Month: February 2011

We’re taking a week off from posting new content — our first break in almost 6 years — so we’re using this opportunity to repost some older articles that didn’t get the attention they deserved the first time around.

(Originally published on July 1, 2009.)

—

Each and every day, I receive emails from readers asking about individual doctors’ and their reputations or even wondering if the doctor they just met with is a good doctor. Most doctors care about you and are competent and ethical, but there are a few who really don’t give a damn about you and look at you as a way to simply make more money. The unethical doctors often push men who are too early to have a transplant (like most 20 year olds) into getting one when they don’t need it, or they expand the number of grafts in a transplant procedure into areas that do not have hair loss under the guise of performing preventive hair transplants which happen to push their fees higher. Unfortunately, there are too many unethical doctors doing hair transplants and while I’m always willing to help when I can, I’m disappointed when I hear how some doctors take advantage of people in an attempt to line their pockets with your money.

In the years I’ve been posting on BaldingBlog, I’ve accumulated a lot of content about avoiding doctors that don’t put patient welfare as priority #1. I’m outspoken when it comes to patient advocacy, so I’ve also written much about how to select your hair transplant doctor. Most of my comments have been put on the daily responses I write to questions posed to me, but I’ve never put all the information in one easy-to-find place and organized it in a way that makes the job easier for the reader. So with that being said, I now present you a new “How To” type of series. These are MUST READ articles for those interested in having hair restoration surgery.

	Selecting a Hair Transplant Doctor
	How to Avoid Dishonest Doctors

 

I also write about why it’s important to shop around for the best doctor before committing to a hair transplant. Don’t be afraid to have to travel to get a surgery that is PERMANENT and on your head! Don’t settle for someone you’re not comfortable with just because it is convenient. At NHI, we offer travel discounts, so factoring travel and hotel costs into your surgery should not be a concern.

Why Should You Visit Us?

 

We’re taking a week off from posting new content — our first break in almost 6 years — so we’re using this opportunity to repost some older articles that didn’t get the attention they deserved the first time around.

(Originally published on November 20, 2009.)

—

This is a patient who I just performed a corrective procedure on. There were many mistakes made here in the past with his other doctors and I wanted to share those problems with you. Knowledge is power, and I hope this will teach you what to look out for so you can prevent them from happening to you. So let’s jump right in…

The Problem

First, let’s take a look at the “Before” photos (click to enlarge):

 

1. The patient had received around 3000 grafts total in three surgeries on the frontal hairline at another clinic.
2. The hairline is harsh, without single hair grafts in front of the larger grafts. Plus, these were not follicular units, but the old type of minigrafts of 3-5 hairs each.
3. The hairline was placed too low and too straight, creating an abnormal edge which made the transplants obvious to the patient.
4. The surgeon made incisions in the scalp that were not kept in the same place, so the patient had two scars rather than one (see arrows in photo above). The second and third surgeries should have been performed at the same location as the first surgery. The location of the upper scar was too high as well, so transplanting into the upper scar made sense to me.

 

The Solution

Here are the “After” photos, taken just moments after the completion of his surgery (click to enlarge):

 

1. I transplanted 1637 grafts total (1391 into the hairline and 246 into the upper scar in the donor area).
2. I built a wide transition zone with only one-hair grafts to break up the leading edge of the hairline so that it would not look transplanted.
3. I had to lower the hairline to get in front of the harsh hairline created by the other doctor. This brought the hairline almost back to its juvenile position, something that I rarely do, but was forced to in this situation.
4. Those 246 grafts transplanted into the upper scar (see arrows in the photo above) should almost completely wipe out its visibility, so he’ll have one scar in the back of his head instead of two.

I find it amazing that this happened recently by a surgeon not far from my office who does a great number of such cases. If this patient had asked to meet some of that doctor’s patients, I am sure that this is the type of work he would’ve seen. People just don’t know or think to ask a doctor to meet with other patients ‘one-on-one’. There is no substitute for meeting patients directly and talking to them about their overall satisfaction. We offer an Open House every month to allow prospective patients the chance to meet up to a dozen of our patients who had surgery. A detectable hair transplant is not what you want and it is easy to see the quality of a doctor’s work by engaging with one-on-one patient interviews.

We’re taking a week off from posting new content — our first break in almost 6 years — so we’re using this opportunity to repost some older articles that didn’t get the attention they deserved the first time around.

