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Originally posted by MyWHTC at www.mywhtc.com.

(http://www.mywhtc.com/forum/index.php?topic=342.0)

A recent patient of Dr. Mwamba wrote this testimony (below) regarding his experience at WHTC. We appreciate his comments and hope that readers find his account helpful.

"I had an excellent hair transplant experience at Dr. Mwamba’s office and I want to relay this experience to patients who are considering surgery for their hair.

If you’d asked me a few years ago, when I first began losing my hair, if I would opt for surgery, my answer would have probably been no. I’d seen people with bad hair transplants from other doctors and, as I am sure many of you can understand, I would prefer to be balding than to have poor hair transplant results. Unfortunately, there are many people that suffer with bad hair work. Regardless, I began researching hair restoration online, looking for better options. I discovered the various online communities and was heartened to find that there were in fact some credible physicians doing quality surgery. As you can imagine, I was excited to know that, amidst all the hair horror stories, there were also many happy patients with good results. I privately contacted different patients from the online forums, and had the good fortune of meeting some of them face-to-face. I also traveled to a handful of the top-rated clinics – all of which I found online
– for surgery consults. I got a good impression from many of the doctors. Still, I didn’t go forward with any of them. One thing I discovered, particularly by looking at hair transplant patients up close, is that hair surgery (even very good hair surgery) is, generally speaking, flawed when you see it in person. I certainly saw a few great results from some select surgeons. And when I say “great results,” I mean surgical results that, in my estimation, could not be identified by the casual observer as being a hair transplant. But, as a detail-oriented person with a critical eye, I saw some subtle aesthetic problems.

After exhaustive research, I essentially decided against having surgery. Fortunately, I eventually became aware of Dr. Mwamba’s practice. After seeing a small sample of Dr. Mwamba’s results in photographs, I decided to meet him for a consult, which was be to be the first of two. His evaluation was extremely thorough and he was receptive to all of my questions and concerns. One of the main things I remembered about this first encounter was Dr. Mwamba’s hairline design. We discussed my goals and wishes and, with these in mind, Dr. Mwamba proposed a hairline, which he outlined on my forehead with a marker. His vision for the shape of my hairline was artful and it complimented my facial features brilliantly. This may seem like an overenthusiastic reaction to a marker line on my head, but, in my experience, most doctors – even the supposed elite doctors – are not especially gifted with hairline design. And it seems to me that this is usually apparent even in the preliminary consult stages. Dr. Mwamba, on the other hand, demonstrated an intuitive understanding of, for lack of a better phrase, “what looks right.” He recommended 2,000 grafts with the non-invasive FUE method to restore my hairline and frontal area.

Needless to say, I was impressed with the first consult and, in the interim between the first and second consult, I was able to correspond with several of Dr. Mamba’s patients. Every person I talked to said they were very satisfied with their results. One of these individuals had had work done with another well-know doctor and, a year or so later, he had a procedure with Dr. Mwamba. He felt his results from Dr. Mwamba were decidedly better and was pleased with his overall experience. I also had the good fortune of seeing one of Dr. Mwamba’s patients in the flesh. In terms of naturalness, this patient’s surgical result was the closest thing to flawless that I have ever witnessed. The shape of the hairline was right on and the lay of the hair was perfect.

During my second consult, Dr. Mamba and I solidified the plan for the surgery. He also addressed some of my other concerns, like the possibility of shock loss and the issue of concealing evidence of surgery in the immediate post-op period. In short, the second consult went well and I made an appointment with Clara, the office coordinator, shortly thereafter.

As a side note, I found out, during the second consult, that Dr. Mamba does not invest in advertising. His patient base is mostly word-of-mouth. This was good to hear as, clearly, this is a sign a high patient satisfaction.

I traveled to Dr. Mwamba’s clinic for my two-day surgery appointment in the early part of this year. Obviously, going in for surgery is a big or. Honestly, though, I can say that I was not very nervous; I felt pretty certain that I had made the correct choice.

