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Subject: "Dr. Wong Patient, 4000 Grafts" First topic | Last topic
jotronicSun Oct-15-06 12:44 PM
Member since Jul 14th 2003
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"Dr. Wong Patient, 4000 Grafts"


  

          

This patient came in on Friday for a visit. I've also got video so once I get time I'll post it. The closure was non-trico as he came in quite a while before we integrated it into our procedures.













Joe Tillman
aka, Jotronic
Hasson & Wong
www.hassonandwong.com
www.hairtransplantmentor.com
Joe@HassonandWong.com

1.800.859.2266

The Truth Is In The Results

7917 FU Grafts

Attachment #1, (jpg file)
Attachment #2, (jpg file)
Attachment #3, (jpg file)
Attachment #4, (jpg file)

  

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Replies to this topic
Subject Author Message Date ID
RE: Dr. Wong Patient, 4000 Grafts
Oct 15th 2006
1
RE: Dr. Wong Patient, 4000 Grafts
Oct 15th 2006
2
RE: Dr. Wong Patient, 4000 Grafts
Oct 15th 2006
5
      RE: Dr. Wong Patient, 4000 Grafts
Oct 15th 2006
7
      RE: Dr. Wong Patient, 4000 Grafts
Oct 16th 2006
8
           RE: Dr. Wong Patient, 4000 Grafts
Oct 16th 2006
9
      RE: Dr. Wong Patient, 4000 Grafts
Oct 16th 2006
11
RE: Dr. Wong Patient, 4000 Grafts
Oct 19th 2006
21
RE: Dr. Wong Patient, 4000 Grafts
Oct 15th 2006
3
RE: Dr. Wong Patient, 4000 Grafts
Oct 15th 2006
4
      RE: Dr. Wong Patient, 4000 Grafts
Oct 15th 2006
6
           RE: Dr. Wong Patient, 4000 Grafts
Oct 16th 2006
10
The video
Oct 17th 2006
12
RE: The video
Oct 18th 2006
13
      RE: The video
Oct 18th 2006
14
           RE: The video
Oct 18th 2006
15
                RE: The video
Oct 18th 2006
16
                     Parting his hair
Oct 19th 2006
17
                          RE: Parting his hair
Oct 19th 2006
18
                               RE: Meds are unpredictable long term
Oct 19th 2006
19
                                    RE: Meds are unpredictable long term
Oct 19th 2006
20
                                         RE: Meds are unpredictable long term
Oct 19th 2006
22
                                         RE: Meds are unpredictable long term
Oct 20th 2006
23
                                              Meds as a NW5 !!!
Oct 20th 2006
24
                                                   RE: Meds as a NW5 !!!
Oct 22nd 2006
25
                                                        RE: Meds as a NW5 !!!
Oct 22nd 2006
26
                                                             RE: Meds as a NW5 !!!
Oct 24th 2006
27
                                                                  RE: Meds as a NW5 !!!
Oct 25th 2006
28

marcoSun Oct-15-06 04:14 PM
Member since Feb 27th 2003
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#1. "RE: Dr. Wong Patient, 4000 Grafts"
In response to Reply # 0


          

great results as always and irrelevant scar as well.

What is this guy going to do when he looses more hair and moves to full NW5 needing another 4000 grafts which is clearly going to happen?

  

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jotronicSun Oct-15-06 04:34 PM
Member since Jul 14th 2003
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#2. "RE: Dr. Wong Patient, 4000 Grafts"
In response to Reply # 1


  

          

Uh, what makes you think it will "clearly" happen? He was already near to true NW5 status anyway (what NW class would you say he is?) and why do you think he'll need another 4000? He has a few thousand available anyway and he's going strong on Proscar.

Joe Tillman
aka, Jotronic
Hasson & Wong
www.hassonandwong.com
www.hairtransplantmentor.com
Joe@HassonandWong.com

1.800.859.2266

The Truth Is In The Results

7917 FU Grafts

  

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marcoSun Oct-15-06 08:49 PM
Member since Feb 27th 2003
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#5. "RE: Dr. Wong Patient, 4000 Grafts"
In response to Reply # 2


          

>Uh, what makes you think it will "clearly" happen? He was
>already near to true NW5 status anyway (what NW class would
>you say he is?) and why do you think he'll need another 4000?
>He has a few thousand available anyway and he's going strong
>on Proscar.

