Dr. Bernardino Arocha

Can’tdecide, I often see men with advanced stage MPB but residual forelock even the most minimal ones with 10-100 hairs ask what is the chance that I may damage their native hair during their surgery? The lesson is that even this minimal amount of hair gives some framing which gives the patient some valued benefit. Dr. Beehner has lectured for years about his approach to surgical restoration of Advanced stage MPB. At the heart of his design is the important forelock area. So you are correct the restoration of the hair line with a focus on the forelock has a profound benefit in our patient’s hair restoration outcomes!

Congratulations Dr. Frank, Work looks very natural and refined! Nice to see you posting. Welcome!

Sorry the link did not work, here it is :http://www.arochahairrestoration.com/en/art/157/

Greetings to all, RC West was correct in saying that: “crowns are the black hole of hair restoration.” They can put great demand on precious donor, so it is usually advisable to consider future hair loss progression, donor / demand ratio and contemplating the quandary of “robbing from Peter to pay Paul.” In other words weather there will be enough available donor to complete the restoration completely as the pattern is fully expressed. Finasteride use can help conserve donor by maintaining the crown. Please see Principles of Crown Hair Restoration for further details. In restoring crowns it is important to anchor the transplant into the thinning areas that are furthest out, that is to work from the outside in. So the first area loss is the last to be restored. This is to prevent hair islands from developing or the halo effect. Thank you all for watching and for your comments!

Gentlemen, No one is saying that this is the best result in terms of density. Quite frankly, I am expecting more to come in the next month or two. I am concerned about it. We are not trying to hide this case why in the world would we post it on an internet forum. We do not want to rush prematurely when there is the possibility that more may grow in only 1-2 months. We pray that there is no underlying physiological reason why this transplant has strayed from the more usual course. We always stand behind our work. We would like to meet with the patient privately to clarify the plan.

So in his case it has worked out great for him even without Propecia. Remember that he is only 5 months post op and he will improve much more in the front/ hair line and crown area at initially. However, with the passing of time, he will likely continue to thin his native hair, as it is genetically programmed. Eventually, he might need a small touch up if this occurs.

Thank you ladies and gents for all your support and kind words. Let me clarify, we always recommend medical treatment to mitigate the chronic progressive nature of Androgenetic Alopecia in our MPB patients. However, remember that the threshold for the visible detection of thinning is 50% hair loss in the area. Our patient had a relatively stronger bridge, with more significant thinning in the frontal third and mid-scalp /crown areas. Hence the 4500+ FUT procedure was enough to restore his frontal and crown areas.

Gentlemen, I would like to start off by stating that our team is also extremely disappointed that our patient was not able to have his procedure done. Our business is to restore people’s confidence by giving them hair. Both sides lost in this case. Our office has never offered 0% financing. We signed up many years ago so our patients had the option to finance the procedure using only the extended payment plans. The company charges us a certain percentage to have these financing plans available to our patients. Other than that, we have no involvement with the two financing companies we use- Chase and Care Credit. Because I am the surgeon, I do not deal with the financial aspect of the procedure. I do not want to pressure my patients by inquiring about their financial situation. Vanitysucks never mentioned anything to my staff or myself with regards to 0% financing until that morning. We have not had problems with this company in the past. I would like to point out that we accept most major credit cards. He had credit cards available. He could even have used the Chase option temporarily as a bridge loan, as it has no prepayment penalty. That would have allowed him to have the procedure and then look for a credit card with a zero or low introductory rate. We expressed these alternative options to him the day of his procedure. We respect his decision not to go through with it. Not only did he lose out on receiving hair, but we lost out as well. It is very unfortunate that this incident occurred, since my team was there ready to treat our one and only patient for that day. My entire team and I eagerly awaited treating this patient, and even had several conversations with him leading up to his procedure date. The patient was visibly perturbed, and I regretted this, but I never want to be pushy. We called him the following day to offer to drive him to the airport; however, our calls went unanswered. In order to respect his privacy, any further matters regarding this situation will be discussed offline between the patient and myself.

MarkyGras, The oil based substances such as fish oil, flax seed oil, and vitamin E need to be stopped about 4 weeks before. Thanks again for this important question.