(Originally published on March 2, 2006.)

—

I saw Bruce Willis on the David Letterman show the other day and he told everyone that he was bald and happy. That could put you out of business so don’t buy your new Mercedes yet doc. What do you think of the balding trend? Is bald beautiful?

I have followed Bruce Willis’ hair loss over the years from his thinning during the TV series Moonlighting, to the present day shaved head look he sports. A while back, I did notice what I thought were hair transplants placed in the front of his head, showing a less than artistic straight line of hair (suggesting a poor hair transplant), but if my initial guess was correct, there would be some signs of it on the front (recipient area) and in the back of the head (donor area). Judging by photos I’ve seen, I can not stand by my original assumption. I do not think Bruce Willis ever had transplant work done. It is interesting that my daughter met him at a party in the mid-90s and engaged him on the balding issue and my transplant services. He commented that he would remember the connection when the time came, so with that knowledge, I have followed his balding over the years waiting for him to come to my office and join others in that line of work that have come my way.

It must be clear to anyone considering hair transplants that the option to shave the head as Bruce Willis does may be lost if you have the procedure, as some scarring may be present at the donor site (even with the FUE technique). I have seen many patients that had a small-session transplant, which was inadequate to cover the bald area, because less hair is moved to produce the fullness that a reasonable person might expect. Small, delicate follicular units will mimic the normal hair and to get that, the doctors performing the surgery must be adhering to the standards of Follicular Unit Transplantation. Anyone with even a good hair transplant that uses strip harvesting would have a noticable scar if the head was shaved, even if it were 1mm in size. For the unfortunate person who had unsightly or poorly planned hair transplants, they may have no choice other than to live under a hat or a hair piece most of the time.

Some men shave their head as a way to accommodate their balding. This is a style that has more recently been accepted by the ‘hip’ young men today. We see many ways these men deal with their balding/thinning at our monthly Open House events, where a significant number of men who have to deal with balding come to learn more about the hair restoration process. Many men shave or clip their hair short, or are wearing baseball hats or hair systems. Unlike the average guy, Bruce Willis could get away with wearing a baseball hat to the Oscars because of who he is, but I would not recommend interviewing for a high powered job with a baseball hat on your head. With a poorly done or incomplete hair transplant, an interviewer might spend too much time looking at the hairline rather than in the eyes of the interviewee.

Society has stereotypes and a bald head is stereotypically a ‘hard’ look, the man’s man look. In the past, Hollywood actors have gone clearly bald (Yul Brynner, Telly Savalas), and they were tough character actors. Bruce Willis now joins that pack, but if he had transplants, unlike those bald men who could elect to let their hair grow in and not shave their head, Bruce Willis may not have that choice. His options may be limited if he wanted both hair and the opportunity to keep shaving his head.

Now to comment on your last inference, I am not buying a new Mercedes and I fully expect to keep driving my Toyota minivan, which seems to get me from here to there just fine. If it is short hair you want, don’t worry about my car payments as I have accounted for those choices already.

We’re taking a week off from posting new content — our first break in almost 6 years — so we’re using this opportunity to repost some older articles that didn’t get the attention they deserved the first time around.

(Originally published on March 2, 2007.)

—

People always ask, “How many grafts will I actually need to have transplanted?” Time and time again, that graft number answer will vary by doctor. When a doctor recommends a certain number of hairs/grafts, the doctor’s experience and his/her artistic skills are used to estimate what it might take to fill in the balding area with enough fullness to meet the person’s needs. I have seen estimates that could be a four fold difference and when you are shopping for a hair transplant, the differences in the estimating abilities of the doctors can be very unsettling. Who do you believe? Clearly you want to believe the doctor who has the lowest estimate for hair moved (transplants are priced by the graft), but then you are locking yourself into what might become a never ending series of hair transplant surgeries with an unrealistic amount of hair transplanted that may not meet your goals.

Does your doctor have the necessary artistic ability, not just to estimate the number of hairs/grafts, but also to take advantage of the hair supply to create a distribution that maximizes the value of the transplants for the most fullness? We have put some factors together to address how a surgeon actually calculates the numbers of grafts. These factors may not apply equally to all people. No two people are the same. The various factors like the thickness of the individual hair shafts (coarse vs. fine hair), the character of the hair (curly vs. straight hair), the color of the hair and the skin (the closer the match, the more full appearance of the hair), and any special needs defined by the patient, make us very different.

