Dr. Michael Meshkin

post-op left temple

pre-op left temple

post-op frontal top

pre-op frontal top

post-op frontal

Post-op frontal picture

Thank you Bill for making me aware of this thread, and allowing me to properly respond. Even though this patient did not identify himself to us and we were not aware of his concerns, We took the liberty to go over all the patient charts and photos that we performed surgery on last November and were able to identify him from the pre-op pictures. Just to make this clear, I do not perform surgery on clients less that 22 years old unless the patient and his family insist that there is a severe pshychological impact on the patient, and in addition if the patient agrees to stay on medical treatment such as propecia and rogaine. In such a case, then I may consider the surgery and this was the case with this patient who came in with his mother. After extensive consultation with this client and his mother and having them both sign the consent forms to make sure they understand the consequences caused by performing surgery in an early age, I made an exception. I repeatedly made sure that he understood the need to stay on propecia and rogaine, if he wanted me to perform the surgery. Therefore we prescribed propecia and recommended rogaine from the beginning. Also I made it clear to him that since we are spreading the grafts into a large area, he needs to return for another procedure. The patient came in November 2008, he had 1800g done to fill in the frontal hairline, mid frontal, and some in the crown area. We did 250 1's, 350 2's to build the frontal hairline and temples and the rest 3's for density in the midscalp and crown area. He came in after 10 months for follow up in September. I am going to present pre-op pictures and also post-op pictures that we took in September. As you can see, the post-op pictures that I have posted does not represent what he has shown in his post-op pictures. I'm suprised because when I saw him in September he was happy with the progress. As you can see from the before and after photos only after 10 months for only 1800 grafts he looked good in September of 2009. It is a surprise to me to see the post op pictures that he has posted and I am wondering if he has done something that caused his hairloss since September when I saw him. We will try to contact him for a follow up evaluation so I can truly identify the problem and take care of his concerns. If he continues without a reasonable merit to make false accusations to damage my reputation, then I have his consent to release his photos and I will be forced to show his full face photos and identity him if necessary, so you can judge for yourselves of the true results. And if those who are quick to judge want, I can use his pre and post ups in my January post under results posted by leading hair restoration clinics.

Hello KLD, We are glad you are happy with your surgery, it was a pleasure working on you. I appreciate you taking the time and commenting in the forum.

Thank you. I know the lighting differs because we are in different rooms for before surgery, during surgery and the post ops. By the way if any one wonders, we did 400 ones, 300 twos and 385 threes for this client. He is extremely happy with the result, but a little shy about showing his face .

Nutritional Factors in Hair Loss By Dr. Mike Meshkin by Dr. Mike Meshkin (created on December 10, 2009 08:34 PM ) Gallery | Comments Crash diets and caloric deprivation of less than 1,000 calories per day or sudden weight loss of more than 20 pounds have been reported to be associated with hair loss. The evidence of hair shedding can be noticed one month after the diet begins. Nutritional factors that are necessary for hair growth are protein, fatty acids, Zinc, Iron, Biotin, Magnesium, vitamins A,C, E, and B complex. Like any other body organ, the hair needs food to grow. Therefore, it is important to know about the quality and quantity of the various nutrients necessary for healthier hair. Tailoring of a diet to achieve a reasonable weight-loss goal must include appropriate levels of essential nutrients. Certain nutrient deficiencies are known to be specifically associated with hair loss such as: ??? Iron deficiency causes anemia, which is known to contribute to hair loss. ??? Zinc Deficiency is known to be associated with hair loss. A very low-calorie diet with little or no red meat protein can contribute to zinc deficiency because zinc is absorbed less readily from plant sources of zinc than from animal sources. . ??? Biotin Deficiency is associated with hair loss as well as some skin disorders. Biotin is one of the B vitamins that have a broad range of functions in the body. Biotin is found in many foods, and has rule in food metabolism. Biotin is found in wheat germ, brown rice, red meat, and egg yolk. ??? Protein deficiency is an outcome of inadequate protein in the diet over a period of time. Extreme vegetarian diets and extreme low-calorie diets may proved inadequate protein intake. Main sources of protein are meat, fish, and dairy products. Your daily food intake should contain adequate vitamins including: vitamin A 800mcg, biotin 50mcg, folic acid 400mcg, vitamin C100mg, vitamin E 10mg and Zinc 10mg per day. Should you decide to engage in a weight-loss program, before or after hair transplantation you should discuss the intention with a hair restoration specialist. You should take caution to avoid diets that could cause or contribute to hair loss.