I think you said it yourself; he absolutely has a typeV pattern. His actual level of loss in that pattern is not what one would normally see as the final extent by any stretch of the imagination. I accept that it could be the case if he is taking meds but it would still be highly unusual. As for the additional 4000; looking at the pattern, it is possible that, at worst his area of baldness would double.

So, I apologise for using the word "clearly". I should have said "almost certainly". If someone will almost certainly progress then that should "clearly" be taken into account to plan for the future.
IS THAT CLEAR ENOUGH FOR YOU.

  

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jotronicSun Oct-15-06 11:30 PM
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#7. "RE: Dr. Wong Patient, 4000 Grafts"
In response to Reply # 5


  

          

Marco,

"I accept that it could be the case if he is taking meds but it would still be highly unusual."

That's news to me.

"If someone will almost certainly progress then that should "clearly" be taken into account to plan for the future. "

Oh, I see what this is. Another, "you didn't plan for the future" post. Look, I think we've established that we don't use up the entirety of the donor area in the front 2 inches of hairline and we don't drop everything so low that the patient has to unzip his pants to comb his hairline. Each case is relative so if he now has 4000 grafts then he's got plenty for future loss which would result in a thinner appearance in the back. If his sides drop, their is plenty to work with. If Dr. Wong placed all 4000 in the front third and he had a discernable pattern, family history and was still pretty young, then you'd have a very valid point but this is hardly the case for this patient.

"IS THAT CLEAR ENOUGH FOR YOU."

Yeah, now that my ears are bleeding from your screaming, tone it dow

Joe Tillman
aka, Jotronic
Hasson & Wong
www.hassonandwong.com
www.hairtransplantmentor.com
Joe@HassonandWong.com

1.800.859.2266

The Truth Is In The Results

7917 FU Grafts

  

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marcoMon Oct-16-06 01:52 AM
Member since Feb 27th 2003
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#8. "RE: Dr. Wong Patient, 4000 Grafts"
In response to Reply # 7
Mon Oct-16-06 01:57 AM by marco

          

>Oh, I see what this is. Another, "you didn't plan for the
>future" post. Look, I think we've established that we don't
>use up the entirety of the donor area in the front 2 inches of
>hairline and we don't drop everything so low that the patient
>has to unzip his pants to comb his hairline.

This was my original question.

"What is this guy going to do when he looses more hair and moves to full NW5 needing another 4000 grafts which is clearly going to happen?"

It was quite simple and totally pertinent. I believe that your answer could have been " we still have donor grafts in store to cover this". Hasson and wong are great surgeons but if you look at your response and tone to my original question you might want to ask if you are doing them any favours at all.

The number of donor grafts that are reported to be available varies from surgon to surgeon so you could just have clarified that without being defensive which doesn't sell the practice well.

  

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biscuitMon Oct-16-06 06:51 AM
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#9. "RE: Dr. Wong Patient, 4000 Grafts"
In response to Reply # 8


          

You should have said "What is this guy going to do --IF-- he looses more hair and moves to full NW5 needing another 4000 grafts? (and delete: which is clearly going to happen)"

The way you said it made it sound like everyone acknowledges that he will end up a NW5, which is not the case. With as many grafts as he had placed in his hairline and top he won't be a NW5 because the transplanted hair will be there. He might lose some coverage in the crown due to MPB, in which case he would have to decide if he wanted to do another HT.

