In a recent email to me, Dr. Puig claims that he gave me "quality care" based on the established medical standards of that time. Unfortunately, that is not true. My bad results are actually due to an unethical doctor usingcut-throat sales tactics and an incorrect approach on an innappropriate surgical candidate.

According to the established medical knowledge of that time:

There is a huge difference between what was promised to me in the "sales office", and what was actually delivered by the clinic. The Cleveland Hair Clinic and Dr. Puig hiried salesmen who lied to the public during patient "consultations". They also created and distributed "educational material" with false and misleading claims. This was not an isolated incident, but an ongoing pattern with Dr. Puig and his clinic. The Cleveland Hair Clinic deliberately prevented patients from making an informed decision about life-altering cosmetic surgery.

Front View

I had a total of 300 plug grafts (three surgeries of 100 grafts each) which was what the clinic prescribed for me. Actually Dr. Puig didn't do any diagnosis or planning with me... The clinic's "consultant" (salesman) Dick Malmin did all of my pre- and post-surgical medical evaluations, even though he has no medical training whatsoever. I didn't know it at that time, but that was ILLEGAL.

I also underwent one scalp reduction (which accomplished nothing for me cosmetically).

During this time, patients were usually told to get multiple surgeries only weeks or months apart... too fast for the patient to realize how badly he was being damaged, until it was too late.

Long strands of hair have bunched together to create little "lockets", which might fool you. In fact, this hair transplant provides me with almost zero coverage.

Look at how the frontal hairline shape is lopsided, how the grafts all have an bizarre 90 degree angle, and how far apart the grafts are.

The clinic claimed that this hair transplant would "duplicate" my natural hair.

Top View

The next photo shows the lack of coverage Dr. Puig's hair transplant gives me. Look at how far apart the grafts are. There seems to be no logic to the spread-out placement of grafts.

The clinic lowballed their estimate, when they claimed that this exact number of grafts would be all that I needed. These grafts do not even come CLOSE to being enough.

Nobody could honestly claim that grafts placed this far apart would be satisfactory. Dr. Puig's graft placement shows no regard for what my appearance would be 5 or 10 years later. In fact this hair transplant NEVER looked good enough to appear in public without a hat.

I was only 21 years old and still had a lot of hair at the time Dr. Puig operated on me.

The lighting in these photos is flat, so it doesn't show the terrible problem I have with pitting and cobblestoning (bumps and divots) on my scalp. The surface of my scalp is in terrible shape from Dr. Puig. Pitting and cobblestoning are signs of sloppy surgery and poor technique.

What Dr. Puig did to me is known as "Attempting an unrealistic area of coverage". This is an OBVIOUS MEDICAL ERROR on Dr. Puig's part. I didn't make up that phrase "attempting an unrealistic area of coverage". In his 1973 medical textbook "Hair Transplant Surgery" Dr. Norwood described that mistake, and warned other surgeons to avoid doing it.

The following diagram (from Dr. Orentreich) reprinted in Dr. Norwood's 1973 textbook, explains that the correct approach is to place grafts closely together, in four separate passes. The spread-out pattern that Dr. Puig did on me was an error that contradicts the established medical knowledge of the time.

This diagram shows that at least four procedures are necessary to fill in even the smallest area. Much like today's "dense packing" of grafts, plug grafts needed to be placed in a tight formation. Dr. Puig's incorrect graft placement has made any corrective surgery much more complicated and difficult for me, because he spread the damage out across a larger area.

For someone who would suffer extensive hair loss, it would take MUCH MORE than four procedures... According to Norwood's textbook, as many as ten surgeries could be necessary. The Cleveland Hair Clinic "lowballed" their estimates in order to make more sales to first-time patients.

Top View: Pre-Corrective Surgery

The next photo is a close up on my hairline, right before the first of six corrective surgeries (so far). These corrective surgeries were NOT done by Dr. Puig. I discuss my experiences with other doctors in the Corrective Surgery section of the website.

The hairs have been trimmed in preparation for the pluggy graft to be punched out, and then the follicles are recycled into other areas. The punched-out hole from the "corrected" graft gets stitched together, creating a small scar. This process is time-consuming, inconvenient, and expensive, and often does not result in a perfect correction. No matter how many corrective surgeries I get, I will never look completely normal again.

Look how much distance there is between the front row of grafts, and the next real "row". What Dr. Puig did does NOT follow the established approach to graft placement in the diagram (above) at all.

Massive Damage in the Donor Area

According to the Cleveland Hair Clinic, my donor sites would be "undetectable".

CHC's consultant Dick Malmin claimed that the donor scars would "shrink", while Dr. Puig's booklet "The Plain Truth About Hair Transplants" (documented on this site) claims that the donor sites will "close in" with a "complete undetectible healing" that the booklet claims is "even more amazing than the regrowth of the new hair". I am still waiting for the donor scars to "shrink" or become "undetectible" as I was promised.

The scarring is so severe that my hair is "see through" over a large area, and the donor scarring is obviously visible if my hair is mussed or moved even slightly.

Any small breeze or movement through my hair makes the severe donor scarring obvious to other people. This means that I must keep my head covered at all times. Because my donor area was totally destroyed by crude punch grafting techniques, it means that any future "repair" surgeries can only have a limited success: Most of my donor area was wasted by Dr. Puig. The area of scarring is huge, and some of it is hidden in this photo.

Look how close together the punch scars are. In many places there is no "bridge" between scars (the scars touch each other) which creates a big hairless gap. These "overlaps" are proof that Dr. Puig was careless and sloppy when he punched out grafts.

