Dr. Ricardo Mejia

Looks great. Dr. Farjo did an excellent job and you will be very pleased. As to what to tell people who might ask what happened to your scalp if you do not want anyone to know. I usually tell my patients to tell them you have seborrhea or psoriasis, a benign scalp condition that leads to flakiness and scaling. YOur dermatologist is treating it. Yes, its not the same and doesn't look exactly like that. However, I believe if you quickly give a plausible answer, they are more likely to accept it and forget about it and move in.

Bill:

I am referring more to hairs that develop into a curly q or cork screw appearance rather than the the frizziness. Nice job moderating! Kudos!

Bill:

We have the opportunity to see live patients from physicians at our International Hair restoration surgery meetings. Dr. Zeiring did good work on the patients presented. In regards to the subsequent comments, I agree if patients do not have a good consultation and they do not feel comfortable, there is always possibility of unclear goals and expectations with the patient and doctor.

I would have to disagree with some of the comments made.

1. Dhoose75. Check your facts carefully. YOur post and link is actually in favor of board certification. The doctor mentioned in the story which I reviewed is not a Board Certified Dermatologist nor a fellow of the AMerican Board of Dermatology (http://www.aad.org)

2. Thus a more important reason for Board certification. Board certifications are necessary to insure the appropriate educational knowledge and competency of your physician. Board certifications are required in Dermatology every ten years. I am currently retaking my boards. Why? To assure I am a competent physician up to date with the knowledge in my specialty and to provide the very best care for my patients.

3. Board certifications are a measure to assure your doctor has passed certain levels of competency.

4. As for the ABHRS. Not every doctor can pass the test. YOu have to demonstrate written clinical competency in hair restoration as well as take a situational oral exam. Additionally, you have to have done at least 100 cases in a year and have presented your results to peers who review the work, many of which are posted and recommended on this site. SOme docs simply do not qualify and hence, not just any doc get get board certification.

Ricardo Mejia MD

Board Certified, Dermatology and Dermatologic Surgery,

Dioplomate, American Board oif Hair Restoration Surgery

Plesase grow: See my previous post.

1. Trico can be used on previous stretched scars. The main thing is to reduce the tension when trying to do a scar revision. Ideally, this would be to take out only the scar and very minimal if any hair. However, most patients do not want to undergo a procedure strictly for scar revision and doctors will try to combine a hair transplant and scar revision simultaneously. If you have a 5 mm wide scar and you are trying to do another full hair transplant session, the extra 5 mm is alot on the tension when you bring the wound back together.

2. Loose scalp laxity is a double edge sword. It allows you take a good wide donor strip. However, there are some individuals that have a genetic tendency toward wide scars with looser scalp. This is believed to be a genetic variant of a collagen disorder called Ehlers-Danlos.

3. See my previous post regarding internal sutures. You will get different opinions.

4. Staples are just as good as sutures in some studies conducted. One study indicated no difference, although there was more pain reported. Staples are faster.

There are no good clear well controlled studies indicating which is best. Some studies have been done comparing one side (half the occipital area) with internal and the other without. There was no discernable difference. IN cosmetic Plastic surgery and dermatologic surgery, it is common to use internal sutures to reduce the tension on the wound for a better cosmetic result. WIth larger graft sessions,you need to take a wide area of donor and this increases the risk of tension. I have found in my own personal experience better results with internal sutures. During my initial fellowship, we did not use a significant amount of internal sutures, and I had more stretch scars. Many other excellent surgeons will tell you the opposite. Which ever technique is used is the one the doctor has the best experience and results with. It certainly speeds up the operation not to use internal sutures. Unfortunately there is not alot of agreement. You are going to get some inflammation with any type of suture and from the healing process. Just look at all the pictures posted onthese sites. The red scars is the inflammatory healing phase. I have not had a problem with internal sutures. They only time you will have problems is when there is too much tension. This is usually due to the width of the excision being removed.

