Jeffrey Epstein MD, FACS

Not going to get involved in this thread, other than to simply provide the details of Glajo's prior surgeries. On presentation to me 3 years ago, Glajo had already had 6 prior old-fashioned procedures, all done in his late teens/early 20s, with significant scarring, unaesthetic appearances, etc. I performed a total of 700 grafts on him- the first 500 grafts in a reparative procedure including donor site scar repairs for which he was extremely satisfied and grateful, the second a small touch up of 200 grafts which the patient feels is the cause of all his problems. Here is what I posted on this website back in April, 2009 in response to his initial negative post: Besides being in regular communication with me, what all 4 of these posters have in common was that their procedures were performed 20 plus months ago, and they represent a very small fraction (less than 0.4%) of all procedures I performed over the past 2 years. The only recent post was from the poster Glajo, who unfortunately gave little details to his situation- but I feel the need to provide some of these details while staying within HIPAA regulations: 1. I performed a reparative procedure on him almost 3 years ago to repair the results of terrible work including donor site scarring and unaesthetic appearances he had done by another surgeon years earlier when he was in his early 20s/late teen; 2. he had outstanding results from my work, for which he thanked and blessed me for repeatedly (on his chart are multiple emails thanking me for giving him back his life); 3. around 16 months ago he strongly requested that I perform another small procedure on him that resulted in what he felt was thinning in the donor area in the left temporal region. I have attached on this post close up photos of this area to let each reader decide for himself if in fact the patient has had a significant improvement, rather than a worsening in appearance of this area. To appease the patient, 8 months ago I performed a touch up FUE procedure, transplanting both scalp and beard donor hairs into the area of concern. 4. I have had to deal very delicately with this patient - and have been nothing but sensitive and caring with him, as I certainly try to be with all my patients, including most recently meeting with him and his mother , who had to take care of him after the severe emotional/psychological reaction he had over his initial poor work, performed by another surgeon, that resulted in him quitting school. This patient represents just one of the more than 350 patients on whom I have performed reparative procedures over the past 2 years- and I truly wish to help him achieve the best outcome. I love my work, and I love the satisfaction that comes from making a positive difference in the lives of my patients. Over the past 2 years I have received over 200 unsolicited letters and emails from patients thanking me for their results- which can be viewed on my website along with over 700 sets of before and after patient photos. I have always placed my patients' interests first, and provide all of them with my cellphone number and personal email address so that each of them can contact me anytime they have a concern. While I respect the free flow of information on the Internet and certainly think it can be a great tool for education, unfortunately, at times it can serve as a source of misinformation or distorted information when not provided in its entirety or in context. It is unfortunate that while there are few limits on what can be said about a surgeon, there are many limits as to what a surgeon can disclose in response to try to tell the complete story. While I recognize that no surgeon can have 100% satisfaction with 100% of his or her patients, most of us do aspire to achieve this with our patients and I certainly will continue to help those patients that are not completely satisfied in light of realistic expectations, in any way that I can. That's what I wrote 3 months ago, and there is nothing else to add. Glajo's photos were provided at that time- photos that I took of the left temporal region upon his presentation to me, then photos of the same area at the same distance and lighting using the same camera approximately 8 months after his last (200 graft) procedure with me. The photos, which I have shown to numerous colleagues, and which I posted for complete transparency, clearly show the improvement in scarring and minimal to no reduction in density- and please note that Glajo's initial density was quite low. Despite his prior posts 3 months ago, I had continued to offer to Glajo at no cost another FUE reparative procedure using beard or scalp hairs to attempt to help fill in what he feels is thinning due to his 8th procedure. Jeffrey Epstein, MD,FACS

I congratulate Dr. Feller, along with any of my colleagues who come up with a device designed to improve the results of any hair transplant procedure. Over the past year, I have become a big fan of FUE procedures, performing 3 to 4 of them weekly. With more experience, the average procedure size has increased, to where they now are typically 1100 to 1300 grafts in one day, and frequently a second procedure on the same patient the next day of 500 to 700 grafts- depending upon the donor density. My instrument of choice is the Harris Scribe® System, which utilizes a disposable 0.8 mm sharp punch to score the skin, followed by a 0.75 mm or so "bullet" that bluntly separates the follicular unit from the surrounding tissue. While very happy with these instruments, I am looking forward to trying out Dr. Feller's instrument. Knowing what a solid surgeon he is, I am optimistic that this device may improve the process, in terms of reducing surgeon fatigue. Jeffrey Epstein, MD, FACS Miami and NYC

