Jeffrey Epstein MD, FACS

for sure- most of my colleagues will tell you to wait another few years before having a procedure. rather, you should consider going on Propecia. The one execption I make in young people is when there is diffuse thinning of the frontal forelock, and the goal of surgery is to work within that conservative forelock and fill it in. good luck- and please feel free, if you wish, to send some photos for me to evaluate. sincerely, Jeffrey Epstein, MD, FACS www.foundhair.com Miami and NYC

wish you the best of luck. in my practice, body hair transplants are used to augment the results from standard scalp donor hairs. i find that these hairs have a significantly lower rate of growth, but can, when they do grow, be effective in conservatively improving appearances. Jeff Epstein, MD, FACS www.foundhair.com miami and nyc

Benihana- I agree- travel to obtain the very best doctor is a small inconvenience, and avoids the need for reparative work in the future. Keep up doing your homework. Sincerely, Jeff Epstein, MD, FACS Miami and NYC www.foundhair.com

Carl- Glad to see you are doing your homework. For most patients, I do not require the hair to be shaved in the recipient area, as I know the problems this creates in returning to work and life as usual. This may mean the procedure takes a bit longer, but for most of my patients, this is a worthwhile tradeoff. One thing- are you 24 years old? Sincerely, Jeff Epstein, MD, FACS Miami and NYC www.foundhair.com

To this day, FUG (strip excision) remains the gold standard for hair transplantation. In most cases, the fine line scar heals as less than 2 mm in width, and with the trichophytic closure technique, it further helps to conceal this scar. In my practice, the cost of FUE-obtained grafts is around 3 times as expensive per graft. Jeffrey Epstein, MD, FACS Miami and NYC

Most doctors can put you in touch with some patients in your area. My office routinely connects prospective patients with some of our own patients who have already undergone a procedure. Best of luck. Jeff Epstein, MD, FACS www.foundhair.com

As a surgeon, I have always felt it is my responsibility to perform every one of the procedures myself- and this approach has served me, as well as some of my leading colleagues who have been mentioned in this discussion, well. Hair transplantation is no different than any other plastic surgery procedure, where subtle differences in aesthetics can make a significant difference. It is ny philosophy that the surgeon, and not the technicians or the clinic, determines the final quality. Another important point brought up in this discussion thread is the issue of graft counts- where the performance of 3000 or even 4000 plus graft procedures are promoted as "superior". The reality is, all graft counts are not equal- for it is the number of hairs and not the number of grafts that are important in determining density. I cannot tell you how many patients I have seen for second opinions have been told that they are a candidate for a 3600 graft procedure - when in reality, unless follicular units are separated or there is some creative graft counting, the maximum graft count may max at 2600 or so. I don't know how to explain this difference- but I cannot emphasize strong enough to perspective patients to do their research, look at photos of the surgeon's actual results, and see what kind of graft counts were obtained. Jeffrey Epstein, MD, FACS www.foundhair.com

Eyebrow transplantation is one of the most challenging delicate hair transplant procedures, and I cannot advise you strong enough to find an experienced surgeon. You should conduct a thorough investigations on the internet, and make sure that your surgeon performs these procedures on a regular basis. To have this procedure performed right the first time is worth the additional time researching to find the best surgeon as well as the time to travel to have it performed. Jeffrey Epstein, MD, FACS www.womenscenterforhairloss.com www.eyebrowtransplantation.com