I checked in with the doctor the day before the first day of surgery and we did a final pre-surgery evaluation. Dr. Mwamba was thorough, as always, and that helped to dissolve any small traces of anxiety that I might have had. Dr. Mwamba worked on the final design of my hairline with a surgical marker. He and I both scrutinized every curve until we finally agreed it was perfect. Prior to that meeting, I told Dr. Mwamba that I was willing to have him shave the back and sides of my head, which is a typical practice in FUE surgery. At the last minute, though, I explained that I was worried about having a drastically different haircut as I was expected to return to work ten days post-op. Although the follicle extraction sites would be essentially healed by then, Dr. Mwamba was sensitive to that fact that I didn’t want to draw attention to my hair when I returned to work. Rather than completely buzzing down the back of my head, he pinned my hair up, using
little , and buzzed the hair in three long and narrow patches. This took a long time and I am grateful that Dr. Mwamba patiently prepared the hair. At the end, he held up two mirrors so that I could see what he had accomplished. It was quiet amazing, actually. When the hair was pinned up, I could see that more that half of back of my head was shaved with the buzzer. But, because the shaven rows were separated by rows of long hair, I was able to totally and completely conceal the bare areas. When the hair  were removed, the long hair flopped over the shaved patches and it appeared as though my scalp had never been touched. As it turned out, this made going back to work after surgery very easy!

The next day was day 1 of surgery and it went very well. I met Dr. Mwamba’s two assistants and I must say they were, like Dr. Mwamba, extremely kind and gentle. They performed the anesthesia very slowly and I think this was done in an effort to minimize the discomfort. It was in fact relatively painless. The team worked well together, without complaint. Whenever I would come back from a bathroom break the staff would be ready, smiling, and eager to get back to work. This sort of detailed aesthetic surgery takes long hours to perform and, I suppose, fatigue can be a concern. The assistants worked in shifts, taking periodic breaks, and, as a result, never appeared the least bit tired. I must also add that Dr. Mwamba has tremendous stamina and focus. Except for a few short trips to the supply cabinet, Dr. Mwamba was always in the room. Aside from the lunch break, during which all four of us ate together, Dr. Mwamba took his breaks in the surgery room. So, while he might have been resting his arms for a few moments, he was still supervising his techs. This is rare. If you read online accounts from patients at other clinics, you will see that, in most cases, the doctor leaves the room for extended periods while the assistants place the hair grafts. This not a bad thing necessarily, if the assistances are good and the doctor has already prepared the sites for the grafts. I will say, however, that I felt very safe in the surgical chair because Dr. Mwamba was always there and always involved. Dr. Mwamba not only cut the grafts and created the sites – as is standard practice, as far as I can tell – he also placed many if not most of the graphs himself. Again, this is rare. Most other doctors leave the entire graph placing process to the assistance. The assistance worked extremely hard, but I was very grateful for Dr. Mwamba’s undivided attention and total involvement in the surgery. I went home that night wearing a loosely fitting cap that the assistants provided for me. I took off the cap in my hotel bathroom and was happy to see our progress for the day. I am sure the average person would think my immediate post-op scalp looked weird. I have to say, though, that after seeing hundred of immediate post-op photos from other doctors, my head looked good. Patients usually have bloody crusts and the like around where the grafts are placed. In my case, the scalp was relatively clean and smooth. Except for the tinge of the skin and some minor scabbing, the grafts simply looked like stubble.

Day 2 of surgery was much like day 1. Everything went smoothly and the staff worked hard. One of the final stages of the surgery involved placing the single hair grafts along the hairline. Having this area filled in was particularly exciting for me. By the end of the second day I was very tired, but very content. Having watched Dr. Mwamba and his assistants working so diligently and skillfully, I was certain they had done everything humanly possible to perform a world-class hair transplant surgery. When I stood up from the chair for the last time, Dr, Mwamba said, “Hmm, I like your hairline.” I found that to be amusing, as it seemed to sum up his personally: reserved, but confident.

I checked in with Dr. Mwamba and the staff the next day and everything seemed to be in order. In the days following the surgery, I sprayed the grafts regularly with a Biotin spray, as prescribed. Like I stated before, the hair on the back of my head was clipped in such a way that the extraction sites were entirely hidden with the longer surrounding hair. Aside from the occasional itch, the back of my head was out of (the public’s) sight and out of (my) mind. Going into this operation, I did not have a major preference between FUE surgery, which is scalpel-free, and strip surgery, which is more invasive. I was more concerned with the hairline and the overall appearance of the hair. But now, having gone through the surgery, I am very happy that Dr. Mwamba performed the FUE procedure. I think the sutures and the staples associated with strip would have bothered me, as would have the scarring. With Dr. Mwamba’s FUE, everything seems to have healed beautifully.