After October 2008

Clearly there has been a significant amount of attention and speculation generated by my name and work in recent months. It seems the busier my practice and more prominent my reputation becomes, the larger a target I am. I would like to put the comments and speculation being posted about me into perspective- as a number of them have been generated by people who are not my patients but are rather fueling a fire for a variety of reasons I am not really sure of, and others simply need to be told in the context of the entire situation- half of the story and half truths do not make for a basis upon which to judge anyone. I have been a major fan of this site for a number of years. One limit of a site where individuals post comments is that there is often a lack of follow up to the story- when some comments are made at a certain time, and then there is no follow up from the patient or from the doctor who took care of that patient when with time there was further growth or the patient realized his/her expectations were unrealistic. What makes the situation for physicians like myself very difficult is that there are HIPAA laws which prevent me from making any comments beyond what I am going to say. However, I would like to provide some follow up on the patients rehashed in this post who are claimed to be disappointed and abandoned. Actually, ,they have been in regular communication with me - one who had his first procedure almost 2 years ago is now waiting for the results of his touch up procedure to grow out and is being worked-up by a colleague to determine if anything more than his wearing a hairpiece is cause for his delayed growth, one who had his procedure 2 years ago and last posted a year ago is planning on having a touch up procedure with me, one who had his procedure 2 years ago is happy with his final outcome, and one who had his surgery almost 2 years ago was referred to an overseas colleague who noted that his genetic condition (no further details I can provide) puts him at risk for scar widening- something this surgeon has seen before- and unfortunately may not be able to be helped any further. Besides being in regular communication with me, what all 4 of these posters have in common was that their procedures were performed 20 plus months ago, and they represent a very small fraction (less than 0.4%) of all procedures I performed over the past 2 years. The only recent post was from the poster Glajo, who unfortunately gave little details to his situation- but I feel the need to provide some of these details while staying within HIPAA regulations: 1. I performed a reparative procedure on him almost 3 years ago to repair the results of terrible work including donor site scarring and unaesthetic appearances he had done by another surgeon years earlier when he was in his early 20s/late teen; 2. he had outstanding results from my work, for which he thanked and blessed me for repeatedly (on his chart are multiple emails thanking me for giving him back his life); 3. around 16 months ago he strongly requested that I perform another small procedure on him that resulted in what he felt was thinning in the donor area in the left temporal region. I have attached on this post close up photos of this area to let each reader decide for himself if in fact the patient has had a significant improvement, rather than a worsening in appearance of this area. To appease the patient, 8 months ago I performed a touch up FUE procedure, transplanting both scalp and beard donor hairs into the area of concern. 4. I have had to deal very delicately with this patient - and have been nothing but sensitive and caring with him, as I certainly try to be with all my patients, including most recently meeting with him and his mother , who had to take care of him after the severe emotional/psychological reaction he had over his initial poor work, performed by another surgeon, that resulted in him quitting school. This patient represents just one of the more than 350 patients on whom I have performed reparative procedures over the past 2 years- and I truly wish to help him achieve the best outcome. I love my work, and I love the satisfaction that comes from making a positive difference in the lives of my patients. Over the past 2 years I have received over 200 unsolicited letters and emails from patients thanking me for their results- which can be viewed on my website along with over 700 sets of before and after patient photos. I have always placed my patients' interests first, and provide all of them with my cellphone number and personal email address so that each of them can contact me anytime they have a concern. While I respect the free flow of information on the Internet and certainly think it can be a great tool for education, unfortunately, at times it can serve as a source of misinformation or distorted information when not provided in its entirety or in context. It is unfortunate that while there are few limits on what can be said about a surgeon, there are many limits as to what a surgeon can disclose in response to try to tell the complete story. While I recognize that no surgeon can have 100% satisfaction with 100% of his or her patients, most of us do aspire to achieve this with our patients and I certainly will continue to help those patients that are not completely satisfied in light of realistic expectations, in any way that I can.

