surprise. Don't expect a hug from Cole. He's a competitor. He has treated me great.
Best of luck!
dr. cole
Member
- Reaction score
- 47
After 26 years in the field of hair restoration surgery, it is a shame my reputation hinges on a body hair, repair case that had no options other than the cutting edge procedures possible at the time, systems that were not time tested. I often push the envelope to come up with better options for patients. Anyone without hope and options needs a solution. Few search for answers and even fewer physicians other than myself come up with these options. Body hair transplantation developed for one simple reason, and that rationale was to solve problems for patients without hope. When you walk out on that limb to help people with solutions that did not exist before you developed such options, the limb will occasionally snap, and you will fall. The overwhelming majority of patients are happy you tried your best using the best rational reasoning available at the time. When you walk out on that limb, and you do your best, and you change a life from misery to content, one has no better feeling. When you venture out on that limb, and you are truthful about the consequences, and you fail, the overwhelming majority of patients are happy you did your best, and you tried. Only rarely do such patients complain because you pushed the envelope on creativity and you did your best but did not get you the result both of you hoped to accomplish. What follows is the story about Arfy. It's the real story and not the one he presents.
Arfy had numerous plugs placed on his scalp in the 1980s. He posted about this multiple times in the forums. I felt sorry for him so I offered to remove his plugs one follicular unit at a time. This was a new procedure that I began developing in 2003. It worked well on Arfy as it had on numerous other patients between 2003 and 2004. I have since used this technique on hundreds of patients to help them.
Arfy had many, many plugs. I softened all of them by taking out one follicular unit at a time from his multiple plugs. It took me about one week to finish this procedure. I did the entire work at no charge to Arfy. I redistributed the hair, which means I grafted it back into the scalp and the open donor plug scars in the donor area. We tried to hide a linear scar on the right side of his hairline that resulted from an attempt to remove one line of plugs but left him with a linear scar on the hair line. My procedure left no obvious scars. It was cutting edge surgery at the time. Even today not many surgeons can do this procedure, which involves punching out one follicular unit at a time. We removed well over 1000 follicular units in this procedure.
After I was able to make Arfy look like a normal balding guy without all those hideous plugs, he wanted to pursue a body hair transplant. You have to understand the status of body hair transplants from 2003 through 2006. Ray Woods had pioneered FUE body hair transplants in the late 1990s and he was quite positive about them. In 2003 there were three physicians outside of Ray Woods in Australia, who offered FUE. They included Rob Jones, Alan Feller, and myself. Most of the people who perform FUE today either learned it from myself, Rob Jones or someone we taught. In 2003 I had performed over 8000 strip procedures, but I was the first besides Ray Woods to recognize that FUE offered tremendous benefits over strip surgery (FUT). Patients began contacting me for FUE in 2003 and they also began contacting me for body hair transplants in 2003.
Dr. Woods had made body hair seem like the next best thing to the refrigerator. When patients began to contact me for body hair, I knew how to get the hair out. I just didn't know if it would grow. I didn't encourage anyone to have body hair. Patients encouraged me to perform the body hair. Most were out of scalp supply so the only option they had was body hair. I didn’t know if it would grow, and I made sure patients knew this.
