Dr. Ricardo Mejia

There is usually redness and inflamation in scars that can linger and fade away with time. Give it time and you should start seeing more hair growth in the scar.

We do not perform surgeries on patients where girlfriends, boyfriends or spouses want the procedure done. The patietn mus tbe interested and committed to the process fo hair restoration and improvement.

Hair Help:

As I posted previously, before any woman proceeds with surgery, she should properly be evaluated for medical and other conditions that can mimick female pattern thinning. Be sure not to ignore this as I have seen many women have surgery only to find out later there was a medical reason for their hair loss.

We deal with a lot of women and it is our standard pratice to assure this is done. For a womans perspective on hair tranpslant results you can view the video below.

Kudos for warning patients on skin cancers. I recently wrote an article about Scalp cancers in hair transplant patients. I will try to get the article to Bill to post. It is in the Hair Forum this past month.

Just today there was a suspicious lesion in a patients donor area that I biopsied that could be a basal cell.

Melanomas are the deadliest of skin cancers and can also occur whre the sun does not shine. See your dermatologist for a good full body skin exam.

Thanks for all who posted. I am in the process of researching this very issue to provide a more detailed precise evaluation. I would appreciate if those with the problems of CVG email me your photos privately to hairdocMD@aol.com and any other additional information that you have not shared on this site.

Thank you

There should not be any problems with Botox on the transplanted hair follicles.

NG2GB:

To answer your question, Does Propecia lose its effectiveness?

First, one has to look at the 5 year data of propecia which can be viewed on their website. Additionally one has to define certain terms in your question, e.g. what do you define as "losing effect": no growth, no maintenance or stabilization?

Propecia 5 year data

When you look at the mean change in hairs from baseline there is a significant rise at year one stabilizing through year two. However, if you look at the graph, there is also a downward slight trend through year 5 , but overall significantly better than baseline. Hence, if you were to ask me about 5 years I can say Propecia continues to be beneficial over placebo through year five and beyond even if you were to extrapolate the data through year ten. . I do not have the statistical data on the ten year graph, but if it continues to plateau or even continues to dip slightly, it is still providing a better benefit than placebo. You can say that propecia has lost some effect in hair growth counts from its peak at year one and year two, but is continuing to be beneficial based on the data. I do believe Propecia continues to provide a benefit at ten years.

I have seen a very small percentage of patients (in the minority) that took propecia and their hair loss continued to recede. I do not have any data on every other day dosing of Propecia to say that it is just as effective. However, there have been previous threads discussing the half life of propecia and its binding that suggest it should be (http://www.hairrestorationnetwork.com/eve/showthread.php?t=154062) Of course this is "by report" theoretical and plausible and seems reasonable , yet there is no study or data to scientifically say with certainty it is just as effective as propecia.

You can do FUE after strip harvesting but then it depends on what you define as stripped and what you define as a significant amount of grafts. Every case is unique and deserves special considerations. For e.g. I posted a NW 6 grey haired patient with limited donor

(NW6 Grey Haired) .

I just recently did a third procedure and he did very well with no visible scar. I would be more hesitant on a fourth because of his limited donor area coverage. However; if the patient wanted more hair, I could certainly do FUE.

Hope this helps

Here's a more direct website:

http://www.botoxcosmetic.com/tools/find_botox_doctor/find_a_botox_doctor.aspx

There are different techniques to inject the forehead which depend on how big a forehead you have, how active the muscles are, how much extension laterally and vertically you have. The units will also depend on whether you are looking for total resolution or subtle improvement. Everything is customized to the patient. The number of units can range anywhere from 4 to 2o units. The more units, the longer the result and more likely to get rid of more of the lines. Cost per unit ranges anywhere from 10-20 per unit. We charge $15 per unit. You can also check the website at www.allergen.com for the docs that do alot of injections. Good luck

Kris Johnson is not a physician. You must have had your procedure done by somebody else in the group. Last I knew, only doctors could perform surgeries.

Want hairs:

The incision depth usually matches the length of the follicle or graft. You probably had longer follicles which may have required a deeper incision. BUt the grafts or grafts are not buried deep beneath the skin. The correct terminology should probably be I had longer follicles requiring a deeper incision. If the incisions are made too shallow, the techs will have a hard time planting the grafts and they will not fit nicely.

Ricardo Mejia MD

Hair Transplant Network Physician

Jupiter FL

Chucky:

I would recommend you take some benadryl every time you reach for your wallet.

NN:

I have emailed the patient to correct his location. He had written my name and location as the location for his hair transplant site. He is not an employee or associated with my practice just as you are not associated with Dr. Shapiros practice.

I suspect you do not know the quality of my work yet and that is okay. I have spent the past ten years improving my techniques to provide the best results for my patients. Consequently, I would prefer to not be compared to the Burger kings or chains. From your previous posts, I realize your judgement and opinion is based on the number and quality of photos or pictures on my website. I have ignored this site for the past two years since my recommendation. I have posted a few photos but it is very time consuming for me. As a physician yourself, I am sure you realize this as well as realize it would be unfair for me to refer to you as a burger king physician when I have not seen first hand the quality of work you do as a doctor. I am sure you believe you are a great doctor and do the best for your patients and I would equally give you that opportunity.

Respectfully,

Ricardo Mejia MD

Hair Transplant Network Physician

Wiz:

I am glad to hear you are doing well. We look forward to your progress and photos.

Bill: He is not an employee or associated with me other than a patient. I suspect he accidently put the name and location of the doctor as his HT Location site.

Looking forward to seeing your growth. Feel Free to post your photos and concerns on this forum. It is a wealth of information with many experienced patients that have been through your experience.

Ricardo Mejia MD

Dr. Proctor.