Dear Posters- Just want to clear up a few items. First, Irishlad was all along taken care of me- at no point did I "leave him high and dry" - in fact, I was in regular communication with him (have an email trace to prove it, which starts from him writing to me a week after his procedure thanking me for the most positive experience). I have most recently sent him to a colleague in Europe who I had evaluate him. His yield was unfortunately less than expected, and I continue to stand by my work. Second, Wanthairs was done a year earlier, and like IrishLad had less than expected growth. I in fact did take care of him- offered him a second procedure at no expense, and he is completely content with the outcome of how I handled things. Third, in case anyone wishes to speculate about my "weak link"- I offer anyone out there, rather than merely pontificating and offering theories, to come in to my office and see my operation. My planting techs: Karelia, Candy, Linda, Raul, Elsa, Niurka, Carlos, and Karen, have each been with me on average 6 years- with 5 of them in the hair restoration profession for more than 10 years. These assistants are so highly trained that they are able to plant grafts in recipient sites 0.5 mm to 0.8 mm- the smallest of any practice to my knowledge. My cuting assistants: Mercy, Vivian, Alicia, Carmen, Marie Carmen, Jackie, Carmen, Peggy, and Marie similarly are outstanding professionals, with 6 of them with me for over 5 years, and the rest with me from 2 to 4 years. We have 15 Mantis scopes, a fully accredited AAAHC operating facility (a very rare certification for a hair restoration practice), and chart review and quality assurance standards up to the very highest level of standards. I perform typically 10 procedures a week, making for over 500 procedures a year. If there are more than 5 patients in the past 2 years who have posted negative posts, and whose posts can be proven as legitimate, that would still be a rate of less than 0.5%. I urge you to all go to my website, and see some of my new features- including a magnifying glass that shows close-ups of hairlines, donor sites, and entire areas of restored scalps, on more than 600 patients. Is there any other clinic or doctor that has such transparency- willing to show close ups of so many of my patients, and of hairlines, of which I am most proud? I am devoted to my work and my patients, enjoying every day hearing from my patients (a third who come to me seeking the repair of prior work done elsewhere), seeing the positive transformations on them, and most importantly- doing the very best work I can and providing the most professional care. As a board certified facial plastic surgeon with almost 15 years' experience as a respected leader in this field by my peers and patients alike, I welcome anyone to come to my office and meet with some of my many thousands of happy patients- and most importantly, to meet me and see how I treat my patients with respect and care. Jeffrey Epstein, MD, FACS Miami and NYC

Dear Please Grow Please- Before you even think you have the "facts" about me and my practice, I suggest you do some homework first. Start by going through my website photo gallery, where you will see what is likely the LARGEST SINGLE COLLECTION OF HAIR TRANSPLANT BEFORE AND AFTER RESULTS, SHOWING NOT ONLY LITERALLY THOUSANDS OF BEFORE AND AFTER PHOTOS, BUT ALSO A UNIQUE TOOL THAT ALLOWS THE VIEWER TO DRAG A MICROSCOPE OVER THE HAIRLINE TO ALLOW ONE TO SEE HOW TRULY NATURAL THE RESULTS ARE. Do you have any idea how many of my happy patients have in fact written into this website? Have you ever done a search to see that there are over 1300 comments about me on this site, the overwhelming majority from my patients and others touting my fine work not only in primary cases but also in reparative work? Do you also have any idea how many procedures I perform every year? Do you know that the average time my top techs have been with me is over 5 years? Do you know that one of the most challenging procedures - eyebrow transplants- from an artistic and technical aspect- is something in which I specialize, and that over 30% of my work is reparative? I urge anyone out there to really research their surgeon, do a "find" search under this site, speak with some of his / her patients, and look at the artistry of results, then make your own mind up. Jeffrey Epstein, MD, FACS Miami and NYC

The trichophytic closure, despite what a number of surgeons claim to give the very best result, is NOT the gold standard, I am very sorry to say. Like Dr. Lindsey (I believe like me a facial plastic surgeon who was trained in trichophytic closure techniques in residency and fellowship- in my case, I have been using the trichophytic closure technique for over 18 years), I have seen more than 100 trichophytic closures over the past 2 years, done by other (very respected) surgeons, and the bottom line is- sometimes they come out very nice, but other times they do not. This variability is largely the result of how much widening of the scar there is, which is in no way related to the trichophytic closure- and in fact, it has been suggested that in donor site closures under tension, the trichophytic closure technique not be used for it does, even just a little bit, remove a bit of skin edge and therefore can increase donor site closure tension. A few other problems with the trichophytic closure technique- in patients with thick hairs, there can be some cyst formation. Also, there can be some "clumping" of the hairs- essentially little patches of 2 to 4 hairs that grow thru the scar, rather than a smooth diffuse growth. Now anyone can say I am wrong, for, after all, they have seen many photos of trichophytic closures and they look great. In fact, if you wish to see literally hundreds of excellent donor site results with trichophytic closures (what I call the HITS technique- hair induction through the scar) you can go to my website www.foundhair.com. However, the reality is, that in some patients the results of the trichophytic closure is not any better than if the standard closure was used. When excellent plastic surgery closure techniques are used, the result of the donor site scar can be outstanding, although there is some degree of variability to results. Jeffrey Epstein, MD, FACS Miami and NYC