My first body hair case was into a strip scar. His strip surgeon had left him with a wide strip scar in an attempt to perform a very large second FUT procedure. I took hair off his thigh and moved it into his strip scar. It grew nearly 100% and he never complained about his strip scar again. From that point on, he started coming to me to graft hair off his body into the top of his head. That case was only around 200 grafts, but it grew remarkably well. In the fall of 2003 a patient contacted me for a large session of body hair to his crown, top, and front. I advised him that I had no idea if the hair would grow and I discouraged him from doing the procedure. He told me that he had plenty of money since he worked for Intel as an attorney. He did not care if the hair did not grow. He was willing to that that risk regardless of whether the hair grew. He also stated that he did not like his body hair so I’d be doing him a favor to take the body hair off. After multiple attempts to discourage him, he came in for surgery and he had just over 7000 total grafts placed in one week of daily surgery. Again, the growth was almost 100%. Between 2003 and 2006 I performed many body hair procedures. Some grew remarkably well and some had a yield under 30%. In some instances, there was no growth. I began looking for ways to improve the yield. I studied every possible option. One of the first things I noted about body hair was that the percentage of telogn hairs was much higher on the body. Sometimes telogen ratios would reach 60%. I began to compare the growth rate of telogen to anagen hair in terms of yield. I found that anagen hairs had a higher growth rate percentage in every study I performed. However, focusing on anagen hair alone did not guarantee a great yield. The yield could still be zero with anagen hair off the body. Based on the slight benefit of anagen hair over telogen hair in terms of yield, I began requesting all patients to wet shave three days before the procedure. Then I looked at density. In the one density study I performed, I compared lateral incisions to vertical incision, and density. I set density at 20 per sq cm to over 40 per sq cm. I found growth rates under 30 grafts per sq cm grew to a 60% yield in this patient, but anything over 30 grafts per sq cm grew in at under 5% in terms of yield. Lateral and vertical incisions had no impact on survival of the grafts. Based on this data, I limited densities of body hair to under 30 grafts per sq cm, but still some patients had a yield of zero. Then I studied body hair from the back, legs, chest, abdomen, arm, etc. I found that in some patients one source would do better than another source, but there was no way to predict which would be better. In some patients back hair did better. In some patients’ chest hair did better. In others abdomen or leg hair would do better. I studied every possible scenario I could think of but there was no combination of options including source, density, or anagen hair that produced a universally good yield. To this day, I think I am the only person on the planet who actually looked at every possible option. In 2005 we began to look at beard hair. This became the only consistent source of body hair. I’ve had patients who failed on every possible source until we moved those patients to beard hair. I presented all my data in Brussels this past year to FUE Europe. At the end of my presentation Bob True, the editor of the Hair Transplant Forum International, commented that it was the best and most through presentation on body hair that he had ever seen. I tried to publish all the data in the last major text on hair transplantation edited by Robin Unger, but she was so far behind the times that she did not recognize how valuable the information was to cutting edge physicians. She chopped the data to pieces. It will finally make it to the next text where Bob True is editing my section and he understands it. Robin on the other hand has always been 10 years behind the times.
So where did Arfy fit into this history. He came when I was still cautioning patients on proceeding with body hair, but before the major failures in body hair and before we had our study data. I discouraged Arfy from doing body hair for very practical reasons. First, he was a Norwood 6 and might become a NW7. He had over 225 sq cm of hair loss. On average there are 80 follicular units per sq cm. This meant he had lost over 18,000 follicular units. Follicular groups average between 2 to 3 hairs each, but may contain over 4 hairs each. Body hair grafts average 1 hair each. Based on follicle numbers, Afry would need between 36,000 to 60,000 body hair grafts to appear full and that is only if all the grafts grew. A great body hair yield is 60% so one might add another 40,000 or more grafts to make up for the ones that did not grow and that’s only if the yield were optimal.
During Arfy’s procedure, I worked hard. I did my best. We charged him for 3000 grafts, but we did over 5000 grafts. If there was anyone, who I really wanted to have a great result, it was Arfy. I did not want to do his procedure, but I did it based on his insistence and I did my best.
Arfy came back after a year and he wanted his money returned. I told him that I would consider it, but I could not see how we could do that based on the time we had invested in his surgery. He kept calling the office about a refund and he found a sympathetic lower level front office employee’s ear. That employee agreed to a refund of some sort, but never consulted with me about this refund.
Years later Arfy contacted Spencer Kobren through his agent and stated that he wanted a refund or he was going to make public statements denigrating me should I fail to refund his money. That’s blackmail and it’s against the law. I did my absolute best to help Arfy. I worked my tail off to help him. The last thing I was going to do was respond as he wanted to blackmail. I did not encourage Arfy to do this procedure. I discouraged him from doing it. When he elected to do this procedure, I did my absolute best to help him. So who is at fault here? Perhaps is it me for letting this patient talk me into doing something that might now work out well for him. Perhaps it is Arfy. He does not post any photos showing where he was before I corrected his plugs and where he was after I corrected them. He does not even acknowledge this life changing procedure. He focuses only on his failed body hair transplant and promises of a refund by a low level employee, an hourly employee. Arfy does not mention that he blackmailed me.