Patient presented with a Class 2 hairloss on the Norwood scale. We performed 1000 grafts for the frontal and temples and some in the mid scalp area. We used Ultra Refined Follicular Unit grafting technique for the front and used Trichophytic closure to suture the donor area.

Crash diets and caloric deprivation of less than 1,000 calories per day or sudden weight loss of more than 20 pounds have been reported to be associated with hair loss. The evidence of hair shedding can be noticed one month after the diet begins. Nutritional factors that are necessary for hair growth are protein, fatty acids, Zinc, Iron, Biotin, Magnesium, vitamins A,C, E, and B complex. Like any other body organ, the hair needs food to grow. Therefore, it is important to know about the quality and quantity of the various nutrients necessary for healthier hair. Tailoring of a diet to achieve a reasonable weight-loss goal must include appropriate levels of essential nutrients. Certain nutrient deficiencies are known to be specifically associated with hair loss such as: ??? Iron deficiency causes anemia, which is known to contribute to hair loss. ??? Zinc Deficiency is known to be associated with hair loss. A very low-calorie diet with little or no red meat protein can contribute to zinc deficiency because zinc is absorbed less readily from plant sources of zinc than from animal sources. . ??? Biotin Deficiency is associated with hair loss as well as some skin disorders. Biotin is one of the B vitamins that have a broad range of functions in the body. Biotin is found in many foods, and has rule in food metabolism. Biotin is found in wheat germ, brown rice, red meat, and egg yolk. ??? Protein deficiency is an outcome of inadequate protein in the diet over a period of time. Extreme vegetarian diets and extreme low-calorie diets may proved inadequate protein intake. Main sources of protein are meat, fish, and dairy products. Your daily food intake should contain adequate vitamins including: vitamin A 800mcg, biotin 50mcg, folic acid 400mcg, vitamin C100mg, vitamin E 10mg and Zinc 10mg per day. Should you decide to engage in a weight-loss program, before or after hair transplantation you should discuss the intention with a hair restoration specialist. You should take caution to avoid diets that could cause or contribute to hair loss.

There are many products that may harm or damage hair. Here are a list of products or procedures that may damage hair: 1. Hair Straightening, it is done in three ways, chemical, mechanical and by heat. Chemical straightening breaks down disulfide bonds. They are available in the form of pomade. They are water resistant, long lasting, and produce excellent results. If done improperly, it can cause chemical burn and permanent damage to the hair shaft and skin. Mechanical straightening is in the form of pomade and contains oily substances such as olive oil, castor oil, safflower oil, mineral oil, lanolin, and petroleum. They are less effective and less damaging then the chemical straightening process. 2. Hot comb or hot Iron can be heated up to 300 F. While pulling the hair, the heat breaks the hydrogen bonds to reshape the hair. The effect of this process can be improved if hair is treated with oil prior to using the heat. If this is not used properly, it could cause burn, scar, damaged hair and scalp. 3. Hair spray is used following shampoos to manage the hair. It adds body and makes the hair look shinier. They come in the form of spray or aerosol. The efficacy depends on the concentration of the copolymer in the spray. 4. Gel and mouse are considered thickening products. They are used for management of the hair after shampooing, by adding body, shine, hold and increase volume. 5. Coloring agents come in different forms. The progressive or gradual coloring requires repeated application and it is easy to apply. It produces gradual darker color. The temporary hair dyes are water soluble and can be easily removed by shampooing. They are applied following shampooing in the form of rinse, gels, mouse or spray. They are hypoallergenic and easy to use. The semi-permanent hair coloring last for up to two weeks and can be used for highlighting. They are easy to use. The permanent hair coloring is mixed with hydrogen peroxide to last longer. The hair can be dyed to lighter or darker color. They are highly allergenic, and a patch test should be performed prior to using the product. If planning perming your hair, permanent hair coloring should be done at least 10 days following the perming procedure. Too often hair coloring is damaging to the hair shaft; bleaching is more damaging then darkening the hair. 6. Blow drying is used to style the hair after shampooing. If it is used on high temperature, it can dry out the natural moist of the hair and can be damaging. It is recommended to keep the temperature as low as possible and do not blow dry when the hair is too wet. If you have questions about a specific type of procedure or product and its effect on your hair, please let me know.