---------------------------------------
"Sometimes it is not enough to do our best; we must do what is required." - Sir Winston Churchill (1874-1965)

  

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UGLY MAN 4 LIFEMon Oct-16-06 01:01 PM
Member since Jan 19th 2003
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#11. "RE: Dr. Wong Patient, 4000 Grafts"
In response to Reply # 5


          

>>Uh, what makes you think it will "clearly" happen? He was
>>already near to true NW5 status anyway (what NW class would
>>you say he is?) and why do you think he'll need another
>4000?
>>He has a few thousand available anyway and he's going strong
>>on Proscar.
>
>I think you said it yourself; he absolutely has a typeV
>pattern. His actual level of loss in that pattern is not what
>one would normally see as the final extent by any stretch of
>the imagination. I accept that it could be the case if he is
>taking meds but it would still be highly unusual. As for the
>additional 4000; looking at the pattern, it is possible that,
>at worst his area of baldness would double.
>
>So, I apologise for using the word "clearly". I should have
>said "almost certainly". If someone will almost certainly
>progress then that should "clearly" be taken into account to
>plan for the future.
>IS THAT CLEAR ENOUGH FOR YOU.
>
>


You need to educate yourself about graft numbers.

  

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Sweet CheeksThu Oct-19-06 05:24 PM
Member since Oct 04th 2006
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#21. "RE: Dr. Wong Patient, 4000 Grafts"
In response to Reply # 1


  

          

absolutely natural! Outstanding!

JJ

  

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Dens1Sun Oct-15-06 05:20 PM
Member since Oct 03rd 2004
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#3. "RE: Dr. Wong Patient, 4000 Grafts"
In response to Reply # 0


  

          

great, natural result as usual!

200 grown out minis/micros from strip session in the 90s
500 FUEs with Dr Gho in two sessions
July 11th, 2005: 2500+ stripFUs with Dr A in India

check the details of my ht-procedure with Dr A under "Dens1":
http://hairsite.com/serendipity/authors/21-De

  

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biscuitSun Oct-15-06 07:26 PM
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#4. "RE: Dr. Wong Patient, 4000 Grafts"
In response to Reply # 3


          

Looks great, nice density and a natural looking hairline, the patient must be ecstatic. Congrats to Dr Wong.

---------------------------------------
"Sometimes it is not enough to do our best; we must do what is required." - Sir Winston Churchill (1874-1965)

  

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JonnyESun Oct-15-06 10:06 PM
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#6. "RE: Dr. Wong Patient, 4000 Grafts"
In response to Reply # 4


          

Looks great, very natural and the scar is nice and thin.

Minoxidil twice a day
1.25 proscar once a day
3083 grafts by Dr. Armani in April 2004

  

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ReadyFreddyMon Oct-16-06 06:56 AM
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#10. "RE: Dr. Wong Patient, 4000 Grafts"
In response to Reply # 6


  

          

Fantistic. That's a pencil thin strip scar.

  

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jotronicTue Oct-17-06 11:37 PM
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#12. "The video"
In response to Reply # 0
Wed Oct-18-06 01:11 AM by HairSite

  

          


http://www.hassonandwong.com/mediagallery/movies/cgml.html


Joe Tillman
aka, Jotronic
Hasson & Wong
www.hassonandwong.com
www.hairtransplantmentor.com
Joe@HassonandWong.com

1.800.859.2266

The Truth Is In The Results

7917 FU Grafts

  

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m123Wed Oct-18-06 04:04 AM
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#13. "RE: The video"
In response to Reply # 12


          

Nice , very nice. I hear no audio, is it just my machien ?

  

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jotronicWed Oct-18-06 04:12 AM
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#14. "RE: The video"
In response to Reply # 13


  

          

Nope, no audio. I muted it in the final draft as I didn't think people wanted to hear my telling the patient to do 360 degree turns on the stool, techs and patients chatting etc

Joe Tillman
aka, Jotronic
Hasson & Wong
www.hassonandwong.com
www.hairtransplantmentor.com
Joe@HassonandWong.com

1.800.859.2266

The Truth Is In The Results

7917 FU Grafts

  

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SKWed Oct-18-06 05:26 AM
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#15. "RE: The video"
In response to Reply # 14


  

          

Try putting some background music next time.

  

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johnpWed Oct-18-06 05:54 PM
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#16. "RE: The video"
In response to Reply # 15
Wed Oct-18-06 05:57 PM by johnp

          

Very interesting. This is why it's good to have both video and regular images. This guy appears to have more density in the video than his pics. The pics dont do him justice.

  

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helpmeoutThu Oct-19-06 04:09 AM
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#17. "Parting his hair"
In response to Reply # 16


          

What if he wants to part his hair the other side, can he do that?