So where does body hair stand? I cannot say that our attempts to perform body hair were universal failures because they were not. I do think that Ray Woods could have been more forthright about the potential for failure with body hair. Had Dr. Woods done this, we might have spared Arfy this failure. Unfortunately, based on our early successes and the positive comments by Dr. Woods, we were perhaps too confident that we might succeed. However, the only knowledge we had about body hair in 2004 and 2005 was based on results to date and many were quite good. Chest hair in particular changed many lives from cosmetic disfigurements with scalp reduction scars to normal lives. Body hair in general was not a complete failure. I’d estimate that about 25% of patients did very well. My only regret is that we did not get the failures first and then the successes stories because failures might have saved Afry from being a body hair failure. Still body hair positively impacted many lives. Body hair changed many lives from cosmetic disasters to success stories. We just could not predict who would be a success story and who would be a failure. Today I would tell Arfy that he has a 25% chance of success and a 75% chance of failure with body hair. I could not tell him this in 2003 through 2007. Hair transplant results take time to understand. They take experience and time. Arfy jumped on board body hair before we had either one.
What has changed with body hair? The answer is beard hair. In 2005 we began moving beard hair. We were initially reluctant to move to the neck and beard because we were worried about scarring. What we found was that beard hair has a low telogen ratio, a high anagen ratio, and a yield between 50 to 100%. The beard hair is coarse so each hair covers well. Beard hair is wavy to curly so each hair covers well. Best of all, beard hair extractions heal almost universally with minimal white dotting that is perceptible only with magnification. Beard hair removal tightens the neck and lifts it. Only in rare instances are pits lift in the extraction sites. The negative of beard hair is that the beard hair color may not match the scalp, fine straight scalp hair does not match curly, coarse beard hair, and the wave or curl of beard hair may be too great with the hair longer. If your hair is straight, it is best to keep the beard hair shorter.
Some patients do not like their beard hair grafts and they stop. Some love them. We recently had a patient of 89 years of age in for his fourth treatment of beard hair. He loves it though I can say that at 89 years of age we do find a higher percentage of telogen hair on the beard for some reason.
Beard hair is an option for Arfy. I’d be happy to do a trial on him if he likes at no charge. If he likes it, I would do more at no charge. My objective remains to make patients happy. However, I cannot guarantee patient satisfaction. Only God can make guarantees on personal happiness. All I can do is my best and that’s all I have ever done for anyone.
Arfy had numerous plugs placed on his scalp in the 1980s. He posted about this multiple times in the forums. I felt sorry for him so I offered to remove his plugs one follicular unit at a time. This was a new procedure that I began developing in 2003. It worked well on Arfy as it had on numerous other patients between 2003 and 2004. I have since used this technique on hundreds of patients to help them.
Arfy had many, many plugs. I softened all of them by taking out one follicular unit at a time from his multiple plugs. It took me about one week to finish this procedure. I did the entire work at no charge to Arfy. I redistributed the hair, which means I grafted it back into the scalp and the open donor plug scars in the donor area. We tried to hide a linear scar on the right side of his hairline that resulted from an attempt to remove one line of plugs but left him with a linear scar on the hair line. My procedure left no obvious scars. It was cutting edge surgery at the time. Even today not many surgeons can do this procedure, which involves punching out one follicular unit at a time. We removed well over 1000 follicular units in this procedure.
After I was able to make Arfy look like a normal balding guy without all those hideous plugs, he wanted to pursue a body hair transplant. You have to understand the status of body hair transplants from 2003 through 2006. Ray Woods had pioneered FUE body hair transplants in the late 1990s and he was quite positive about them. In 2003 there were three physicians outside of Ray Woods in Australia, who offered FUE. They included Rob Jones, Alan Feller, and myself. Most of the people who perform FUE today either learned it from myself, Rob Jones or someone we taught. In 2003 I had performed over 8000 strip procedures, but I was the first besides Ray Woods to recognize that FUE offered tremendous benefits over strip surgery (FUT). Patients began contacting me for FUE in 2003 and they also began contacting me for body hair transplants in 2003.
