Dr. Bernardino Arocha

Seattlejim, Youngsuccess is correct, it looks like you might have post surgical shock loss. The photos are blurry,and low resolution but it does not look like scar ? Rogaine 5% twice per day can help with post surgical shock loss, or just the tincture of time. It should recover. All the best,

Big_foot, Bill has offered some good information. Dr. Feller certainly is a fine surgeon option available for those in the New York area,the others are: http://www.hairtransplantnetwo...list.asp?StateAbr=NY .I was completing my answer to your questions, when your reply to Bill beat my posting it. Thanks for your interesting questions. It is a bit complicated to discern without the benefit of a physical examination. Alopecia Areata can manifest in different presentations: 1. The common annular 'coin' lesion(s): 2. Diffuse pattern hair loss; and lastly 3. Ophiasis, which occurs with a band-like hair loss pattern involving the temporal (sides) and occipital (back) areas. Traction alopecia resulting from the hair styling used by male followers of the Sikh faith can look a lot like the Ophiasis type pattern Alopecia Areata. Did your Dermatologist perform a scalp biopsy? That would have confirmed the diagnosis if there was a doubt. Both conditions can produce hair loss in a similar pattern, hence a scalp biopsy can shed light helping to differentiate the two and also rule out any activity if in fact you had Ophiasis type Alopecia Areata. If there is no disease activity presently, or if it was due to Traction Alopecia then you might indeed be a candidate for hair transplantation. I don't think that being 21 years per se precludes surgical treatment, even if you are predisposed to Male Pattern hair loss, as long as sound hair restoration principles are fallowed and you are deemed a suitable surgical candidate.

Ron J, Those are some very interesting and insightful questions. Please use this link to answer your questions about crown hair restoration: http://www.arochahairrestoration.com/en/art/157/ FUE can be a source of additional donor harvesting to provide further numbers of grafts if necessary. I agree with you that there is overzealous FUE donor harvesting in non-permanent donor zone, hence some transplants may prove to be temporary ones in those with the advance MPB genes. I have treated some severe stage 7 NW patterns with good results after only one session of course without addressing the crown. However, this patient was able to return for a second mega-session to address the crown and further refine the first transplant if need be. Here it is: http://www.regrowhair.com/hair...patterned-hair-loss/

Agree with Drs. Shapiro and Charles, and Ron J. These are all important points to consider in the hair restoration planning. The frontal third is pivotal in the creation of a nice hair restoration outcome after all it is what everybody including the patients sees the most while framing the face. The density in the mid scalp does not need to be created as high. A pivotal factor in the determination of the final outcome rests with the hair characteristics, here is a link to an article on this: http://www.regrowhair.com/hair...-transplant-results/ The ???black hole??? of hair restoration is the crown, in which the area grows exponentially with increases in the crown radius. Extra caution needs to be employed before undertaking to restore this area.

LOL Bill I appreciate your good intentions. Thank you PGP it means a lot to me to have your support. Of course I thanked Pat personally when he visited my office. It goes without saying that without Pat no one would be on this community, so I am indebted to him for that, and I sure do appreciate his great accomplishments. PGP, regarding the discount on our fees that is $2000 discounted from our regular fees per patient multiplied by the total patients that we are operating on in May and June 09 that is a substantial amount, if we really get busy maybe we can do more.

Thanks to All, Special thanks to Ceasar08,hairthere,WorkInProgress,milkman85 and Bill In appreciation of the communities overwhelming support we will be offering $4. per FU graft for the months of May and June 09.

ISHRS is an educational society there is little barrier to entry. The American Board of Hair Restoration Surgery and the International Board of Hair Restoration Surgery are the only credentialing organizations in the field of Hair Restoration Surgery.To sit for the exam requires either a one year fellowship or documented experience.

Speegs, I always ask the patients if they want to stage the procedure in more that one session. Why would you want more sessions unless it is for budgetary reasons. Remember that over 70% of my patients achieve their goals with only one session if they have the recommended size procedure and treatment.

Speegs, We perform everyday what the vast majority of hair restoration surgeons say cannot be done. With over 70% of our patients achieving beyond their expectations for a successful hair restoration. We prove on a daily basis that what they tell you is impossible is the norm in our practice. That is not to say that we cannot perform smaller sessions, it is only common logic that if you can do more, you can do less. None the less, you assume no risk because if you elect to do more or less it is none the less guaranteed that if any follicular units fail to grow we will replace them free of charge. It is that simple.

