Private Teaching For Physicians In Hair and Eyebrow Transplants

Greetings,

I just completed a private teaching course with a very skilled physician from Saudi Arabia, Dr. Wissam Adada. He works in a well known medical institution in Riyadh, and came to my clinic to learn my approach and techniques in Hair and Eyebrow Restoration. I always enjoy these teaching opportunities because it allows me to work with a physician one to one and share my knowledge in the field. We had a nice combination of cases including an eyebrow transplant and a number of hair transplants both via follicular unit extraction using the new SAFE scribe and strip harvesting. I look forward to keeping in touch with Dr. Adada as his practice grows and continuing to be a resource for him in the field of Hair and Eyebrow Restoration.

All the best,

Marc Dauer, M.D.

Tags: Hair Restoration Teaching, Hair Transplant Teaching

FUE (Follicular Unit Extraction) To Cover Donor Strip Scars In Hair Transplantation

Greetings all,

Today I would like to discuss the issue of donor strip scars and how to approach them when they are too wide, or noticeable, or the patient just wishes to cut their hair very short. In the world of Hair Restoration today there are many physicians trying to push the envelope of grafts in a single session. Physicians trying to perform 4000, 5000, or even 6000 grafts in a single session. Using the strip method, the only way to achieve these numbers is by taking a donor strip that is very wide. This puts undue tension on the skin closure and can then result in very wide donor scars. Sometimes though, even under the best of circumstances and a proper closure, a wider than expected donor scar can also occur. I have been seeing more and more of these patients from other physicians recently.

After much experience I am finding that when you attempt to excise these scars, often times they will just come back again. The best approach to this situation is to harvest grafts via FUE ( Follicular Unit Extraction) and then transplant the grafts into the scarred areas that are devoid of hair or have very little hair in them. Typically the grafts grow nicely through the scar tissue and provide hair coverage of the scar which acts to conceal the scar thus making it more feasible to cut the hair short.

I have included photos below of a patient who had multiple strip scars from a procedure performed by another physician. The ‘before’ photos show the donor area shaved and the donor scars. The ‘after’ photo shows the FUE punctate sites (these heal in about a week) and the hair immediately transplanted into the donor scars. A difference in the donor scars with hair transplanted into them is immediately visible and when the hair grows in this should provide nice coverage to the donor scars and allow the patient to cut their hair much shorter than was possible before.

I hope this sheds some light on the topic.

All the best,

Marc S. Dauer, MD, ABHRS

Tags: follicular unit extraction, FUE, Hair restoration, Hair Transplantation, Hair Transplantation Hair Restoration, Hair Transplantation Hair Restoration in Younger Patien, Los Angeles

How To Avoid Post Operative Swelling In Hair Transplant Procedures

Greetings,

In years past patients who underwent hair transplant procedures experienced a significant amount of facial swelling in the forehead and around the eyes post procedure. Typically the swelling occurred at around 3 days post operatively after the hair transplant and usually resolved by around 6 days post operatively. Oral steroids have been used in the past to combat this swelling and definitely helped to reduce the swelling in many instances, but taking oral steroids, even in small doses, can subject the patient to other possible complications. This led the hair transplant community to look for other options. In the context of any hair transplant procedure I use what is called “tumescence” to allow for easier graft placement. Tumescence is where saline fluid is injected into the scalp in the regions where the new hair is to be transplanted. This accomplishes a few different things. Firstly, it compresses the vasculature down below which then allows us to cause less vascular injury when placing the grafts. Also, it stretches the scalp which also causes less bleeding, thus allowing for better visualization. Finally the stretching of the scalp also “widens the playing field” of the area to receive the hair transplants, thus allowing us to place the grafts closer together. When the scalp shrinks back to it usual size this helps to create optimal density. What I now routinely do is mix in a small amount of injectable steroid solution, diluted in the saline that is to be used for tumescence. In addition, I no longer give any oral steroids. Since there is no downside to diluting such a small amount of steroid into the tumescence fluid, this make it much safer for the patient then taking oral steroids and the results have shown that greater than 90% of my patients experience no post operative swelling after a hair transplant procedure. In the rare case that swelling does occur, it is then possible to treat with oral strides if so desired. This truly has been a major advance in the field and one that greatly benefits the patients and decreases possible complications.

All the best,

Marc Dauer, M.D.