On white skinned people, those with blonde hair have a fuller look while those with black hair will have a more ‘see through’ appearance. The blonde haired man, the very fine haired man, or the very bald man who has a hair supply that might not be adequate to cover the bald area will be different in their needs for fullness. When the calculations are not clearly evident, it is the doctor’s art that saves the day to maximize the value of the hair transplants that are received. We generally try to restore 25% of the original hair density in a ‘typical’ patient. Some people may require more than 25% of the original density and if you are one of these people, you should understand what you need and why you need it. Even if the overall achieved density is 25%, some areas may require more and some less than 25%. In people with fine or dark hair and light skin, a higher density than 25% of the original density is often required. In blondes with fair skin, less than 25% of the original density might meet the ‘fullness’ requirement. This is critical, because you look for fullness in the end result of the transplant process and it is the doctor’s art that addresses just how that fullness is to be achieved. Keep this in mind as you look to the analysis below.

The math for estimating number of grafts needed for a bald area:
We have proposed a 25% rule, which means that the balding person can go from a completely bald area to 25% of the original hair density that was there prior to the balding. The following calculation also assumes that the person used in this example has an average density of 2 hairs/mm2 (average density of a Caucasian). Every person is different, so the final number of grafts that will produce the fullness that a person wants to achieve (and can afford to purchase), are independent variables. These calculations were originally defined in a classic medical journal article written by Rassman in 1993 (Rassman, W.R.; Pomerantz, M.A. Minigrafts, the art and science. International Journal of Aesthetic and Restorative Surgery. 1(1): 27-36; 1993).

by William R. Rassman, M.D. and Jae P. Pak, M.D.

We’re taking a week off from posting new content — our first break in almost 6 years — so we’re using this opportunity to repost some older articles that didn’t get the attention they deserved the first time around.

(Originally published on September 14, 2006.)

—

Once you have a follicular unit transplant (FUT), if the procedure was done with care, there is no question that the results can’t be detected in any casual encounter, or even on close inspection in most circumstances. Yet with that said, there is still a difference between patient results that go beyond the characteristics of (1) hair shaft thickness, (2) hair character, and (3) hair color.

Let’s take a look at a patient who had two hair transplant procedures. The patient is Dr. Jon Perlman, the well-known Beverly Hills plastic surgeon that has been featured on ABC’s television show, Extreme Makeover. After his first session, he had good results that nicely framed his face when his hair was groomed. But on close examination, his hair was somewhat see-through. Dr. Perlman has very fine hair, so the bulk of each hair shaft was lower than average. By undergoing a second procedure, the bulk was doubled and the results shown in the pictures below say a great deal about the change he experienced. He was more-than-satisfied after the first procedure and thrilled after the second one. A good transplant became a great transplant.

Sometimes patients will tell me something like, “I don’t want it too thick and I am afraid if I put too much hair there, it will look unnaturally thick.” In all of the years of doing this surgery, I have never, ever had a patient who told me that I had made the hair too thick in a single session. We have seen many of our patients (initially satisfied, but wanting more hair) receive another transplant and become transformed back in time to their youthful look. By performing NHI’s pioneering dense packing procedure, we can increase the density of hair in a single procedure, often reducing the number of procedures needed to obtain results like the one shown here, but when the hair is super fine (like the example below) then two sessions may be needed. For many people, hair is like money — the more you have, the better it is.

Click the photos to enlarge.

Before and After 2 procedures (2890 grafts total):

 

For more photos, click “read more” —

—

Before (left) and immediately after surgery (right):

 

After 1st procedure (1529 grafts):

 

After 2nd procedure (1361 grafts):

 

We’re taking a week off from posting new content — our first break in almost 6 years — so we’re using this opportunity to repost some older articles that didn’t get the attention they deserved the first time around.

(Originally published on October 17, 2006.)

—

Follicular Unit Extraction (FUE) has been in vogue with hair transplantation surgeons in recent years. It is an elegant approach where one follicular unit is taken from a patient’s donor area, one at a time. There are no scalpels or the traditional linear scar. An FUE procedure requires a special 0.7 to 1 mm diameter tool that is used to harvest each hair follicle. All incisions and cuts leave a scar, but an FUE scar is barely visible to the naked eye because each FUE scar shrinks to less than 0.5mm.