Perhaps you can help clarify an uncertaintly for me since you may be more knowledgeable on the manufaturing side of things. Can we assume in the manufacturing process that the drug is distributed equally in the tablet. I have heard from prior meetings that there is always the possibility when quartering tablets that you could get inconsistent dosages, for example we assume if we quarter a 5mg tablet that we get 1.25, 1.25, 1.25 1.25 mg. However, I have heard, you may get 3, 0,0 , 2 or 5, 0,0,0 etc etc. Is there any basis for this? The concern has been that you may not be getting the proper daily dosage to provide the necessary effect. I also recognize that this would be an advantage for Merck if we did believe the inconsistent dosage philosophy. I am also not aware if anyone has actually done a sample on quartering and measuring the actual concentrations. ANy thoughts on this?

Ricardo Mejia MD

Hair Transplant Network Physician

Overall Avodart has significantly more side effects than propecia. There is a higher increase of sexual side effects as well. I do not place many patients on Avodart, but perhaps others will comment on their experiences.

Most of the benefit is seen in the crown and the midzone. I do see patients with finer vellus like hairs in the front that they notice, but not stronger terminal hairs. It is not as beneficial for the frontal hairline.

While some people do not get significant growth, the benefit of Rogaine and Propecia is to maintain you and prevent you from progressively losing your hair.

Hairgo,

Here is what a follicle or follicular unit graft looks like. A follicle is implanted according to the size of the graft. Follicle sizes range in size from 4-8 mm. I have enclosed a photo examples of 1, 2, 3, hair follicular units.

Ricardo Mejia MD

Jupiter FL

The data on propecia supports once a day therapy to obtain the best results.

Use of body hair for transplants has been done. Theoretically, yes you could use the hairs from leg depending on the individual womens hair characteristics. I am not aware of this being done routinely for eyebrows if you have good donor hair on your scalp. The results would probably be inconsistent and not worth trying. This technique has not been presented at any meeting that I have been to.

This case is very interesting. It is difficult to interpret the facts of a case or jump to conclusions without in depth understanding of this persons medical history knowledge and details of the case other than what is reported.

"A 52-year-old Southern California man who died during a routine hair transplant procedure was administered three times the normal dosage of lidocaine, a local anesthetic, according to a wrongful-death lawsuit filed by his widow.... Within an hour of going in he was dead."

While it APPEARS and is written the patient had an overdose, we really do not know what happened. As I illustrated in my post above, I myself could have been victim to an alleged lawsuit if my patient decided to wait an extra hour or two to have his heart attack.

However, let us look at what is reported.

1. The death occured within an hour of arriving at the clinic. From all of you who have had a hair transplant, how many of you recall being anesthetized that quickly. Usually, in my office, we have another consult to review the plan, mark the areas, cut and shave the appropriate areas of hair , take photos. By the time we are ready to go depending on patient questions etc, it could take an extra 30 min to one hour before anesthesia.

2. Within the first hour, most hair transplant physicians are anesthetizing only the donor area and removing the donor area.

3. Three times the normal dose of lidocaine:... hhmm. Physicians are aware of what the maximum limit is. Generally, it is approx 25 ml of 2% lidocaine with epinephrine or 50 ml of 1% lidocaine with epi or even more volume if you are using diluted tumescent type solutions. Assuming you used a concentrated solution, that would be 75 ml of 2% lidocaine to be administered in the first 1 hour. This is a huge amount especially since the first part of the procedure is to anesthetize the donor area. If this were true, yes there is a case for malpractice. But it does not make sense from a physicians standpoint in the first hour. If it was a long 12-hour megasession, maybe. . Generally most physicians use volumes in the order of 6-12 ml of diluted solutions 1% or less to anesthetize the donor area. Some do use volumes of 50 to 100 ml of saline or salt water to super tumesce the donor area. .If the allegations are correct, a serious error had to have occurred where 2% lidocaine was used instead of saline and they were supertumescing the donor area. This is the only way I can conceivably see this error from occurring and it is hard to imagine. Most physicians have protocols in place to prevent fatal errors.

It is unfortunate this happened irrespective of the cause or error. It is important to recognize that any procedure carries risks. Chucky, we do have emergency protocols should a patient have a bad reaction other than just dialing 911. In my office,we do have a "crash cart", automatic defribillator, oxygen and I am trained in Advanced Cardiac Life Support Measures. Most physicians do the same and at our conferences we do review emergency protocols.

Ricardo Mejia MD, FAAD

Hair Transplant Network Physician

Jupiter FL

Dr. Beener has made some excellent observations. While many consider trichophytic closures the gold standard, there are many examples of great or lack of visible scars without trichophytic closure. This may be perhaps the reason for the debate. Consequently, trichophytic closures has been more popularized lately to mask the appearance of the scar whether it is done in the first or last procedure. It is important to assure you are doing the best for the patient whether you do or do not do a trichophytic closure. Unfortunately, it is very easy for others on this site to label a physician as doing subpar work if a trichophytic closure is not done yet still obtaining superior results without it. Some physicians have also reported increased cysts formation in the donor area following trichophytic closures. I have in my experience found tricophytic closuresto be useful and do use them in my practice. However, there are clinical cases where I preferred not to use it and still obtained great results comparable to trichophytic closures. I am also sure several of the coalition docs have files of excellent donor site scars prior to trichophytic closures that if posted on this website, you could not tell the difference.

My messed up eyebrows are ruining me!

P.S. It appears there is a problem with your eyebrows rather than just enhancing natural eyebrows. This would be the reason for a local visit to your doctor. To assure you do not have a medical condition for loss of your eyebrows, alopecia areata or trichotillomania. Even after eyebrow transplants with the best surgeon, you will not get good results if you have an immunological problem.