Tags: Eyebrow Transplant, Hair restoration, Hair Transplantation, Hair Transplantation Hair Restoration, Hair Transplantation Hair Restoration in Younger Patien, Hair Transplants, Los Angeles

Facial Hair Transplants

Greetings,

Today I would like to discuss Facial Hair Transplants. Many people of varying ethnicities have varying amounts of facial hair due to hereditary factors or even due to facial scarring secondary to trauma or surgical intervention. Facial hair transplants are also beneficial in female to male transgender patients to allow the individual to grow more of a full beard. It is possible to take hair from the head and transplant it to areas of the face where the patient may desire more hair. It is possible to harvest the donor hair for facial hair transplantation by either the strip harvesting method or follicular unit extraction. The hairs placed on the face are almost entirely single hair follicles and they are placed in receptor sites that are created with a custom size blade that measures between .5mm-.7mm depending on the caliber of the individuals hair. It is imperative that the receptor site angles are created almost parallel to the skin to make the new hair grow in as naturally as possible. Is it also very important to follow the changing directions of facial hair as you move along to different areas of the face. The growth timeline is very similar to other areas where we perform hair transplantation in that most of the transplanted hairs initially stay for about 2-4 weeks and then fall out. The new hairs then begin to grow in at 3-4 months and about 50% growth is seen at 6 months and full growth is seen at around 12 months. Below I have shown an example of a patient with almost no hair in the goatee region. The first photo shows the patient before the procedure with the transplanted areas marked out. The second photo is immediately after the procedure and the third photo is 10 days after the procedure with many of the transplanted hairs still present and appear to be growing. Most of these grafts will fall out in the next few weeks and they will begin to grow back at 3-4 months post operatively. I hope to post a follow up photo at 9-12 months.

All the best,

Marc Dauer, MD

This is a pre op photo of a beard transplant.

This Photo is 2 weeks post operatively after a beard transplant.

Immediately Post Op Beard Transplant

Tags: beard transplant, facial hair transplant, sideburn transplant

Hairline Design In Hair Transplanation

Greetings,

Today I would like to discuss hairline design in Hair Transplantation. Many factors need to be taken into account when considering how to design a hairline in a Hair Restoration procedure. The patients age and eventual donor to recipient ratio are two very important factors to take into account when designing a hairline. When examining a patient for the first time, I always estimate the patients eventual hair loss pattern. By doing this I can estimate how many grafts the patient will eventually need to cover all the thinning areas, not just the areas that are thinned at the time of examination. I can also estimate the patients total donor supply (the total amount of grafts the patient will be able to donate from the permanent hair zone). In patients who are younger (under age 35) and experiencing hair loss, chances are they are going to lose much more hair over the next 30+ years. Many times these patients want to be very aggressive with their hairline design and location because they cannot imagine how much more hair they are going to lose and how much donor hair they will eventually have. My job is to educate the patient as to why we need to be conservative with the hairline design in a young patient undergoing the procedure for the first time. I explain that every persons donor reserves are finite and once the donor hair is depleted, there is no more. That is why it is so important to use every hair in the most judicious way so that the patient ends up with a completely natural result that looks as good when they are 35 as it does when they are 65. I always try to stay on the side of being more conservative in the hairline design on a patient’s first hair transplant procedure. Everyone who has this procedure once has it performed at least a second time, so I typically explain that I would prefer to bring the hairline down a little in a second procedure rather than risk depleting donor reserves or placing the hairline in a unnaturally low position. You can very easily lower a hairline, but once the hairline is too low, you have a problem. Also, if given the choice of having a slightly more mature hairline with greater density, or a lower hairline with lower density, most people will always choose to have more density and a slightly higher hairline. Older patients with mild to moderate thinning can have a more aggressive hairline design as in most of these cases there is no risk of depleting the permanent donor reserves. Another consideration is hair to skin color contrast. Dark hair on light skin shows through more than light hair on light skin or dark hair on dark skin, so in patients with a non-ideal hair to skin color contrast, this must also be taken into account on how aggressive to get in designing the hairline in their hair transplant procedure. Hair curl and caliber also play factors as a slight increase in hair diameter by only .1mm can add up to a 30% increase in cosmetic density and curly hair also can add greater amounts of cosmetic density than fine straight hair. Finally, the most important factor in designing a hairline is to maintain a irregular irregularity to the hairline. There can be no straight lines and the irregularity cannot be in a linear fashion. This is something that is not appreciated by many physicians practicing in the field of Hair Transplant surgery today. A bad hairline design is a dead giveaway for a hair transplant and must not occur under any circumstances. Only single hair grafts must be used in the first 2-3 mm of the hairline, and we always tend to use the finer grafts in the hairline.

Thank you for reading my brief explanation on my approach to hairline design in Hair Restoration procedures.