Dr. Woods had made body hair seem like the next best thing to the refrigerator. When patients began to contact me for body hair, I knew how to get the hair out. I just didn't know if it would grow. I didn't encourage anyone to have body hair. Patients encouraged me to perform the body hair. Most were out of scalp supply so the only option they had was body hair. I didn’t know if it would grow, and I made sure patients knew this.
My first body hair case was into a strip scar. His strip surgeon had left him with a wide strip scar in an attempt to perform a very large second FUT procedure. I took hair off his thigh and moved it into his strip scar. It grew nearly 100% and he never complained about his strip scar again. From that point on, he started coming to me to graft hair off his body into the top of his head. That case was only around 200 grafts, but it grew remarkably well. In the fall of 2003 a patient contacted me for a large session of body hair to his crown, top, and front. I advised him that I had no idea if the hair would grow and I discouraged him from doing the procedure. He told me that he had plenty of money since he worked for Intel as an attorney. He did not care if the hair did not grow. He was willing to that that risk regardless of whether the hair grew. He also stated that he did not like his body hair so I’d be doing him a favor to take the body hair off. After multiple attempts to discourage him, he came in for surgery and he had just over 7000 total grafts placed in one week of daily surgery. Again, the growth was almost 100%. Between 2003 and 2006 I performed many body hair procedures. Some grew remarkably well and some had a yield under 30%. In some instances, there was no growth. I began looking for ways to improve the yield. I studied every possible option. One of the first things I noted about body hair was that the percentage of telogn hairs was much higher on the body. Sometimes telogen ratios would reach 60%. I began to compare the growth rate of telogen to anagen hair in terms of yield. I found that anagen hairs had a higher growth rate percentage in every study I performed. However, focusing on anagen hair alone did not guarantee a great yield. The yield could still be zero with anagen hair off the body. Based on the slight benefit of anagen hair over telogen hair in terms of yield, I began requesting all patients to wet shave three days before the procedure. Then I looked at density. In the one density study I performed, I compared lateral incisions to vertical incision, and density. I set density at 20 per sq cm to over 40 per sq cm. I found growth rates under 30 grafts per sq cm grew to a 60% yield in this patient, but anything over 30 grafts per sq cm grew in at under 5% in terms of yield. Lateral and vertical incisions had no impact on survival of the grafts. Based on this data, I limited densities of body hair to under 30 grafts per sq cm, but still some patients had a yield of zero. Then I studied body hair from the back, legs, chest, abdomen, arm, etc. I found that in some patients one source would do better than another source, but there was no way to predict which would be better. In some patients back hair did better. In some patients’ chest hair did better. In others abdomen or leg hair would do better. I studied every possible scenario I could think of but there was no combination of options including source, density, or anagen hair that produced a universally good yield. To this day, I think I am the only person on the planet who actually looked at every possible option. In 2005 we began to look at beard hair. This became the only consistent source of body hair. I’ve had patients who failed on every possible source until we moved those patients to beard hair. I presented all my data in Brussels this past year to FUE Europe. At the end of my presentation Bob True, the editor of the Hair Transplant Forum International, commented that it was the best and most through presentation on body hair that he had ever seen. I tried to publish all the data in the last major text on hair transplantation edited by Robin Unger, but she was so far behind the times that she did not recognize how valuable the information was to cutting edge physicians. She chopped the data to pieces. It will finally make it to the next text where Bob True is editing my section and he understands it. Robin on the other hand has always been 10 years behind the times.
So where did Arfy fit into this history. He came when I was still cautioning patients on proceeding with body hair, but before the major failures in body hair and before we had our study data. I discouraged Arfy from doing body hair for very practical reasons. First, he was a Norwood 6 and might become a NW7. He had over 225 sq cm of hair loss. On average there are 80 follicular units per sq cm. This meant he had lost over 18,000 follicular units. Follicular groups average between 2 to 3 hairs each, but may contain over 4 hairs each. Body hair grafts average 1 hair each. Based on follicle numbers, Afry would need between 36,000 to 60,000 body hair grafts to appear full and that is only if all the grafts grew. A great body hair yield is 60% so one might add another 40,000 or more grafts to make up for the ones that did not grow and that’s only if the yield were optimal.
