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Topic Title: I'm doubtful that surgeons offer much guidance
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Created On: 05/31/2016 09:42 PM
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 05/31/2016 09:42 PM
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takingaction
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I've consulted with several doctors over the years. Nobody has ever been particular about placement, density, what have you. Either the attitude was to do less than I wanted or agree on a number and region of my concern (with hairline border drawn) and be vague about how many hairs would be placed in each section. The long-term plan was even more vague. Is that how it usually goes?

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"Maybe it's because I'm older and wiser, but I just cannot understand why some people are so reckless with their health."
 06/22/2016 02:43 AM
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Calvin 3.0
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Sounds like you've been seeing the wrong surgeons.


If you haven't been making any long trips to other cities/regions for consultations then you aren't investing enough into this.

Narrow your search to a few top contenders, then do consultations.

There is an old saying in the HT world, if you aren't willing to travel thousands of miles to get a HT then you aren't serious/committed enough to be doing it.


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 06/22/2016 07:06 AM
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topcat
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In my opinion the majority of these doctors are estatic if they can just get the hair to grow. For them this alone is quite an accomplishment. A better approach is for the patient to understand the numbers completely along with the extreme limitations of what can be achieved. Then question the doctor and see if you get honest answers. If you observe the number of doctors that are high norwoods that have not had a ht themselves it's a clue. If you observe the doctors that have actually had a hair transplant ask yourself if you are comfortable with that look. Find those doctors and look at the work on their own head and is that what you are hoping to achieve?

When one understands the limitations completely they can then start to look for those that have the skill to work with what is available in a well thought out long term plan. The key is skill as in being able to pick out the exactly right caliber and color hair from the donor zone and knowing exactly where to place it in the recipient zone. It becomes a giant puzzle for most if they do not have the natural eye and that would be the majority.

Although this is not a perfect example most end up with a transplant that looks like the tree below. The thickest and darkest hairs taken from the occipital zone are placed in the hairline and regardless of if they are singles or not something looks out of place to the casual observer they just can't place their finger on it so they just stare. They don't tell you that when you have the strip or limit their fue extractions to a small area at the back of the head.



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Stay away from doctors who perform mega sessions, have posts deleted, attack posters, sue patients & forum owners, use power drills or robots. I recommend fue with hand punches in the .70-.85 range. I consulted with dozens of clinics over the years and there was a recurring theme regarding FUE among some employees of those other clinics. I was told Bisanga was the man my research told me the same and my experience validated my own research.
 06/24/2016 09:20 PM
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takingaction
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"If you aren't willing to travel thousands of miles to get a HT," maybe it's because it's not practical. I think people who encourage that much travel don't understand some basic realities. One whose loss isn't headed to Nick Cage territory can go to a hack and get solid results, as long as the hack agrees to do what a patient with good judgment wants. I think I've known enough for a while.

A few locals I saw have their fans in the hair loss community. They offered more information than the offers, but still not much actual guidance, other than, There's no particular reason to do a transplant.

I know about the thick, dark hairs in the hairline issue, but 1) it's not a big deal when much of the original hairline is going to remain for years, 2) the natural hairs in front are thick and dark, and 3) there's little thinning elsewhere. No surgeon ever brought that up in discussion. Also, if the hairline is deliberately made a bit zig-zag, it diminishes the weirdness of a very strong hairline.

All that said, I'm a little puzzled by why the typical doctor doesn't give more direction. Would it scare people off?

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"Maybe it's because I'm older and wiser, but I just cannot understand why some people are so reckless with their health."
 06/25/2016 07:20 AM
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topcat
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The typical doctor in my opinion that gets into this industry does so because they can't seem to make it elsewhere by practicing real medicine and the money seems to be very good. This represents probably the 90%. For them ht all looks simple enough but unfortunately it's not which is mostly too bad for the patient.

So now you have all these young guys many who are desperate giving undue respect to many who simply deserve no respect. These doctors in turn start to buy into the whole thing which of course inflates their ego making a bad situation only worse over time. These doctors realize that they really don't need to be the best nor do they need to offer the best type of procedure as desperate young guys are an easy sell. Young guys don't know it but a couple of dozen just like them walked through the door over the last several days and the script is always the same. Like a comedian that hones and polishes his material over and over until only what works is left. And guess what it works.

