After 26 years in the field of hair restoration surgery, it is a shame my reputation hinges on a body hair, repair case that had no options other than the cutting edge procedures possible at the time, systems that were not time tested. I often push the envelope to come up with better options for patients. Anyone without hope and options needs a solution. Few search for answers and even fewer physicians other than myself come up with these options. Body hair transplantation developed for one simple reason, and that rationale was to solve problems for patients without hope. When you walk out on that limb to help people with solutions that did not exist before you developed such options, the limb will occasionally snap, and you will fall. The overwhelming majority of patients are happy you tried your best using the best rational reasoning available at the time. When you walk out on that limb, and you do your best, and you change a life from misery to content, one has no better feeling. When you venture out on that limb, and you are truthful about the consequences, and you fail, the overwhelming majority of patients are happy you did your best, and you tried. Only rarely do such patients complain because you pushed the envelope on creativity and you did your best but did not get you the result both of you hoped to accomplish. What follows is the story about Arfy. It's the real story and not the one he presents.
Arfy had numerous plugs placed on his scalp in the 1980s. He posted about this multiple times in the forums. I felt sorry for him so I offered to remove his plugs one follicular unit at a time. This was a new procedure that I began developing in 2003. It worked well on Arfy as it had on numerous other patients between 2003 and 2004. I have since used this technique on hundreds of patients to help them.
Arfy had many, many plugs. I softened all of them by taking out one follicular unit at a time from his multiple plugs. It took me about one week to finish this procedure. I did the entire work at no charge to Arfy. I redistributed the hair, which means I grafted it back into the scalp and the open donor plug scars in the donor area. We tried to hide a linear scar on the right side of his hairline that resulted from an attempt to remove one line of plugs but left him with a linear scar on the hair line. My procedure left no obvious scars. It was cutting edge surgery at the time. Even today not many surgeons can do this procedure, which involves punching out one follicular unit at a time. We removed well over 1000 follicular units in this procedure.
After I was able to make Arfy look like a normal balding guy without all those hideous plugs, he wanted to pursue a body hair transplant. You have to understand the status of body hair transplants from 2003 through 2006. Ray Woods had pioneered FUE body hair transplants in the late 1990s and he was quite positive about them. In 2003 there were three physicians outside of Ray Woods in Australia, who offered FUE. They included Rob Jones, Alan Feller, and myself. Most of the people who perform FUE today either learned it from myself, Rob Jones or someone we taught. In 2003 I had performed over 8000 strip procedures, but I was the first besides Ray Woods to recognize that FUE offered tremendous benefits over strip surgery (FUT). Patients began contacting me for FUE in 2003 and they also began contacting me for body hair transplants in 2003.
Dr. Woods had made body hair seem like the next best thing to the refrigerator. When patients began to contact me for body hair, I knew how to get the hair out. I just didn't know if it would grow. I didn't encourage anyone to have body hair. Patients encouraged me to perform the body hair. Most were out of scalp supply so the only option they had was body hair. I didn’t know if it would grow, and I made sure patients knew this.
My first body hair case was into a strip scar. His strip surgeon had left him with a wide strip scar in an attempt to perform a very large second FUT procedure. I took hair off his thigh and moved it into his strip scar. It grew nearly 100% and he never complained about his strip scar again. From that point on, he started coming to me to graft hair off his body into the top of his head. That case was only around 200 grafts, but it grew remarkably well. In the fall of 2003 a patient contacted me for a large session of body hair to his crown, top, and front. I advised him that I had no idea if the hair would grow and I discouraged him from doing the procedure. He told me that he had plenty of money since he worked for Intel as an attorney. He did not care if the hair did not grow. He was willing to that that risk regardless of whether the hair grew. He also stated that he did not like his body hair so I’d be doing him a favor to take the body hair off. After multiple attempts to discourage him, he came in for surgery and he had just over 7000 total grafts placed in one week of daily surgery. Again, the growth was almost 100%. Between 2003 and 2006 I performed many body hair procedures. Some grew remarkably well and some had a yield under 30%. In some instances, there was no growth. I began looking for ways to improve the yield. I studied every possible option. One of the first things I noted about body hair was that the percentage of telogn hairs was much higher on the body. Sometimes telogen ratios would reach 60%. I began to compare the growth rate of telogen to anagen hair in terms of yield. I found that anagen hairs had a higher growth rate percentage in every study I performed. However, focusing on anagen hair alone did not guarantee a great yield. The yield could still be zero with anagen hair off the body. Based on the slight benefit of anagen hair over telogen hair in terms of yield, I began requesting all patients to wet shave three days before the procedure. Then I looked at density. In the one density study I performed, I compared lateral incisions to vertical incision, and density. I set density at 20 per sq cm to over 40 per sq cm. I found growth rates under 30 grafts per sq cm grew to a 60% yield in this patient, but anything over 30 grafts per sq cm grew in at under 5% in terms of yield. Lateral and vertical incisions had no impact on survival of the grafts. Based on this data, I limited densities of body hair to under 30 grafts per sq cm, but still some patients had a yield of zero. Then I studied body hair from the back, legs, chest, abdomen, arm, etc. I found that in some patients one source would do better than another source, but there was no way to predict which would be better. In some patients back hair did better. In some patients’ chest hair did better. In others abdomen or leg hair would do better. I studied every possible scenario I could think of but there was no combination of options including source, density, or anagen hair that produced a universally good yield. To this day, I think I am the only person on the planet who actually looked at every possible option. In 2005 we began to look at beard hair. This became the only consistent source of body hair. I’ve had patients who failed on every possible source until we moved those patients to beard hair. I presented all my data in Brussels this past year to FUE Europe. At the end of my presentation Bob True, the editor of the Hair Transplant Forum International, commented that it was the best and most through presentation on body hair that he had ever seen. I tried to publish all the data in the last major text on hair transplantation edited by Robin Unger, but she was so far behind the times that she did not recognize how valuable the information was to cutting edge physicians. She chopped the data to pieces. It will finally make it to the next text where Bob True is editing my section and he understands it. Robin on the other hand has always been 10 years behind the times.