Paul Rose presents the best perspective on this debate- and that is, we clearly have a device that has, at best, some marginal efficacy. There is no debating that it is not the cure for hair loss. Furthermore, I find there to be a paucity of photos or patient testimonials adequately proving the efficacy of what is an expensive therapy. There is a difference, a definite difference, between minoxidil and lasers, and that is the financial incentive for proprietors- whether physicians or non-medical hair clinics- to sell this technology. I have heard too many patients report that they were sold laser therapy as an additonal $1000 plus adjuvant therapy to their hair transplant. According to a patient who consulted with me, the clinic with whom he had his hair transplant told him that the reason he did not get full growth from a hair transplant was because he did not comply with the post-procedure laser therapy regime that cost somewhere around $1000. In addition, these lasers are promoted to physicans and hair clinics as "profit centers"- making me question the motives of those who provide them to patients. I am not saying the device doesn't work- only that we need more evidence before we elevate the expectations of our patients who pay all this money. Science commands objective analysis- which all too often is thwarted by financial incentives. Almost all reputable scientific meetings and journals require authors/presenters to reveal any financial incentive he/she has with a specific technology. This allows the listener/reader to put the information provided in perspective. This is not to accuse any doctor of being disreputable - only that it puts the entire situation in focus. I can provide my financial relationships with companies: none.

That's right- I am in my Tampa office for consultations on an intermittent basis. The office is able to provide all after-procedure care including suture removal and follow up visits. Sincerely, Jeffrey Epstein, MD

Dear Community- I have read with great interest all of your comments and input on this topic. As a surgeon with almost 14 years of specializing in surgical hair restoration, with plenty (too much, unfortunately) of experience repairing bad hair transplants, and seeing many many patients seeking to improve their results from prior procedures, I have in turn developed an approach that I feel maximizes results, while minimizing the risk of complications. As such, there is a balancing act- as to obtaining the maximum number of grafts, while avoiding any significant donor site scarring as well as making sure that patients achieve the kind of density they have come to expect from seeing my work. I have not embraced the 4000-plus graft procedure except in those cases of significant scalp laxity, high donor density, and maximum demand for hair. Not to say that this is the norm, but I have seen TOO MANY patients who were told by their surgeon that they were getting 4500 grafts- but in reality, these grafts contained no more hairs than what I transplant in a 2800 graft procedure where I do not divide up follicular units, and/or these patients were left with too wide of a donor site scar to be acceptable to my standards. I am looking forward to seeing my patient again, for I do anticipate speaking with him about going to perhaps 3000 or 3200 grafts, if it seems appropriate and without increased risk. I so encourage all of you to visit my website photo gallery and see the kind of results I typically achieve with procedures of 2500 to 2700 grafts. Furthermore, I welcome any of you to write me directly with your thoughts/feedback. Sincerely, Dr. Jeffrey Epstein www.foundhair.com Miami and NYC

Dear Gentlemen- Pat brought to my attention the discussion going on at length about my charging for consultations, and unfortunately some erroneous information is being passed on. I have been in practice for almost 14 years now, providing the state of the art work with my dedicated team of 14 assistants. Never have I had anyone do my consultations other than myself- I personally take the time to meet and speak with each patient, examine him or her, and provide them with my recommendations. Sometimes those recommendations are to not undergo a procedure, for my reputation for being honest is my most important asset. I typically receive 6 new internet inquiries EVERY DAY, as well as follow up emails with more questions from easily another 10 patients a day. I typically spend 3 hours a day personally replying to these emails, as well as speaking with patients on the phone- for NO CHARGE. Why?- because i am trying to help people even if that means advising them not to have a procedure but to answer their medical questions. In addition, along with personally performing 2 procedures every day, I typically see 5 new patient consults in my Miami office- and do not charge for these consultations. These patients are provided with my recommendations based upon my thousands of cases' experience. Last year, due to the overwhelming demand for my work in the northeast, I opened an office in NYC. When I travel to NYC, I typically travel with 5 of my assistants and office manager, and pay an additional (not cheap- the office is located on Park Avenue and 56th Street) facility fee (i.e. rent) for these 2 days. To help offset the extremely high additional cost to me, I have decided to charge for consults a fee of $175. Let me be very clear, to all of you who feel you have the right or the knowledge to even question where my heart is, that I have waived this fee when patients are unable to pay it- such as the young male who is just starting to lose hair, or the burn victims. I am not in the business of telling online consult patients that they should go to my NYC office and pay me $175. Clearly, Greg's online consultation form required me to meet with him in person- perhaps he was quite young and I felt it particularly critical for me to examine his donor area or to assess his maturity for the procedure. As a physician, I sometimes need to personally meet with my patients beforehand, prior to their flying a long distance for a procedure and typically blocking out a period of time afterwards for healing. In order for me to PROPERLY assess the occasional particular patient, I sometimes need to meet with them in person. Likely once he called my office, he was told by the person making his appointment of the consultation fee- and if there was a particular problem with that, he could have asked that the fee be waived, which my office typically does I love what I do, and I give my heart to each of my patients to make sure they get the very best results. I cannot understand how some of you can criticize not only the way I manage my practice, but also to question my integrity. Who are some of you to criticize from such an uninformed perspective. Let me tell you how many hundreds of thousands of hours I have put into my training, my lecturing, my writing, my pro bono work, my teaching at the University of Miami- none of which has ever been compensated for. So now I charge a relatively small consultation fee to help partially offset my extremely high costs of making it easier for patients in the NY/New England area to see me, and I am criticized? If anyone wishes to have a consultation with me, I am happy to provide the most information I can by an online consultation www.foundhair.com or by email jsemd@foundhair.com. And I want to gratefully thank those whose comments were positive, more reflective of what I and my office provide for every patient.