The only complication I experienced – if one could call it a complication – was some slight inflammation on the right side of my hairline. Dr. Mwamba and I talked over the phone about this issue and he recommend that I apply a specific topical treatment. The inflammation subsided in a matter of days.

I returned to work ten days after the surgery. Fortunately, I am able to wear a hat in my office so nobody had a clue about the operation. I did, however, have several formal business meetings shortly thereafter. The back of my head looked totally normal as a result of the way Dr. Mwamba had buzzed it in discreet sections. I used hair products to style my existing hair in a way that hid the pink tinge of the grafted area. No one was the wiser. Since then the pinkness has subsided drastically.

As far as I can tell, none of my pre-existing natural hair was damaged during the surgery. I think this is a testament to Dr. Mwamba’s skills. The hair in the frontal part of scalp, which is very thin and wispy, was in no way damaged. That is remarkable to me as Dr. Mwamba dense packed over 1,700 grafts in that area.

I am thoroughly satisfied with every aspect of my experience with Dr. Mwamba thus far and I expect great results in the months to come.

I hope prospective patients find this account helpful in their hair transplant research."

[What is Follicular Unit Extraction (FUE)?]

What is Follicular Unit Extraction (FUE)?

Follicular Unit Extraction(FUE) is a method of obtaining donor hair for Follicular Unit Transplantation(FUT), where individual follicular units are harvested directly from the donor area, without the need for a linear incision. With the FUE technique, a .8mm to 1 mm punch is used to make a small circular incision in the skin around the upper part of the follicular unit, which is then extracted directly from the scalp.

Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE) are sometimes mistakenly viewed as being two totally different hair transplant procedures. FUE, in fact, is a sub-type FUT where the follicular units are extracted directly from the scalp, rather than being microscopically dissected from a strip that has already been removed. To say it another way, in Follicular Unit Transplantation, individual follicular units can be obtained in one of two ways; either through single strip harvesting and stereomicroscopic dissection, or through FUE. Therefore, when comparisons are made between FUT and FUE, what is really being compared is the way the follicular grafts are obtained (i.e. strip harvesting and dissection vs. direct extraction). The process in the recipient area is the same.

The main advantage of FUE is that it does not cause a linear scar. Therefore it is useful in patients who for one reason or another may in the future want to have their donor area very short. (<1cm in length). This advantage was the main reason for the development of the technique.

History of FUE

FUE developed primarily as an effort to address donor scarring that occasionally became a problem with strip surgery. The evolution is interesting and goes as follows: Strip surgery by its nature produces a linear scar in the donor area. Usually this scar is fine and easily hidden by the remaining donor hair as long as it is longer than 1 cm. However, occasionally the scar can be wider and harder to hide.

When graft sessions started to become larger about 10 years ago the size (width) of the donor strip also became larger in order obtain the increased number of grafts. The larger sessions were a breakthrough and improved results in the recipient area. The field was so excited about the improved results they were slow to notice that there was an increased incidence of wider scars now appearing in the donor area. In retrospect this makes sense as wider strips will in some patients cause increased wound tension which is the primary cause of larger scars. In response to this problem a few physicians began the development of an alternative method of harvesting grafts…hence the birth of FUE.

By extracting individual grafts with a small micro punch a linear scar was avoided. The first hair restoration physician to promote this technique was Dr Woods from Australia. Unfortunately early versions of this technique had their own problems. Extracting each graft was difficult and a high transaction rate and damage to the grafts occurred. In addition the process was slow, expensive, and much less grafts could be done at a time then with strip harvesting.

A final problem was the realization that the potential for visible scarring also occurred with FUE…just a different form of scarring.. With FUE scarring consisted of multiple small white dots in the donor area at the sites of each extraction. This was not a linear scar but could be noticed as a spotty or moth-eaten look in the donor area if the hair was cut very short. For this reason FUE did not find acceptance in the main stream early on.