Thank you for your complements....

Thank you, Julius.

Some consider hair to be the most aesthetic part of the face. As such, baldness can dominate one's appearance, drawing attention from a beautiful face. The hairline is where your scalp hair borders your forehead and frames your face, thereby bringing out the beauty and richness of one's features. When the hairline starts to recede, one's facial features also recede into the background. A primary reason for seeking hair restoration is to restore your appearance to the condition before hair loss. One of the more critical decisions in hair restoration is determining where your new hairline should be, which should carefully be discussed with your physician. The physician should follow several cosmetic rules to design the hairline. The doctor should place the hairline in correct position. The doctor should use all of the cosmetic guidelines, rules and tools available for creating the hairline such as the following: ???Rule of thirds- dividing the face in three equal proportions(described by Leonardo De Vinci) ???Measuring more than 8 cm from the mid-glabellar point ???Hairline not lower than the original hairline before hair loss began ???Customize the correct shape of hairline individually such as: Widows peak, and correct flaring ???Creating different shapes of forelock for people with limited donor area ???Irregular soft and subtle hairline The best hairline recreated by transplantation is one that is natural and blends with your other facial features. The physician should take into account the facial contour, ethnicity, gender, age, hair characteristics, patient desire, expectations, type of donor hair selected, graft placement, size of grafts and overall transplant technique to ensure a natural appearance. Before you proceed with a hair restoration procedure, you must be certain that you are fully informed and understand the physician's recommendations and that likewise the physician understands your wishes and concerns. The best results of hair restoration require complete physician/patient agreement. Although a hairline can be reconstructed surgically, it is always better to get it right the first time. The physician should assess your hair restoration with an open mind. While you have firm ideas of how you perceive yourself the physician may have other recommendations based upon the likelihood of need for future procedures as your hair loss continues. It may be necessary to consider the need for future revisions in hairline to accommodate progressive hair loss. Age is a factor as the earlier one starts to bald the greater his hair loss may be as he grows older. The physician needs to have the patience to properly explain his recommendation of a proper hairline which should be based on patient's age, shape of face, donor availability, texture and hair color to reach a satisfactory compromise.