So where did Arfy fit into this history. He came when I was still cautioning patients on proceeding with body hair, but before the major failures in body hair and before we had our study data. I discouraged Arfy from doing body hair for very practical reasons. First, he was a Norwood 6 and might become a NW7. He had over 225 sq cm of hair loss. On average there are 80 follicular units per sq cm. This meant he had lost over 18,000 follicular units. Follicular groups average between 2 to 3 hairs each, but may contain over 4 hairs each. Body hair grafts average 1 hair each. Based on follicle numbers, Afry would need between 36,000 to 60,000 body hair grafts to appear full and that is only if all the grafts grew. A great body hair yield is 60% so one might add another 40,000 or more grafts to make up for the ones that did not grow and that’s only if the yield were optimal.
During Arfy’s procedure, I worked hard. I did my best. We charged him for 3000 grafts, but we did over 5000 grafts. If there was anyone, who I really wanted to have a great result, it was Arfy. I did not want to do his procedure, but I did it based on his insistence and I did my best.
Arfy came back after a year and he wanted his money returned. I told him that I would consider it, but I could not see how we could do that based on the time we had invested in his surgery. He kept calling the office about a refund and he found a sympathetic lower level front office employee’s ear. That employee agreed to a refund of some sort, but never consulted with me about this refund.
Years later Arfy contacted Spencer Kobren through his agent and stated that he wanted a refund or he was going to make public statements denigrating me should I fail to refund his money. That’s blackmail and it’s against the law. I did my absolute best to help Arfy. I worked my tail off to help him. The last thing I was going to do was respond as he wanted to blackmail. I did not encourage Arfy to do this procedure. I discouraged him from doing it. When he elected to do this procedure, I did my absolute best to help him. So who is at fault here? Perhaps is it me for letting this patient talk me into doing something that might now work out well for him. Perhaps it is Arfy. He does not post any photos showing where he was before I corrected his plugs and where he was after I corrected them. He does not even acknowledge this life changing procedure. He focuses only on his failed body hair transplant and promises of a refund by a low level employee, an hourly employee. Arfy does not mention that he blackmailed me.
So where does body hair stand? I cannot say that our attempts to perform body hair were universal failures because they were not. I do think that Ray Woods could have been more forthright about the potential for failure with body hair. Had Dr. Woods done this, we might have spared Arfy this failure. Unfortunately, based on our early successes and the positive comments by Dr. Woods, we were perhaps too confident that we might succeed. However, the only knowledge we had about body hair in 2004 and 2005 was based on results to date and many were quite good. Chest hair in particular changed many lives from cosmetic disfigurements with scalp reduction scars to normal lives. Body hair in general was not a complete failure. I’d estimate that about 25% of patients did very well. My only regret is that we did not get the failures first and then the successes stories because failures might have saved Afry from being a body hair failure. Still body hair positively impacted many lives. Body hair changed many lives from cosmetic disasters to success stories. We just could not predict who would be a success story and who would be a failure. Today I would tell Arfy that he has a 25% chance of success and a 75% chance of failure with body hair. I could not tell him this in 2003 through 2007. Hair transplant results take time to understand. They take experience and time. Arfy jumped on board body hair before we had either one.
What has changed with body hair? The answer is beard hair. In 2005 we began moving beard hair. We were initially reluctant to move to the neck and beard because we were worried about scarring. What we found was that beard hair has a low telogen ratio, a high anagen ratio, and a yield between 50 to 100%. The beard hair is coarse so each hair covers well. Beard hair is wavy to curly so each hair covers well. Best of all, beard hair extractions heal almost universally with minimal white dotting that is perceptible only with magnification. Beard hair removal tightens the neck and lifts it. Only in rare instances are pits lift in the extraction sites. The negative of beard hair is that the beard hair color may not match the scalp, fine straight scalp hair does not match curly, coarse beard hair, and the wave or curl of beard hair may be too great with the hair longer. If your hair is straight, it is best to keep the beard hair shorter.
Some patients do not like their beard hair grafts and they stop. Some love them. We recently had a patient of 89 years of age in for his fourth treatment of beard hair. He loves it though I can say that at 89 years of age we do find a higher percentage of telogen hair on the beard for some reason.
Beard hair is an option for Arfy. I’d be happy to do a trial on him if he likes at no charge. If he likes it, I would do more at no charge. My objective remains to make patients happy. However, I cannot guarantee patient satisfaction. Only God can make guarantees on personal happiness. All I can do is my best and that’s all I have ever done for anyone.