Another factor that added to the slow acceptance of FUE was the fact that major improvements had occurred in traditional strip harvesting at the same time. Improvements included; more accurate ways to predict scalp laxity; exercises to improve scalp laxity; better suturing and stapling techniques, and finally the development of the “trichophytic” closure. With these improvements, most strip surgeries were now leave a very minimal scar and in the majority of case the hair could be worn as short as 1cm without the linear scar being visible.

So in review the early problems associated with FUE techniques in combination with improvements in strip harvesting led to a very slow acceptance of FUE into the mainstream hair transplant surgery.

However the story does not end there. A handful of hair replacement physicians still believed that FUE could be a powerful tool if the problems could be worked out. They improved the instrumentation and technique dramatically over the last 5 years. Among the advancements were the use of smaller punches that decreased the incidence of the “spotty scarring”; limited depth scoring that reduced transaction, motorized punches that made it easier to score the skin; a better understanding of the amount of extractions that can occur per area before scarring occurs; blunt dissection techniques, and many others. The result of these improvements have made it possible to perform FUE much more consistently with minimal damage to the grafts, more grafts per procedure, and less of the spotty scarring occurring in the donor area.

Some of the physicians who were responsible for the improvements in this field include (in no particular order) Jim Harris, John Cole, Bill Rassman, Bob Bernstein, and Alan Feller. In essence we now have two very useful and powerful tools for removing grafts from the donor area. We have both strip harvesting and FUE. Both work quite well and both have their advantages and disadvantages. Some situations are perfect for the use of FUE while other are better suited for FUT.  At Shapiro Medical Group (SMG) we feel it is good to be skilled in both techniques and be able to use the tool that is most appropriate for a patient’s situation.

What Type of Patient potentially benefit from FUE

The main benefit of FUE is that it does not involve the creation of a “linear” scar. It is therefore particularly useful for the following type of patients:

1. For hair loss patients who for one reason or another want the option to wear their hair very short (<1cm) and not have any evidence that a procedure was done. If a patient has his head shaved (or much less than 1cm in length) a linear scar may be noticeable even if it is very fine. This may be due to the subtle change in direction of hair above an below the scar. Most patients don’t plan on cutting their hair this short so for them this is not an issue. However there are some patients who like this short hair style and want the option. There are other patients who may be in the military and need to keep their hair short. With FUE after the extractions heal it is very difficult to see the incisions even with the hair this short and patients retain this option. There is still a potential for some spotty white dots to be noticeable with FUE but this is less likely as long as the patient has the right skin type, the proper punch size is used, and the number of extractions in a specific area is kept below a critical amount. 

2. Another group of patients FUE is appropriate for is the young hair loss sufferer who currently needs only a small amount of grafts in an area like the hairline but in whom if the future degree of balding is not known. Some young patients in this position state that if they did progress to total loss of hair on the top of their head they would rather just shave their head than have to go through with more surgeries to keep up with the loss. They are not sure they can the commitment more surgery in the future if needed. With FUE they retain the option to stop and shave their head if they have only done 1-2 small procedures.

3. Another use for FUE is in the patients who have already had strip harvesting and now have a tight scalp which would make more strip harvesting difficult. FUE can be used to obtain more grafts.

4. Another application of this technique is to camouflage a widened linear donor scar from a prior hair transplant procedure.

Potential Limitations of Follicular Unit Extraction (FUE)

As seen above there may be some real indications for the use of FUE. However it is important to point out its limitations also.

FUE’s main limitation, when compared to FUT, is that it is less efficient in harvesting hair from the rich mid-portion of the permanent safe zone. In FUT, the strip is taken from the optimal (central) part of the donor region and all the hair in this area can be removed and transplanted. After the strip is removed, the wound edges are sewn together. In FUE only a portion the hair is extracted, but the intervening bald skin between the follicular units is not removed. Therefore, the hair restoration surgeon must leave enough hair in the area to cover the remaining donor scalp. Consequently from this very rich area of donor supply only a portion of the hair can be harvested perhaps only half as much as with FUT. This represents a significant disadvantage, since a limited donor supply is the main factor that prevents a complete hair restoration in many patients. To compensate for the inability to harvest all the hair from the permanent zone, the surgeon may eventually be tempted to harvest hair from the upper and lower margins of the original donor area and risk the hair being of poor quality or being non-permanent.