Sometimes giving a patient too much information puts a doctor at a disadvantage. It's easier to plead ignorance if one has to in the long run. A good example would be robotics. Many doctors and others in the industry clearly admit some in writing that in the beginning the punches were much too big. Of course if one were not aware of this fact then they could plead ignorance. But what about the doctors that actually knew about the smaller punches and the higher yields and actually wrote as such..............ignorance can no longer be a defense. Easier to play stupid and not say much it's a safer bet.

1) it's not a big deal when much of the original hairline is going to remain for years



I disagree it is a big deal. Surgical restoration cannot duplicate natural density regardless of the availability of donor. Most at best can achieve 50% so going into an area that already has 50% density or better is futile and a waste of money and donor more often then not.

You can read posts by patients on this forum that have multiple surgeries in the same area and the density is the same. Chances are the new work might be transecting some of the older work. But if you can get a patient to come back that is not happy they tend to lose their chance to sue, not so much for the result but their chance to sue for deceptive marketing. If one is under the illusion that this is the hairline guy, the doctor that will give you that thickness you oh so desire, well then the expectations might be unreasonable due to the marketing.

When you take transplanted hair and butt it up against natural hair that is thick and dense the contrast can easily be seen so young guys end up staring in the mirror wondering why it looks so thin. Maybe they were not a candidate to begin with and it's not that the hair is too thin but the hair behind it is too thick.

Regardless it all comes down to having the right information which the industry itself doesn't seem to be offering much of as it would hurt sales but they don't need to as young guys keep feeding their ego. Even repair patients are careful about what they say because they become too desperate and it all feeds the ego of the industry. Here is a crude analogy that appears in both "Menace to Society" and "New Jack City" the desperate druggie says to the dealer "I will suck your d*ck" and that is how it for many with hair loss. They will do anything and they don't care about having all the information, just get it done. Give me what I need. When the customer base becomes top heavy with the desperate nobody needs to answer your questions.............they don't have time..............next. The ego just gets bigger and bigger until they start believing it will never end and so they get bolder and bolder.

Hope this is helpful.


BTW I do also understand it is a human frailty on the part of the doctors. No different than others that seek power, wealth, and fame it can all become a trap. We see it every day in the news. I live in Illinois and many of the politicians are in jail. In fact Governor Blagovich lived only about 5 blocks away from me and I thought he was a really nice guy. He always made sure to wave to me as he jogged by the house. I mean how can you not like a guy that smiles and waves to you.............lol.............I sure hope he is doing well.

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Stay away from doctors who perform mega sessions, have posts deleted, attack posters, sue patients & forum owners, use power drills or robots. I recommend fue with hand punches in the .70-.85 range. I consulted with dozens of clinics over the years and there was a recurring theme regarding FUE among some employees of those other clinics. I was told Bisanga was the man my research told me the same and my experience validated my own research.

Edited: 06/25/2016 at 07:40 AM by topcat
 06/25/2016 10:17 AM
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takingaction
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Someone can have passable hair with a weak hairline, but there's no good hair without a decent hairline. (I'm pretending that creative combing, concealers, hairpieces, etc., do not exist.) I didn't say natural density - another thing I've found doctors neglect to bring up - but it can look like normal density if done well. Also, you're forgetting that most men don't have the A pattern of hair loss. The temples will disappear, but most of the center of the hairline likely will persist for a long time. Anyway, since hair loss treatments don't usually stop a receding hairline, the only way to have good hair is to keep patching it up. 10% transection isn't too bad if there's a large donor supply.

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 06/26/2016 12:31 PM
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Calvin 3.0
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The shaft thickness issue seems to vary depending on the individual. It's always there but I mean the severity of the problems it causes. Also, some guys see a significant difference in how dark the hairs look depending on their thickness. Thinner hairs get lighter shaded as the MPB process progresses. It won't make a brunette into a blond but it can be noticeable when you try to make a transplanted area blend with an original one.




When it comes to major FUE work, I think some harvesting of hairs outside the safest donor areas is acceptable. (but certainly not with strips! Hell no!) This is a very controversial/inflammatory idea but I think the logic holds up.

With heavy strip restorations there is some loss of density throughout the whole scalp, just from pulling the strip wounds closed. If you only harvest FUE grafts from the safe-zone then there is no loss of density at all outside the safe-zone. That's one of the reasons why strip patients have more lifetime grafts available to them than FUE. Strip patients are not DIRECTLY lifting grafts from outside the safe zone but they are INDIRECTLY removing density from those areas by stretching them to cover a bigger portion of the skull.