During Arfy’s procedure, I worked hard. I did my best. We charged him for 3000 grafts, but we did over 5000 grafts. If there was anyone, who I really wanted to have a great result, it was Arfy. I did not want to do his procedure, but I did it based on his insistence and I did my best.
Arfy came back after a year and he wanted his money returned. I told him that I would consider it, but I could not see how we could do that based on the time we had invested in his surgery. He kept calling the office about a refund and he found a sympathetic lower level front office employee’s ear. That employee agreed to a refund of some sort, but never consulted with me about this refund.
Years later Arfy contacted Spencer Kobren through his agent and stated that he wanted a refund or he was going to make public statements denigrating me should I fail to refund his money. That’s blackmail and it’s against the law. I did my absolute best to help Arfy. I worked my tail off to help him. The last thing I was going to do was respond as he wanted to blackmail. I did not encourage Arfy to do this procedure. I discouraged him from doing it. When he elected to do this procedure, I did my absolute best to help him. So who is at fault here? Perhaps is it me for letting this patient talk me into doing something that might now work out well for him. Perhaps it is Arfy. He does not post any photos showing where he was before I corrected his plugs and where he was after I corrected them. He does not even acknowledge this life changing procedure. He focuses only on his failed body hair transplant and promises of a refund by a low level employee, an hourly employee. Arfy does not mention that he blackmailed me.
So where does body hair stand? I cannot say that our attempts to perform body hair were universal failures because they were not. I do think that Ray Woods could have been more forthright about the potential for failure with body hair. Had Dr. Woods done this, we might have spared Arfy this failure. Unfortunately, based on our early successes and the positive comments by Dr. Woods, we were perhaps too confident that we might succeed. However, the only knowledge we had about body hair in 2004 and 2005 was based on results to date and many were quite good. Chest hair in particular changed many lives from cosmetic disfigurements with scalp reduction scars to normal lives. Body hair in general was not a complete failure. I’d estimate that about 25% of patients did very well. My only regret is that we did not get the failures first and then the successes stories because failures might have saved Afry from being a body hair failure. Still body hair positively impacted many lives. Body hair changed many lives from cosmetic disasters to success stories. We just could not predict who would be a success story and who would be a failure. Today I would tell Arfy that he has a 25% chance of success and a 75% chance of failure with body hair. I could not tell him this in 2003 through 2007. Hair transplant results take time to understand. They take experience and time. Arfy jumped on board body hair before we had either one.
What has changed with body hair? The answer is beard hair. In 2005 we began moving beard hair. We were initially reluctant to move to the neck and beard because we were worried about scarring. What we found was that beard hair has a low telogen ratio, a high anagen ratio, and a yield between 50 to 100%. The beard hair is coarse so each hair covers well. Beard hair is wavy to curly so each hair covers well. Best of all, beard hair extractions heal almost universally with minimal white dotting that is perceptible only with magnification. Beard hair removal tightens the neck and lifts it. Only in rare instances are pits lift in the extraction sites. The negative of beard hair is that the beard hair color may not match the scalp, fine straight scalp hair does not match curly, coarse beard hair, and the wave or curl of beard hair may be too great with the hair longer. If your hair is straight, it is best to keep the beard hair shorter.
Some patients do not like their beard hair grafts and they stop. Some love them. We recently had a patient of 89 years of age in for his fourth treatment of beard hair. He loves it though I can say that at 89 years of age we do find a higher percentage of telogen hair on the beard for some reason.
Beard hair is an option for Arfy. I’d be happy to do a trial on him if he likes at no charge. If he likes it, I would do more at no charge. My objective remains to make patients happy. However, I cannot guarantee patient satisfaction. Only God can make guarantees on personal happiness. All I can do is my best and that’s all I have ever done for anyone.
5 days post op and the swelling is 90% gone. Nothing exciting to report.
This is my second pass with Cole. My first round was 2.5 years ago.
As far as cost goes, I had a budget. I sent my photos in and visited 2 of the 3 doctors. I called the offices and told them the budget and the days I am available. If they could make that work then great, if not I'll wait. You have to be willing to walk away.
