Dr. Ricardo Mejia

Yes you are correct. There are exceptions to the rule taking into account the variety of factors number of grafts transplanted etc.

Aaron. That is a great term especially in todays environement.. "the hair greed virus" Kudos. I will keep using it. Thanks for the comment

My general advice to patietns is nobody needs a hair transplant and you do not need one. Nobody should convince you to have one either. You should enter into this voluntarily after having had a proper consultation with a physician and understanding the risks benefits and limitations in your specific case. Keep in mind you will get many personal opinions which may not be relevant to your case, history and or goals and expectations. Carefully research and determine if your hair loss is a significant concern to do something about and consult with a professional to give you the proper counseling and recommendations. Consider your options carefully before jumping into any decision.

Thanks for your comment. The whole frontal hairline was excised. He is very pleased and it has changed his whole outlook dramatically. He is no longer fearful of a windy down or swimming in the pool.

I usually put patients on meds rogaine, Propecia and wait at least one year. I generally am very cautious for anyone under 25 and would rather patients wait. You may find priorities change as youget older where all of a sudden you find perhaps you do not want one, you get married and no longer "need" one, you shave your head and more comfortable with a shaven look. Things change and better to wait.

To answer the possible causes, refer to my previous thread on understanding shock loss: understanding shock loss

As Dr. Charles mentioned. Many Docs like to wait and see what others have been doing in order for the kinks and bugs to be ironed out. SInce it is new we like to be cautious. After the AMsterdam meeting and learning more about it, it does have potential and promise and will also be incorporating int the practice. But as scientists, we always like to see good scientific published peer reviewed studies that prove its efficacy. And that takes time.

There are cases if we know a patient is coming back for a second procedure we do not do a tricho closure. Why? In order to do so, you trim the superior edge of the skin approx 1mm or less on the lower border of the incision. In doing so the hairs will grow through the scar. In the subsequent procedure it is better and easier to preserve those hairs and dissect them easier if they are not growing through the scar. However, the scar would look much better. In fact the patient I posted recently non tricho closure did not have a tricho closure because we anticipated that he would come back for a second procedure. However, he was very pleased with what was done and desired no further surgeries since his goals were met. In hindsight, I should have done my tricho closure even though he has a great scar. I feel it could have been better with the tricho closure. It is for this reason that I do them in most cases now because you never know when a patient will say " Gee Doc you did more than I expected, its great and natural and I am good for now" There is another old post several months back where Dr. Beener and I also commented on this issue. You may want to look for it.. I could not reference it right away.

I would say it is very possible. It depends what you mean by shock loss. You may wnat to refer to my previous discussion on shockloss. understanding shock loss

He does have good donor density so if he wanted to have more denisty he does have the donor area to easily do that.

Kudos on your decision. It is very wise to consider your future hair loss progression. I too had a patient in your same shoes and progression at age 23. I also explained the bald is beautiful approach and how it is very fashionable and accepted today. He decided too shave his head and is even more happy now with his decision and new look.

Yes you are correct. The objective of a physician consultation is to evaluate the patients goals and provide the best result that fits his goals and budget with the expected number of grafts. Could we have transplanted 4000 grafts with higher density. Yes. BUt that was not the plan or route the patient chose.

53 year old male desiring coverage in frontal area of scalp. Calculated area to cover in frontal area plus temporal corners: 138 cm squared. Limitations: budget. Total Number of grafts: 2826 Overall "average" density: 20.5 FU/cm sq, some areas more other areas less in order to achieve cosmetic density and distribute grafts accordingly. Patient very pleased. Has no desire to further or augment density as his objectives have been realized with this one procedure.

This patients main concern was to lower the hairline along the "alleyways" and soften this transition as drawn in the red markings.

Agree with Bill. In person always best.

There are many variable about the success rate. The type of scar. the thickness, the underlying blood supply/ vascularity, the location. In general scars have reduced blood supply and we do get good results provided we minize the trauma to the area, the epinephrine concentrations and try not to dense pack too much. These are the main concerns. If you have a good graft from either FUE or strip, the above are the main issues for the success rate.

yes we do check for hepatitis and HIV. But most improtantly it is not at all about protecting ourselves, it is about patient safety. We utilize universal safety precautions irregardless. What if you have a liver that can not handle the lidocaine anesthesia or a bad kidney or bleeding or clotting problem? As a physician , we have the responsibility to assure your safety and understanding the metabolic requirements of what we give you is important and how it is metabolized and excreted through yoru kidneys is important. It is added information just like checking your blood pressure to reduce the risks of comlications.

Petesman: See the post written on understnading shock loss. You should be fine and the hairs will regrow.

Petesman In answer to your question below, I have previously written the above thread to help understand the various definitions and meanings. Your hair can "shock" out for a variety of reasons listed above. Generally it is not great and in most cases not permanent. Dr. Mejia petesman Hard Core Real Hair Club Member Posted May 20, 2009 03:58 PM my questions are 1. the 1200 hairs that were newly implanted, can they cause shock loss or permanent shockloss the the old implanted hairs? 2200 DHI Ireland june 2007 Rogaine 5% may 2007 Lasercomb jan 2008 Nizoral aug 2007

If you are trying to get your blood work covered by your insurance, you may need to go through your family doctor with certain insurances. However, you can at any time go to a lab with a prescription for the tests from your hair doctor and pay out of pocket and the results go to you and your hair surgeon. your family doc does not need to know.

It is best to use small incisions, minimal depth to avoid transection of underlying vessels, avoid high dense packing, low concentration of epinephrine in the tumescent solution. Angle of the blade is important to avoid significant deep trauma. As long as you are using small instrumentation for the perpedicular or coronal slits, you shoould be fine. I like the perpendicular slits.

I have one patient whose wife doesn't even know. Only those that you tell or see you post op will have a clue.

I am sorry to hear about the news. I will keep her in my prayers.

Tuja: You have hair already and you are not completely bald. Consequently there are different game plans. 1. Fill in the density between existing hairs to augment what you already have. In this scenario, graft counts can range in the lower numbers and above as you experienced without trying to push the limit. In this scenario, many surgeons would not necessitate shaving your head completely and 2400 grafts can be accomplished without shaving 2. Maximize the graft density count per square cm. In this scenario, it is alot easier to dense pack with a totally shaven scalp. The differences may lie in what the objectives are for each physician, the desire to maximize the graft count per cm squared and the area in which they intended to place the grafts and the hairline locations as noted above. Can you comment if any of the physicians said you did not have your head shaven?

If there are enough patients that can confirm the validity of increased hair growth response, then I will start recommending it in my post op regimen.