All the best,

Marc Dauer, MD

An Example Of A Natural Looking Transplanted Hairline

Another Example Of A Natural Looking Transplanted Hairline

Tags: Eyebrow Restoration, Eyebrow Transplant, Eyebrow Transplantation, Hair Loss, Hair restoration, Hair Transplantation, Hair Transplantation Hair Restoration, Hair Transplantation Hair Restoration in Younger Patien, Hair Transplants, Los Angeles

New F.U.E. S.A.F.E System

Greetings all,

For the past few months I have been using a new machine for my FUE procedures called the “SAFE System”. For those of you who are not familiar, FUE stands for “Follicular Unit Extraction”. It is the process where donor follicles are taken out one by one, instead of removing them via the “Strip Method”, where a strip of donor scalp is removed and dissected under the microscope into individual follicles. There are a number of advantages and disadvantages to FUE vs. Strip Harvesting but I will not get into this discussion here. FUE is typically described in marketing and promotional advertisements as a “scarless” procedure. This is not actually true. What is true is that FUE causes many “micro scars” in the areas where the follicles are removed. In most cases these micro scars heal well and only leave a small dot of hypo-pigmentation in each spot where a follicle is removed. This is usually cosmetically insignificant as the area where the donor hair is removed is usually covered by the remaining hair in that region. The other issue with FUE is that in the past there has been a high rate of transection with the removal of the follicles. This means that in the process of removing the follicle, the structural integrity of the follicle is compromised, thus giving the follicle a much lower percentage chance of growth. The goal is a system where there is a low rate of transection and where the follicle is exposed to the lowest amount of trauma possible. There are many new automated and manual systems available now for FUE and I did extensive research into all of them and decided that the SAFE system was the way to go. The thing I really like about this system is that the punch that is used to extract the donor follicle has a blunt tip as opposed to a sharp tip that most of the other systems use. What this means is that since the tip is not sharp there is a much lower incidence of transection. Since donor follicles are very finite in each individual (the average person has about 8000 donor follicles), a lower transection rate of even 10-20% can result in hundreds or possibly even thousands of saved follicles. In addition, because the tip is not sharp, I believe it causes less trauma to the underlying vasculature, which can protect the scalp for future procedures. Also, because this system is motorized, like a small drill, it allows you to “score” the follicles much quicker, thus allowing more follicles to be harvested in a session. With this system, you still have to manually extract the follicles, manually trim the follicles, and manually implant the follicles, but the automation in the drill definitely speeds up the process. FUE is good for some patients and has it’s advantages and disadvantages. We are now able to transplant up to 1200 follicles in a day with the new FUE system, as opposed to significantly lower numbers before this system. In addition, FUE allows us to harvest chest hair, back hair, and beard hair for donor follicles. What is most important, is that every patient throughly understands all the advantages and disadvantages of both harvesting techniques before deciding which route to take in their own hair restoration journey.

Marc Dauer, M.D.

Tags: Eyebrow Transplant, F.U.E., follicular unit extraction, Hair Loss, Hair restoration, Hair Transplantation, Hair Transplantation Hair Restoration, Hair Transplantation Hair Restoration in Younger Patien, Hair Transplants, Los Angeles, S.A.F.E. System

Discomfort associated with Hair Transplantation procedures

Greetings all, a very common question I am asked is, “how painful is a hair transplant procedure?” Most people imagine it like a trip to the dentists office or some sort of extremely painful process. In reality, it is not like that at all. That is not to say there is no pain associated with the procedure. The level of pain however is very tolerable, and most would quantify it as minimal. To begin with, I use a vibrating mechanism when administering my anesthesia (all local anesthetic) which greatly reduces the discomfort associated with the injections. Because the brain perceives vibratory sensations quicker than painful sensations, by using the vibration it greatly reduces the discomfort associated with the injections. Once the numbing injections are complete, the patient should then be pain free for the duration of the procedure. After the procedure I prescribe pain pills for my patients, but most tell me they don’t even need to take them longer than a day or two. By day 3 most of the discomfort is gone. I can attest to all of this because I have had the procedure myself, so I am not only speaking from my experience as the treating physician, but also as the patient. I hope this clarifies any confusion related to this topic.

All the best,

Marc Dauer, MD

New Advancements In Hair Restoration

The Latest Advancements In Hair Restoration

Eyebrow Hair Restoration and Concealment of Scarring with Hair Transplantation

By Marc Dauer, M.D., ABHRS

Hair Restoration has come a long way from the unsightly large “plugs” of yesteryear. Today we practice Follicular Unit Transplantation which allows us to relocate hair follicles in the same way they naturally occur. This technique has also allowed us to transplant hair to other areas of the body besides the scalp.