Most of the time the Doctor doesn't even know how much the patient is paying. It's like this in most medical offices in the US. Sadly it's like buying a car. I walked into the finance office to buy my Harley and the finance guy told me I didn't qualify for the low interest rate. I would have to pay $750 extra over 5 years. I told the guy either you're being fed a line or i'm being fed a line, either knock $750 off or put the bike back on the floor. They said they can't do that so I walked out. 4 days later the dealership called and said they found away to reduce the bike $750.
Although I was still Pi$$ed because I felt like they thought I was a chump I loved that bike and agreed and picked it up that night. This is the same for most Doctor offices.
For Vories you set up an appointment and he gives you a price. His FUE is pretty much the cheapest and I'd say there is no negotiating with his price. I wanted to go to Shapiro and I all but signed papers but the sales guy kept changing things. One call he told me Ron/Paul don't do the extracts. I think Joe does the extractions. That's all he does so, ok, I'll buy that. the next call was for me to come in the day before to have the recipient sites made up. I was not aware of this BUT I remembered Bernstein mentioned about doing the same. Then after I mentioned Tillman pointed me to Shapiro my Graft cost went up .50. Now, I"m getting pi$$ed and my blood pressure is rising. I told the sales guy i'm out. It's the sales guys that messes everything up. unfortunately a businesses sole purpose it to make money and if the sales team or managers don't perform then they are out! The Doctors I've mentioned are all great but most Doctors don't have a clue what the patient is paying or how the office is run.
Cole does go out on a limb to try new techniques. Most offices sit back and wait to see if guys like him fall. A great business strategy but is it good for the consumer? The ISHRS gives grants for guys to go out on that limb http://www.ishrs.org/grant-recipients.php I only hope they give that money ($2400) after a review that it's legit research. However I do not agree with any entity using grants and claiming they developed a proprietary process but it happens all the time. Greco claims to have developed a proprietary process of PRP and CRP that slowly releases growth factors yet he's taken numerous grants. I don't agree with this but it's legal and make sense as a strategic business option. I could be wrong on this, if so someone please correct me.
Hope this helps. Sorry for the long post but I'm bored being 5 days post op.
dr. cole
Member
- Reaction score
- 47
I think Joe Greco is pretty solid as far as PRP goes. I did not dive into PRP. I waited because I don't like new technology that I don't understand for hair loss. Then I visited Joe Greco in 2008. He sold me on the technology. Once I'm in on something, I do my best to advance that technology. Joe told me that he was working an extracellular matrix to prolong the release of growth factors. That's why I added Acell beginning in 12/2008. Now the whole world adds Acell to PRP. However, Acell is expensive, so I'm working on a new protocol that will be less expensive. Besides, who know whether a burst of growth factors is better than a sustained release. We need to study this.
I was slow getting in on SMP for the same reason. I didn't understand it, and I recall many bad tattooing examples of the scalp. I waited, watch, and then jumped in. Now I'm one of the few that combines hair transplants and SMP on the same visit. I push the envelope on what I understand. I approach SMP with the intent to deliver a 3D appearance, which means the dots vary in size, intensity, and variance. SMP must mimic the natural appearance of the scalp. On the scalp, follicular groups might be large, small, light, and irregular in spacing. If the result is, all the same, it looks fake.
As far as grafting, I understood this. That's why I pushed FUE when no one wanted anything to do with it in 2003. I quickly saw the benefits. Now I have more FUE experience than anyone in the world. I choose to avoid discussing other clinics, but I will say that some hospitals give presentations that clearly point out that these clinics haven't a clue how to produce great results in all patients. Every patient is different. You can't approach all the same. It's like approaching every problem limited to a hammer. Unless the problem is a nail, you will fail. Sometimes you need a screwdriver. Sometimes you need a brush. Sometimes you need a saw and not just any saw. Every patient has a different type of skin, a different size of a follicle, a different depth of the follicle, various laxity, varying degrees of follicle attachment, etc. One should prepare for what we run across, and we have to know how to adapt and modify to get the optimal result. I'm always cautious of clinics with a singular approach.
