Dr. Ricardo Mejia

Dr Feller makes a good point. It is well known the patients we worry the most about are the ones with very elastic scalps.

I agree hair pieces can look very natural. Even as a hair transplant physician, I do recommend them for patietns because they can provide as much density as you want over 100% of your scalp quicker and faster. I have a good friend that has one and it looks great.

I have seen patients with artifical hair that subsequently developed alot of fibrosis and scarring on their scalp. The artificial hair is a foreign body and over time your scalp starts to react against it.

Best of luck with your decision.

I have posted some info below. Hope it helps

Scar stretching

After 6 days from surgery, it is unlikely to be a graft.

Everybody is different, but in our case at 6 months we saw alot of hair growth in the area to reassure the patient and myself, everything was going to be fine. Hairs from the trichophytic closure were growing nicely through the incision line masking any evidence of a scar. If I ge4t a chance I will try to document her photo case and hair growth in a seperate section.

In my practice, I tell patients they do not need hair they are fine justt the way they are. However, if they desire hair, then I tell them what I can do for them. Hair loss is a personal issue and for some not an issue. We do not make it an issue unless the patient is very concerned about it.

It is unfortunate some people regret their hair transplant. A well informed consultation discussing the risks benefits and alternatives is critical to assure a successful experience with all patients. Of course, also being in the right hands of a skilled physician.

I have hade one case in a woman of severe shock loss in the donor area. It was a large session over 3000 grafts in an area of low density. The area did have some tension in the closure area. SHe was very concerned as well as I, but the hair did regrow completely with minimal if any permanent hair loss. Time will heal all wounds. I also recommended using rogaine 5% for my patient.

WIth time, I hope your hair loss will improve. Do not worry.

PLease grow. It is possible to get failed transplants due to too much trauma and damage in the recipient blood supply. We do monnitor the recipient area carefully to assure we do not get any dusky areas that could "potentially" comprimise the vascular blood supply. With the newer smaller instrumentations, limited depth of incisions and tumescence, this is avoided. There can be other unfortunate albeit rare cases of while failed transplants have occured which have been covered in previous topics.

MMHCE:

See my topic on understanding shockloss. In the right hands hematoma formation and wound dehiscence is rare. Keep in mind while some things sound worrying, we are dealing with a surgical procedure with many variables. As surgeons, we are very careful regarding all of these variables to limit any complications. I don't think there is any surgeon in the world practicing for many years who can honestly say they have never ever had a complication in any type of surgical discipline They are rare, but can occur. Hence the informed consent.

MMHCE:

This is a better place to address your answers regarding shockloss so as not to rewrite the whole topic.

There is a much higher chance of shockloss with increased tension. You can still get shockloss simply from the surgical trauma induced. Other factors include trauma to underlying vessels arteries with reduction of blood supply, infection, wound dehiscence, hematoma formation. I recently had a patient come to me from Costa Rica with a pseudomanas infection and wound dehiscense of the donor area.

Yes I have the tests in my office and perhaps will run it on myself to see.

I usually have a fixed fee price for a range of grafts. I give my patients a not to exceed price. Even if I put more grafts in above and beyond the range, there is no extra charge. SOme clinics charge by the graft. It is not unreasonable to understand all your finances ahead of time and ask these questions and findout if you will have to pay more for any grafts above 500. Most reputable clinics will always transplant the hair in excess of the planned amount. I have one clinic in my area that has told patients in the middle of surgery, Gee we got an exta 500 grafts, you can pay for these or we can throw them away. Know how your surgeon will deal with excess grafts above and beyond your plan. If it is on a per graft basis, then you should know what your potential maximum cost is so you will not be surprised.

I have got the good genes so do not need one at this time. Things may change but doubtful given my family history. There are many good doctors that I would trust to do my hair. I only wish I had a good revolving mirror.

There are multiple variables to this answer. It can occur either place and depends on technique and closure. Usually in the donor area, it is due to tension on the wound edges.

I would recommend you go back to your doctor and discuss your concerns with him or her to see what they can do and keep an open dialogue with your physician. If you are not happy with the physicians answer get a second opinion from an equally good doctor.

If I had a patient in your shoes and I agreed it was too low, I would correct the situation and help you until you were satisfied. If I did not agree and it was a perceptual difference and it looked good to me, I would send you to another surgeon of equal caliber and get a second or third opinion from a reliable source.

if it is an old scar, products are not likely to be too beneficial. You may need to consider trichphytic scar revision. Fresh dermatologic surgery scars can be treated with ALdara, silicone, mederma, plain aquaphor ointment for moisturiztion, pulse dye laser treatments, although this would not be too advisable near hair follicles. My experience is good surgical technique helps reduce the need for topical treatments.

