Hair restoration
PRP and Hair Transplant Procedures
Greetings,
I have recently begun to experiment using PRP, which is platelet rich plasma, in certain hair transplant procedures. PRP has been used in wound healing for a number of years. Recently some have begun to use it in conjunction with Hair Transplant procedures. The PRP is obtained from the patient prior to the procedure via a blood draw. The blood is then spun down to separate the red blood cells from the PRP. The PRP contains growth factors that aid in healing. We have been experimenting injecting the PRP into the donor region, bathing the grafts to be transplanted in the PRP, and then spraying the PRP onto the scalp for better post operative healing. So far the initial results have been promising. I still cannot definitively state that I see a superior result using the PRP compared with procedures performed without it, but I will continue to investigate and look forward to having more information moving forward. I also plan to offer it to my patients who are interested, though letting them know that we are still in the experimental phase. I look forward to discussing this further in the future.
All the best,
Marc Dauer, MD
Hair Transplants and Patients on Antithrombotic (Blood- Thinner) Therapy
Greetings,
I recently read an interesting article written by Dr. Yagyu from Japan that discusses guidelines for patients who are on antithrombotic therapy and interested in having a hair restoration procedure.
The procedures we perform as Hair Transplant Surgeons are typically completely elective and as such do not warrant putting the individual in any sort of medical danger. Along these lines, we are often approached by patients who may be taking antithrombotic medications including aspirin, coumadin, and plavix for a variety of medical conditions. In the past, the thinking has been that since we are usually transplanting into the scalp or face, and since the areas are so vascular (which is part of the reason why there is such good growth of follicular grafts and such a low incidence of infection) that it would not be a good idea to transplant someone who is on one of these antithrombotic medications, as it would be difficult to control the bleeding and thus difficult to create sites for the transplanted hair and place the grafts as well. This study by Dr. Yagyu included 25 patients with cardiovascular disease who underwent 46 hair transplant procedures. Risk factors in these patients included coronary artery stents, prosthetic heart valves, and atrial fibrillation. The conclusions based on the results showed that in these patients low dose aspirin “does not cause hemorrhagic tendency and it can be continued before hair transplantation”. The study also determined that low dose coumadin also does not interfere with surgery and can be continued before a hair transplant procedure. My own experience with a patient taking Plavix prior to undergoing an eyebrow transplant procedure, was that in this specific case, there were no complications associated with the patient taking an antithrombotic medication.
It is always imperative to weigh the risks against the rewards associated with any patient undergoing a surgical procedure, but the results of this study are very positive in regards to patients who require antithrombotic therapy and wish to undergo a hair transplant procedure.
All the best,
Marc Dauer, M.D.
News On Growing Hair In Mice
Greetings,
Recently there has been a lot of discussion in regards to an article in CBS news (see below) that discusses researchers growing hair on mice. My thoughts on this are that this is one of the first in a series of studies that hopefully down the line will lead us to the ability to clone our own hair in a laboratory setting. I still believe we are at least 20 years away from being able to do this in a practical and economical way, but this is definitely the future of Hair Transplantation. The ability to clone one’s own hair will negate the need to harvest the hair from the individual either via FUE or FUT and will also give us unlimited supply for any demand. Again I believe we are at least 20 years away from this, but this is definitely the future of Hair Transplantation and I look forward to being a part of this exciting future. Here is a link to the article.