As a surgeon who performs several FUE procedures a week, I have found an expanding role for this procedure. Any young patient (less than 30 years old) who first of all is at a higher risk of a widened donor site and also cannot decide at this age if he is going to one day want to shave his head is, in my opinion, just as well treated with FUE as the strip- PROVIDED that he has realistic expectations and understands that it is highly unlikely that more than 1800 or so grafts can be obtained in a single procedure (which in my OR typically runs over a two day period (12 to 14 hours total). A very important consideration to keep in mind that has not been even mentioned here is the aesthetics of the transplanted grafts- how these grafts are positioned and distributed. In my experience, this is the single most important factor in terms of the naturalness and density achieved. Jeffrey Epstein, MD, FACS Miami and NYC

Tough question- in that fees vary widely, as does the kind of work performed. Over the past few years, the average procedure size has increased significantly across the board, thus theoretically lowering graft prices. It is always good to research fees, but I, as well as many of my colleagues, would advise you that one should choose a surgeon by his / her work, not the fees. A great surgeon can do more with a smaller number of grafts, in many cases. Jeffrey Epstein, MD, FACS Miami and NYZC

I have a different approach. I allow, on the 6th day after the procedure, for my patients to resume full exercise and normal hair washing, with the exception of no swimming until all crusts fall off. For most patients, by 6 to 7 days most crusts are gone. I do recommend no yoga or other activities in which there is stretching of the neck for the first 3 to 4 weeks. However, you need to ask your surgeon for his advice to be sure of achieving the kind of results with which he/she feels comfortable. Jeffrey Epstein, MD, FACS www.foundhair.com www.womenscenter.com Miami and NYC

Couldn't be happier that Oprah chose to have Bob Bernstein as her guest. Congrats Bob, and while I was busy placing hair grafts during your segment, I am sure you were clear and presented a balanced approach. Jeff Epstein, MD, FACS www.foundhair.com

One other thing- in some men, low eyebrows can make a major contribution to the fullness of the upper lids. There may be a chance that a browlift is indicated. Sincerely, Jeff Epstein, MD, FACS

Dear Shmutzydawg- I did not get involved with this thread earlier because it was clear from the other posters (who clearly are more objective than I) that there is nothing at this point to be alarmed about at all. I am not sure who you are, but can assure you that your grafts were placed in the most aesthetic fashion, with care and caution, and that at 7 months, it is FAR too early to make any sort of assessment. That is not to say that other patients do not have impressive growth at 7 months, but that many others like you simply take longer to grow in. Be patient, as you have heard, and don't throw the baby out with the bathwater. With 3800 grafts, you should have an impressive result, one that I look forward to hearing about. And if for any reason you are that 2 or 3% of patients that do not fully grow in, you can be assured that I will replace any grafts at no charge- that is my policy, and has helped me to earn the trust of so many patients. Jeff Epstein, MD, FACS Miami and NYC

actually guys- it was Nurse Neeni. really. i remember that much. nice party Pat and Bill- it is always best to share positive moments with my respected colleagues. the meeting overall was outstanding, with lots of good information passed around. Jeff Epstein, MD, FACS

A lot of very good points were raised in this thread, and I wanted to provide my perspective. I am quite proud of the team I have assembled- a total of 18 full time assistants- who have been working with me a minimum of 14 months, and the maximum 14 years. The majority of my assistants have been with me for 6 years. Each assistant has certain talents: 5 of them are my designated assistants who do the slivering -these assistants have been with me on average 7 years; 7 of them specialize in graft placement - these have on average 9 years experience in hair transplantation, the majority spent working with me; several of my assistants are such outstanding graft dissectors that I make sure that this is what they spend the majority of the time doing; I even have certain assistants who specialize in assisting with FUE procedures, a few others who are my "eyebrow" team; and a few who assist me with most of the donor strip removals. By having such a large team, I can be confident that: there will be no fatigue; that cases can proceed expeditiously but not harried nor rushed; and that if one or two assistants are out, I can proceed with a full team irregardless; and that each assistant has the opportunity to subspecialize and take advantage of her /his own talents, thus enhancing personal satisfaction (as well as the experience as well as final results for the patient, which is the most important element). That all being said, this large team doesn't necessarily mean that our cases get done extremely quickly. For example, just yesterday, on a case of 4370 grafts, we started at 8:15 am and finished at almost 4 pm. During that case, I had two assistants placing at all times, the patient took a 25 minute lunch break, and a total of 4 assistants worked on him placing the grafts. The recipient sites were all 0.6 to 0.8 mm in size. The donor strip was removed in two separate pieces- the first strip removed at 8:30 that provided approximately 3500 grafts which got placed in around 6 hours, while the second strip providing an additional 850 grafts that got placed in around 2 hours- those last 800 or so grafts always seem to take the longest to get placed because we are working within already planted areas and seeking out any remaining recipient sites. By dividing the donor strip into two separate sections, even though the case took almost 7 1/2 hours, at no time were grafts out of the body longer than 5 1/2 hours. Jeffrey Epstein, MD, FACS Miami and NYC Foundation for Hair Restoration www.foundhair.com

