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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.

CharlieChaplin