Dr. Ricardo Mejia

Thank you for bringing this to my attention. I was unaware this was posted by my assistant who is new to the hair transplant network posting process. I will discuss with her and make sure she gets the proper photographic training and learns The proper posting guidelines. Fortunately, the patient is happy and the results were delivered as expected I couldn't agree with you more. Thanks again for your understanding and bringing this to my attention

At 2 months it is not likely you are losing any grafts at all. You are likely shedding hairs. Follow your dermatologists advice and keep good follow up with him or her and your dermatologist.

Enjoy the hair you have and use preventative measures and medications to keep it.

Minoxidil will help maintain hair and transplant hair grow. It may not necessary grow faster.

It is not likely to be succesful. You would need to do a FUE, Follicular Unit Extraction to get the root of the hair follicules.

It will be rejected by your body until we can clone hairs ,or develop a hair that is not going to affect your immune system. Will need to wait for cloning.

Yiddo. The point of going outside the safe donor area is to buckshot scatter the grafts all over so they do not coalesce together and become more visible. The more scattered the better the clinical result and less noticeable. To analyze this mathematically, assume for a second an average safe donor zone of 30 cm long by 4 cm wide with a density of 70 follicular units per centimeter squared. This equates to an available donor area of 8400 grafts. The big question is how many extractions per cm squared will your doctor make to scatter the grafts so they are not too close together.

If you extract 100 percent 8400 grafts you will have a large donor area 4 cm wide with no hair

10%. =840 g

20% = 1680 g

30% = 2520 g

40% = 3360 g

50%= 4200 g

So patients strictly doing fue who need an average of 4000 grafts over time will have a donor depletion of 50%. This could be quite visible and we like to lessen the percentage of extracted hairs per cm squared with FUE. Hence if you want to lower your percentage to 30%, the only way to do it is to expand your donor area larger than the traditional safe donor area. If you want to prove this point, draw a 1 cm square. Take a ball point pen and see how many punch holes you can make in this area.

It all depends on the clinical look of your donor area, the scalp laxity and the ability to do another strip while replacing the old line and leaving a similar or better result. If you are going to do a small case like 800 grafts, generally this is easily done with strip while removing the old scars and doing trichophytic closures to improve the result. However, a proper clinical exam and consult would be the only way to assure you got an accurate response based on your hair goals, quality of hair etc. The advantage of doing a strip is I can generally extract more grafts and give you more hair in one day provided the donor exists to do so without significant tension.

Will we ever elect a bald president? See this journalistic viewpoint Below

Carlos Miller's Awakening

You can view the live surgery that was broadcasted on the Internet at the following link

Jupiterderm Skin and Hair Doc

Click on Carlos' hair transplant or follow his journey and see section on live streaming.

I do both fue and fut. The majority of my cases are fut. In my practice it is more efficient and cost effective do a 2500 to 3500 graft case in one day With FUT. THe 12 hour cases as noted above for fue are long and tiring for both patient and doctor. I can not do as many grafts in one day with the fue than I could with fut. Consequently I personally prefer the FUT method. The primary purpose to FUE is for those patients that prefer to avoid a linear line and are ok doing it in stages with added expense. Other clinics specialize only in fue doing megasessions daily and that is fine if it works for them,

Most all doctors including myself will take from the safe donor area. However, as you start doing megasessions and trying to transplant 6000 grafts over time, eventually you expand outside the safe area to avoid the scars from blending together. The evidence is supported by presentations .by fue doctors at national meetings. You can also find megasession fue pictures on line showing the fue scars outside the traditional safe donor area. It is generally not an issue until advanced hair loss. In most cases patients have good density already with little risk of advanced hair loss. In that case neither fut or fue would be visible.

Many of the topical camouflage treatments discussed on this websites do a good job at minimizing the effects of lighting on the scalp. Give them a try if you have not already to see how your hair looks with the lighting that makes you look thinner, good luck

Everyone has to decide which option is best whether a hair system or shaving it off completely or surgery. the first two options are non invasive and consequently generally cause no harm. You can always fall back to surgery if desired. But once you start surgery you are committed in many respect. I agree the problem with hair systems can mess up existing hair. The ideal situation for a hair system is a patient who is severely balding and lacks little hair on top. The problem I sometimes see is hair systems put on patients that really do not need them. They have great density minimal thinning and a Norwood 2 or 3. The whole top of the scalp is shaved to glue on a system to cover small recessions in the temple areas. In this case I do agree that a system can mess up your hair and you really should not be considering one,

As a person ages, it is possible FUE scars will be seen first because they are done outside the safe donor area. If done properly, the fut line if in the proper donor area will not be seen. In my experience, I have not seen scars stretch with age.

You are correct. Many older men sometimes just Want a subtle improvement. They are not looking to create an 18 year old hairline. Consequently , everything is planned based on the patient consultation and objectives, which in this case was to create more hair with natural subtle results.