Ricardo Mejia MD

Jupiter Dermatology and Hair Restoration

I would not be concerned with your surgery going awry in terms of growth. It is very rare to get poor growth. YEs it is a risk and reported and even in the best hands, it happens. Sometimes we do not understand why patients get poor growth when all factors are equal. This is described in the literature and textbooks. It would be very rare that something would go wrong with the doctors you listed. I know them well. As for the "etc." that opens the box on a host of other questions and expectations regarding density coverage etc that hopefully you have cleared with your physician. If you have a rendency for a hypertrophic scar,there is always a risk of the same even with the best surgeon. Some individuals have a genetic tendeny towards stretch scars or thickening of the scars. Keep close followup with your doctor to evaluate the condition early on. If it starts to thicken, you need to follow-up closely so they can minimize the effect. It is best to treat thickened scars early after surgery.

Ricardo Mejia MD

Jupiter Dermatology and Hair Restoration

MY experience with discussions from multiple meetings and other hair transplant surgeons as to why people are not happy and have regrets.

1. Misrepresentation of the procedure and patients were sold. They were not given clear expectations, reasonable and were not warned about the risk of future loss and maintenance.

2. Patients who started too early in life and priorities or finances change later on and they can not continue with the maintenance.

3. Generally, patients that had transplants several years ago when even the top physicians were not doing all microscopic follicular unit hair transplants. OUr specialty has evolved over time making the procedure more natural with high dense packing.

4. Physicians who are not properly trained or do not have enough experience. Hairs have the wrong direction, angles, an inappropriate locations.

5. Be also wary of those physicians that have a car salesman attitude like they are the best and are light years ahead of every body else and have never heard of other good physicians in there area. This is classic negative campaigning to elevate their stature above anyone else. They will sell you on the fact they have done more procedures than anyone else and are stuck doing the same old techniques, noit keeping up to date with changes. BUt who cares if Mac Donalds has over one billion served, it is still not the best hamburger. Look for quality not quantity.

6. Consultants are paid on commission in most cases. There are many good ones that accurately reflect the procedure and yet there are others that want to get you in for surgery. Make sure you consult directly with the doctor and review all issues. Mkae sure he feels you are a good candidate and have realistic expectations.

7. Low graft counts to lower the price with a promise of a full head of hair.

Remember, Your Hair transplant surgeon is your doctor. You should feel he has your best interest in mind and is concerned about how you feel about your hair what your goals are and what your expectations are. WIthout this, he is just a pure salesman and I would be vary cautious of these types of individuals.

WHen all these issues are discussed and you are both on the same page, it is a formula for a succesful result.

I am not familiar with Dr Calder. I am familiar with Dr. Zeiring. HE is a good physician and will do a good job for you. As has been recomended on this site, you may want to find out how long Dr. Calder has been doing hair restoration.

Ricardo Mejia MD

BOth Dr. Epstein and Dr. Bernstein do very good qulaity work and are well respected in the hair transplant surgeon circles. You will not go wrong choosing either one.

Ricardo Mejia MD

JUpiter Dermatology and Hair Restoration

Choosing the right hair restoration surgeon is a personal and difficult decision. There are many good physicians that can deliver excellent results that are not heavily marketed or promoted. YOu have to make sure you have a good feeling about your doctor that he is being forthright and honest with you and that he is available to support you and deliver consisten t results. Talk to actual patients and see if you can meet with them live to judge the quality of the hair transplant yourself. This is the best way of assuring if the doctor is right for you and you want that particular style of hair transplant. In the end, you will have a variety of different opinions and for some it is a matter of travelling to the best place they feel comfortable with based on the opinion polls of others. There are some physician that are not members of the coalition that do great work and yet there are others I would certainly be vary wary and suspicious of. You can see if your doctor is a member of the ISHRS organization and or a diplomate of the American Board of Hair Restoration Surgeons or other professional societies in the UK that advance the education and knowledge of our specialty. Make sure they are also active in these societies keeping up to date with the latest techniques.

Ricardo Mejia MD

Post Hair transplantation frizziness and kinkiness is rare. Usually it is only a few grafts that are seen but generally not a significant portion of the hair. As was posted, careful handling of the grafts to avoid crushing the follicle is essential to avoiding this problem. YOu may notice some improvement. However, there are a few grafts that will persist with some kinkiness.