  

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jotronicThu Oct-19-06 05:34 AM
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#18. "RE: Parting his hair"
In response to Reply # 17


  

          

helpmeout,

He can style his hair any way he wants and get away with it.

Joe Tillman
aka, Jotronic
Hasson & Wong
www.hassonandwong.com
www.hairtransplantmentor.com
Joe@HassonandWong.com

1.800.859.2266

The Truth Is In The Results

7917 FU Grafts

  

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gillenatorThu Oct-19-06 07:21 AM
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#19. "RE: Meds are unpredictable long term"
In response to Reply # 18


  

          

After reading the initial posts on this thread regarding hairloss meds and the progression of MPB, please keep in mind that patients respond to medications differently and especially when considering the long term. I think arguments were made on both sides to be diligent in life planning our goals of hair restoration. Possibly this patient has adequate BH donor to blend in the less visual impact areas in case he continues to progress beyond his current hairloss class. I started cutting Proscar ten years ago, just had my fourth strip procedure, and Dr. Shapiro noted that I had not progressed beyond my class 5 status back in 1996. The most advanced class in my family history was six so I was not far from that at the age of 41.

So I'm impressed with the fact that finasteride has worked efficiently for me over the past ten years. But does that guarantee the next ten years and beyond? No it does not. HOWEVER, there are other medicinal options like dutasteride which inhibit both types of DHT, and who knows what the future holds regarding improved meds and even the promising advent of HM and the like.

There are risks to any of this and so after careful research and consideration, we each have to make that informed decision as to whether we are willing to accept that level of risk associated with the meds, and of course surgery. There are no guarantees in any form of elective surgery but obviously there are indeed benefits as noted in this patient being previewed. He was in fact able to attain a very nice result.

Gillenator

I am not a doctor; all opinions shared are not medical advice but my own views. Contributing Physicians: Dr. Glenn Charles, Dr. Jim DeYarman, Dr. Paul Rose, Dr. Ron Shapiro, Dr. Christian Bisanga, Drs. Bob True & Bob Dorin

  

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xairyhay1Thu Oct-19-06 04:15 PM
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#20. "RE: Meds are unpredictable long term"
In response to Reply # 19


          

Why would a Norwood 5 stay on meds for a decade if they didn't grow any new hair?

Isn't that like holding on to your welcome mat after the tornado blew your house away?

  

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SkywalkerThu Oct-19-06 06:55 PM
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#22. "RE: Meds are unpredictable long term"
In response to Reply # 20


          


- and at least the Welcome mat is not going to cost you money

______________________________________________________________________________________

If you disagree with my opinion I do not mind - I am not paid to post here and I am not a missionary.

  

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biscuitFri Oct-20-06 08:40 AM
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#23. "RE: Meds are unpredictable long term"
In response to Reply # 20


          

>Why would a Norwood 5 stay on meds for a decade if they
>didn't grow any new hair?
>
>Isn't that like holding on to your welcome mat after the
>tornado blew your house away?

The meds don't usually grow new hair, the realistic goal is to slow down the rate of loss. The problem is that after 10 years of usage you have no idea how effective the meds have been. If you stop you could lose even more of the horseshoe area and go beyond a NW5.

---------------------------------------
"Sometimes it is not enough to do our best; we must do what is required." - Sir Winston Churchill (1874-1965)

  

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SkywalkerFri Oct-20-06 03:18 PM
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#24. "Meds as a NW5 !!!"
In response to Reply # 23
Fri Oct-20-06 03:21 PM by Skywalker

          

I have allways accepted that people will make different judgement calls on Finasteride/Dutasteride and that my view is not popular on these boards (although much more popular in the general population of people with MPB), however, the idea that anybody as a NW5 is taking these drugs shows to me at least that some people are totally incapable of doing a basic cost/risk/benefit analysis.

I suppose you could perhaps justify trying them for a year to see if you are one of the very few (and I mean very few) who get sensational regrowth - but if not - then that's it with meds in my view for a NW5.

______________________________________________________________________________________

If you disagree with my opinion I do not mind - I am not paid to post here and I am not a missionary.

