Dr. Bernardino Arocha

The secret to getting very fine scars that is minimally visible to invisible lies in the minimizing of tension vectors at the wound margins. Consequently, all my FUSS patients get two-layer closures. The deep layer, is the workhorse, it brings the wounds margins close or nearly touching by interrupted sutures. Then the superficial layer is closed with a running baseball suture. I use all kinds of sutures; always of course an absorbable suture for the deep layer, as this will stay in place. The choice of suture in closing the superficial layer is immaterial, as this suture will be removed anyway. For more information, please see: http://www.arochahairrestoration.com/en/art/104/

mmhce, Technically this is not cobblestoning. It appears to be tenting, which results when FU grafts are left elevated or sticking out too much. Sparky, is correct, this will be easy to correct in a small FUT procedure by a competent surgeon.

stromhold and Mike the Dane, It is difficult to make recommendations without the benefit of an in person consultation. My comments are just my comments based on the information you are providing.It is worrisome, that in spite the foresight of the maximal medical therapy for almost the past year, there is no significant growth in the crown area. Well, if you had the benefit of reading the articles at the links provided, you would know the reasons that crowns require more work, frequently needing a second touch up procedure. My approach would be to restore the hairline, frontal and mid-scalp areas to your satisfaction, before embarking on the crown. MTD is correct in worrying about your crown, because of the vertical component, which in essence acts as a billboard because of the way the light hit the follicles. These vertical crowns can eat up a lot of grafts. I have successfully restored NW 7s with large vertical crowns but they require a serious commitment in both donor resource and time. Stromhold, What side effects? Finesteride has been around in the form of Proscar (Finesteride 5 mg) and used for the treatment of BPH for 20+ years. We know that it is a safe and efficacious medication from having used it for that long. I don't think that it will cause permanent damage. Also, I am not saying that you should wait until you are a NW 7, I encourage you to get evaluated, in a personal consultation. All the best!

stromhold, There is no doubt that you have an advance MPB, destined to be NW 6/7. It is a very good advice to start on maximal medical therapy consisting of Propecia, Rogaine 5%, and Nizoral 2%. Do not lose hope because cases like yours while challenging are able to be successfully restored if the donor characteristics are favorable. There are many examples of similarly severe MPB that were favorably restored, here are some: Here is a link to articles: http://www.arochahairrestoration.com/en/art/128/ , http://www.regrowhair.com/hair...patterned-hair-loss/

Thanks hair_care, That is correct he has at least that much longer to grow. What's more on exam he had TNTC stubble on palpation, and that confirms your suspicion!

Thank you hairthere, It is all about the positive changes and happiness that is created. There is too much bad things happening in the world. It is just a small increment in the positive karma, but we are all trying to turn the tides and increase the World's Karma bank one patient at a time.

Dieting with total calories of as much as 1200 can result in diffuse hair shedding in 1-6 months after the start of the diet. The prognosis for recovery of the hair is very good after discontinuation of the diet. For more information on nutrition and hair: http://www.arochahairrestoration.com/en/art/99/

Thanks for taking the time to view and for your kind comments azn_guy_001, Mick from Farjo, Severn. Sorry about the tardy response, we were out of town. It is correct that scars do take 6-12 months to mature; during this time it is more likely to stretch if tension vectors are applied to the margins. Hence, it is prudent to avoid lifting exercises that causes pulling in the neck area. Patients with looser tissue are also prone to stretch more. Spot on, the hair stylist was overly aggressive with the clippers, a fade from 0- 3 is fine, but leaving it a little longer (2 or 3 guard) over the scar will minimize scar visibility. If the scar is still visible after the healing is complete, options are to do a revision of the scar, or FUE transplant into it. For additional information: http://www.arochahairrestoration.com/en/art/104/ This patient is so thrilled by his rejuvenated look that he is not concerned about the scar. B. Arocha, M.D., ABHRS

Future_HT_Doc, Mick from Farjo, Bill, orangehair, and thanatopsis_awry: Your kind comments are very much appreciated, to have the approval of experienced posters such as yourselves is very meaningful. hair_me_out, I hear you clearly, thank you so very much! We love your comment "Hair Dr. Rock Star." We will work very hard to try to never lower the bar! You are a cool cat. Happy New Year to all. All the best in 2010!

irish numpty, Thanks for taking the time to post, and for the kudos!

hair_me_out, No, it is not necessary to totally avoid, but I recommend modifying the exercising. It is advised that exercises that pull on the neck directly be avoided for that length of time, such as squats, and heavy shoulder shrugs. One can do most machines in the gym as long as it does not pull on the neck. Bench presses for ex. are ok but use good form, do not arch the back and pull on the neck while straining with weights than you are able to lift.

shine on, Remember that Plastic surgery is called what it is because of the skin's inherent elasticity or plasticity. Skin or scalp will stretch when tension vectors are applied. Such tension vectors applied to a wound before it has a chance to mature (6-12 months) will be more likely to stretch. For more information, please see: Post-surgical scars in Hair Restoration Surgery

rpachigo, Is absolutely correct. I first learned it from one of my mentors in my fellowship training, while learning scalp reduction procedure in 2002.