These wounds were not stitched up, they were left gaping wide open and oozing blood. Patients were sent home from the clinic with a hundred gaping open wounds in their scalp. These were HOLES that went deep, that would eventually fill in with scar tissue (not 'shrinking' as Dick Malmin told me). The post-operative directions were to swab the gaping bloody holes several times a day with alcohol. Imagine what it is like to have the back of your head look like raw hamburger. I was expecting that the holes would "shrink" or "close in" like the clinic promised. Obviously that never happened.

I would have never guessed in a million years that it was LEGAL for a doctor to make a hundred large holes in a patient's scalp, and then NOT suture up the wounds. Even shady tattoo parlors and piercing studios cannot legally do this kind of thing, but somehow when a doctor does outpatient cosmetic surgery, he can apparently do whatever he wants, with no rules and no legal oversight.

Who the hell could consider this crude surgery a "cosmetic improvement"?

Dr. Puig has destroyed my donor area, leaving me with major repair work to do, and basically no donor hair to do it with. I have been examined by three other hair transplant surgeons to get advice on possible corrective surgery. All three doctors told me that any attempt to harvest new grafts from this area using contemporary Strip Excision harvesting (using the new grafts to conceal the plugs I have from Dr. Puig), will probably result in an even MORE obvious NEW scar that could be impossible to hide. (See the section on Strip Excision for more information on how that technique is done). Removing any more donor hair from this area will yield up very little donor hair, and probably just make the area even more "see-through" to the punch graft scars below .

In short, this means Dr. Puig has left me with severe damage, and limited options for any future corrective surgeries.

"Working with a Limited Donor Supply" "As we have discussed, the stereo-microscopic allows dissection of hair from within scar tissue and maximizes the amount of hair that can be obtained in areas of low density. In spite of this technology, there are many situations in which the amount of transplantable hair is well below what we would generally be required for a complete restoration. It is especially common for patients who have had open donor harvesting (as part of the punch-graft technique), or those who have had scalp reductions or scalp lifts to have markedly depleted donor supplies." http://www.newhair.com/corrective_procedures/cp-large_grafts.asp

Here's page 10 from Dr. Puig's booklet "The Plain Truth About Hair Transplants" booklet. Did Dr. Puig actually tell people "The Plain Truth" about Open Donor scarring?

Puig's booklet also claims that Cleveland Hair Clinic physicians "insist (that) sound medical practices be followed". After each surgery I was sent home while oozing blood from a hundred of these gaping open donor wounds. Does sending a patient out the door with bleeding open wounds seem like a "sound medical practice" or more like a medieval torture?

Remember that during the era I had my surgeries, patients were urged to get multiple surgeries only weeks apart... too quickly for the patient to realize how badly he was being damaged.

Again, the clinic promised me that these donor sites would "SHRINK".

Scalp Reduction Scar

The next photo shows the approximate area of my scalp reduction scar from Dr. Puig. My scalp reduction was one of the worst experiences of my life. It was an extremely gruesome experience. A strip of flesh approximately 6 inches long and one inch wide was surgically cut away from the middle of my scalp, and the gap was sutured together, resulting in a single straight-line scar. This was supposed to reduce the amount of balding area I had, but it actually accomplished ABSOLUTELY NOTHING.

A person's scalp is physically attached to their skull. Cutting the scalp away required a considerable amount of scraping to detach the connective tissue from my skull. I will never forget the scraping sounds as they detached my scalp tissue from my skull. The only benefit from this operation was in boosting the clinic's profits. This scalp reduction was a totally useless surgery that should not have been done on me.

First I had two grafting sessions of 100 grafts, then the scalp reduction, followed by the "final" session of 100 grafts. These surgeries were done over a period of several months, which was typical. Clinics urged patients to get through their course of surgeries as quickly as possible.

In flat lighting, my scalp reduction scar can be hard to see, but in dim lighting it looks like a crevice or "valley" in my scalp. In the photo you can see that the last row of plugs was placed into the scar.

I have permanently lost a lot of sensation in my scalp because of these surgeries. A scalp reduction is very invasive, and nerves were cut. I was not warned of this by Cleveland Hair Clinic, even though it was well-known by doctors that "denervation" would result. I only have about 50% of the sensation left in my scalp. At this point I know it is a permanent condition.

I have already had 6 corrective surgeries, which I discuss in the Corrective Surgery section of the website. Even after 6 corrective surgeries, I still look terrible. I estimate that I will need a minimum of 10 more corrective surgeries just to look somewhat normal again. Even that will not give me a totally normal appeance, because there is a massive amount of damage that can't be completely corrected.

• Cleveland Hair Clinic failed to do adequate screening of patients. Instead, when they looked at me they only saw dollar signs.
• Dr. Puig gave me a diffuse pattern of grafts covering a large area. This makes repairs more complicated, because the repair area is larger.
• Virtually every single graft that Dr. Puig placed was angled incorrectly.
• Most of the grafts have problems with pitting and cobblestoning (divots and bumps), and all the grafts are tufty or pluggy.
• My donor supply was wasted, leaving me with very little hair to camoflage Dr. Puig's shoddy work.
• Scarring in the donor area is so bad that it will require thousands of grafts to be put back there, to try to minimize the see-through appearance.
• Punches in the donor area were taken from too high up, and those scars need to be removed or filled in.
• Donor grafts were punched too close together, creating overlaps. It shows how sloppy Dr. Puig was.
• I have had 6 corrective surgeries already, which is just the beginning.
• I will need a dozen (or more) additional corrective surgeries which are expensive, inconvenient, and emotionally exhausting. I will never be able to look completely normal.

I have already had six repair surgeries, bringing the total number of surgeries to ten. By the time I am finished fixing what Dr. Puig did to me, the number of total repair surgeries could easily reach 15 or 20. The fact that I need to ungergo this many corrective surgeries, to undo the shoddy work of a surgery that was supposed to IMPROVE my appearance, is outrageous!!!

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