Dr. Michael Meshkin

Hello there, I just became aware of this thread. I first want to thank all the kind words from every one, but I felt I must step in and clear some things before this goes any furthur. I have been performing hairtransplantation surgeries for the past twenty years exclusively, and I have never had any consultants to do my job. I do all the initial consults and then the prospective clients are moved to our scheduling room. I have very informative and experienced staff whom some have been working with me for the past twenty years. If the clients have any furthur questions which they may have forgotten to ask during the consult with me, they may either return and ask me or if they choose they can ask my assistants. However, my assistants' primary goal is for scheduling. The clients are always encouraged and welcomed to come back to me on the same day or make another appointment for a second or third consult if they do desire. I never proceed to do surgery unless all the questions and concerns are answered. We donot have any patient advocate, consultants or sales persons at our office now or ever. As far as my client AM is concerned, he came to our office this last weekend and six month hair growth progress is very good and on schedule. He was concerned about a small scar formation on the right side of the donor area. As I explained to him when he had his previous surgery with Hair Club, they took the donor way below the safe zone in the right side and compromised the blood flow in that region. As a result of that, the blood circulation was compromised in the right side which caused the scar formation. Furthurmore, because of the hair clubs mistake of taking the hair from the wrong area, the hair planted from his first surgery didnot grow. The left side where the donor hair was taken by me is healing perfectly and almost undetectable. I explained to him that when the scalp is loose enough , the small scar on the right side can be corrected easily. I have his prommision to post his before and after photos in a few months when his hair fully grows. I will post the final results soon.

We cropped the photos so that you can see the hairline more close up. Let me know what you think.

We cropped the photos for more close up pictures, I think you can see the hair line better closeup. I will see if I have any photos without flash to post here.

The patient is a class IV a and had minimal amount of hair in the frontal central area. We rebuild the frontal hair line,the temples and added density to the mid scalp area. I did shave the area we worked on, and unfortunetly I wasnot able to locate a preshaved picture. but if you look closely you can tell the minimal amount of native hair he had. Thanks mattj, and Dr. lindsey for your kind comments.

Thank you Dr. Charles, I appreciate your comment.

Medical Treatment and other options: Finasteride (Propecia), an oral medication available by prescription only, has been introduced to the market in the past decade. Finasteride is approved only for use by men. Through scientific studies, it has been shown to re-grow hair in some men and stop hair loss in an even higher percentage. Finasteride works by decreasing the formation of DHT, a hormone responsible in large for male pattern hair loss, while not reducing testosterone, the overall male hormone responsible for masculinity. Therefore, any side effects that may involve male sexual function are mild and occur in less than 2% of all patients. Finasteride has been available for over 10 years and has been shown to be somewhat safe and effective. Finasteride (Propecia) works best for early and moderate hair loss, but it may also help patients with more advanced hair loss to preserve their remaining hair, and its use is suggested by hair restoration surgeons as an effective medication to slow down or reverse male pattern hair loss in many men. It is often used as a complimentary treatment for hair transplant patients. Topical minoxidil (Rogaine) has been around for over 15 years and is helpful in slowing down hair loss, but less effective in helping new hair to grow. A higher concentration (5% solution) of minoxidil is now available for men and has been shown to be more effective than the 2% solution. 5% minoxidil solution is generally not recommended for use by women because it may stimulate the growth of facial hair, and also because at least one study suggests that it is not more effective than the 2% in females. Both finasteride and minoxidil must be used on a continual basis in order to sustain results, and if discontinued, the process of balding resumes. These medications may not work for everyone, but they have a proven track record that shows some benefit to many people. In addition, combination treatment with minoxidil solution and finasteride may provide added benefit for men with androgenetic alopecia. Laser treatments for hair loss are also available. It has been claimed that low level laser increases the quality and health of growing hair. It increases blood lymph and circulation to the hair follicles, decreases inflammation and energizes the follicular cells, allowing the hair to grow thicker and fuller. They come in forms of either laser combs or oscillating hoods. It must be used up to three times a week, each time 20 minutes for about 6-12 months to see the results. They are more effective if used in conjunction with Minoxidil or Propecia and are considered to be safe. However, the long term effectiveness and its safety need to be further investigated before the device is substantiated. It is important to research these products thoroughly before using them. There are many undocumented "miracle cures" that have circulated the market since the 19th century. You can either blindly accept the claims these products make and purchase them or you can approach them with some skepticism to discern the products reliability. It is always good to look for documented proof on products such as FDA approval to discern whether the product has in fact stimulated hair growth in a majority of persons using it in a safe manner with minimal side effects.

This is 25 year old patient with a class four on the Norwood scale of hair loss. He is thinning in the frontal hairline, temples and the mid front scalp areas. He didnot have any thinning in the crown area. When he came for consult, he had been using propecia and rogaine for a year and said that he didnot have any improvement and didnot want to use medical treatment. We decided to do a 2000 graft session, ultimately we did: 350 one hair units 475 two hair units 1300 three hair units for a total of 2125 grafts We only worked in the frontal hairline, temples and the mid frontal area, we didnot work on the crown. These are pictures from the before, immediate after, two week follow up and one year post op. He is currently not using any medical treatments.

1 year post-op Class IV A 2100 grafts frontal area

Hello guys, sorry about the late response, our internet was out for the past two days, complimentary of the storm in southern california. little rain and even the internet stops working, we are so spoiled here. This client is not on any medical treatment regimen as far as I know. His hair characteristics is thick, wavy and coarse which helps the look. He just returned for a second procedure a couple of weeks ago and we were able to fill in the frontal area for more density and also work on the crown area.