I appreciate your kind consideration and insightful precaution in preparation for your upcoming day. It is very difficult to accomplish a densely packed hairline and mega session hair restoration when a patient presents with thin blood. So I applaud you and every single patient who follows the provided preoperative instructions carefully. I would also add to avoid aspirin for at least 10 prior, other NSAID s or 3 days prior. To build up your coagulation factors eat plenty of greens, as much raw as possible, spinach, kale, mustard greens, dandelion greens, or liver. Stop Rogaine ,exercise and alcohol consumption 5 days before. If you follow these carefully your hair restoration surgeon will be very happy, as he will have a very clean surgical field, and what's most important you will have a far easier day. I find that patients that bleed a lot also metabolize their local anesthetic much more rapidly. This will prolong the day and increase the level of discomfort needlessly.

Hello MarkyGras, We are excited and looking forward to working with you. Please do not hesitate to call our office directly toll free 888-723-4247! Thank you for posting such a relevant and important topic! There is one study that suggest that MSM is safe for up to 12 weeks. I do not know how safe it is for longer term use. It presumably works by providing sulfur. With regards substances that should be avoided prior to surgery to minimize bleeding, here is a list compiled from the textbook by Drs. Unger and Shapiro and myself: HERBS, SUPPLEMENTS, AND VITAMINS THAT CAN POTENTIALLY INCREASE BLEEDING. ANGELICA ROOT ARNICA FLOWER ANISE ASAFETIDA BOGBEAN BORAGE SEED OIL BROMELAIN CAPSICUM CELERY CHAMOMILE CLOVE ALCOHOL COENZYME Q10 Creatine DANSHEN DEVIL’S CLAW DONG QUAI FENUGREEK FEVERFEW FLAXSEED LUCID GANODERMA GARLIC GINGER GUGGUL GINKGO BILOBA GINSENG GREEN TEA ONION HORSE CHESNUT ICORICE ROOT LOVAGE ROOT PAPAIN MAGNESIUM MEADOWSWEET PAPAW PARSLEY PASSION FLOWER HERB POPLAR QUASSIA QUININE RED CLOVER SAW PALMETTO RUE SWEET CLOVER TURMERIC UMBELLIFERAE VIT. E WILLOW BARK SZECHUAN PEPPER PLANT BARK Topical Rogaine

Thanks Mick and all, I appreciate your taking the time to view our work and all your kind comments!

Nice and natural outcome which matches the density of the overall top of his head. Bravo!

mag39, It is impossible for me to render an opinion without the benefit of seeing you. I was just answering part of your question. Good luck.

mag39, This is an important blog, as there are many drugs that can cause hair loss in the different stages of the hair cycle. The most commonly prescribed drugs that can cause hair loss include: Captopril and Enalapril, Dicumarol, Heparin, and Warfarin, Carbamazepine, Mephenytoin, Phenytoin, and Valproate, Atenolol, Lavetalol, Metoprolol, Propanolol and Timolol, Bromocritine, Verapamil, Cholestyramine, Clofibrate, Nicotinic Acid , Cimetidine , Levodopa , Lithium , Nitrofurantoin , Ibuprofen , Isotretinoin , Aminosalicyclic Acid and BCP’s. However, it is important to realize that still the most common cause of hair loss in both men and women is still pattern hair loss arising from inherited patterns of hair that are miniaturized under the influence of hormones or their metabolites.

Johnny1386, Hair color does have a significant impact on hair restoration outcomes. It is the amount of contrast between the skin color or complexion and the hair color that is important. That is, dark hair with pale complexion will appear thinner, while dark hair with a dark complexion will camouflage better hence appear thicker. For more information on hair characteristics and their impact on outcomes, please see:How Hair Characteristics Impact Hair Transplant Results | Hair Loss Q & A

