Dr. Ricardo Mejia

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.

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.

Eyebrow: As Dr. Epstein pointed out, eyebrows are very delicate and require precise small incisions at the right angles. The best way to assure confidence in the procedure is to have a personal consult with Dr. Epstein or other surgeons. If possible view live patients. Eyebrow reconstruction is primarily done to restore eyebrows from burns and scars are congential lack or loss of eyebrows. It can also be used to enhance or fill in eyebrows. In these cases the characteristics and quality of the hair and reasons for seeking this procedure may influence the determination whether you are a candidate or not. I think you have narrowed your choices to a very qualified group.

There has not been a scientific study to prove the benefit of scalp exercises. However, we and patients have found them to be beneficial. You do not always need them. IN cases of larger sessions and tighter scalps, I do recommend it. There is more detailed info posted on the exercises, scars and stretching from a previous post where I detailed more info. You may wish to review it. Elasticity and Scalp Exercises Ricardo Mejia MD Hair Transplant NEtwork Physician Jupiter FL

I would not necessarily agree to a generalized statement that HT is not recommended for women. As I and others have posted previously, there are other factors to consider which need to be addressed with a proper medical exam and consultation. We do have a list of referral patients that you can contact directly if you do not get feamle replies here. PLease send a private email. Women do have successful transplants assumning the medical issues have been investigated and resolved. Ricardo Mejia MD HAir Transplant Network Physician Jupiter FL

At our ISHRS meetings, we bring in actual live patients to review first hand. I have personally examined and reviewed patients from Dr. Wong and Dr. Shapiro. Analyzing both hairlines is difficult to determine coronal /perpendicular vs sagittal/lateral. Unfortunately, we are in one dimensional society on this internet forum and only with good proper 3D evaluation do you realize the excellent results that can be obtained with different techniques, blades and styles. More importantly, these studies demonstrate the passion and commitment these doctors have for helping us advance and better understand the hair restoration process.

P.J. Very nice observation. If you take your sound wave an make it into a traingular wave: /\/\/\/\/\/\/\/\/\/ \/\/\/\/\/\/\/\/\/\ You get what is called a Z-Plasty type of repair. We have used this in dermatologic and plastic surgery for different reasons. Yes Hair transplant surgeons have utilized this technique in attempts to minimize the appearance of wide stretch scars. In many cases they have worked well. The idea is to distribute the tension vector forces in a horizontal plane as opposed to a vertical plane. The technique is available and reserved for certain cases, but it is not widely used. If I find a before and after photo, I will post it. Ricardo Mejia MD Hair Transplant Network Physician and Dermatologic Surgeon Jupiter FLorida

I'll do spell check next time. Promise

I generally do not initially recommend a hair transplant for women unless they have had a proper medical workup. I found too many cases of underactive thyroid, low ferritin/iron and causes of telogen effluvium or shock loss due to other factors mimicking androgenetic alopecia. I have also found two cases of diffuse alopecia areata, an immunological condition where the hair transplants would not work. FIrst get the appropratie evaluation and workup. Once you everything is done and you are a cndidate for surgery, hair line lowering can be done. Photos of female hair line lowering Ricardo Mejia MD Jupiter FLorida

Arrie, Bill et al: I will be happy to voice my opinion on your thread. I personally feel this is an excellent venue to help and educate patients. I appreciate an educated patient. It makes my job easier. In somecases it made my job harder. FOr example I had a patient who came to me very knowledgable almost demanding I had to do 60 FU/cm2 in one pass all over his NW5 head in order to get a good result. He had soft grey hair which would not have resulted in the best efficient use of his donor and for grey hairs ones and two hair grafts would not have worked for him. Irrespective, I spent almost 2-3 hours in consultation reviewing everything to assure he was comfortable with the plan I set out for him which differed from what he learned or was told on the internet. In the end he was a happy patient. From what I have seen Bill has been doing an excellent job in balancing out posts. Physicians utilize different techniques different instruments to get great results in their hands with their staff. People have posted very astute questions. SOme have posted generalized statements without any backing whatsoever which IMO is not justified. However, everyone is entitled to an opinion. There are many ways to produce state of the art hair transplantation, just like there are many different techniques to provide a great face lift. There is no one ideal hairline or hair transplant. Everyone is unique and different and what is appropriate for one may not be appropriate for another. Each transplant has to be uniquely qualified, discussed with the patient for the goals and objectives set out between patient and doctor. Hair transplantation is an evolving field and we are always looking for ways to make things better. Having educated patients and well balanced discussions and photos on this forum reminds us of what we are doing anyways and can only help the patient get the right help for their needs. Keep up the good posts.

Its good information to have and look at for curiosity. Depending on the age of the patient and norwood stage, we generally have a good idea of where the hairline was. However, that may not necessarily be where it should be, especially in advanced stages like the patient below: Adavanced Norwood stage During the consultation, I generally ask patients to draw where they would like the hair line to be. I then determine if it is appropriate based on the patients age, future expected loss, donor density and scalp hair characteristics to give the most natural and dense results. I do use photos when a patient uses reference to "getting his hair back the way it used to be". Other patients below have different concepts of where there new hairline should be. russ howard New Real Hair Club Member Posted November 30, 2004 08:24 AM Hide Post Firstimer, Here's a different approach to designing a hairline that I found worked well for me. Weeks prior to my procedure I made cut-outs from light brown posterpaper to replicate different hairline shapes and placed them on my forehead.This enabled me to see my face and "hairline" from different angles in the mirror. I kept experimenting until I found the one that best complimented my face and seemed age appropriate. I didn't want the hairline I had in my 20's or 30's but one that suited my face now (50's). The morning of my surgery when Dr. Mejia traced the outline for my hairline, I was more than confident that this was exactly how I wanted it to look, no indecision, no second guessing...after all, I wanted it to be right the first time. As it turns out... the experiment paid off! Had I gone with the original designs that were shetched on my head in prior consultations, I would not have had the desired results...Best of luck!