Cosmetic hair products for grooming and styling can help you improve your image and your life style. They can change your look, reshape your face and thereby make you look younger. If you are experiencing thinning hair there are some products that can be used to make your hair look fuller and thicker. Styling and grooming products such as shampoos, conditioners, hair spray, gel, mousse and blow dryer can be used to manage the hair into the desired style. They can also add more body and make the hair look shinier, thicker and voluminous. Hair coloring agents make you look younger and are used to minimize the contrast between the hair color and the color of the skin, thus creating the illusion of more hair. Perming and curling can make the hair look thicker by camouflaging some of the thinning areas The hair shaft is made of keratinized cells, and subjected to various environmental aggressions and chemical products. Hair shaft is broken into three major layers--the cuticle (outside), the cortex, and the medulla (central layer), the major characteristics of the shafts that affect its function and appearance are elasticity, texture, and porosity. Hair has three major chemical bonds, disulfide bonds, hydrogen bonds and salt bonds. These characteristics will affect the permeability of the hair to the hair products, such as types of shampoos and conditioners, hair coloring agents, permanent waves and relaxers, styling aids, hot combs, etc. Hair is made of Sulfur, Carbon, Oxygen, Nitrogen and trace elements. Hair specialist will assist and educate his clients with understanding of these hair products for preserving healthy hair. Shampoos are intended to remove excess oil from the hair and scalp, reduce the number of bacteria and other micro-organisms that live on the hair and scalp, and cleanse the hair from dirt and dead skin cells. Baby shampoos are mild, and generally leave the hair in good condition for styling. Shampoos sold for adult use may combine cleansing detergents with a number of conditioners to improve hair flexibility, for example, a strong cleansing detergent such as lauryl sulfate may remove so much oil that hair becomes unmanageable and subject to static electricity. It may be necessary to experiment with several shampoos before finding one that is suitable. Shampoos come with different chemicals and different detergent types for cleaning. Mild cleansing shampoos contain Nonionic detergent, polysorbate, nonoxynols and polyoxymers leaving the hair more manageable. Nonirritating shampoos contain Amphoterics, Glycinates, propionates, and betaines and have mild cleaning characteristics. Deep cleansing shampoos contain anionics, lauryl sulfates, laureth sulfates, sarcosines, and sulfasuccinates which may be harsh and irritating to the eyes. Conditioners should be used after shampooing to facilitate more vibrant, more manageable hair ready for styling. There are a variety of conditioners available in the market including leave-in conditioners, which are applied after hair is dried following a shampoo and left in the hair. Newer leave-in conditioners cover the hair shaft with a thin coating of a polymer, which temporarily repairs hair shafts and eliminates static electricity as a styling problem. These hair thickeners and polymer coatings are not usually appropriate for use on fine-caliber hair, as the coating weighs the hair down making it difficult to style. Short-contact conditioners, which are applied during or immediately following shampooing are left on the hair for a few minutes before being rinsed off. They are good for treating chemically processed hair, and decreasing static. Finally, deep protein conditioners are also applied after shampooing, but are left on the hair for up to 30 minutes before removal. They contain hydrolyzed protein thickeners which give temporary strengthening to the hair shaft, repair split ends and damaged hair. Permanent waving is the most challenging styling technique. The beauticians who perform this procedure should have clear knowledge about the products and artistic talent required for the process. There are several steps involved in perming in which the disulfide bonds are reformed to its new shape. This process can take about 2-3 hours and it is suggested that the client does not shampoo for a few days. If this process is done improperly, it can cause damage to the hair and the skin. The perming lasts four to five months. Straightening is done in three ways, chemical, mechanical and by heat. Chemical straightening breaks down disulfide bonds. They are available in the form of pomade. They are water resistant, long lasting, and produce excellent results. If done improperly, it can cause chemical burn and permanent damage to the hair shaft and skin. Mechanical straightening is in the form of pomade and contains oily substances such as olive oil, castor oil, safflower oil, mineral oil, lanolin, and petroleum. They are less effective and less damaging then the chemical straightening process. Hot comb or hot Iron can be heated up to 300 F. While pulling the hair, the heat breaks the hydrogen bonds to reshape the hair. The effect of this process can be improved if hair is treated with oil prior to using the heat. If this is not used properly, it could cause burn, scar, damaged hair and scalp. If you are experiencing hair loss it is important to know that some products and procedures may be damaging your hair and may contribute to your hair loss.

The hair texture, hair color and skin contrast is always taken into account for each patient. Since this patients' hair color was lighter and had a nice skin/hair contrast, we decided to use more of larger follicular units. This allowed for natural result as well as density.

If you are willing to travel, there are alot of fine doctors in the U.S with many years of experience. There are many clinics which give discounts for travelling and also because of exchange rate, you will get alot more for your money.

Thanks guys, I take into account facial contour, ethnecity, age, and type of donor hair to achieve maximum density with a natural result for each patient. My twenty years of experience helps me use the size of grafts and graft placement in the recipient area customized to different hair characteristics such as textures, colors, and skin contrast for best results with minimum number of grafts. For several factors, we cannot do large sessions on everyone. These reasons could be donor availability, tight donor site, and patients budget. So I try to do my best with what I am presented with.

The 2500 grafts session consisted of 350 ones, 750 twos, 960 threes and 530 fours, for a total of 2590 grafts and a total of 6,850 hairs. His hair density is pretty good.

Hello Everyone, This is a 50 year old patient with a class 6 on the Norwood scale of hair loss. We decided to do 2500 grafts because his donor area was tight. We were able to build a nice hairline and temple points. We also transplanted in the mid front and the crown area.

50 year old Class 6 MPHL

If you pay close attention to the picture from his donor site, you notice that the hair in that area is darker and curly. The transplanted hair just took the same color and characteristics of the donor hair, and thats why its darker and curly.

thank you bill, I appreciate your comments......