Ricardo Mejia MD

I have had some patients wear a crown piece and overall they have been satisfied. As you are aware, you need to get the right type with the right density match.

Ricardo MEjia MD

I would have to agree with many of the posts that overall you have good hair. Cases like yours have been presented at our international meetings of hair restoration. The question is would you transplant or not? There is no ideal consensus on what doctors would do. In general you have to have very good and long discussions with your doctor regarding your expectations risk of future loss and reasons for a hair transplant. You should get other opinions from other respectable doctors and not be persuaded into a transplant at first glance. Doctors also need to be aware of psycosocial issues with the patients and interventional counseling may be needed if things are not consistent. Nobody in this forum needs a hair transplant, irrespective of hair loss stage, yet they all have individual stories and reasons, goals, desires and objectives for having it done. It is purely a personal and cosmetic issue. Like others who have had procedures done, you have your personal rasons, image and reasons which are important to you and valid and should not be ignored or discounted. Our main objective is to do no harm, do our very best and provide the best results consistent with current medical standards keeping the hairline natural and aethetic today, tomorrow and in the future. Patients similar to you have gone through hair transplantation and have been very pleased. Others later on in life are pleased, but priorities changed and the maintenance of additional procedures to keep up with ongoing hair loss is too much for them and they wish they never got started. You need to examine your reasons carefully and anticipate all the risks of future loss and maintenance before proceeding with any surgery. Patients should also be committed to medical therapy as well.

Ricardo Mejia MD

Jupiter Dermatology and Hair Restoration

Ricardo Mejia MD

Jupiter Dermatology and Hair Restoration

In my own practice, only a handful have experienced true sexual side effects that required them stopping the medication. Everything was reversible and they did not experience a long delay in return to normal.

Ricardo MEjiaMD

Propecia is not 100% effective. The data on propecia is well documented on their website. There is a nice video and chart showing how initially you can get an incease in hair count but over time it stabilizes and then even decreases. While you have progressed with your hair loss, the real questions is how much faster or further woould you have progressed without it. I have several patients that have had similar results.

You will get some benefit, but you get better results with the 1mg.

Ricardo Mejia MD

Unfortunately, complications occur in even the best hands. Idiosyncratic reactions have been reported albeit rarely. All surgeries carry a risk and patients should be well informed.

Ricardo Mejia MD

Jupiter Dermatology and Hair Restoration

No, the grafts will be rejected.

Ricardo MEjia MD

The decision for where the hairline should be placed varies in my practice from patient to patient. There are many factors that I consider and a patients risk for significant loss is always a great concern as well as there expectations for the future. At a younger age, most patients want to maintain their youthful hairline and you have to balance the donor area, the head and skull proportions and the expectations. If you are motivated, you will do the number of procedures necessary to give you maximum density over time as Bill has done. In my experience, if you achieve over 6000 grafts total, you have alot of hair. This is what you need to anticipate if you want to achieve maximimum density and if your donor area will give you 7000-9000 grafts over time. Younger patients in my practice also need to be committed to propecia and rogaine to maintain and prevent future loss. Remember, Your hairline is not just where you want it today but where you want it when you are 40 or 50.

Best of Luck.

Ricardo MEjia MD

I have not embraced Lasers fully in my practice. ALthough there is some data and discussions from other physicians regarding the validity of the data and the benefits as noted by patients, there is still debate amongst us hair transplant physicians. I have the combs available for patients in my office with the clear understanding that it may or may not work. Similar to Propecia or rogaine, if it works, you need to keep using it.

Ricardo Mejia MD

It is difficult to interpret photos and expectations on the website especially if they do not show before and after photos from the same position and lighting. However, I can see from the thinning areas of the crown a significant tendency for ongoing hair loss which may not necessarily be improved with Propecia and or Rogaine. I personally know Dr. Rose and have the highest regard for his work. The temple areas can receded with time irregardless of propecia. As a physician we are always trying to make sure we are on the same page with the patient and even when we think we are, somehow we are not. Close communication and follow-up with Dr. Rose will always lead to a successful result.