I had the largest ISHRS research grant given last year of $10,000. My study cost me $60,000. I have one this year that will cost $135,000. My research grant was only $2500.00. There is no fairness in life especially if you do research. I offered up three research studies this year and received nothing on two of them. From a research perspective, I'm going in the hole this year.
Hey, Mach. Good luck! Keep me posted. Good luck on that Harley. You know this year I finally decided to offer hair pieces to my patients with advanced hair loss and limited donor supply. I found a presumed good company, worked out a deal with them, brought in a patient, measured him, and ordered. Then they called me back to tell me that I had to spend $8000 for a license fee. That company is CNC or Caesar Ragazzi out of Italy. I find this embarrassing. I thought I finally found a reputable hair piece company after many years of looking. Sales associates are all the same, and so are wig salespeople it turns out. Anyway, only 2 or 3 of my patients want a hair piece. I can't blame them. Why pay so much for something that costs little to make.
I was slow getting in on SMP for the same reason. I didn't understand it, and I recall many bad tattooing examples of the scalp. I waited, watch, and then jumped in. Now I'm one of the few that combines hair transplants and SMP on the same visit. I push the envelope on what I understand. I approach SMP with the intent to deliver a 3D appearance, which means the dots vary in size, intensity, and variance. SMP must mimic the natural appearance of the scalp. On the scalp, follicular groups might be large, small, light, and irregular in spacing. If the result is, all the same, it looks fake.
As far as grafting, I understood this. That's why I pushed FUE when no one wanted anything to do with it in 2003. I quickly saw the benefits. Now I have more FUE experience than anyone in the world. I choose to avoid discussing other clinics, but I will say that some hospitals give presentations that clearly point out that these clinics haven't a clue how to produce great results in all patients. Every patient is different. You can't approach all the same. It's like approaching every problem limited to a hammer. Unless the problem is a nail, you will fail. Sometimes you need a screwdriver. Sometimes you need a brush. Sometimes you need a saw and not just any saw. Every patient has a different type of skin, a different size of a follicle, a different depth of the follicle, various laxity, varying degrees of follicle attachment, etc. One should prepare for what we run across, and we have to know how to adapt and modify to get the optimal result. I'm always cautious of clinics with a singular approach.
I had the largest ISHRS research grant given last year of $10,000. My study cost me $60,000. I have one this year that will cost $135,000. My research grant was only $2500.00. There is no fairness in life especially if you do research. I offered up three research studies this year and received nothing on two of them. From a research perspective, I'm going in the hole this year.
Hey, Mach. Good luck! Keep me posted. Good luck on that Harley. You know this year I finally decided to offer hair pieces to my patients with advanced hair loss and limited donor supply. I found a presumed good company, worked out a deal with them, brought in a patient, measured him, and ordered. Then they called me back to tell me that I had to spend $8000 for a license fee. That company is CNC or Caesar Ragazzi out of Italy. I find this embarrassing. I thought I finally found a reputable hair piece company after many years of looking. Sales associates are all the same, and so are wig salespeople it turns out. Anyway, only 2 or 3 of my patients want a hair piece. I can't blame them. Why pay so much for something that costs little to make.
dr. cole
Member
- Reaction score
- 47
There are some really good doctors in Europe, for sure. The reason is simple. Europe embraced FUE long before the USA. Asia caught on the FUE long before the USA too. Here is what you have to remember. In 2003 there were only two doctors in the world focused strictly on FUE, Ray Woods and myself. Most of the doctors in Europe are either, sons, grandsons, or great-grandsons of someone I taught. Daughters too. Many of the really good doctors in Europe buy equipment from me. Equipment that I developed. My hands are good and my eyes are good. I care. Having said all of this, I agree 100% that there are some fine doctors in Europe. I would not say the same about the USA yet. The interesting thing is that in 2003 there were no really good doctors in Europe for hair restoration. I think the main thing to remember in Europe is that many clinics allow assistants to extract the grafts. I spoke on the phone today with a patient who had this done in Canada and he had a really bad result. Make sure the doctor does the extractions and controls the procedure. Otherwise, you have no idea what you are getting. There are many good physicians in Europe for FUE. I just can't think of one that is hands down better. If I could, I would. I always prefer to send patients in the best possible location. I think it's great to have variety because no matter how good you are, no one can treat every patient. I know I can't. That's why I continue to teach and train physicians. My objective is not to make one or two lives better each day. My goal is to make hundreds of lives better each day by enabling quality physicians to deliver outstanding results for every patient. I'm pleased you think that Europe is superior. That means I accomplished a mission I had in life, which was to improve the quality of hair restoration surgery. Only Europe and Asia were listening ten to twelve years ago. The USA caught on only because patients began to demand FUE. Hands down, FUE is a better procedure. I'm happy to hear your comment, KO1.