Couldn't have answered any better myself Bill. Nice Job. You serve the members well. Ricardo Mejia MD

Please grow: Yes I reconstructed the temples. I do not have the exact amount of grafts I used, but from the photos, I counted approximately 75 -100 per side. THe amount you use per patient varies due to multiple factors that need to be considered. YOu can see better overall results on the photo album page which shows how it balances the facial proportions. Temple Point reconstruction OVerall Photos

Thanks NG2BB. He is very happy and has framed his face well. We also gave him hair on top as well. You can view better photos of this patient in the hair transplant surgeon review/Michaels Weblog. Detailed photos of patient

Guy: There are several possible causes for your hair loss which can be isolated with a proper exam and consultation and examination of the hair follicles. In my experience, there are times you can see a combination of both factors, i.e. MPB and telogen effluvium or diffuse shedding. This can be induced by a variety of reasons, including stress. Deramtologists typically do hair pull tests to determine the ratio of telogen hairs. The root of the hair typically looks like a club. MOst of my patients describe a significant increase of hair in the shower or when they comb their hair. Dermatologists by training are the most experienced in Hair loss disorders. However, you will find many good hair surgeons who are also knowledgeable on the hair loss diseases as well. To alleviate your anxiety, it would be best to see a professional. Ricardo Mejia MD Hair Transplant Network Surgeon and Dermatologist Jupiter FL

The temple points are a nice area to reconstruct depending on the overall balance and facial features. In my opinion, it helps add to the overall youthful appearance. As was stated, it is not neessary to transplant, but in the right cases is an added benefit. See example below. (assuming I paste the photo in correctly) RIcardo Mejia MD Hair Transplant Network Physician Jupiter Florida <pre class="ip-ubbcode-code-pre"> </pre>

Arrie: I can only speak for myself: Time, effort, patient consents. Plus we are busy enough. Some of us feel we do not need to do a significant amount of advertising or Marketing. BElieve it or not, it does take a significant amount of time, at least for me it does.

Nikkop: Thanks again for your other post. It is posts like yours that help elevate the standards of hair restoration surgeons. Per some of the moderators notes previously, I do not want to step on Davids thread. I will be happy to address any of the concerns or issues in specifics with your opinion on this thread. Thansk again. Ricardo Mejia MD

Nikkop: You are entitled to express an opinion without a proper consultation of the patients goals, expectations, coverage vs density, hairline and budget, some of which was done for as little as $3000. ALl the photos on the website are from patients over 7 years old and display distinct characteristics. At that time many physicians were not doing ultra refined Follicular unit HT as we are doing today. Im ny opinion, I cutomize my approach differently with each patient after a full consultation SO yes, you are correct,if you have a certain look or image you expect, it may not be representative in the photos shown. I can tell you the patients are extermely happy. However, I will be happy to comment on any specific issue you haver rather than a generalized statement. Can you also give me the name of a physician that will do an Ultra refined session of 3500 grats for $3000. I will post more updated photos for you when I get a chance. Got to get back to work. thanks for your opinion. Ricardo Mejia MD

signed sealed and delivered. If we plant hair, might as well plant more trees!!! Ricardo MEjia MD

Bill et al: Thank you for your input and recommendation. Rest assured I will try to get the photos for you. There are a few obvious reasons for delays on my part. 1. I am professionally obligated by a code of medical ethics and HIPPAA privacy laws not to publish or disclose any photos of patients without the knowledge and written consent of my patients. It is not always easy for me to get these consents from my patients. I do not have these on all my patients and consequently I have to invest a significant amount of time tracking them down for written consents, if they do agree. 2. I have not placed a significant emphasis on marketing or advertising and posting photos since my recommendation on this website almost two years ago. Pat has been recommending it, but as I stated, I never saw the need to do it or recommend to my patietns to post their experiences. But as I have learned, it is important for you to see and a pictures says 1000 words. I do have some on this site as well as on my website. www.skinandhairdoc.com. I invite you to at least preview those until I can get new more recent work and update my website. 3. With Bills Permisision and my patients, I can have Bill post my patients and any testimonails on my patients behalf if they are unable to do so, themselves. This way at least you can see for yourself. 4. Arrie: No disrespect taken. The latin word for doctor is "Iatros" which means "to teach", a philosophy which I try to live by. I am a faculty instructor at live hair transplant surgery workshops and speak regularly at meetings, as well as the upcoming Dermatology editor for the Hair Forum. Thanks to Pat's suggestion for me to become more involved with the forums, I have found an additional outlet to impart the knowledge I have. The bad thing about it is that I have enjoyed doing it and I have found the people on this forum to be extremely knowledgeable and helpful to other patients. MY wife thinks I am a Hair Junkie, MY 6 year old doesn't like it, but fortunately I am a night owl and can take the time. Be patient... God is not finished with me yet. Ricardo Mejia MD

Ketoconozole nor salicylic acid will block DHT. There is no topical formulation that blocks DHT that has been clinically proven. FOr my patients I recommned 5% Roagaine. There is a new foam available which has less of a risk of causing scalp irritation. Propecia is Finasteride and finasteride has been used at 5 times the dosage for men with prostate problems longer than propecia has been around. It has been determined to be safe and has a good track record. More detailed information on long term saafety can be obtained at www.propecia.com. Dutasteride has higher sexual side effects than propecia. Ricardo Mejia MD Hair Transplant Network Surgeon Jupiter FL