There are many variables that contribute to the success or failure of an FUE. As one can imagine, harvesting a single hair follicle one at a time can be extremely tedious and fatiguing to the surgeon if he/she had to do it several hundred times for each procedure. More importantly, negotiating a 0.7 to 1 mm diameter tool to perfectly encompass a hair follicle is technically challenging even under magnification and requires a very steady hand and much experience doing it. Of course, one might ask how a doctor gets that experience and what the cost is to the patients from which that experience comes from.

There are also uncontrollable patient dependent physiologic variables as well, including:

1. Hair characteristics such as color and thickness
2. Skin characteristics such as hydration level, elasticity, degree of fatty tissue content
3. Idiopathic variables (the unknown)

All the above variables contribute to what is called a transection rate. A transection of a hair follicle means that a portion or even the entire hair follicle was cut along its body and could be damaged, which may jeopardize its viability. A complete transected hair follicle will not grow hair when it is implanted.

A “successful” extraction of one hair follicle with the current FUE technique is a very relative term. To better illustrate this point we must understand the anatomy of a follicular unit with respect to the transection rate. One follicular unit can be a group of one, two, three, or four hairs. One patient may have a predominance of two-hair-grouped follicles and the other four-hair-grouped follicles. For example, when a surgeon extracts a four-hair-grouped follicle with an FUE technique and transects half the follicle, only two hairs will grow and the remaining two may be killed off, lost in never-never land. The way some doctors count, this is widely considered a successful FUE effort (not by me, of course), because this means only 50% of hair was harvested and 50% is lost forever! To make matters worse, the patients may be fully charged ($$) for that follicle even with the transection as long a one hair is viable (a shady process to say the least). What is even worse than that is that in a complete transection, that follicle is likely dead forever and even if the doctor did not charge for the complete transaction (as he/she should not charge for it) it would be considered by me to be negative value, reducing the person’s donor hair forever. One may argue that acceptable transection rate for a “successful” FUE is 10% or less, but this is not advertised and most patients (the consumers) do not have a clear understanding of this fact. Nothing in real life is 100%. Even the traditional hair transplant surgery with the donor strip incision has a 2 to 5% transection rate.

From a historical point of view, it is interesting to note that New Hair Institute (NHI) was well aware of the possibility of transection rates in excess of 10% as early as 1997 before FUE was in vogue and four years prior to the landmark article published by Rassman, et. al. In conjunction with Dr. Jae Pak (with his mechanical engineering background) the two designed and built a prototype computerized video Follicular Extraction (FLEX) device which was patented by Dr. William Rassman (U.S. Patent 6,572,625). Even that device did not achieve did not consistently achieve the ideal ‘less than 10% transection’ in all patients and FUE can not match the 2 to 5% transection rate of the traditional donor strip incision. The transection rate by our NHI surgeons are still well within the 10% range for FUE and we make no pretenses that it is better than that routinely. Because of inherent limitations of FUE and uncontrollable patient variations, any claims of transection rate of less than 10% should be viewed as highly suspect. The automated process covered by the patent technology (above) is not commercially available… yet!

With the current state of technology, a surgeon may perfect his FUE technique, but the inherent patient variability will keep the FUE transection rate higher than the traditional donor strip incision technique. An informed patient should know the risks and benefits of any surgical procedure. The FUE procedure with its virtually non detectable scarring is an attractive alternative to the traditional donor strip incision and may be good when the amount of hair needed is small because the balding area being treated is not great, but its inherent transection potential may be a deterrent for the very bald patients who want the most hair possible from their donor site.

More information on the FUE technique:

• FUE info / photos
• FUE Megasession info / photos

We’re taking a week off from posting new content — our first break in almost 6 years — so we’re using this opportunity to repost some older articles that didn’t get the attention they deserved the first time around.

(Originally published on April 5, 2007.)

—

I’ve put together a nice list of things to consider if you’re interested in having a hair transplant, particularly when comparing the Follicular Unit Extraction (FUE) technique and the Follicular Unit Transplant (FUT / strip) technique.

FUE pros

• There will not be a detectable scar in donor area. Of course the scar will be present after every skin incision, but since scars are very small and scattered in a larger area, they are not detectable even on a head with a close crew cut.
• There are no sutures or staples to be removed. The small pointy wounds on the back of the head will be left to be closed on their own with no sutures or bandages.
• There is minimal or no pain in donor area after the removing the grafts.