Class 6 MPHL 2000 grafts. Front and Midscalp area.

By the way if any one wonders, we did 400 ones, 300 twos and 385 threes for this client.

hello all, I am posting the cropped magnified photos, tell me what you think. Frontal Top frontal Right Temple . Left Temple

Thank You Bill for your comment. What I meant with my response to lost my swagger was that the hairline is also thick and natural in person, I didnot use any element or styling technique to make the post up pictures look good or the preops look thinner as questioned. These picture presentations are done exactly the way presented by many other clinics , as a matter of fact some clinics shave the preop pictures and then post ops are grown out hair with either comb down or styled a certain way to create more illusion of hair. I donot do that and my patients pictures and my results are still questioned. In regards to the camera, presently I am using 12 mega pixal camera, if you think that is not enough resolution, I will get a higher resolution. In regards to this client, he actually looks better in person then his post up pictures. To hopefully clarify the skepticism, I will add cropped/ close up pictures tommorow.

"where are all the "GREAT JOB", "LOOKS NATURAL" comments from the cheerleader squad? Not one positive comment from the squad... wrong doc?." Dear Not Just Yet I agree with you completely and I always wonder about that my self. To Lost my swagger , The hairline is very thick in person and also in the pictures. I will post a very close up picture tommorow so you can judge for you selves. And also with most of my clients, I do get very good results with less number of grafts and at a reasonable cost. Again for this patient, there is no photo shop and he looks absolutely great in person. I hope he allows me to post his video so you can see and hear him for yourself.

Hello NW, I visited your web blog and looked at your picture that you posted. You do have darker hair against a lighter color skin, so higher number of grafts would be recommended to get a more natural result. I was asked in another thread as to how I come up with the number of grafts needed and I will review that here. There are many factors involved in the decision making process, but I will name a few which are the most important. Keep in mind that even with a certain classification on the norwood scale of hair loss, each case is assessed individually. The elements that influence me to determine the number of grafts include: the patient's age, goal and expectations, the degree of hair loss, donor size, density and laxity, hair characteristics, the hair's texture-fine or coarse, the contrast between the patient's hair and skin color, and whether or not previous grafting procedures have been done and the progression of the future hair loss. Making treatment recommendations require an extensive examination and a frank discussion of possibilities between the patient and I. I also give the patient a realistic estimate of the total cost, number of grafts needed and number of procedures required to get the expected result. Sometimes due to economic factors, patients decide on the number of grafts according to their budget. We try to push for the desired number of grafts for the optimal result but some clients just cannot afford the cost. So we try to do our best with the number of grafts that the patients can afford and ultimatly decides to do.

Thanks future HT Doc, you have already matured in your understanding of hair restoration surgery and I aplaud you for that. You certainly didnot overstep your bounds and I do appreciate your understanding of my comprehensive approach for each customized treatment option, and I thank you for your comments.

Secondly, In this thread Some of you asked about the method I use to come up with the number of grafts for each procedure. There are many factors involved in the decision making process, but I will name a few which are the most important. Keep in mind that even with a certain classification on the norwood scale of hair loss, each case is asessed individually. The elements that influence me to determine the number of grafts include: the patient's age, goal and expectations, the degree of hair loss, donor size, density and laxity, hair characteristics, the hair's texture-fine or coarse, the contrast between the patient's hair and skin color, and whether or not previous grafting procedures have been done and the progression of the future hair loss. Making treatment recommendations require an extensive examination and a frank discussion of possibilities between the patient and I. I also give the patient a realistic estimate of the total cost, number of grafts needed and number of procedures required to get the expected result. Sometimes due to economic factors, patients decide on the number of grafts according to their budget. We try to push for the desired number of grafts for the optimal result but some clients just cannot afford the cost. So we try to do our best with the number of grafts that the patients can afford and ultimatly decides to do. During the initial consultation, at our clinic I spent a considerable amount of time to educate my patients utilizing computerized hair analysis to evaluate the extent of hair loss, hair characteristics, and donor density. I use different methods and computer animation to estimate the number of grafts needed for transplants. We provide all information necessary for our patient so that they can make an educated decision. Again, each treatment is customized to the patient's needs and concerns. I also use all viable treatment options, including nonsurgical therapies, such as medical treatment. I recommend beginning medical treatment of significant hair loss as soon as the problem has been identified. Even if a patient decides to proceed with a surgical hair restoration, medical treatments may slow or prevent additional hair loss in the future. Medical treatments such as finasteride and minoxidil are usually recommended for men with hair loss to help preserve or partially reserve thinning hair in the rear crown and in the top area. Hair transplants can be used to fill in the front hairline and thicken the front half of the scalp, and medical treatments can be used to maintain hair behind the transplants and to possibly enhance the long term results of hair restoration surgery. In the past twenty years I have always used a comprehensive approach to address each clients needs and concerns individually.

First of all I want to thank Dre for clarifying the situation, and I would like for him to call and make an appointment at his earliest convenience to come in, so we can find the cause for his hair loss and use all the available treatment options to help him.

I have already emailed this patient to return for a follow up visit to find out whats going on. I hope he responds.

I just posted immediate post ops for right and left temples. Let me know what you think.

I have to admit I was a little skeptical in posting this patient result because I knew some people may question the number of grafts, but it is truly 1000 grafts. I only have a few immediate post ups for this client which are a little blurry. I will post the ones that are clearer so you can judge for yourselves. This patient is a little shy in showing his face, but I have a video clip of him and if he allows me, and bill instructs me as to the way to post videos, then I can post the video for you. But again thanks for your complements.

post-op crown

pre-op crown

post-op right temple

pre-op right temple