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- 5,209
the real question is - what are your prices?? For people like me, that would need at least 4,000 FUE, $8 / graft is serious money, 32k. Why would I get that in the US, when I could get $3 / graft in EU? we are talking about 20k difference.
dr. cole
Member
- Reaction score
- 47
Great point, Buckthorn. The real price break is in Turkey. Europe is middle of the road. The USA is higher in cost. When you have nurses working below minimum wage in Turkey, it's hard to compete in the USA. Remember that in Turkey and much of Europe, it's the nurses doing most if not all of the surgery, and these nurses all make far less than in the USA. Perhaps clinics in the USA eventually will all collapse due to price competition. I know that I'm working on something in Mexico for this reason, but it will not be nurses doing the surgery. I also know that I try to work within a patient's budget already. However, my nurses make 25 to 36 dollars per hour. In the USA we can afford to do only so many deeply discounted surgeries each month. If the USA collapses, I don't think this is good for quality because the USA has always driven quality in medicine. There were over 3200 applicants for 217 spots in my medical school this year. The average grade point average out of college was 3.8. It is much easier to get a place in a medical school outside the USA. Medicine outside the USA does not pay as well, so the brightest minds seek other fields. That means the intellectual quality offshore is not as good. I don't like to see things trending this way, but I can hardly blame people for seeking a lower price. I understand this. Just remember that the quality FUE done across the world today originated in the USA. Don't expect anyone in Europe to be the leader in the next great thing. Yes, Dr. Woods promoted FUE, but he taught no one. It was the USA that figured out FUE and then showed the rest of the world. The brightest medical minds are still in the USA. How long this will last, is unknown, but that's a fact.
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As for European surgeons Dr De Reys is pretty cheap, almost Turkish prices, he takes good care with the extractions and does it all himself. He gets great yields. Perhaps a bit too conservative though. For people with large slick bald areas he's one of the best, but for hairline work... The jury is still out.... I've seen some good results but not sure if I'll be one of them. His aftercare for me was almost non existent though.
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dr. cole
Member
- Reaction score
- 47
Hiker, many BHT cases failed. Caronhead was after Arfy. However, there were many dissimilarities. Afry was a BHT after a plug hair transplant. Sometimes these old techniques can poison the scalp. Caronhead was a virgin scalp. We combined BHT and scalp hair on him, and nothing grew well. We attempted two following procedures on him that also failed using scalp hair. The two following procedures were for free, and they were not successful. His skin did not accept the transplants. What I do not know to this day is whether the BHT poisoned his scalp or whether his scalp was poisoned before the first transplant. I think that we can poison the skin. I believe that grafting can set up an autoimmune reaction to future hair transplants. I do know that the grafts in both cases were excellent. What I am not sure is whether the BHT set up an autoimmune reaction in at least the case of Caronhead. I suspect that in Arfy's case his old plug grafts poisoned the skin to future hair transplants. I'm not sure what the pathophysiology was with Caronhead. I do know that many who did not respond to BHT did respond to beard hair grafting, so I do suspect an underlying process with Caronhead. Caronhead was a great guy. I wish I could have delivered in his case as with all my patients. I could say that BHT was an ill conceived idea by Dr. Woods, but I also know that BHT resurrected many lives. I just wish that those predating my entry into BHT had been honest with the potential for failure. We had some amazing results from harvests from the chest, back, abdomen, and legs. We also had some dismal failures. The high percentage of failures is why I rarely harvest from these secondary regions any longer. I am doing one next week, but he has responded well from every source. Today, I would suggest head first, then beard, then chest, then abdomen. I think that anything below the beard works well in only 25% of patients.