Dr. Ricardo Mejia

If you are looking for a full head of hair, you are better off in a hair system. You would not be a good candidate for full restoration maybe a very limited frontal forelock. As w mentioned, shaving it off is a great option which I advise to many of my patients and they are very happy.

A lot depends on how aggressive you want to lower your hairline and if you are trying to blend into the middle. you can utilize a simple mathematic formula by dividing the total number of grafts by an estimated square centimeter area that you want to transplant. For example 2000 grafts into 100 cm squared is 20 grafts per cm squared but not as good as 40 grafts per cm squared if you pack them into an area of 50 cm squared. To get an accurate estimate to compare what you are being told, calculate the area you are trying to fill in. Hope this helps.

There is more to a man than just his hair. While I have no clue to the emotional toll you are personally enduring, I can only tell you of the experiences from my patients. I did have a young guy who was not a candidate for hair restoration because of his expectations and poor donor area at a young age. I did convince him to either try a hair piece or shave it off. He did shave it off. While at first it was hard to get used to, eventually he did as well as the rest of his friends and even girlfriends. he is happy and dating now and it is not because of is hair, but rather his unique personality that makes hiim. On the other hand, I have had young patients that were not candidates for hair transplantation go to a hair system and they are very happy. As ws mentioned, you need to decide what is in your best interest. Give it a try and if it doesnt work for you try something else.

Spanked. I must agree on the emotional toll it plays. I find this even more painful in my female patients. Interestingly, what I have noticed form several of my patients is an acceptance by many once they did share with there friends or colleagues at work it was surprising to see how many patients told me many of there co workers or friends we very supportive , several even more inquisitive about possibly doing it themselves and several that said they were thinking of having the procedure themselves. It would be interesting to get a statistical poll or feed back of the many patients that actually came out and told their coworkers or friends, if the feedback was positive as in the cases of my patients.

The ARTAS is a good device. I looked at it for my office, but currently unable to implement it. For one, I would need a dedicated room I currently do not have available. THe traditional FUE technique in my hands Does the job well and very efficient.

I have not seen any convincing data to support the claims. As a scientist and dermatologist understanding the structure and function of skin, it is highly unlikely there will be a problem. I personally would not have an issue if my pregnant wife cut a tablet and fed me a pill. I personally would feel very comfortable. I would welcome any studies that perhaps I am not aware of to the contrary which demonstrate the absorption of finasteride simply by touching it. On the other hand, since you have been around the block a long time, you also realize pharmaceutical companies and doctors must practice defensive medicine to protect against malpractice claims. We know that taking finasteride systemically in a women can cause problems with a male featus. Consequently, similar labeling requiirements must be imposed cautioning women against handling the medication, otherwise any women With a birth defect suddenly has grounds to sue a manufacturer or doctor claiming they handled the pill. if it was so easily absorbed, current studies with Transcutol P 1% in combination with water, propylene glycol and 2-propanol in rats would not be undertaken. They need special solvents In an effort to help deliver finasteride topically. Generally, most physicians including myself follow the party lines as recommended by the manufacturer primarily from a medico legal issue. If the finances of an individual or of significant concern, cutting a 5 mg tablet which in some cases is covered by insurance for a minimal copayment is much cheaper than Propecia, then it is a suitable alternative. If there is concern or uncertainty about topical absorption, then do not let pregnant women handle the medication. That is what I also tell my patients, even though I know it is an extreme low risk.

it is certainly easier to take a 1 milligram tablets of propecia. I have asked for the data on systemic absorption of touching a cut finasteride tablet. I have not gotten any replies or studies. It is a theoretical risk and promoted due to uncertainty and cya. Finasteride is a large mecule and our epidermal skin barrier prevents absorption. While it is advocated not to touch, it is an extremely low low risk

Stretch scars can happen irregardless of the type of closure. My technique for minimizing this problem is to reduce the tension as much as possible. This involves a layered closure technique not just in the subcutaneous layer, but also the galeal layer to hold more of the tension, a 2-0 vicryl stitch will hold the tension longer than a 4-0 vicryl stitch, so the type o f sutures can also make a difference. Focus on minimizing the tension by removing small amounts at a time whether it is by width or dividing the scar in parts. Even after all the above techniques are used, the risk of a stretch back scar is possible. However, I have good success with the above. I typically prefer to do as little as possible which is contrary to what patients want which is to get it all done at once and do more hair transplants at the same time. Focus on just the scar revision. A lot of physicians do not use deep sutures noting that the results are good enough. As a dermatologic surgeon, in all my plastics closures, I prefer a two layered closure which adds more value and results in my closures. Many plastic surgeons doing hair sometimes do not use deep sutures as noted above, the results are good enough. However, they would never do a facelift without a two layered closure or deep sutures. It all comes down to providing support in the deeper layers to minimize tension on the epidermis. Hence this I my philosophy in the donor area and it works well in my practice.

Yes with fut we do not shave the back of the head. We only shave the area that is removed. The hairs will then hide any sutures easily. Even for the donor area we do not require shaving the head. My patient population likes to get back to work with as normal appearing head as possible.

