| To
the members of the community:
My two-year
process of exploring the option of surgical hair restoration
came to an end last month, when I underwent four procedures
(a little over 2400 follicular unit grafts) with Drs. Woods
and Campbell. The surgeries went very well, yet as I think
about the exhaustive and exhausting nature of the research
that led me to my decision, I realize that the research
process was considerably more difficult for me than the
actual surgeries (although I unconditionally caution fellow
community members not to take any surgery lightly, as even
in the most capable hands it is a serious matter).
Why was the
research process so difficult, so draining, and at times, so
discouraging? After learning about the pain and suffering
inflicted upon so many good people (many of whom whose
selfless help made a major difference for me in my decision
making process), I reached an understanding with myself that
if I was going to go forward with a surgery (or surgeries),
I had to protect myself against making a hasty choice based
upon desperation to deal with my hair loss. I absolutely had
to accept the principle that I, as a prospective patient,
had certain inalienable rights.
Accordingly,
in order for any surgeon(s) of any reputation to touch my
head or get a penny from me, they needed to--and without
exception--meet certain requirements and perform surgery in
a manner that protected my rights as a patient. I had a list
that essentially coincided with the list Dr. Woods and Dr.
Campbell have just posted. My research process ended when I
learned in the fall, through what I felt was sufficient
evidence, that these two surgeons could meet the
requirements I set.
As a
patient in general, not only as a "Woods patient",
I want to expand upon the value of taking such a list
seriously.
First, my
decision-making process did not involve entirely
self-imposed discipline. Posts from and email correspondence
with patients, many of whom were repair patients whose lives
had been unimaginably altered by the lack of insights such
as theirs when they first took the surgical route,
reinforced in the starkest, most human of ways my
understanding of the consequences of abandoning the
standards that I came to know were important to hold as
sacrosanct. It was really a group effort, with many of the
posters here playing a role of value in my life of which
they were not aware. I think patients and prospective
patients need to stick together through thick and thin. Done
alone, without an understanding of what I needed to look
for, a different decision with unimaginable consequences
would have been a likely outcome.
Second, I
want us to make sure the bar is raised and kept high for the
standard of care to which we are entitled--a standard that
is not scientifically or practically impossible yet requires
high levels of skill, ethics, and dedication to the idea of
the patient as a person (rather than as part of a schedule,
part of a projected income, or part of a hair transplant
marketer's concept of a target audience). For years, hair
transplant patients have had an unacceptably low level of
control over the process. Only with the advent of Internet
forums has the hair transplant industry been forced to
really move closer to standards of care that patients
demand, rather than generally adhere to the minimum standard
of care required to remain economically viable. The
increased interest of doctors in non-strip methods, in my
opinion, is a perfect example of the power patients can have
when they unite behind the concept of their rights to better
care.
Third, I
look forward to the day when any person looking into
surgical hair restoration can walk into any clinic, question
any doctor, and/or consider any surgery with the benefit of
a checklist like this containing their basic rights, that if
not capable of being met, can prevent that person from
making a life-altering mistake. I look forward to the day
when hair transplant surgeons know that they must be able to
honor those rights through word and deed or look for another
line of work.
I want to
place Dr. Woods' and Dr. Campbell's list in the context of
my own experience.
<<
1. No Strip Excision to be performed or offered by the
clinic >>
Honor thy
new technologies! I think there is growing agreement on this
point, as evidenced by the number of surgeons looking into
this avenue of treatment.
<<
2. No assistants. Only a 1 to 1 doctor patient ratio.
The day a patient decides to alter their appearance via hair
transplantation is one of the most important days in their
life. They deserve the absolute attention of a skilled micro
surgeon throughout the entire removal and placement of every
follicle. >>
Honor thy
concept of medical school! You pick a doctor based on the
doctor. The doctor has the medical degree. You look at
previous patients based on who the doctor was. You consider
the doctor's reputation and history. Your consult(s) should
be with the doctor. A transplant involves the removal of
donor follicles and their relocation to the recipient area.
The transplant doctor should perform the transplant from
start to finish.
<<
3. No legal disclaimer This allows lawyers to defend the
indefensible results of poor surgery.
4. All
doctors are to be fully trained, assessed and accredited
according to a strict code of conduct, ethics and ability.
All
surgery is to be performed according to highly skilled
microsurgical standards and discipline.
5.
Patient interaction and intra-operative monitoring of
follicular placement >>
Honor thy
patient's eyesight! Dr. Woods and Dr. Campbell allowed me to
view the removal of the first 100 follicles in the first
procedure (to have done it for all 2400 follicles over four
days would have taken far too much time, viewing 50 per
procedure is probably more practical than 100), the
condition of the neighboring follicles, and the live
placement of the follicles on a large monitor with the
benefit of the 35-power Zeiss magnification they used. I
didn't have to take Dr. Woods or Dr. Campbell at their word
on things, they were happy to show me what was being done to
my head and to my follicles so I would know what was
happening.
<<
6. Largest instrument to be used for follicular placement is
a 21 gauge hypodermic needle >>
Honor thy
recipient area! If the follicle upon removal is in proper
shape and therefore not surrounded by dermis or other
excessive tissue, there is no need to use a placement tool
larger than a 21-gauge needle. No scalpels, slits, slots,
etc. Dr. Woods and Dr. Campbell use the 21-gauge and quite
often the 23-gauge (even for many 3-hair follicles; Dr.
