If the patient elects to proceed with the insertion he/she is laid on the side. The fleshiest part of the upper outer quadrant of the buttocks is located and cleansed. This is usually midway between the iliac crest and the greater trocanter. A 10cc syringe of Lidocaine is used with 2cc of N/S using a inch 25 gauge needle to infiltrate an area parallel to the table. A very small shallow puncture is made at the point of infiltration. A female trochar or male trochar is inserted through the puncture site and quickly angled parallel to the table anteriorly along the path of the local anesthesia to the hub of the trochar. The stylus is removed and the appropriate size pellets are placed in the trochar and inserted with the plunger.
Dr. Mark Richards is one of a handful of nationally and internationally recognized experts in the emerging field of bio-identical pellet hormone therapy. He instructs physicians in how to start this therapy in their practices. He also lectures to physicians at medical specialty conferences (Plastic Surgery and Anti-Aging) regarding the extensive science of the last 70 years supporting the use of bio-identical hormone pellets to enhance and restore health and well-being in aging humans. He has practiced and taught Plastic Surgery for over 21 years, and has practiced and educated others in bio-identical pellet therapy since 2008. He is board certified in Plastic Surgery.
Hormone replacement therapy has been shown to have other beneficial effects. In a study women taking estrogen through HRT showed that the estrogen positively affects the prefrontal cortex by boosting the working memory. This suggests that estrogen may play a key role in certain frontal lobe functions in women.  Women using HRT after menopause have no additional weight gain compared to women who do not use HRT.  Also women who use HRT with an estrogen component show positive effects in their sex life (mainly increasing their sex drive and sexual sensitivity) but the effects are inconsistent across women. These sexual improvements may dissipate after receiving some forms of HRT for extended periods of time.