In Follicular Unit Extraction the wounds, although small, are left open to heal, leaving hundreds to thousands of tiny scars. Although not readily apparent, this scarring distorts adjacent follicular units and makes subsequent sessions more difficult. This is an additional factor that limits the total available donor supply in FUE.

Although new techniques and instrumentation significantly decrease the amount of transection and damage during the extraction, the inability to fully access the mid-portion of the permanent zone in a hair transplant procedure, significantly limits the total amount of hair that can be accessed through FUE, rendering it a far less robust procedure than FUT for moderate to advanced balding.

Other potential downside for FUE is that this new procedure is much more labor intensive and time consuming; meaning it costs more to perform and far fewer grafts can be obtained in a single session when compared to traditional strip harvesting.

Another downside is that not all patients are candidates for the procedure. Many are, but some are not. In some patients FUE is easy and the grafts can be extracted with little to no transaction. In other cases extraction produces unacceptable levels of transection (damage due to cut hair follicles In the past few years with improved techniques and instrumentation the ability to extract grafts more easily with little to no harm has improved greatly. However it is important to either test patients before the procedure or have an alternative plan if during the procedure it turns out that the patient is not a good candidate

ADVANTAGES
DISADVANTAGES

 No linear scar:
-Important for those that want to wear their hair very short)
-Most important reason for technique****
-Maximum graft yield if used exclusively is lower than with FUT
-Due to inability to harvest all the hair from mid permanent zone
-Distortion from initial FUE makes subsequent FUE difficult
-Greater potential for follicular transection (damage) than FUT

Decreased healing time
Grafts harvested outside the permanent area may be lost in future

Decreased pain in donor area
May begin to see spotty scarring in donor area after a larger number of grafts have been harvested

Useful for those with tendency to scar (Asians)
Takes longer and is therefore more expensive

Ideal for repairing donor scars that can’t be excised
Grafts are finer with less tissue protection and therefore more susceptible to trauma.  There is potential for less yield

Extends the area of donor supply and may add to total donor supply
Capping or Buried grafts may occur with certain techniques

Creates the possibility of harvesting body hair and beard hair
So much attention and time is given to the donor area that the recipient area sometimes does not get the attention it deserves

Useful in specific young patients that need only small quantities of grafts

Dr. Ron Shapiro

(for more information, visit www.hairlossexperiences.com)
(for information on Drs. Ron and Paul Shaprio, visit www.shapiromedical.com)

How Hair Grows
The portion of the hair that we can see is called the shaft. Each shaft of hair protrudes from its follicle, which is a tube-like pouch just below the surface of the skin. The hair is attached to the base of the follicle by the hair root, which is where the hair actually grows and where it is nourished by blood capillaries. Like the rest of the body, hairs are made of cells. As new cells form at its root, the hair is gradually pushed further and further out of the follicle. The cells at the base of each hair are close to the blood capillaries, and are living.

As they get pushed further away from the base of the follicle they no longer have any nourishment, and so they die. As they die, they are transformed into a hard protein called keratin. So, each hair we see above the skin is dead protein. It is the follicle, which lies deep in the skin, that is essential in growing hair. Also, the thickness of each hair depends on the size of the follicle from which it is growing.

Hair growth is not a continuous process: it has several stages.

ANAGEN PHASE.
The first phase is the growing stage. Hair grows at about 1 cm each month, and this phase can last between 2 and 5 years.

CATAGEN PHASE.
As this phase begins the bulb detaches from the blood supply and the hair shaft is pushed up.

THE TELOGEN PHASE.
This is followed by a resting stage, during which there is no growth. This phase lasts about 5 months. At the end of the resting phase, the hair is shed, and the follicle starts to grow a new one. At any moment, about 90% of the hair follicles of the scalp are growing hairs in the first phase; only about 10% are in the resting phase. If a follicle is destroyed for any reason, no new hair will grow from it.