Woods actually used the 23-gauge for an entire section close
to the front) and used only the bevel of the needles to make
the sites and the follicles are now securely in; the use of
these small needles did not compromise their ability to
orient the follicles in endeavors as careful as recreating
the swirl of the crown (done by Dr. Campbell). There's
simply no need to take risks with anything more traumatic.
While there are people who will heal properly from an
18-gauge needle or even some of the scalpel methods, no one
should have to belong to that group of patients who
"somehow got scarred" because a doctor thought a
certain more traumatic instrument was better to use for any
reason that compromised the outcome of that single patient.
One mistake is one too many and one mistake that was
avoidable is unconscionable, in my view.
<<
7. Random intra operative video assessment of follicular
removal from the donor site verifying transaction rate
directly to the patient. >>
Like I
said, I think the patient should be able to see around 10%
via video, in order to ensure:
<<
8. Donor Site Conservation and Protection. >>
Honor thy
donor follicles! I kept close track of the transection rate
during the first two of my four procedures. The transection
rate for the first procedure was 1.66%, the transection rate
for the second one was 2.00%--of the small number of
follicles transection upon extraction, most will grow when
placed back into the donor area. I am a Norwood 4/5 and
barring Propecia having more staying power than I can
imagine, I will become a Norwood 6. Having dark, fine donor
hair, I could ill afford to have my donor supply poorly
harvested. Wasting follicles was simply not an option for
me, nor should it be for anyone, especially since it is
entirely avoidable.
And, Honor
thy donor follicles' neighbors! Not only was it important to
avoid wasting follicles being extracted, but also to keep
follicles that may be used in future surgeries from being
damaged or destroyed. Every donor follicle counts, whether
it's being harvested for grafting now, being saved for
future use, or just being used to serve its purpose in
covering the donor area.
<<
9. No intravenous sedation or analgesia
The
patient should be aware, lucid, fully informed and
interacting during the procedure. Drugs that significantly
affect the patients' ability to make decisions and interact
must not be used.
10. Do
No Harm. >>
Honor thy
peace of mind! It took me two years, countless hours of
research, and the only people I felt could guarantee they
would honor the most basic tenet of the Hippocratic Oath
were half a world away. (And I was a virgin scalp, not a
repair patient.) I hope that every doctor in between here
and Australia (and on the side of world my plane didn't fly
over) reads this last comment, not with a sense of personal
bitterness, but with the understanding that I was and am not
alone in thinking this (as evidenced by the other
"Woods patients").
*To Dr.
Woods' list, I would only add the following corollary:
THE RIGHT
TO NON-EXISTENT/NEGLIGIBLE SHOCK LOSS ("Honor thy
existing follicles"): One of the most difficult points
of my research was a consultation with an American
transplant surgeon who is on all the recommended lists and
considered an expert among experts. He first gave me a
prescription for Propecia to save my miniaturizing follicles
and then within minutes devised a surgical plan that would
involve, by his own admission, substantial and permanent
shock loss of most of the very follicles the Propecia was
prescribed to save. The plan involved transplanting through
most of the existing hair. The phrase, "the hair you
get to keep after telogen effluvium" was literally
used, as if keeping my pre-existing hair was some kind of
gift. A couple of weeks after my Woods/Campbell procedures,
I can report that despite having quite a bit of cosmetically
noticeable miniaturized hair (making me as clear a target
for shock loss as their can be), I have experienced no
noticeable shock loss (if I do, you will know and I will
retract this point). It appears I did not have to "take
one step back to take two steps forward." When I did
the math, I realized this shock loss nonsense involved
taking one step forward when the doctor admits that two
steps are desirable and cosmetically necessary to make the
surgery worthwhile. We are paying doctors to add hair to the
recipient area, not to take it away and hope for a net gain
(unfortunately, I spoke with several people who ended up
having a net loss from their surgeries due to shock loss).
Just as it is important to use donor follicles well and to
avoid damaging future donor follicles, the preservation of
existing follicles in the recipient areas is--as long as
Propecia continues to work--still a big part of the overall
coverage. If people are going to lose hair, it should be
because Mother Nature won out, not because a surgeon freely
chose to use techniques that could not avoid or severely
limit shock loss.
IN
CONCLUSION, I IMPLORE MY FELLOW COMMUNITY MEMBERS TO TAKE
THE IDEA OF A PATIENT'S BILL OF RIGHTS BASED ON THESE
CONCEPTS SERIOUSLY, AS THEY APPEAR TO HAVE SERVED ME WELL
AND PERHAPS AVERTED AN EMOTIONALLY CATASTROPHIC DECISION.
EVEN IF YOU DISAGREE WITH SOME OF DR. WOODS' AND DR.
CAMPBELL'S POINTS IN TONE OR CONTENT, KEEP THIS DISCUSSION
GOING AND PUTTING ASIDE PERSONAL RIVALRIES OR THE DESIRE TO
SCORE POINTS ON OUR FELLOW POSTERS; LET'S REALLY TRY TO MAKE
THIS WORK. IF THE TECHNOLOGY EXISTS, AND IF OUR DEDICATION
TO THE IDEA OF OUR RIGHTS AS PATIENTS IS THERE IN FULL
FORCE, IT CAN WORK.
The
above is taken directly from Charlie's
post
in the Hair Transplant Forum. Feel free to follow the
discussions in the forum following Charlie's post.
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