| 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.
The Woods Technique News & Updates
|