I usualy tell my patients to cut them all in 1/4 and put them back in the bottle . It s more efficient this way

5 hair follicular unit grafts do exist although more rare. Some may also interpret this as a double follicular unit. But we do see them on occasions with patients that have great density.

I never tell a patient he "needs" a transplant. In fact you need nothing at all. From a clinical standpoint ,it is also possible you had periods of telogen effluvium, although I canot make any diagnosis without a proper medical consult and evaluation. Your numbers of hair loss per day are within normal limits, Telogen effluvium can occur from stressful periods alone in your life. I have seen guys thin out worse than you simply from stress alone, althoug this is short lived. I have a video at Jupiterderm Skin and Hair Doc which describes this more in detail with women but is also seen in men. Normal hair loss per day is estimated between 50 to 150 hairs per day. We can not be absolutely sure about the redness without a good personal exam, although the etiologies, can be seborrheic dermatitis, irritant dermatitis and the early beginnings of lichenplanopilaris, a scarring type of alopecia ( rare) and even flushing post showering. Medical therapy is recommended if you have androgenetic alopecia. If you have hair loss due to telogen effluvium, the hairs will typically regrow on their own and absolutely no medical therapy is warranted. Patients that have a slow gradual progression of hair loss over years typically have androgenetic alopecia especially if you have a family history. If you experience acute periods of a lot of hairs falling out at times or shedding( especially over 3 months) with some stabilization, you could have telogen effluvium. Many patients have a combination of both.

You will need to speak to your doctor regarding which is best for your scenarion. In my practice whether I do fue or fut, you typically should not see punch scar or strip scars. We can shave just small portions of the scalp for fue. If you are doing a large procedure, then shaving would certainly be easier for fue. Strip is more efficient and can hide the scar in the back easily with longer hair styles. We do not require shaving the recipient site. Hence you can blend it in to existing hair. The only downside is the scanning and crusting for the first week or so which could be more noticeable. Wearing a hat will definitely help hide what you have done. I would advise wearing a hat regularly for two to four weeks before so people get used to you wearing a hat and will not ask questions once the procedure is done.

I have done patients at age 83 who are now enjoying their hair regularly on the golf course. If you are in good health, your age iw not a factor. It all depends on your donor area and objectives,

My point exactly Dr. Beehner. We also customize the blade type to the graft sizes and the type of scalp tissue.

What I tell my patients is you only need to take it as long as you are concerned about your hair loss. Once you get to a point in your life where it does not matter you can always stop it. For some people, that day never comes. For others who seem to get into hair transplant early on in life, it comes after they get married and have kids and realize the hair is not as important as other factors in there life. This is the reason I caution young patients with a strong family history of balding to not rush into hair transplants and to start medical therapy to slow the process down. If you have side effects they are reversible once you stop them. I have never had a patient with permanent side effects.

We have been saying we are close for many years so who really knows. we have been saying every year about 5 to 10 years away.

As a physician, when a patient comes to me with doubt about having the procedure done. I usually advise medical therapy. If they are severly anxious, in some cases even counseling or acceptance. I had an 18 year old patient that I convinced to shave his head and give it a try. You know bald is beautiful for some people and the in thing. Look at pit bull and other celebs. nonetheless, my patient is bald and couldn't be happier, dating and enjoying life. I can't say this is for everyone, but every person needs to take a close look at there reasons. Keep in mind if you have a family history of severe balding, you would need more than one procedure and need to save a lot more over time as you age. Starting medical therapy for young patients is typically the route I choose at least for the first year to assure they are committed.

Everybody needs to make a buck as they say. It is no different than companies advertising FUE with an old outdated strip surgery stretch scar with short hair where the scar is easily seen and another photo with longer hair combed where the scalp can't be seen with a comment, which procedure would you rather have. it is misleading just as you mentioned. when I consult with patients about their hair loss , I always tell everyone they do not need it. Nobody needs a hair transplant. It is a personal Want and desire and purely cosmetic. Good observation nonetheless.

You are way ahead of the game with the density on your crown. If you have already had a transplant, you know you have male pattern baldness. However it does not appear to be a big factor in your crown. enjoy.

Photos do not always tell the complete picture . However, the importnt question is if you want more density do more grafts if your donor density allows it. If you are not happy with the frontal hair line and it appears pluggy then by all means, I certainly typically do an fue type plug reduction and recycling. The decision rests on a good consultation of your objectives and examination of your donor density.

I know Dr Reed personally and I do recommend him.

Your cut hairs I'll not grow. We are getting closer to hopefully cloning a hair follicle, But time will tell.

It is always a good idea to follow up with a medical professional. If all the stitches are not removed or if a portion is left under the skin, you may risk developing an inflammatory reaction or a stitch grqnuloma. Feel your scalp regulary and if there is any irregularity have it evaluated, I have seen several cases from other surgical offices where stitches were not completely removed.

You may be referring to PRP and stem cell stimulation with a product called A cell. This a study we are currently undergoing. There are several case reports and presentations regarding the benefits. However there is no clear study proving any stem cell stimulation. It is a theoretical benefit based on the growth factors that are injected. We are hoping to get good results in men and women with androgenetic alopecia. We are also experimenting with scarring alopecias such as lichen Plano Pilaris.