Bill- Actually, the issue is less the number of existing hairs, but rather the density/calibre of those that are present. For example, on a second procedure, the prior transplanted hairs do not in any way need to be trimmed, as they are solid and hold their own. Jeffrey Epstein, MD, FACS

Good question Bill. The angle of the hairs from the scalp can be determined by looking closely at the hairs just as they emerge from the scalp. After years of performing these procedures, I can focus just on a small area, and appreciate that angle, whether or not the hairs are long or short- and then mimic that angle with my recipient sites (actually the recipient sites are made at a slightly more acute angle due to the fact that, as they heal, the grafts tend to rotate up a bit). Yes, it does take more time to do this, but I have yet to find a patient who, knowing that in my hands there is no compromise to the final result, is not willing to sit in the OR chair for another hour or two as the price for not having his hair shaved. Another point- women. Certainly this group of patients are not going to allow the head to be shaved, and yet good to excellent results are capable in these patients. Maybe it's because I have performed so many procedures on women that I feel more comfortable working in between longer hairs- or maybe it is vice versa, given my experience working in men on whom I don't shave the hair. Jeffrey Epstein, MD, FACS Miami and NYC

I really try to avoid responding directly to comments made specifically by one of my respected colleagues, but I do feel I need to make some clarifications. First, almost any plastic surgeon in the world, of which I am one, as well as the majority of hair transplant physicians, will tell you that skin clips (the technical term for "staples") or staples are both easier to place and quicker as well- that is why emergency room doctors tend to use them for closing scalp wounds. That is not to say that there aren't challenges to properly using skin clips, nor is that saying that sutures are absolutely better. HOWEVER, once again, so that absolute statements are not made, this is up to the individual surgeon. It is my experience, in over 14 years of performing these procedures, that IN MY HANDS, sutures are superior than skin clips for closing the donor site, because they allow for more close approximation of the wound, they can be placed more carefully and delicately, and they are more tolerated by patients. In addition, because I now have found an absorbable suture that resorbs beautifully without inflammation, they are very easy for all of my out of town patients, not requiring removal. However, please note that these comments are NOT absolutes, rather they reflect my experience. 2. I am not sure what type of sutures were being compared to the stapler, but the Ethicon 3-0 Prolene sutures cost $6 apiece, while a multishot stapler costs $6 apiece as well 3. I can assure the majority of my patients that by not cutting their hair, there is no compromise in my ability to make recipient sites, nor our ability to place the grafts. As I wrote earlier, in that 10 to 15% of patients who have that baby fine vellus hair that will potentially interfere with the procedure, I will in fact trim the hairs. I want to reiterate to all participants in this site that hair transplantation, much like any other aesthetic surgery procedure, is a mixture of art and technical skills. The surgeons participating in this site have, for the most degree, proved not only that they are in possession of some combination of these skills, but that they try to look out for their patients' best interests. I would also hope that they would act in the most professional fashion, and point out when things are facts and when they are opinion. Fact: male pattern hair loss is genetic. Opinion: it is necessary to shave the head to get the best results in hair transplants Fact: there are several ways to close donor sites, each which have their own merits and downsides Opinion: staples are better than sutures, and they are harder to place properly Jeffrey Epstein, MD, FACS Miami and NYC www.foundhair.com

I am glad that Bill has given this topic its own thread. It ssems that there is some confusion, as well as significant debate, amongst the contributors to this site, as to the relative merits and downsides of shaving versus not shaving the scalp. In my practice, I have routinely reserved shaving for those patients who have that baby fine vellus hairs that have a tendency to getting trapped under the planted hairs due to their lack of any body- the rest of my patients do not get shaved, as I feel that the presence of the hairs provides the following benefits: 1. I can best see the natural direction of hair growth 2. During the course of the procedure, I can see where more hairs are needed as I can best appreciate the existing distribution of hairs 3. Finally, most patients definitely prefer having their own hairs so that they are presentable. Please understand that there is no right and wrong to this debate. Rather, every surgeon has his/her own approach towards this. Personally, in my over 14 years of practice, in which I have performed over 5500 procedures, this approach has been developed. Jeffrey Epstein, MD, FACS Miami and NYC www.foundhair.com

