Why are some recommended doctors not included in the Coalition?

Why are some doctors recommended on the Hair Transplant Network but not members of the Coalition of Independent Hair Restoration Physicians? Are there two different standards?

I would like to clarify the distinction between a physician only recommended on the Hair Transplant Network and that of a physician who is both recommended on the Hair Transplant Network and also a member of the Coalition of Independent Hair Restoration Physicians.

This distinction is written on the page entitled “How we select the physicians recommended on this site“. But I think that many have not seen this page. In any case, a fuller explanation, with background may be even better. The Hair Transplant Network has existed since 1999. When it began “Follicular Unit Hair Transplantation” was the new “gold standard”.  

The Hair Transplant Network  led the way in helping people learn about it and the few hair restoration physicians who at that time performed it. As patients demanded this more patient friendly procedure more and more physicians moved away from mini/micro grafting and embraced the new gold standard procedure. Those who did this procedure successfully were recommended on this site.

Six years ago a “mega session” was 1,500 grafts and hair transplant sessions bigger than 2,000 grafts were rare. Hair transplant surgeons also typically used blades to create incisions that were 1.5 mm (versus incisions as small as 0.6 or 0.7 that are now created with Ultra Refined Follicular Unit grafting). With such big incisions and bulky follicular unit grafts, dense packing was not really possible. Thus to achieve decent cosmetic density patients needed to do two or more sessions in a given area.

Standard follicular unit grafting was more refined than the mini/micro graft procedures that preceded it. But over the past several years leading hair restoration physicians have continued to improve and refine follicular unit hair transplantation.

Two or three years ago it became apparent that some physicians performing follicular unit grafting had pulled away from the pack and had taken follicular unit grafting to an ultra refined level. These physicians were using very tiny blades and needles to create much smaller and less invasive incisions – into which were placed grafts that were more slender (with all epidermis surrounding the hair shaft and the excess fat tissue removed). This more minimally invasive and refined procedure enabled surgeons to dense pack follicles in higher densities so that patients could achieve acceptable cosmetic densities in “one pass”. These ultra refined hair transplant techniques also had less impact on the scalp and thus “shock fallout” diminished for patients. Healing time was also faster.

Some surgeons also moved toward performing larger sessions exceeding 3,000, 4,000 and some times even 5,000 grafts in one session. Such large sessions required the clinic to have large staffs that worked longer hours. But such super mega sessions of ultra refined grafting enabled patients to get optimal naturalness, density and coverage in one session. Naturally patients began to identify and gravitate to those physicians and clinics that provided this more evolved procedure that was ideal for the patient, even though tougher on the clinic.

I felt it was important to identify and recognize those hair restoration physicians and clinics who had risen to the challenge of successfully performing what we now refer to as Ultra Refined Follicular Unit Hair Transplantation. So in March of 2005 the membership standards for the Coalition of Independent Hair Restoration Physicians were raised to an ultra high level and only physicians who had mastered this most advanced and refined technique were allowed to renew their memberships. Six members did not meet this much more demanding standard and were dropped from the Coalition. Thus only those who had evolved their skills, staff and techniques high enough to perform large sessions of ultra refined grafting were invited to remain in the Coalition.

The elite members of the Coalition are recommended on the Hair Transplant Network and exclusively presented on the Coalition Hair Loss Learning Center. Those physicians who continue to provide good solid standard follicular unit grafting with successful results are still recommended on the Hair Transplant Network for follicular unit grafting. But they are not granted membership in the Coalition.

Thus if a patient, for example, only needs or wants a 1,500 session and wants to stay in their area they can still find a competent and skilled physician who performs standard follicular units. Since there are over 1,000 physicians providing hair transplantation in North America alone, those recommended on the Hair Transplant Network but who are not in the Coalition are still providing much better results than the average clinic that often provides hair transplantation as a sideline.

However, for those patients who need or desire much more coverage and density in one session, they should consider traveling to a clinic with a proven reputation for providing large sessions of ultra refined grafting.   Members of the Coalition now are truly masters of ultra follicular unit hair transplantation.

There are over 600 members of the ISHRS (International Society of Hair Restoration Surgery). But there are currently only 23 members of the Coalition. In my opinion, very few ethical physicians are successfully performing large sessions of ultra refined follicular units with consistently excellent results. Over the past nine years I have attended over a dozen international hair restoration meetings, researched hundreds of physicians and clinics, and traveled to observe surgeries in dozens of clinics from Sao Paulo, Dublin, Vancouver and in between and the number of truly excellent clinics is disappointingly small.

Hair loss sufferers come to this community to learn about, discuss and find the very best clinics. The Coalition and its membership is the culmination of my last nine years of research in seeking the very best. I intend to keep the standards for Coalition membership ultra high. In fact only one new member has been added in the past six months, despite interest from dozens of physicians.

I expect that the Coalition will not only provide patients but the hair restoration profession with a true benchmark for quality. Those who do the hard work required to be granted membership and who are willing to have their results critiqued on our forum will earn our trust.

I recently posted an article on this blog  by Coalition member, Dr. Tykocinski of Brazil, in which he challenges his colleagues to adopt the new “gold standard” in their clinics. Physicians are now feeling the pressure to meet the new gold standard not only from educated patients but from Coalition physicians. Many will make excuses and drag their feet. But a few will rise to the challenge and they will in time be invited to join the Coalition.

I hope and expect that by demanding the very best from physicians we will provide a strong incentive for hair restoration physicians to embrace and provide only the very best techniques.

Onward and Upward, Pat –

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