Dr. Shapiro, Nice discussion. I agree that the transplant yield is probably 95+%. In our center we perform serial harvesting, in order to minimize the out of body time. When the team completes the trimming of the tissue, then another section is harvested, while part of the team trims, others place and so on. It is a little more work, but worth it. Shine on, Those are some very good questions! Would love to answer, but I do not want to highjack this thread.

RajToor, Thanks for the kind words! This patient was a NW IVa, at only 5 months post op he is looking much improved. Happy Holidays to all!

RajToor: Thanks for the comments. This patient came in for a consultation at age 37, he scheduled the procedure for a few months later. The results posted on the web site state that he is 6 months post, he was 6 months post consultation, but only 4 months post-procedure. Sorry, my assistant overlooked that fact. He is now 11 months post procedure. Presently 39, but looking 20 is a good place to be! "Time stands still for no one." To grow old is a good thing, given the alternative.

We will be posting some additional jpegs and post placement photos to help shed some further light on his preoperative situation. However, I think that the photo of him standing in full noon time sun is definitely very illuminating about his result at only 7 months. Have a great weekend everybody.

thanatopsis_awry, Thanks again for the comments. This patient has certainly made a nice and natural improvement over the 10 months since his procedure. I agree with you that if he grew it out a bit the singling and layering would greatly improve his coverage, and look of greater density. I think that he has some military commitments, hence the styling. With a little more time the transplant will undergo further maturation and growth giving him a thicker result anyway.

Severn, Thanks for the kudos. I am sure the patient is happy with all the kind comments about he looking so much younger. We seem to want to be older when very young. Congratulations on your recent procedure and happy growing! thanatopsis_awry, You are absolutely correct, he has more maturation with thickening of the hair caliber and maybe even more growth to come. WE really appreciate you taking the time to post. Regarding the videos we are working on it, I just purchased a HD cam. Thanks to all. I need to get back to surgery.

Raphael84, Thanks for taking the time to post and for your positive comments. I reviewed your before jpeg and agree that your hair loss pattern looks similar, but his was much more severe. His hair caliber is fine. We will post other photos later. Thanks for your interest.

hair_care and Severn, Thank you for your kind words about how awesome and good the pics and more importantly the results are. I am sure that my patient appreciates that, not to mention I. hair_care thanks also for the compliment to my patient about looking young, he is nearly 40. Sound hair restoration is often very rejuvenating. Regarding the placement of the hairline, this hairline is very appropriately placed, as a matter of fact, it is very conservative. It is above where suggested by DaVinci's rule of thirds, at or above the 'shingling' point, and in-line with the line that goes from the ear lobe and through the temple point to where the hairline should be. At nearly 40, without crown hair loss, or family history of the same, with severe frontal and temple recession there is absolutely no reason not to restore his lost. With regards to donor management, this is also not correct. This patient has a large, dense donor, and elasticity of 15-18% on the Mayer-Paul scale. Regarding your estimate of his donor available, it is also a little off. Combining FUSS and FUE he has about 12,000 intact FU available. Notice his thick luxurious hair in the back! Have a wonderful weekend gentlemen!

Thanks Raphael84, The patient is enjoying his restored hair for now, he has not yet planned to do a second procedure to restore his crown. He is a good candidate if and when he decides.

Greetings! Thanks Bill and thanatopsis_awry, for all your kind words. Yes, I was aware of his styling preference. I always make it a point to ask, it may in certain cases, especially those that have financial constraints or donor limitations, to endeavor to maximize their outcome with certain hair styles. But in general, when our hands are not tied by such limitations, then my goal is to restore the hair to a neutral styling state close to the patients original hair orientation so they are not "boxed" in to any particular hair style.

29 yo wanting to restore the hair line, frontal , and mid scalp areas. He prefers to style his hair combed forward "Ceasar" style. The after photos are taken about 14 months post procedure.

On average, 10% of the hair is in the telogen phase at any time in the normal individual. The telogen hairs are more likely to be part of the larger follicular unit grafts, the 3,4, and 5 hair follicular units. This is yet another advantage of using transillumination and microscopes in the slivering and graft trimming processes.