You are correct. Fortunately these days we have options for patients and advanced our procedures to have FUT one linear cut producing between 6000 to 8000 grafts which in most cases is hidden by the hair or you can have FUE with 6000 to 8000 punch cuts scattered through out the back which is also hidden by the hair. The advantage of fut is the hairs come from the safe donor area as opposed to outside the safe donor area which is more likely to miniaturize over time. Either way both scars either linear or punch scars are hidden by your donor hair.

We are utilizing A cell and PRP platelet rich plasma in our office as well. in theory both these products have extracellular matrix proteins and other factors that we would like and hope stimulate regrowth of hari follicles. Doctors have presented case studies to suggest this mechanism of actiion. I am a firm believer tht this combination does present hope to stimulate regrowth of hair follicles which is why we are of offering this treatment. However, we are not exactly sure on the exact mechanism of action. I am very straight forward with my patients and suggest the possibility of stem cell stimulation.As of this date, I do not have any direct evidence that it in fact does stimulate stem cells to duplicate or regrow in human hair. If this were the case it would be widely publicized on the ACell company website. They can only state the obvious facts which is extracellular support for wound healing and tissue regeneration. We will hopefully have more data as our studies progress. Stem cell is an excellent marketing buzzword , we are seeing stem cell facelifts, stem cell peels, skin care products with stem cells to look younger. I do think we are closer and these products may hold the key. More research is needed. But I would like to see the study or evidence that directly proves any of these products cause duplication or cloning of hair follicles in Vivo before I tell my patients that it definitely does do so. But in the meantime, I suggest it might and our treatments will help validate what is being said. Hopefully by next year we will have more data from myself and Dr Niebalski, an excellent surgeon, and others that definitely proves these points.

We typically plan the surgery with the intent to leave only one line. It is imperative when Starting with your first transplant that it is done correctly to assure future success of subsequent trichophytic incisions to leave a proper result. The line from the first surgery is removed with the second surgery.

Aaaaaaaaaaaaaaaa

Bbbbbbbbbbbbbbbb

Aaaaaaaaaaaaaa

Assume the line above b is the initial surgery line. When we take a strip we take a rectangle shape from line A above to A below. The line scar from the original surgery is removed as part of the strip. This is a crude example but hope it helps to illustrate the point.

If I am transplanting a patient that is going to need 3000 grafts or more, then FUT is more efficient and more economical for the patient and can be done in less time. FUE is recommended in my practice for those that definitely want to avoid a strip surgery and would rather have the punch scars. Each individual physician has the skill to do the surgery correctly. It's a matter of properly consulting with each physician on the risks and benefits and costs.

My viewpoint is as follows.

The decision to do surgery on a patient involves a proper physician patient consultation. This involves a personal insight to the patients goals and objectives, his personality, his psychiatric assessment, his feelings, his past medical history, his family history of baldness, a proper examination of his donor area recipient area

, evaluating the area of miniaturization and the degree of hair loss. More importantly, it is a one on one dialogue the physician has with the pateint to understand why this patient wants the surgery, should he have it, and is it in his best interest based on his risk of future loss. Additionally, is the planned surgery realistic and natural appearing based on the consultation and the objectives set by both the patient and the physician. IF the answer is yes to the above and there is no harm to the patient and a benefit that far exceeds the risk, then the surgery is appropriate.

There are some men that do not eat chicken because they are fed hormones and they are afraid they will grow female breast. I do not have all the facts on chicken, but I eat like chicken. Everyone is entitled to an opinion above whether the surgery should have been done or not. But can anyone answer the questions above???

I for one as a physician do not know this patient nor any of the answers above. We can assume every 17 year old is an irresponsible kid? Do you know if the consultation was conducted along with his parents and approved by his parents? They are responsible adults looking out for the well being of their child? Are they not? Do you know who the parents are? Do you know how many seperate consultations they had with the Dr. to discuss the case?

For those that have the answers to the above patient dialogue and or consultation with the patient and or parents, then pick up the stone and feel free to cast it. I am sure Dr. Mohebi would be happy to hand you the stone as well. We are all welcome to an opinion and we do not have to eat chicken, but we have no knowledge or facts on this case.

I for one do not know all of the above. I would not expect Dr. Mohebi to summarize his whole consulation and examination with this patient which led to his medical decision. It is a difficult process we surgeons wrestle with every day and we have to live with our actions. Consequently, every patient is dealt with as an individual and evaluated differently case by case.

If this patient was 27 with the same pattern of hair loss would he be a candidate for surgery? Most would say yes. If this is the same patient at age 27 with a similar hair loss pattern as when he was 17, then why not give him ten years of enjoyment with his new hair if you agreed to transplant him at 27? Your answer will probably be assumptions based on who this person is at 17 or maybe what you were like at 17. Nonetheless, that is the key, it is an assumption not based on facts or any understanding of this particular physician patient consultation process.