I got pulled out of my operating room to post on this thread, as some doctors seem to make this a personal competition between colleagues which, because I do not feel is professional, I will not engage in. Hair transplantation is not a competition between surgeons, it is a combination of art and technique, in which passion, skill, and years of experience all play critical roles. The only real winners are those who get the very best results, and that means the most natural appearing hairlines, the greatest density, the least detectable donor site scar, and the best overall experience. There is no right nor wrong when it comes to the issue of shaving versus not shaving. Different surgeons have different opinions and experience, and therefore approach shaving the patient's head individually. It is my opinion, developed over my 14 years specializing in hair transplantation, during which I have performed over 5500 procedures, that I can get better results without shaving the head in the overwhelming majority of my cases- the exception being in those patients who have that real baby fine vellus hair that seems to have no body and continually gets into recipient sites as grafts are being placed- in fact, the case I am doing today, a 3600 graft procedure on a 52 year old patient, has just this sort of hair and I have trimmed the majority of his hair. However, I prefer to leave the hair at its regular length in the great majority of patients for the following reasons (and please note that this is based on my personal experience and should in no way be considered dogma): 1. I can best see the natural direction of the original hairs 2. I can best appreciate, as the procedure proceeds, where there is the greatest need for more density- something that, once the hair is shaved, does not seem to permit me- thus allowing me to add more and more hairs to those areas of greatest need 3. Patients usually prefer it For these 3 main reasons, I and my team of 18 full-time assistants, with their average of over 6 years of experience in this field, are quite experienced in working in and around the hairs when they are left their usual length. Yes, this does add another 15% or so more time to the procedure, but this extra labor cost is well worth it. I feel that there is absolutely no compromise in my ability to achieve the greatest possible density, because I am working with recipient sites that are 0.5 to 0.8 mm in size, with which I am able to minimize trauma to existing hairs while maximizing the achievable density. Once again- there is no right nor wrong. Jeffrey Epstein, MD, FACS Miami and NYC www.foundhair.com

To everyone out there- Dr. Feller and I both respect each other. We're two of the good guys. Let's move on. I have only asked that we protect the Forum's educational (and hopefully professional) integrity, nothing more. Let's make sure we not allow this site to become one giant billboard- we're beyond that. The Derby was great- wish I had put my money on Big Brown- and the Atlanta Hawks. Jeff

Dear FHL- I have several responses and thoughts about your words. 1st- There are over 30 email correspondences between you and I, from between your intially contacting me in 2006, until the last one on November 24th. During the course of our pre-procedure emails, I learned that you were disappointed with the results from a prior procedure performed in Portland in 2001, and that you had relatively fine hair throughout. After evaluating your situation, I advised you that, as stated in my email onb August 27, 2007 , quote "I do anticipate that I can at least partially fill in those areas of greatest cosmetic concern with a procedure of 1200 to as many as 1500 or so grafts. The KEY DETERMINANT AS TO THE DEGREE OF IMPROVEMENT YOU CAN EXPECT IS THE THICKNESS OF YOUR HAIR IN THE DONOR AREA. I know you have been through this before, but I do believe that, given my experience, I can achieve as good an improvement as possible." 2nd- We planned on performning 1200 to 1300 grafts, yet I able to obtain 1620 grafts, which was provided to you as a courtesy. Most of your grafts contained one and two hairs. 3rd- I took extra care to explain to you that there was a limit as to the amount of coverage you could expect, but that I would do my very best- for I only wanted you to have realistic expectations. I had serious second thoughts about doing your procedure, for two reasons: first, you had many emotional issues related to your hair loss and disappointment with your prior work; and second, the fact that you were continuing to have some hair loss despite being on both Spironolactone and Synthroid. However, after extensive conversation with you, we decided that it would be worth a try to provide as much help for you as possible, due to the emotional toll your hair loss was inflicting on you. 4th-Post-procedure there are at least 6 email correspondences between us, when I have always been available to answer any questions you have. To date, you have yet to send me any post-procedure photos showing your results to date- which, at just 6 plus months, are very early. 5th- Hair transplants are not for every woman. However, in 2007, I performed 142 hair transplant procedures on women, and the overwhelming majority of them have had excellent results. I recently wrote an article on hair transplants in women for Plastic Surgery Products Magazine- and in the article, I wrote that the main challenge of these procedures is pre-op counseling, so that the patient has REALISTIC goals of the procedure. In your case, FHL, I really did try to do that, and explained to you that I would only do my very best, but could not guarantee good results, especially because of your prior experience as well as your thin donor hairs. I am here to help you in whatever way I can. It is important, for all patients, that you choose a surgeon with whom you can correspond- and I do feel that I have always been here for you, FHL. Sincerely, Jeff Epstein, MD, FACS Miami and NYC www.womenscenterforhairloss.com www.foundhair.com