Hello Happy, Welcome to this online community the Hair Transplant Network. I am glad that you recognize the importance of researching hair transplantation and options. A thorough evaluation is of prime importance it does include diagnosing the cause of the hair loss, and subsequently determining the best treatment options. Of utmost importance in the title of your post is the experience part, trichometer or any other instrument is just that a tool that in the hands of an experienced hair restoration physician can be used to your advantage. Be weary of heavily marketed machines, and gadgets, nothing can replace the skills, knowledge and experience of the doctors that are showing consistently excellent results on this network! Hair characteristics are very important factors to take into account in the short and long term planning of hair restoration surgery, here is a link to an article:Is there a Way to Accurately Measure Donor Density for a Hair Transplant? | Hair Loss Q & A How Hair Characteristics Impact Hair Transplant Results | Hair Loss Q & A Hope this helps, B. Arocha, M.D., ABHRS Dallas Hair Restoration, Hair Replacement by Dr. Arocha in Dallas, TX

gynuine, Thanks for your kind comments. This patient hiked the South American Andes with a heavy back pack soon after his procedure. His donor scar while not bad is a little wider than our usual donor scars. Please take a look at this link:Photos - FUT Donor Scars on Hair Transplant Dallas for Dallas Hair Restoration in Dallas, TX

Danielkiwi, The answer is yes; we always do estimate the donor density. Remember that it does vary along the length of the strip. Normal density, before AGA sets in is about 100 FU/cm2, so these FUs are normally spaced about 1mm apart. This is the pre hair loss density, after AGA sets in it can be much less. So usually the numbers the donor yields are very close to the estimated, but there are many unknown factors that can come into play during surgery that may decrease the actual yield. We always do our very best to get the target number provided that it is done safely and soundly. RadioShack makes the device that is referenced on Dr. Rassman’s web site; it is called the illuminated microscope. There is nothing magical about it, it costs about $15. Yes I do have one, but whether I use it or count with my surgical loops, it is the same. By far the easiest way is to take a jpeg with my high def Nikon, load it into my Mac, were I can blow it up as much as I need on a 30 inch monitor, where the counting is easy!

There are several devices to measure follicular density. Basically it is a magnification lens with a 1cm2 demarcation. To use it we trim the hair in the area, then the loop is used to view and count the number of follicles in the 1cm2 area. The problem is that in most individuals the density varies all along the strip, higher in the middle and lower along the sides. Also the breakdown of the number of hairs within the follicles varies along the strip, with more one and two hair follicles in the temporal sides and a higher percentage of 3+ hair follicles in the middle of the strip. Despite all the above, most experienced hair restoration surgeons can be fairly accurate within ± 50 FU most of the time.

Anouar, It is common for balding men to trim their hair short, to decrease the density disparity between their thick fringes and the thinning area. This patient had no part in the before photos, simply there is little to part. The hair in the frontal and mid-scalp was miniaturized. The transplant plan drawing clearly shows the reconstruction of the hairline, frontal and mid-scalp areas, these were the main areas restored. Some transplantation was done to the left side crown. The placement photos have been in the gallery. While this is an excellent growth for only 8 months, there should be much further improvements in the coming months. For the size area restored this is not too large a session!

azn_guy If you are thinking of DUPA, diffuse unpatterned alopecia, then you are correct they are not candidates, because they will miniaturized their donor hairs. However, this patient has patterned hair loss, going from a persistent anterior fringe to a NW 6, hence he was an excellent candidade. Anouar, We are one of the few practices that does not shave the head for surgery, are you suggesting that we trim them for their after pictures? Study the before after photos, I think the transformation is very significant. If you need more information take a look at his video: http://www.youtube.com/watch?v=tias0KgYR8c For further questions, take a look at our new web site: http://www.dallashairloss.com/

Severn, Of course Drs. Hasson, Wong, and the Shapiros are excellent surgeons and very capable of treating a minor case of pitting. My post was simply to answer this gentleman's questions; I am not suggesting that he should travel all the way from California to see me. Do not get me wrong, I am always more than happy to do anything I can to help. However, with many capable surgeons recommended in this network in closer proximity to this gentlemen's home, I think he might be better served if he visited them. Drs. Carman, Rassman, Reed, Ross and Gabel are some that I think he should consider.

hairtop, It is absolutely possible to correct pitting, especially such a small number.I am sure that there are many excellent surgeons close by that can help.

It is not the number of procedures that is finite but the number of follicles that are available to be moved, i.e. the donor bank. Withdrawals from this donor bank can be of any size but the total will never exceed the amount present in the donor bank. In general, it is always better to accomplish the goals in as little a number of procedures as possible. That is, because it is always easier to maximize the yield from the donor if less procedures are done. It is generally fine to stage the hair restoration over multiple procedures, as long as sound management of this precious non-renewable resource is adhered to.The preceding refers to donor management in FUSS procedures.