Not sure why my prior post did not come through- perhaps because I attached some photos. I'll have Pat add my photos to the post. The trichophytic closure technique has been used by plastic surgeons for years in browlift surgery. During my plastic surgery training, we learned the importance of choosing the proper edge to deepithelialize- thus my choice of the lower edge. This is a technique I have been using for 6 months, and last month I presented my technique and experience at the Live Surgery Workshop held in Orlando. Overall, the best candidates for the procedure are those with fine hair, while not as good candidates are those with thick curly dark hair, due to the higher incidence of cyst formation. Also, second surgery patients are not as well treated as first timers. Jeffrey Epstein, MD, FACS Miami and NYC www.foundhair.com

Dear Yeti- Not sure if you have had an opportunity to speak with or even meet any of my patients who live in the UK. Please let Roxy from my office know if you would like for us to arrange for this. As far as scarring goes, the trichophytic technique, which I have presented most recently at an international hair meeting, helps to reduce scarring. Sincerely, Jeffrey Epstein, MD, FACS

Credentials do provide some degree of assurance of competency, but only those that hold relatively high credentialing standards- such as recognized medical boards like the American Board of Facial Plastic and Reconstructive Surgery, Fellow of the American College of Surgeons, and the American Board of Hair Restoration Surgery. However, you all have the most direct way to evaluate surgeons- just go on the websites, and look at actual photos. And not just 5 or 10 before and afters, but 50 or 100 or more, to get the very best picture of what the doctor is able to do. Artistry, professionalism, and commitment to patients is not something one can read from a list of credentials- it comes from seeing the doctor's work, hearing what other patients have to say about him, and speaking or emailing with the surgeon directly. Sincerely, Jeffrey Epstein, MD, FACS http://www.foundhair.com

Dear MW- With over 12 years of transplanting experience, the situation you describe is definitely very atypical, but can rarely occur, even with a respected doctor. I have some questions: Do you take any nutritional/bodybuilding supplements?; Do you smoke cigarettes regularly?; What was the degree of hair loss originally? Sincerely, Jeffrey Epstein, MD, FACS http://www.foundhair.com

Steve- My suggestion on finding a top surgeon is to go through the photos they provide on their website, then consider making a consultation appointment with one or two of them. Ask to speak with one or more of that doctor's patients, and find out just how many reparative procedures the surgeon performs every week. Most patients in your situation will feel that it is worthwhile to travel if necessary, however right in NYC you do have not only myself, but also Dr. Bernstein who is a respected colleague. Sincerely, Jeffrey Epstein, MD, FACS Foundation for Hair Restoration Miami and NYC