FUE cons

• Not everyone is a good candidate for this procedure. We always test our patients before doing the actual procedure with several biopsies with different methods and view the grafts under microscope to see whether we can harvest them without damaging the hair follicles. If we see a lot of transected (damaged) follicles, we can not proceed with this procedure.
• It is more expensive (almost double the cost compared to the strip procedure). Follicular Unit Extraction is very tedious and every graft should be individually extracted by the surgeon as opposed to the strip method where skin is removed first and grafts are harvested under a microscope.
• It takes more time, sometimes up to twice the time when compared to a strip procedure for the same number of grafts. A procedure to harvest one thousand grafts may take six to eight hours.
• A large area of the scalp needs to be shaved or clipped very short. This is not acceptable for many patients.

There are a few issues that are important to look at and understand. Hairs within a graft can be killed by improper harvesting (e.g. drying, cutting it at a critical point in the anatomy of the hair follicle within a follicular unit). This can happen if there is poor cutting techniques in strip harvesting, or in actual transection of hairs within a follicular unit during an FUE procedure. I personally do not believe most of the doctors who claim 95+% successful hair counts from FUE and I would love to pay a visit to some of these doctors and actually do the hair count from their FUE extracted grafts.

Thick grafts (those that are transplanted with fat around the follicular unit) can tolerate air exposure longer than a skinny graft (which can dry in seconds when exposed to the air). But tolerating air exposure for longer than 10-20 seconds suggests to me that hair follicle death may occur and the staff do not have strict quality control process implemented. What is important is not how many hairs are extracted successfully and anatomically intact. The important question to ask is, “Will they grow?”

The best part about strip harvesting is that there is a very high yield with the experienced team. The risks of scar formation that is detectable (greater than 3mm wide) is about 5% with the first procedure, 10% with a second procedure, and higher with a third procedure. Other than the scar possibilities and a slightly more painful recover period of a day or two, the strip procedure is more cost effective and more efficient from a time and yield point of view.

We’re taking a week off from posting new content — our first break in almost 6 years — so we’re using this opportunity to repost some older articles that didn’t get the attention they deserved the first time around.

(Originally published on January 28, 2008.)

—

I am concerned about the loss of sex drive from taking propecia. I took propecia for about 6 months and my sex drive was non existant. I stopped taking it over a year ago and it has returned, some what, but not nearly where it was before. Is there a product that will help it return, or anything that can be done? I would rather be bald with a strong sex drive, than a head full of hair without one.

You need to go see your doctor for a physical examination and possible testing. While Propecia can cause a decreased sex drive (in 1 to 2% of men), it is temporary since the drug only lasts in your blood stream for about one day. After one year, I hardy doubt your sexual problem is due to Propecia. You need to see a doctor for further evaluation. In fact, erectile dysfunction may be one of the first signs of an underlying medical problem.

Here are a few facts about sex drive / erectile dysfunction / impotence that I found at Minnesota Men’s Health Center:

• One in 10 men (10%) in the world have erectile dysfunction.
• 30 million men in the United States have erectile dysfunction.
• 50% of men with diabetes have erectile dysfunction, frequently within 10 years of diagnosis.
• The likelihood of erectile dysfunction increases with age: 39% at age 40, 65% over the age of 65.
• Smokers have a higher likelihood of erectile dysfunction.
• Men who smoke more than 1 pack per day have a 50% higher chance of impotency than nonsmokers the same age.

And from the Mayo Clinic:

Nonphysical causes:

• Psychological problems. The most common nonphysical causes are stress, anxiety and fatigue. Impotence is also an occasional side effect of psychological problems such as depression.
• Negative feelings. Feelings that you express toward your sexual partner — or that are expressed by your sexual partner — such as resentment, hostility or lack of interest also can be a factor in erectile dysfunction.

Physical causes:

• Nerve damage from longstanding diabetes (diabetic neuropathy)
• Cardiovascular disorders affecting the blood supply to the pelvis
• Certain prescription medications
• Operations for cancer of the prostate
• Fractures that injure the spinal cord
• Multiple sclerosis
• Hormonal disorders
• Alcoholism and other forms of drug abuse

The physical and nonphysical causes of erectile dysfunction commonly interact. For instance, a minor physical problem that slows sexual response may cause anxiety about attaining an erection. Then the anxiety can worsen your erectile dysfunction.