Follicular Unit Transplantation is the general term to describe transplantation of naturally occurring follicular units. Typically hair grows in clusters of 1,2,3, and 4 hair follicular units. There are two main techniques used to harvest these follicular units. The first and most commonly used method is called “The Strip Method”. This involves taking a narrow strip of hair (usually not to exceed 1.5 cm in width) from some region in the permanent hair zone (in men this is in the occipital and parietal regions of the scalp) and dissecting the strip under magnification into individual follicular units. The other technique used in harvesting is Follicular Unit Extraction. This involves using a biopsy punch tool, usually between .6mm-1.2mm, and extracting the individual follicular units from the permanent hair zone for transplantation into another area.

Eyebrows are one of the most important defining characteristics of the face. Often you don’t even realize the full impact that eyebrows make until you see a person without them. With the Follicular Unit Transplantation, it is now possible to restore natural looking eyebrows that will last a lifetime.

Eyebrow hair loss can occur for several reasons in women and men. Physical trauma (such as burns or lacerations), medical treatments (such as chemotherapy or radiation therapy), excessive plucking, and even menopause, can all contribute to eyebrow hair loss. In the past some people opted for eyebrow tattoos to recreate lost eyebrow hair. Eyebrow transplants can be implanted over eyebrow tattoos to recreate natural looking eyebrows.

The hair to be transplanted into the eyebrows is usually harvested from either the mid occipital region or the nape in the posterior auricular region. In both cases the hair in these areas is of finer quality, thus more accurately resembling natural eyebrow hair. With an artistic eye, and keen attention paid to the individuals facial characteristics, the boundaries of the new eyebrows are drawn in so that the patient can see the shape of their new eyebrows. Once the design is completed the area to be transplanted is anesthetized with local anesthetic containing epinephrine and then tumesced with saline solution. The tumescence allows the grafts to be placed closed together, while elevating the skin further away from the underlying vasculature, thus resulting in less vascular damage. Small recipient sites are made with a solid core 22 gauge needle, with care taken to limit the depth to the size of the follicle to be transplanted. Grafts placed too deeply may result in excessive bruising and/ or cyst formation or scarring. Only single hair follicular units are placed in the eyebrows.

Hair Restoration Conference in Kuala Lumpur, Malaysia

Greetings, I have just returned from leading a teaching conference on Hair Restoration on behalf of the American Academy of Aesthetic Medicine in Kuala Lumpur, Malaysia. This was my second visit to Malaysia. The attendees came from Malaysia, Singapore, and India. It was a slightly smaller conference so it really gave me an opportunity to spend a good deal of individual time with all the physician attendees, which was gratifying personally. Kuala Lumpur is an amazing city with incredible architecture. I will post a photo of the twin towers at night, and one of me and the attendees. I look forward to hosting another conference in KL in March 2011.

All the best,

Marc Dauer, M.D.

Tags: American Academy of Aesthetic Medicine, Hair Transplantation, Hair Transplantation Hair Restoration, Malaysia

Dubai Hair Transplant Teaching Conference

Greetings all, in more recent news, I have just returned from Dubai teaching a course in Hair Transplant Surgery. The attending physicians came from Iran, Iraq, Syria, Lebanon, Dubai, and the United States. It was very interesting to hear the practice experiences of the attending Cosmetic Surgeons in their respective countries. One physician from Iraq described how he treated Saddam Hussein’s wife, who then brought him to treat Saddam himself. He went on to treat Saddam for a period of 5 years, all the while his 6 brothers were killed by Saddam’s people. He wears a Rolex watch that Saddam gave him as a gift. Another physician who currently practices in Iran described in great detail how the current political and social issues there have affected his practice and his personal life. The city of Dubai is a sight to behold. The infrastructure is modern and well planned. The malls are all like the nicest stores on Rodeo Drive or 5th Avenue. I went to the top of the tallest building in the world (2 1/2 times the size of the Empire State Building!), went skiing in the indoor ski resort, and saw the world’s only 7 star hotel. I also had the chance to meet some new prospective patients and follow up with some of my existing patients who live in the Middle East. I may be going back to Dubai in the next few months to perform cases on private patients there and will keep you updated on these activities. I have posted some photos of my trip below.

All the best,

Marc Dauer, M.D.

Conference Attendees

Skiing Indoor In Dubai

Tallest Building In The World