  

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gillenatorSun Oct-22-06 08:37 AM
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#25. "RE: Meds as a NW5 !!!"
In response to Reply # 24


  

          

biscuit explained it very well and I'm rather srprised that there are several of you who appear to not understand the benefit of "slowing down" the progressionary effects of MPB. Some of the younger guys value the meds "only if" they can attain re-growth and what they sometimes "hope" to reverse MPB, which is impossible since MPB is progressive in its nature and non-curable at this point in time.

So, it "has never" been my goal or objective to "regrow" any hair I had already lost to MPB by the age of 41 when I started finasteride. In other words, and I stated this earlier, I have real potential to reach class 6 without the meds. Progressing from a class 5 to class 6 WILL DEMAND MORE DONOR which as we all know is LIMITED. Instead I chose to continue taking finasteride and using my limited donor to add density, rather than continuing to chase more hair loss. Let me explain.

If I were to progress from class 5 to 6, that would require more grafts to cover an additional 3cm width by 30cm length to cover the circumference around the skull in the parietal zone. And that's a conservative estimate! To adequately produce the illusion of coverage, let's also be conservative and say I'll go 40 FU per cm2. Now let's do the math. 3cm X 30cm = 90cm recipient area to fill in. 90cm X 40 FU = 3,600 additional grafts. And that's 3,600 precious grafts, and grafts I want to save and/or use elsewhere, not chase hairloss as I said earlier. Oh, and don't forget, that's also 3,600 grafts in cost that I can save in money because I don't necessarily have to add to my density front to back. That's something I chose to do BECAUSE I DID NOT PROGRESS FARTHER, because I did make the critical decision to get on finasteride TEN YEARS AGO. Had I not got on the meds ten years ago, I would not have that option today to add more density now would I?

More math. 3600 grafts X $8.00 FUE = $28,800 OR 3,600 grafts X $4.00 strip = $14,400! I pay a mear ten dollars copay for 30 tablets of proscar and cut four ways. That lasts me four months. Ten dollars times four equals forty dollars per year times 10 years equals $400. So really, you don't need to judge nor critique my analytical abilities nor my fundamental understanding and knowledge of MPB. And BTW, I speak for many, many guys 40 and older taking finasteride for the very obvious same reasons. You'll see when you get there because don't forget, you're aging day-by-day just like the rest of us.

Now, that being said, let me now explain to you how you can monitor whether or not you are visibly progressing in your MPB or if the meds are in fact really slowing it down. Simply demand that your hairloss doctor monitor and chart your demarcation zone or pattern of loss AND invading miniturization on an on-going basis. This is easily accomplished with the use of a video telescope whereby a hair count of the demarcation zone is performed and then the still images are downloaded for future comparison purposes. Then, with the use of a densometer, the areas of impeding miniturization can be charted and evaluated year-to-year, again charting any and all changes in hair count, hair mass, diameter shaft analyses, etc.

One last thing. Just because you think it's Einstein to only use the hairloss meds IF they meet your criteria DOES NOT imply that someone taking them for purposes unique to yours equates to anything less intelligent. In fact if you really understand the fore-mentioned math, you'll really see who the fool is.

The other thing you need to be really careful about is assuming everyone else holds your values and viewpoint. Have you read your signature disclaimer recently? Maybe practice what you preach? Patients have different needs and varying goals, try to keep that in mind, that is if your goal is to help others here.

Gillenator

I am not a doctor; all opinions shared are not medical advice but my own views. Contributing Physicians: Dr. Glenn Charles, Dr. Jim DeYarman, Dr. Paul Rose, Dr. Ron Shapiro, Dr. Christian Bisanga, Drs. Bob True & Bob Dorin

  

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SkywalkerSun Oct-22-06 05:58 PM
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#26. "RE: Meds as a NW5 !!!"
In response to Reply # 25


          


The first thing I would say, is what my disclaimer does say, IT IS MY OPINION, that is why I put the disclaimer in there in the first place it is not there by accident please get a grip.

You conveniently miss out a few key factors and use your anecdotal evidence as a key factor (not wise).