We’re taking a week off from posting new content — our first break in almost 6 years — so we’re using this opportunity to repost some older articles that didn’t get the attention they deserved the first time around.

(Originally published on September 7, 2007.)

—

I received this email from a patient of mine and I have reposted it below with his permission (removing any identifying information, of course). This was not solicited, and it serves as an example of those men out there that are looking into hair systems (otherwise known as wigs or toupees). The price chart at the end of this post could be a wake-up call to many that think hair systems are cheaper than hair transplants.

In the end, transplanted hair is YOUR hair and the only maintenance you might need to do for it is to use shampoo and perhaps even use a comb. Oh, and visit a barber from time to time, if you’d like. You know, the things you did when you had hair the first time.

And now, the patient email…

Dr. Rassman:

As usual, it was good to meet with you to discuss my case. It is amazing that what we (operative word here) will accomplish in 21 months negates over 13 years of living with worry and dread about my hair loss! On some level I am certain you understand the value of your work; on the other hand, it is impossible for you to fully comprehend what you and your great staff at NHI have done for me and your other patients!

Here is a breakdown of my costs from a hair replacement salon in Los Angeles from June 2000 through January 2006. I wore a competing hair system from 1995 through 2000, but did not keep thorough records of those costs. Therefore, the $16,000+ indicated on the spreadsheet does NOT include the previous five years, so the total amount I spent on hair systems is actually higher that what my spreadsheet shows. In fact, I am certain I spent more on hair “replacement” than what I will spend on 5000+ transplants with NHI.

To be fair when you reprint this spreadsheet, post the the following as well:

1. This spreadsheet is ONE PERSON’S experience with hair systems. It was my reality and should be viewed as such. Your costs will vary from my mine.
2. The price for a hair system included two of them: wear one while the other gets service or cleaned.
3. The months where there is no dollar amount were the times I did not go to the salon for servicing.
4. I work in an industry that required my systems to look absolutely real at all times. The months where you see me spending $200-$400 were instances when the unit had to be colored or have hair added. Again, in my case it was a necessity. If you are in, say, another profession like a machinist, you may not have to obsess over your hair system. You WILL have maintenance, though, perhaps not as much. Also, to be fair, some people do most of their own maintenance, so their costs would be lower as well.
5. In June 2000 the systems were just over $3000. Flash forward to 2004 and they were over $5000. I got 4 years use out of mine before they were replaced, and that was on the higher end of the average life cycle because of my meticulous maintenance. They might have had to be replaced before that if I did not treat them so well.

I wonder what systems cost today in 2007?

Bottom line: I spent $16,000+ over five years wearing hair. Sure, the initial costs for systems were cheaper than surgery, but their VALUE quickly fades over time. It costs more upfront for a high quality transplant, but its VALUE over the course of your lifetime is incalculable.

Thanks again for everything. Looking forward to my next transplant session.

Here’s the spreadsheet he sent me with the costs incurred for purchasing and maintaining his hairpieces.

Hair System Costs By Month
2000	2001	2002
Jul $3031.00 * Aug $65.73 Sep $199.80 Oct $95.00 Nov $120.72 Dec $139.38   * Initial cost for 2 systems	Jan $135.14 Feb $125.00 Mar $91.73 Apr $110.06 May $402.52 Jun $13.50 Jul $145.59 Aug $179.42 Sep $113.70 Oct $197.80 Nov $91.20 Dec $270.00	Jan $258.69 Feb $153.07 Mar $156.21 Apr $103.49 May — Jun — Jul $175.93 Aug $162.62 Sep — Oct $131.90 Nov — Dec —
2003	2004	2005
Jan $101.12 Feb $105.00 Mar — Apr $146.25 May $183.27 Jun — Jul $87.86 Aug $138.69 Sep — Oct $176.39 Nov — Dec $282.35	Jan $204.58 Feb — Mar $172.63 Mar $2796.00 ** Apr $142.64 May $2589.06 *** Jun — Jul $216.69 Aug $233.68 Sep $272.27 Oct $131.00 Nov $130.84 Dec $120.26 ** 1/2 Deposit on a new system *** Remaining balance on new system	Jan $240.89 Feb $120.98 Mar — Apr $112.00 Apr $128.05 May $78.50 Jun $155.29 Jul — Aug — Sep $113.41 Oct $209.50 Nov $99.50 Dec —
2006	Grand Total (after only 5.5 years)
Jan $99.50	$16,257.40