Dear Incubus- First, any type of procedure performed at just 20 years old should have been done very very conservatively. Second, the results of the second procedure can likely be at least moderately improved, including a repair of the donor site scar. Your best bet is to send some photos to some of the doctors you choose, possibly having a consultation with one or more of the doctors in the south Florida area, and see what can be done to improve your appearance and more importantly, your self image. Jeffrey Epstein, MD, FACS

Personally, for over 12 years, I have advised my transplant patients to use minoxidil typically once daily for the first 3 to 4 months after a procedure. It has been my experience that this results in an acceleration of regrowth from transplanted hairs, cutting down the interval between procedure and new hair growth from 3 1/2 to 4 months, down to 2 1/2 to 3 months. Not necessary, but certainly helpful- and can even be helpful if used as infrequently as once every few days. Jeffrey Epstein, MD, FACS Foundation for Hair Restoration Miami and NYC

Dear Joe- There are a number of reasons why I would seriously advise you against having any hair grafting to the crown region. Given the size of your crown region (which will only increase in size with age, unless you maintain an impressive response to Propecia) it would take a minimum of 1200 to 1500 grafts to achieve even a modest increase in the density to the area- assuming you have all 1 to 3 hair follicular unit grafts placed to the area- and these are grafts that you should "conserve" for work in the future along the more anterior regions of your scalp. The results of crown work are never as impressive as they are with further forwards work, likely due to both the actual large size of the crown area which is usually underestimated, as well as the fact that, if restored properly, a swirl pattern will result in the hairs growing away from each other, thus resulting in a thinner look for the amount of grafts expended. This is the advice I give to all of my relatively young patients such as yourself. I use the anecdote- You know why camels smile all the time? It's because they cannot see their humps. Enjoy what you have up front, and don't make a mistake that you will likely regret years in the future. Get real finasteride, to provide you with the best chance of maintaining your crown region hair. Best ofluck. Sincerely, Jeffrey Epstein, MD, FACS Miami, FL www.foundhair.com

Dear Nile- Having performed over 2,500 reparative procedures over the past 10 years (approximately 25 to 30% of all procedures I perform are on patients who have had work done previously and with which they are less than satisfied) it is my recommendation that you pursue one of two courses. Option 1 is to have all of the plugs removed- this is called punch plug removal, and involves the removal of the plugs using similarly sized punches, then the 3 or 4 mm remaining holes sutured closed. This likely would require two procedures spaced a minimum of 8 weeks apart, and will result in some fine line scars which are much less noticeable than the plugs which are now quite evident. Option 2 is to undergo further grafting- which could basically allow, with the placement of 2500-plus grafts in a single procedure, for the filling in of the anterior one-third to two-fifths of the top of your scalp. The downside to this technique, in your case, is that your plug grafts are placed so low, seemingly less than 8 cm above the root of your nose, and therefore would result in a very low hairline. Therefore, I recommend you first have the plug grafts removed, then if you wish to have hair, pursue the transplant option. Finally, there is no reason I can see for you looking to have body hair placed- this is not a standard approach, with a typically low rate of hair growth, and besides, your donor area likely could donate a total of 5,500 or more grafts, even with the scarring from your prior plug grafts. You can see lots of examples of reparative procedures by going on my website (www.foundhair.com) as maybe on the websites of some of the other physicians listed under the Network. Sincerely, Jeffrey Epstein, MD, FACS Miami, Boca Raton and Tampa, Florida www.foundhair.com

I want to thank you all for considering me in this discussion. I can only advise you all, as prospective patients, to do your homework as Pat has instructed you all to do. Speak with other patients, and most importantly, speak with the surgeon and see his hairline work. Wishing you all positive experiences. Sincerely, Jeffrey Epstein, MD, FACS Miami