If you lift a mild amount of grafts from areas all over the scalp during FUE work, and those hairs are mixed in among the safe-zone ones, then it will help reduce the issues with color and shaft thickness mismatches. It will also help preserve the donor area & increase the lifetime possible FUE donor supply.


"But what about those 'unsafe' or 'semi-safe' hairs being lost to MPB later?"

What about it? If you're going to lose that density in the future then you're going to lose it. The only difference is where those hairs are at the time. You can lose them all in their original locations, or you can lose them while some are scattered throughout the transplanted areas too.


"But transplanting from unsafe areas would mean paying good money for grafts that I would eventually lose again!"

So what? You'll live. It allows a bit more realistic & thorough HT restoration earlier in your life this way. When that future loss eventually hits it will take its toll more evenly throughout your head, front and back. Seems like a decent deal to me.


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pretend to know what I'm talking about.

Edited: 06/26/2016 at 12:38 PM by Calvin 3.0
 06/27/2016 06:59 AM
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topcat
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Maybe when you deal with enough desperate people over time you develop a "God Complex" or maybe you just give up in trying to give good guidance. My drug addict example is very extreme and provocative which is the intention. Can you guide someone that desperate in the right direction? It becomes very difficult. They want what they want and if one doctor does not give it to them surely someone else will. Maybe this helps to understand why one is not receiving proper guidance. But the clues are all around you one only needs to look long enough to understand the mathematical limitations of the procedure while also understanding there is zero room for mistakes by hacks. You have to go directly to the top of the list and lower expectations for what is possible.

Clues are all around. Below are all examples of the "Celebrity hair transplants" which many clinics love to use as a way of promoting simply put out some social proof. Unfortunately most do not see the aftermath 10-20 years later. If they did they might hesitate. These examples all happen to be millionaires some even billionaires and my guess is they spent in an inordinate amount of time getting their hair to look this good for the picture. Which is fine but spending all that time every day becomes a giant exercise in the waste of energy/time in my opinion.

So exactly where did these guys get their advice? If they were to receive the best advice they would understand the limitations of the procedure. If they understood the difficulty in performing the procedure they would have tried to find someone that actually knew what they were doing. But with this type of advice you eliminate probably 80% of the market and 90% of the doctors so chances are some will have to lie along the way.

All these guys were probably surrounded by some very smart people but it can be easy to fool even smart people. Doesn't take much just be willing to do to others what most would probably not because their conscience simply will not let them.





IMG]http://i271.photobucket.com/albums/jj131/topcat911/David%20Gest%203_zpslm8m4fmd.jpg[/IMG]









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Stay away from doctors who perform mega sessions, have posts deleted, attack posters, sue patients & forum owners, use power drills or robots. I recommend fue with hand punches in the .70-.85 range. I consulted with dozens of clinics over the years and there was a recurring theme regarding FUE among some employees of those other clinics. I was told Bisanga was the man my research told me the same and my experience validated my own research.

Edited: 06/27/2016 at 07:07 AM by topcat
 06/27/2016 10:18 AM
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takingaction
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It's funny - I recognized all of them. Most of them are misleading examples, because they began getting transplants in the last century, when the regular techniques were terrible and maybe even before Propecia.

I think nearly all surgeons today can provide decent results, if they don't badly mess up placement or operate on people who aren't candidates. If a patient wants fine-tuning later, he can visit one of the best doctors.

I brainstormed reasons why doctors might not offer guidance. Besides the venal one of See no evil, hear no evil, here they are:
Unfamiliarity with the patient (don't know what to address beside the basics)
Speculation (not fun for some people)
Discomfort (including not particularly liking to talk to most people)

Also, a long consultation is time diverted from more productive activities.

There's also the possibility that most doctors assume patients are doing some online research.

I don't know if a doctor is likely to offer more guidance to a new patient who has already had a transplant. If yes, maybe it was a botched job or he's more serious about doing something (not wasting the doctor's time).


Re the tangent two posts up about transplanting hair from outside the safe zone, I think that's a recipe for disaster unless it's from near the crown and someone has little or no loss there and responds well to medication. My reasoning is that elsewhere hair probably will keep thinning and might accelerate in the senior years. All hairs thin then, in possibly all cases.