1) Finasteride, for most people, STOPS WORKING SO EFFECTIVELY after a number of years, just because it did not on you does not change that. So, it does not seem to make any sense to take Finasteride as a NW5 for years before an HT (if you take it at all) because you do not know where you stand. You make a judgement call to have good hair (via HT and Finasteride now) and take the risk of problems later - fair enough but to take Finasteride AND still look like a NW5 (which is pretty grim) seems the worst option of all.

2) Your whole transplant that you eventually have will rely on hair (and how many grafts you save will vary from person to person)which is already likely to be somewhat affected by a level of miniaturization and has an unknown future. (your cost argument is weak then isn't it?) We are talking about NW5's, so the chance of further progression even with Finasteride is pretty high.

3) Many NW5's have a limited amount of hair that can be transplanted so they probably will need all of it to get a decent result - if the non-transplanted hair they have left then starts to fall out - what on earth do they do then? (again, your cost argument is weak then isn't it?).

4) Finasteride is not a drug to be taken willy-nilly, it can cause all sorts of very unpleasant side-effects (and some subtle ones too) and if you are unlucky those side-effects do not necessarily even come right at the start of using it, so you are always 'sitting on a timebomb'. You conveniently do not mention this at all, but taking Finasteride is NOT a free lunch.

5) If you want to play the anecdotal game - my hair has not shifted in appearance in 14 years since I stopped losing what little hair I have left - if I had been taking Finasteride I would have thought that was the cause of it stopping wouldn't I? Like I said, anecdotal evidence proves nothing.

BTW, where does Einstein come into this? I did not even mention him. You seem upset that somebody has a different opinion on the value of taking Finasteride for years as a NW5 - tough. Newbies can make up their own mind, and if they take the stuff that is fine by me, they have listened to different points of view and can make a choice.




______________________________________________________________________________________

If you disagree with my opinion I do not mind - I am not paid to post here and I am not a missionary.

  

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gillenatorTue Oct-24-06 12:03 AM
Member since Feb 14th 2004
508 posts
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#27. "RE: Meds as a NW5 !!!"
In response to Reply # 26


  

          

You missed the entire point of my post. My reply was not intended to speak for every class 5 patient, although most class 5's would agree with my viewpoint.

And again it's obvious that you're putting everyone in the same long term prognosis. Just where are you justifying your "claims" that efficiency is lost with long term use of finasteride? Please give us the publsihed trials data and the medical journals their emperical findings were published in. Otherwise your claims are nothing more than your unfounded opinions, yet you attempt to make them look like scientific fact.

The other point you missed was the fact that you do not practice your disclaimer when you ridicule opinions of others involving their own educated health care opinions. You're trying too hard to fit everyone in your world or perspective which is very narrow-minded thinking to say the least. And don't wory man, you ain't causing any panic in me. My results speak for themselves.

The last point you missed is that YOU CANNOT SPEAK FOR OTHERS when all of these decisions involving elective medicine are personal choices based on both the known risks and well as the benefits including the meds. Do you really think that guys like the idea of taking hairloss meds? Do you not think we don't know there are risks in taking "any meds" long term known or unknown. Should we all stop taking meds then because of the unknown? Do you see how you're going off the deep end?

You obviously cannot grasp the concept of preserving natural hair subject to DHT as long as possible along with prudent donor management.

Gillenator

I am not a doctor; all opinions shared are not medical advice but my own views. Contributing Physicians: Dr. Glenn Charles, Dr. Jim DeYarman, Dr. Paul Rose, Dr. Ron Shapiro, Dr. Christian Bisanga, Drs. Bob True & Bob Dorin

  

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SkywalkerWed Oct-25-06 07:48 PM
Member since Jan 20th 2003
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#28. "RE: Meds as a NW5 !!!"
In response to Reply # 27
Wed Oct-25-06 07:52 PM by Skywalker

          

I deliberately delayed responding to this thread again in order to reflect. I do not think continuing it would be helpful to others and we are not going to agree on this subject so it seems a waste of time.

I am very happy with my previous response, newbies have heard another point of view and can investigate for themselves.

The tone of your response is of little interest to me and the fact that you cannot understand the points I am making (specifically the obvious law of diminishing returns for a NW5), given the content of your previous posts, I find unsurprising.

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If you disagree with my opinion I do not mind - I am not paid to post here and I am not a missionary.

  

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