How Baldness Occurs
If any of the stages of hair growth are disrupted, the individual may become bald. For example, if follicles shut down (meaning that they stay in the resting phase, and then shed the hair) instead of growing new hairs, there will be less hair on the head. Another reason might be interference with the formation of new hair cells at the root during the growing phase. If follicles have been destroyed (i.e., a burn, loss of layered skin or trauma), there will be baldness in that area. An individual can also look bald if the hairs are growing but are so fragile that they break just as they emerge from the follicle.

Recently, scientists at Columbia University in New York announced the discovery of a gene that appears to be the 'master switch' for hair growth. They found the gene after comparing the genes of hairless mice belonging to a mutant breed, and comparing the genes of 11 members of a family who had lost all their hair. This discovery is a step towards understanding how the hair follicle works and how baldness happens, and may lead to effective treatments becoming available in the future.

Psychology of Hair Loss, Prevention and Re-growth
Hair forms a vital element of an individual's physical appearance. Changes in the hair, including its loss, can have correspondingly profound effects on interpersonal reactions and on self image. Studies that have specifically addressed the psychosocial impact of hair loss in men have shown that men with visible hair loss are perceived as older, weaker, and less physically attractive than their non-balding counterparts. Not surprisingly, such adverse social stereotyping of individuals with hair loss has a considerable impact on the self image, and therefore on the quality of life, of men with AGA. Studies confirm that the negative self-perception of hair loss by others is reflected in the psychological responses of balding men to their own condition. Using standard psychological tests, men with AGA report experiencing distress about their hair loss, feeling less physically attractive, and having greater body image dissatisfaction than their non-balding peers.

Given that many men are strongly motivated to seek help with their AGA, the treatment objectives may variously include the prevention of further hair loss, the maintenance of existing hair, the re-growth and retention of lost hair, or any combination of the three. In most cases, however, prevention and maintenance are the most realistic therapeutic options. In this context, it must be recognized that there is frequently a disparity between what the physician assumes are the patient's needs or requirements, and what the patient actually expects. Although there is a lack of rigorous scientific studies of men's attitudes towards re-growth of their lost hair as compared to the prevention of further hair loss, some indications are available in the literature. For example, in a study in which men with AGA completed the Hair Loss Effects Questionnaire (HLEQ), a high proportion gave responses that were directed towards a future rather than a present state: 93% worried about how much hair they would lose, 87% reported trying to estimate if they were losing more hair, and 8o% tried to imagine how they would look with more hair loss. Cash has also reported that balding men who anticipated more hair loss in the future experienced significantly greater negative events and cognitive preoccupation, and were also less satisfied with their hair and overall appearance than men who anticipated minimal future hair loss.

Some anecdotal evidence, based on market research among 2200 men with at least some degree of hair loss, strongly supports the importance of prevention rather than re-growth to the patient. Thus, when asked directly whether they were more concerned about the amount of hair they currently had (i.e. re-growth) or the rate at which they were losing it (i.e. prevention), most respondents (61%) were equally concerned about the two; of those expressing a greater concern for one or the other, two-thirds were more concerned with prevention and one-third with re-growth Although the ideal for most of the men involved in this research would clearly be a hair treatment that produced both re-growth and prevention, slightly more respondents thought that prevention (43%) rather than re-growth (34%) was essential in a hair loss treatment.

Therefore, it seems that many men are more anxious to prevent further hair loss in the future than they are to re-grow the hair they have already lost. Nonetheless, physicians may incorrectly believe that the patient will only be satisfied with overt re-growth, when in fact he would be content with retaining his remaining hair. This is an important point because secondary prevention, that is the prevention of further loss, is currently a more realistic treatment goal for the physician to offer. This is demonstrated by the drug treatments that have been or are now available.

(Text taken from www.thehairlosscure.com)

Contact Dr. Rose now at his South Tampa location - 813-879-6040

South Tampa Office: 4238 W. Kennedy Blvd - Tampa, FL 33609

Copyright © 2009 Dr Paul Rose Hair Restoration |

Hi,
I am looking for a growth remedy for my 7 yr old daughter. Right now Im using Dr. Miracles growth oil. However, she needs some kind of daily mosturizer, because her hair gets extremely dry and I see that it is also breaking off? Suggestions
Hello everyone,