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 06/27/2016 11:17 AM
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Calvin 3.0
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Another common thread among the guys in those pics is that they are all dealing with high Norwoods.

Aside from getting an incompetent/immoral surgeon that is by far the biggest determining factor about the results. The more you're going to lose, the less likely that HTs are a good choice for you.


The simple ugly truth is, the more you want HTs, the worse of a candidate you probably are for them.


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 06/28/2016 03:24 AM
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topcat
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I recognized all of them. Most of them are misleading examples, because they began getting transplants in the last century, when the regular techniques were terrible


I would disagree these are all state of the art techniques and simply the ravages of time exposing the math. The math is the math is the math is the math. For some the math might work for the long term for most it will not most especially if they were not properly given guidance hence the reason not to give too much guidance answering you original quesiton.


The simple ugly truth is, the more you want HTs, the worse of a candidate you probably are for them


Yes I agree and those that want it the most at a young age without life experience are the easiest sell. They are willing to take big risks because their frontal cortex has not fully developed so they go into it without much thought about the consequences. Many young guys that have had a procedure and are now stuck and they don't particularly like this type of posting and might even refer to the poster as a dick which is understandable. What they might not understand is that the posting might not really be so much for them. The post is for the guy who is just researching and has never had a procedure. We have to help those guys and worry less about ourselves. Point out some of the many pitfalls so that better decisions can be made.

Some in the industry would disagree strongly with my tree example and using hairs from the occipital zone for the hairline as opposed to hairs along the periphery with a technique like fue. I would say just consider the point and then view several dozen hair transplants in person where enough frontal work was performed to make a judgement. Then if you find the point I made to be valid you must then ask yourself why do some in the industry seem to be saying something different and working very hard at doing it and come to your own conclusion. It all just information. Take it all in and don't dismiss anything then try and figure it out on your own.

In my opinion you are going to see a tidal wave of guys coming forward from the last 10 years alone who now realize they were poorly informed. It is also my opinion that this wave will be followed by a second wave of guys who had robotics with a fairly large punch who might now be trying to shave their head and are not expecting what they are going to see.

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Stay away from doctors who perform mega sessions, have posts deleted, attack posters, sue patients & forum owners, use power drills or robots. I recommend fue with hand punches in the .70-.85 range. I consulted with dozens of clinics over the years and there was a recurring theme regarding FUE among some employees of those other clinics. I was told Bisanga was the man my research told me the same and my experience validated my own research.

Edited: 06/28/2016 at 06:23 AM by topcat
 07/02/2016 09:15 AM
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takingaction
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David Lee Roth's huge scar shows he had FUT, which definitely hasn't been state-of-the-art for a while. Joe Rogan began having transplants over 20 years ago, at an age that many surgeons now consider very iffy. Typical transplant guidance seldom seems to go beyond, "You're too young" or (stupidly, if you ask me, because in the long run it can be a big money-maker, but I guess doctors dislike perfectionistic patients) "You haven't lost enough hair."

The more I think about it, the more I wonder how many physicians are even trained to do long-term management of health problems. I doubt that any are formally trained in long-term care of purely cosmetic problems.

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 07/03/2016 07:54 AM
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topcat
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State of the art is determined by where you are in time when viewing something. In the present moment for example hair dot tattooing is state of the art and most in the industry agree and are offering this money maker. Ten years from now its shit and I can't believe guys fell for that marketing crap. It's that simple if one can see it. Get past the desperation and see what is really going on.

The ht industry gave me a good education and I see things my own way. Most ht industry experts don't agree with my point of view and its not necessary for those researching to agree just consider it all as possible.

Most Oncologists would never consider the treatment they offer for themselves which for most is radiation and chemotherapy. But you see this is the industry standard and it is an absolutely huge money maker so it's considered state of the art by the industry. Does anyone expect them to tell you it's shit? But the real point to understand is this. When you are diagnose with cancer in most cases you have no choice but to listen to these experts because you will be too afraid to listen to someone that is not considered an expert by the established industry. You don't have enough self taught knowledge so you are absolutely stuck going for that money making state of the art treatment and keeping your fingers crossed. Even if you have a little knowledge there is no way you can convince yourself to take on the responsibility for making an alternate decision most especially for someone other than yourself like a loved one.