Greetings to all, quote: Originally posted by TC17: You said that Dr. Arocha quoted you $10,000 to $12,000 for 2,500 grafts, but that is a HUGE difference in price. Which one is it? $10,000 would be a very good price, but $12,000 would be pretty steep if you ask me. That's just what he said, about 2500 grafts and 10to 12K for the work depending what he did. It's not so much what I did, as when I did it. We were running a special of $4.00 per follicular unit that month. The regular price for FUT through FUSS is $5 per FU for the first 2000, then $4 per FU for any over that at any time. Thank you all for your time and comments.

Dr. Lindsey, I just noticed your post. My prayers are with your daughter, you and your entire family. I pray that your daughter has a speedy recovery and complete cure. All the best, Bernardino

Thank you gentlemen for taking the time to read and post, but most of all for your support. It is much appreciated. At Arocha Hair Restoration we take great pride in our work, in the past I have posted results early, often as early as the first fallow up visit at about 4 months. If you look carefully, of all the examples of our work submitted by Bill, there is only one at a full 1 year post op, one at 10 months, one at 9 months, two at 8 months and one at 7 months. So even without giving us the benefit of having our result fully grown out and maturing, I think that these are excellent transformations.

True infections in the scalp are rare post operatively, occurring in less than 0.1% of patients. When they occur and are treated properly, little to no damage should result. I have personally never seen one. Folliculitis can occur more fregquently, resulting from ingrown hairs , spicules or foreign body reactions.

mmhce, Theoretically, yes, but actually the occurrence of infections post surgery is less than 0.1% of surgeries. In my practice I have never seen one, other than the occasional patient that gets some pustules from ingrown hairs or spicules a few months after the transplant. However, caution is recommended after surgery to limit aerobic exercise for one week after surgery, not really because they cannot but to prevent exactly what you are describing , that increased perspiration outdoors can bring dirt and grime to the surgical area.

LOL, good one miked. You had me worried for a little while.

Thats for the same reason that it gets numb above the injection site of anesthesia when numbing the donor area. The nerve fibers run that way.

aska, kaounis is right, there is no problem. However, there can be some increase shedding when first starting minoxidil that lasts about 2 months before the hair actually gets thicker. Also there seems to be some synergistic action when combining propecia and minoxidil.

Thanks Dr. Lindsey for your input and experience.As a rule of thumb, to transplant into Discoid Lupus or any other Scarring Alopecia requires serial scalp biopsies 1 year apart showing no disease activity. Some advocate a small test TP to see if will grow, before embarking on a larger session. Once the above signals green, then I work from the periphery in,the density of the TP is dictated by the tissue response, bleeding indicating that the perfusion is adequate. Caution with epinephrine use, I avoid it in this situation to get the best unencumbered tissue feedback.

In addition, there is an extra step in handling,the loading of the implanter. The hairs needed to be left longer to assist in loading the grafts unto the implanter, so I do not think that FUE is an option with this placing method.

Mr.GQ I agree with Dr. Simmons. Tried using the Choi implanter on a few cases years ago. I saw no advantage,regardless of the method of harvesting, the FU grafts need to be loaded unto the implanters. These loaded implanters are then handed to the Dr.who uses it to stick and place the graft into the scalp. It did not seem to offer any advantage in my eyes.

Please use this link to the article as the pictures did not copy. Hope this helps. The results were at only 7 months, he has reported that his hair has improved considerably, but he has not come in for fallow up. Here is the link again:http://www.regrowhair.com/hair-transplant-surgery/approach-to-surgical-hair-restoration-of-advanced-stage-male-patterned-hair-loss/