I do have one guarantee!!!.

I promise you and guarantee you will grow more hair. This I believe is a fair and safe guarantee. I have never had a surgery where I did not get hair growth. And if in the rarest of all chance a patient did not grow hair, I would repeat the procedure for free or refund him his money. That is my committment to quality.

As for guaranteeing fu/cm2, i do agree that is a bit excessive. For one, it has never been measured accurately for a full hair transplant and is very difficult to do.

As you note in some of the posts above that have been done by other physicians, the grafts are divided into singles doubles triples and quads. The main question is how much donor area is each doctor removing to give you the number of grafts quoted. IF you note both gorpy and wantego, they averaged about 2.2 hairs per graft. For example, if we assume each doctor removes the same amount of hair follicles from your donor strip, then you will be getting the same amount of hairs just divided differently.

Assume each doctor you visited was going to remove exactly 5320 hair follicles, then your distributition would be as follows:

DR A: 2800 grafts averaging 1.9 hairs / graft

DR B: 2000 grafts averaging 2.66 hairs per graft

Dr C: 1300 grafts averaging 4.1 hairs per graft

Every doctor uses different tecniques and instrumentations. SOme doctors divide the hairs follicles very fine, some, medium and some like to utilize double or triple follicular units or minigrafts. The double and triple follicular units have more hairs per graft. There are advantages and disadvantages to each technique which depends on where the hair is going to be placed, the caliber , texture and quality of the hair. For example in the hairline, we primarily use only single hairs. In this scenario above Dr. Each doctor is giving you the same anount of hair divided differently.

However, if we assume each doctor averages 2.2 hairs per graft utilizing strictly follicular units, then Dr A will be giving you alot more hair than Dr. C. In general the more hair you get the better. Dr A will be giving you 6160 hairs and DR C 2860 hairs or 54% less hairs than Dr. A.

So the issue of grafts can be confusing when trying to compare what one surgeon is doing compared to another. Obviously in the first example, you will get the same amount of hairs. In the second, you will get a lot less hair. I have never met a patient that said I gave them too much hair and asked me to take it out. In the end if you have done your due diligence and you have to put your faith that the doctor will be doing the right thing for you which is to give you more hair and not be thinking about padding his wallet. good luck.

yes they can be removed and lasered. However, alot really depends on what the problem is what you are not happy with etc. There are solutions, and hopefully you can discuss these issues freely with your doctor. I am assuming you have waited a full year for the hair to grow out. Hair somes out patchy at first and if you are not over a full year, perhapsy you are not seeing the entire picture clearly. It is usually best to wait to see the entire result and then decide what you are not happy with. Make sure you sit down and discuss these issues clearly with your doctor so he can help you.

Hair transplantation does not lead to skin cancers. However skin cancers do occur on the scalp. This is a subjective that I lecture on at Hair restoratio meetings. A physician must be careful to properly examine the scalp to assure there is no evidence of skin cancer on the scalp prior to hair transplantation. Skin cancers can occur in the donor area as well and may appear like eczema or a rash that never heals. I would assume most astute physicians would stop before taking a donor strip from this area. If you transplant from a donor strip that has cancerous tissue, it is possible you could spread it to the recipient area. Keep in mind I said possible. I have not ever heard of a case like this happening. Infections are very rare, however they can occur on occasions. MRSA is becooming more wide spread and has documented previously.

MY general advice to patients is if you are happy with the result of the first procedure and comfortable and enjoying the new hair growth, then there is no need to have a second procedure done. The need for a second procedure as was mentioned is when it starts bothering you again. To some degree this is irrespective of density and coverage. Each person has there own comfort level. Some are very ecstatic with 1500 grafts in the frontal third, others are not happy until they have achieved 8000 grafts and they can no longer see any area of their scalp. It is a personal decision when a patient is ready for the next procedure. As far as surgery goes, in most cases, doctors can always find added areas to fill in with greater coverage and density. Good luck with your decision.

Scars Revisions and Hypertrophic Scars.

Sorry for the mispellings.

I have commented on scars and scar revisions and test grafting in a previous post back in may. You will find many detailed answers on the thread below.

Scar revions nypertrophic scars etc.