You are assuming that doctors care about your long term well being. Maybe you are wrong and they don't' care. Maybe you a just a another customer. Maybe your programming over years has gotten you to believe something that might not be true.................at least consider it.

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Stay away from doctors who perform mega sessions, have posts deleted, attack posters, sue patients & forum owners, use power drills or robots. I recommend fue with hand punches in the .70-.85 range. I consulted with dozens of clinics over the years and there was a recurring theme regarding FUE among some employees of those other clinics. I was told Bisanga was the man my research told me the same and my experience validated my own research.

Edited: 07/03/2016 at 08:27 AM by topcat
 07/04/2016 09:52 AM
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takingaction
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Tattooing anything is a fad. It probably makes sense for some scars and maybe nothing else.

I just object to the scare-mongering. Hair transplantation is not chemotherapy, and this is 2016. Some methods are a waste of money, but almost any transplant or series of transplants will (when used with medication) for years give results that look better than being bald. I wish doctors would care more and focus on giving the patients the most natural, fullest-looking long-term results without mistakes along the way, but I guess people can only spread knowledge online and, through complaints and avoidance, force doctors into doing better. Edit: one very simple thing is for forums to spread the idea that the best way to not lose much hair and not experience transplant failure is to visit a dermatologist when problems arise and for regular scalp check-ups. (Yeah, some dermatologists are lousy at managing hair loss. Fire anyone like that and start anew.)

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"Maybe it's because I'm older and wiser, but I just cannot understand why some people are so reckless with their health."

Edited: 07/04/2016 at 10:12 AM by takingaction
 07/05/2016 03:12 AM
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topcat
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I'm just making a point. If you go to a guy selling chemotherapy that is what you might get. If you go to a guy selling hair tattoos that is what you might get. The guidance you often receive is directly related to what someone is selling so maybe you would be better guided by those that are not selling anything and just passing on some advice/experience.

Start searching for patients that have actually had a procedure. Meet up with them and look to them for guidance. Gather enough of those experiences and you will be infinitely better off than looking towards the industry for answers.

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Stay away from doctors who perform mega sessions, have posts deleted, attack posters, sue patients & forum owners, use power drills or robots. I recommend fue with hand punches in the .70-.85 range. I consulted with dozens of clinics over the years and there was a recurring theme regarding FUE among some employees of those other clinics. I was told Bisanga was the man my research told me the same and my experience validated my own research.
 07/05/2016 09:33 AM
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Calvin 3.0
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Some methods are a waste of money, but almost any transplant or series of transplants will (when used with medication) for years give results that look better than being bald.


I disagree about the 'almost any' part.


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 07/05/2016 09:34 AM
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Calvin 3.0
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.

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pretend to know what I'm talking about.
 07/14/2016 09:22 AM
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takingaction
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I found what amounts to a technical guide.
www.forhair.com/proper-planning-hair-transplant-consultation-process/

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"Maybe it's because I'm older and wiser, but I just cannot understand why some people are so reckless with their health."
 10/30/2016 12:30 AM
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Mountinfan
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Too nuanced for me. Topcat's math makes sense, but query if you are a low Norwood, wouldn't you get cosmetically acceptable results from a top FUE procedure or one of the premier docs--there is one in Topcat's Chicago backyard? I agree with Topcoat that many of the Docs are looking for easy money but there are talented, artistic and ethical ones as well. The future may bring new donor availability or treatments--probably will.
Just look at the Bald2020 website for the abundance of new ideas that have emerged of late. 2020, 2025 or 2030 is not very long term to a 20 something year old. It is all a matter of perspective. A somewhat odd looking tree might be acceptable.

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Mountinfun
 10/31/2016 09:18 PM
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takingaction
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I still don't think the lack of guidance is bad for people who are not at much risk of major baldness or with the patience and resources to get however many transplants eventually are needed. "Bad" in the sense that a patient might feel misled, though.

I will back off the "almost any transplant" [is helpful] claim. Some people just don't have enough supply. For others, I guess if doctors give differing opinions on the hairline, then it's slightly possible that one of them is recommending a hairline that is too low, which will look bad. However, I think when that happens, it's often because the patient pushed for it.

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"Maybe it's because I'm older and wiser, but I just cannot understand why some people are so reckless with their health."
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