Shadow of the Empire State thank you for your comments and questions. The key is reasonable expectations. I don't think that you have read my article entitled, 'Approach to Surgical Hair Restoraiton of Advanced Stage Male Patterned Hair Loss.' The fallowing is a condensed version of a presentation I gave at a cosmetic surgical meeting. Mon 9 Jun 2008 Approach to Surgical Hair Restoration of Advanced Stage Male Patterned Hair Loss Category: Complications , Donor Issues , FUT (Follicular Unit Transplant) , Hair Transplant Surgery , Post Operative Concerns , Session Sizes This insightful hair transplant article was written by Dr. Bernardino Arocha of Houston, TX who is one of our recommended hair restoration physicians. A survey of this hair transplant patient's bald head, shows that the lateral fringes and crown have completely been eroded. The lateral humps have been obliterated, and the hair on the temporal areas (sides) is quite low. This isa level 7 on the norwood scale of hair loss country, it is a follicular unit barren real estate , where there is more hair loss, then there is remaining hair! As if, that is not enough, study of the permanent donor area reveals that the hair density is decreased and the total occipital hair remaining is very diminished by baldness on two advancing fronts. From above, Androgenic Alopecia is eroding the crown, while from below a Retrograde Alopecia is raising the neck hair line. After careful study, it is determined that a minimum of 2000 follicular unit grafts will be needed to commence the hair restoration process. That is, 500 follicular units to raise the lateral humps. Into which, we can anchored the hair line , which is estimated to need at least 1500 follicular units. We do not know at this juncture, whether, we can achieve the full 2000 hair grafts, much less, any extra to transplant into the area beyond the hair line. As always, key is to conserve this limited donor hair resource. That means, binocular microscopy, for slivering and follicular unit trimming. This should increase our donor yield by 25-30%, by minimizing hair transection in this process. Also pivotal, is the use of single blade free hand harvesting of the donor strip. We also planned for a maximal donor harvest. The hair growth yield for this patient came in at 3500 follicular units, meeting our definition for a small hair transplant megasession . It was possible to accomplish the framing of the face, the single most important objective. Then we transplanted the frontal and mid scalp areas, addressing everything minus the bald crown. The crown was left to medical hair loss treatment, Propecia and 5 % Rogaine (minoxidil). While the medical therapy did not cause hair regrowth in the crown, it did improve the donor hair density and hair characteristics overall. Hence, the balding patient has the donor for another large procedure to address the crown or further enhance other areas. The patient had a very good early result at only 3 months post transplant, however, it was much better at 7 months, even though there is much more to come. The donor hair is coarse, making it more difficult to achieve a soft hair line. These results are very natural and the patient of course is thrilled. It may be only hair, but hair is only at the surface, what is even more gratifying is the boost in self-confidence that has been restored, alone with a much more optimistic outlook! Bernardino A. Arocha M.D. ??” Bill - aka Bill'Associate Publisher of the Hair Transplant Network and the Hair Loss Learning Center'View my Hair Loss Weblog Technorati Tags: hair transplant, norwood scale, hair loss, hair density, baldness, Androgenic Alopecia, Alopecia, follicular unit grafts, hair restoration, follicular units, hair grafts, donor hair, hair growth, hair transplant megasession, bald, hair loss treatment, Propecia, Rogaine, minoxidil, hair regrowth, hair characteristics, balding Thank you for sharing: | Ask a Question Related Posts: The Hamilton/Norwood Scale Is it Normal to Experience Hair Shedding With Propecia? How Can I Be Sure a Hair Transplant is Permanent and My Donor, DHT Resistant? What is the Cost of Hair Transplantation and How Many Treatments are Required? Can I Shave My head After a Hair Transplant? ADD A COMMENT You must be logged in to post a comment.'If you have a question, please use our "Ask a Question" page.

Shadow of the Empire State, it is not necessarily so that the younger the start of pattern hair loss the more severe or advance the Norwood stage that will develop. The final pattern is programmed in the genes. In general, the incidence of AGA Norwood III, IV, V, VI, and VII increases steadily with aging. The Norwood VI and VII patterns occur in 10% of men age 50-59, 23% of age 60-69, 22% of age 70-79 and 30% of age 80-89. In this study of 1000 patients there were no patients 20 something with Norwood VII. The important point is that even with the severe presentation of Norwood VII with thin donor it is possible to obtain a very pleasing hair restoration outcome, as long as, sound hair restoration principles are fallowed along with reasonable expectations. mmhce, thank you for your appreciation. Hair loss is usually never easy or welcomed, but it is more acute in the younger patients. In your twenties with only 20 % affected by hair loss or miniaturization you seem to stand out more against the 80% of your peers without the affliction.

TC17, We have talked and he stated that his hair has grown much thicker. He has been rather busy with work and his personal life, and it has been impossible to get him to come in for a fallow up visit.

veeru, Thanks. Probably not, I think that within the next ten years we will have hair multiplication available. Then you could go get all the follicles you want without touching your donor. Scalp exercises are good to increase the laxity only, hair loss is not related to scalp circulation. There are many good conditioners to use on your hair, Procyte makes a good one.