Dear KevKris- I do now recall who you are, and wish to expand on some of your comments. Your procedure was performed on October 2nd, 2007, but we first starting emailing each other in 2005. During that time period, you scheduled surgery 3 prior times before you finally had your procedure, each time you cancelled or were cancelled by my office due to a lack of receiving a deposit. You were given patient references from throughout New England where you live, and we did everything we could to make your planning and research as complete as possible. For your procedure, you were charged for 2000 up to 2200 grafts, yet were given 2376 grafts and were not charged anything additional. Your procedure started at 10:15 am, and you were discharged from my office at 5:35 pm. Almost 7 hours with 12 of my assistants and myself working on you, including providing you with almost 376 free grafts at no charge, giving you lunch, and what you described as a wonderful and professional experience. You intially wrote into the Forum the day after your procedure to post about your experiences under a different name "jddidt"- here is the link: http://hair-restoration-info.com/eve/forums/a/tpc/f/746...351047243#3351047243 In this post, you described how wonderful we all were, how professional I and my assistants were, how our speaking during your procedure with you put you at ease, and how responsive I was to you- quote " arrived back at my hotel around 5pm, took my medication, and sprayed on some more Graftcyte (you need to spray this on every waking half hour for 3 days). For the rest of the evening I just kind of chilled out, relieved it was over and excited about future. I order some delivered Italian food, surfed the web, and watched TV. Dr Epstein called in around 8PM to check on me. He's very personable. Didn't just do it as a PR/obligatory service. He honestly cares! All and all, the procedure experience with Dr Epstein and his great staff was extremely positive." When you emailed me on Sunday, March 30th, I was on the first day of my vacation skiing in Crested Butte with my 3 kids- as a single dad, I greatly enjoy getting some special alone time with them, and like the remoteness of Crested Butte. I did reply to your email 3 days later, while still on vacation, where you expressed some concern about your lack of growth at 6 months, writing to you quote: "XXXX- It is still far too early to judge the growth- for some it can take 12 or more months. Let me go over your chart, and I want you to take things one step at a time and be patient. Sincerely, Jeffrey S. Epstein, MD, FACS Miami and NYC www.foundhair.com www.womenscenterforhairloss.com www.plasticsurgeryoftheface.com 305.666.1774 / 212.759.3484 / 800.370.2883" When I got back from vacation, I called you just last week to check in on you, once again reassuring you that you had some slightly delayed growth, but there was nothing to worry about. I also told you to call me anytime to speak with me, and that since I was going to be in my NY office this week, if you wanted to, I would be happy to meet with you. Instead, you have now chosen a new Forum screen name, and accused me of being a hypocrite- including stating , quote: "In closing, I find it disturbing that Dr Epstein spent far more effort and about three thousand additional words in replying to a couple of (bad pub) threads than he did to a personal email from a patient looking for nothing but support. The question I ask: Did I not warrant as much attention? Is this the same doctor who you described as " He's very personable. Didn't just do it as a PR/obligatory service. He honestly cares! Respectfully, -KK" Do you really think that when I both emailed you last week and this week called you, that I gave you adequate attention, and more importantly, providing you with empathy and support, as well as reassurance? How many doctors reply to their patients while on vacation? How many doctors provide the kind of stellar service you described the day after your procedure when the memories of your procedure were still quite fresh in your mind. I choose not to go any further with this thread publicly. I simply need to clear my name to the public. As far as your results go- at just 6 plus months, I will state publicly- it is too bad that your growth is not as good as it should be, but this IN NO WAY implies that the hairs will still not grow back, nor does it imply that I and my team of assistants did anything other than provide you with state of the art work, and finally, nor does it mean that, if for any reason, your hair does not grow in as well as it should that I will not replace your grafts at no charge. As I have always done, because I GUARANTEE MY WORK. Respectfully, Jeffrey Epstein, MD, FACS