I have previously posted that the internet and one paragraph summaries and comments is no replacement for a proper physician patient consultation. Online in a one dimensional world, It is here where you can not see the forest through through the trees. If you can, then please summarize everything the patient and his parents discussed with Dr. Mohebi.

I am sure Dr. Mohebi had a justifiably sound medical reason to proceed with surgery in "this particular" 17 year old based on his personal knowledge of this person, his character, his integrity, his maturity and his understanding of the whole hair restoration process. The patient and his parents were most likely counseled on the risks and benefits of the surgery, explained the diffuculties in young patients with the possibilities of future loss. The surgery was performed after both parties had agreed to a mutually acceptable plan of action which would be in the patients best interest. This is typically how many surgeons on this forum including myself would decide ultimately to transplant this patient. We are typically looking out for the patients best interest.

Unfortunately we are not at the point where we can grow unlimited hair follicles. Every year new research on the molecular mechanisms and signals which affect hair growth are being learned. We are getting closer but not there yet. A person with extensive hair loss that wants the illusion of a full head of hair can easily consume 6000 to 8000 follicular unit grafts or more. If you calcuate an average area of 150 cm squared at 40 grafts per cm squared , that gives you your 6000 grafts. IF you have a larger head with 200 cm squared thats 8000 grafts. To achieve cosmetic density you would want to transplant at the highest density amount. Previous studies have shown that cosmetic density can be acheieved with an average of around 25 to 30 grafts per cm squared.

There are sacrifices in patients with severe hair loss and that is coverage vs density. You can cover alot of area but perhaps not get the density you are looking for.

Dr. Ricardo Mejia Hair Transplant Surgeon in Jupiter, Florida

IF you look at the older patient at the link above 9th row 3rd one across. He had close to 4000 grafts in an area well over 200 cm squared. Excellent coverage for his age, appropriate. This is an approximate average of 20 grafts per cm squared to get coverage not density for this patient. When I show this to younger patients, they say it is not enough for them. COnsequently, for me they are not a candidate for hair restoration because their expectation with density far exceeds what can be achieved with their limited donor area which in some cases is maxed at 6000 grafts.

Yes body hair transplant is available for those that have alot of body hair and a big financial budget. Body hair is extracted with the FUE method. Body hair does not seem to be as hearty as your donor scalp hair and the results may be less than desirable. For many it is a good complement when you have already exhausted the donor supply. But it my practice it is not a first choice.

Young patients with severe NW 5 will progress to 6 and or 7. COnsequently proper hair restoration goals must be set with patients to assure they understand coverage vs density and the limitations. This is why in many cases we have alternative options such as frontal forelocks or just focusing on the anterior 1/3 of the scalp. I have hooked these patients up with others that have shaved their heads or gone into a hair system so they can see first hand the differences and can be happy with either choice. The bad thing about starting with a hair trasnplant, is once you start, you are somewhat committed to maintaing it for the rest of your life. The best thing about shaving your head is if you dont like it it will always grow back to a point where you do like it. No harm done. You dont have to go cold turkey, every time you get your hair cut, trim it shorter and shorter so it is a gradual progression to baldness and easier to accept. If not then consider the limitations above or wait until hair cloning is perfected and start saving $, because I am sure it will not be cheap. These companies need to make there money back from millions of dollars of lost research.

Generally speaking whatever benefits you gained with the minoxidil, you could lose. BUt it should not accelerate or worsen the degree of baldness you would be without the minoxidil.

Dr Keene and myself years ago did a study looking at men's hairline and found that men who were not receding did have hairlines approximately 5 to 6.5 cm from the glabella. We typically used to use the rule of thirds to define the Hairline or 8 cm above the eyebrows / glabella. This did justify support for lower hairlines in men without a big history of androgenetic alopecia. However, ultimately the decision rests on the physician patient consultation and examination. This is something that cannot be duplicated on the Internet with photographs and or paragraph summaries or two dimensional drawings. There is a reason why several physicans opted out. Were your expectations to unreasonable? Was the hairline drawn too unnatural? Was there any compromise? Did you discuss a two step approach? That is lower according to physician recommendation and if still not happy

you can always lower more later? Irrespective of the answers, I have to live with the surgical decisions I make and if I personally do not feel it is medically reasonable or in your best interest, then I would not put my reputation and skill at risk. So in the end the decision is the doctors. You can keep searching and might find someone to do it only to later realize it really wasn't what you wanted. Good luck

As I mentioned in some of my previous posts. This was a patient who actually told several of his coworkers. He was actually the hot topic as several of his male colleagues were very interested in the procedure and very supportive of what he had done. Surprisingly, he did not anticipate so much positive remarks.