Dear KevKris- I do now recall who you are, and wish to expand on some of your comments. Your procedure was performed on October 2nd, 2007, but we first starting emailing each other in 2005. During that time period, you scheduled surgery 3 prior times before you finally had your procedure, each time you cancelled or were cancelled by my office due to a lack of receiving a deposit. You were given patient references from throughout New England where you live, and we did everything we could to make your planning and research as complete as possible. For your procedure, you were charged for 2000 up to 2200 grafts, yet were given 2376 grafts and were not charged anything additional. Your procedure started at 10:15 am, and you were discharged from my office at 5:35 pm. Almost 7 hours with 12 of my assistants and myself working on you, including providing you with almost 376 free grafts at no charge, giving you lunch, and what you described as a wonderful and professional experience. You intially wrote into the Forum the day after your procedure to post about your experiences under a different name "jddidt"- here is the link: http://hair-restoration-info.com/eve/forums/a/tpc/f/746...351047243#3351047243 In this post, you described how wonderful we all were, how professional I and my assistants were, how our speaking during your procedure with you put you at ease, and how responsive I was to you- quote " arrived back at my hotel around 5pm, took my medication, and sprayed on some more Graftcyte (you need to spray this on every waking half hour for 3 days). For the rest of the evening I just kind of chilled out, relieved it was over and excited about future. I order some delivered Italian food, surfed the web, and watched TV. Dr Epstein called in around 8PM to check on me. He's very personable. Didn't just do it as a PR/obligatory service. He honestly cares! All and all, the procedure experience with Dr Epstein and his great staff was extremely positive." When you emailed me on Sunday, March 30th, I was on the first day of my vacation skiing in Crested Butte with my 3 kids- as a single dad, I greatly enjoy getting some special alone time with them, and like the remoteness of Crested Butte. I did reply to your email 3 days later, while still on vacation, where you expressed some concern about your lack of growth at 6 months, writing to you quote: "XXXX- It is still far too early to judge the growth- for some it can take 12 or more months. Let me go over your chart, and I want you to take things one step at a time and be patient. Sincerely, Jeffrey S. Epstein, MD, FACS Miami and NYC www.foundhair.com www.womenscenterforhairloss.com www.plasticsurgeryoftheface.com 305.666.1774 / 212.759.3484 / 800.370.2883" When I got back from vacation, I called you just last week to check in on you, once again reassuring you that you had some slightly delayed growth, but there was nothing to worry about. I also told you to call me anytime to speak with me, and that since I was going to be in my NY office this week, if you wanted to, I would be happy to meet with you. Instead, you have now chosen a new Forum screen name, and accused me of being a hypocrite- including stating , quote: "In closing, I find it disturbing that Dr Epstein spent far more effort and about three thousand additional words in replying to a couple of (bad pub) threads than he did to a personal email from a patient looking for nothing but support. The question I ask: Did I not warrant as much attention? Is this the same doctor who you described as " He's very personable. Didn't just do it as a PR/obligatory service. He honestly cares! Respectfully, -KK" Do you really think that when I both emailed you last week and this week called you, that I gave you adequate attention, and more importantly, providing you with empathy and support, as well as reassurance? How many doctors reply to their patients while on vacation? How many doctors provide the kind of stellar service you described the day after your procedure when the memories of your procedure were still quite fresh in your mind. I choose not to go any further with this thread publicly. I simply need to clear my name to the public. As far as your results go- at just 6 plus months, I will state publicly- it is too bad that your growth is not as good as it should be, but this IN NO WAY implies that the hairs will still not grow back, nor does it imply that I and my team of assistants did anything other than provide you with state of the art work, and finally, nor does it mean that, if for any reason, your hair does not grow in as well as it should that I will not replace your grafts at no charge. As I have always done, because I GUARANTEE MY WORK. Respectfully, Jeffrey Epstein, MD, FACS

Two other things. More Hair- It's not flowers I want, merely for people to give me a chance and not judge my entire career of 5000 plus cases by 3 or 4 patients (in baseball, that would be batting .999 or something like that, in basketball that would put to shame Steve Nash's free throw shooting percentage). Second, as a Clinical Instructor at the University of Miami teaching med students, residents and fellows, as an active presentor at scientific meetings and author of many scientific articles, and having trained over my career with some of the world's top plastic surgery and hair transplant surgeons, I appreciate the importance of realizing that every patient is different, and that even the very best surgeons cannot always have perfect results, but rather must never stop seeking to improve. Jeff Epstein, MD, FACS