http://www.cbsnews.com/8301-504763_162-57416401-10391704/researchers-successfully-grow-hair-on-bald-mouse-humans-next/
All the best,
Marc Dauer, MD
http://www.cbsnews.com/8301-504763_162-57416401-10391704/researchers-successfully-grow-hair-on-bald-mouse-humans-next/
Transplanting hair via FUE into mustache scar
Greetings,
Today I will discuss a very interesting case I just performed. This patient presented with a skin graft in his mustache region from a previous accident that required extensive Plastic Surgery. He was left with a large scar and no ability to cover the scar as it would only grow a scant amount of hair. The patient prefers to wear a goatee but it is very unnatural with only one side growing hair. In this case I performed follicular unit extraction otherwise know as FUE by harvesting the hairs from his beard on the neck individually with a .8mm punch. I harvested the neck hairs as these will most closely resemble the beard hairs we are meant to recreate. After I harvested all the beard hairs via FUE we placed the grafts individually to recreate a mustache.The angles and orientation of the grafts placed in the mustache were made to mimic the angles of the hairs on the unaffected part of the mustache. Typically there is a slightly lower growth rate of grafts transplanted into scar tissue, but these patients usually have excellent cosmetic results. Below you can see the pre operative photo and the post operative photo and the immediate difference that is seen with the transplanted grafts present over the scar.
All the best,
Marc Dauer, M.D.
Lowering the hairline in a female patient
Greetings,
Today I would like to discuss lowering the hairline in female patients. This is a procedure that has become more common recently with advances in Hair Restoration techniques and the ability to create density that was previously unattainable. In these cases patients report having a high hairline that has been present for their entire lives. In some cases there is thinning behind the hairline, but more often than not, the high hairline is the only issue. With the ability to transplant single hairs into recipient sites that measure .6mm-.8mm we can create cosmetic density in the hairline that rivals a completely normal hairline. Care is also taken to angle the hairs in the exact angle and orientation of the pre existing hairs so that one should not be able to identify any difference between pre existing native hair and the new transplanted hairs. In the case I am highlighting today, this patient has some thinning in her frontal scalp, which I addressed by transplanting hairs into the thinned out region. However her primary concern was her high hairline that had been present for her entire life. I lowered her hairline by just over a centimeter and kept the same design as her original hairline with the peak in the middle. Notice this patient had a very specific angle to her hair growth in the hairline which I maintained with the new transplanted hair grafts. Below you can see the pre operative photo and the immediate post operative photo that show the grafts placed in the new hairline. I hope this discussion provides some insight into this concept.
All the best,
Marc Dauer, M.D.
Rogaine and Propecia For Hair Loss
Greetings,
Today I will discuss the usage of Rogaine and Propecia for treating hair loss. Rogaine is an over the counter medication that comes in a liquid form and a foam form and comes in 2% and 5% strengths. For male patients I typically recommend Rogaine foam 5% twice a day after showering and before bed. Rogaine typically works only in the crown region and is best at slowing down the rate of hair loss and in some cases taking the miniaturized hair (hair that is on it’s way out for good) and turning it back into healthy hair. The exact mechanism of Rogaine is unknown, but it is thought to promote increased blood flow to the scalp by relaxing the small blood vessels that supply the blood flow to the scalp. Rogaine 5% is approved for men, and only the 2% formulation is approved for use in women. The 5% formulation may have better efficacy in women, but it can cause hair growth on the face that is reversible when discontinued.
Propecia is an oral medication that is taken once a day. It works by blocking the conversion of testosterone into DHT which can cause hair loss. The effect of taking the medication is that it can regrow hair in some instances and can also convert miniaturized hair that is on the verge of falling out forever into healthy hair, that is cosmetically significant. Propecia is not indicated for use in women.
There have been many claims about Propecia recently, and various side effects it may cause. I typically have all my patients that are considering Propecia read a detailed explanation of all the benefits and possible side effects prior to beginning to take the propecia. I have seen excellent results with patients using propecia, and in my experience younger patients tend to respond the best to this medication.
There is also anecdotal evidence that propecia and rogaine together produce a more significant effect than either medication independent of the other. The exact cause is unknown, but there seems to be some sort of synergy between the two medications.
In summary, it is always important to examine each patient and presc
New Hair Transplant Patient Testimonial
Greetings,
Here is a brand new video patient testimonial of one of my patients. His story is touching and personal, and his results dramatic. This is after a single procedure so the hairline is very conservative, but in additional procedures we may lower the hairline slightly. I prefer to be conservative in the placement of the hairline on the first procedure, giving the patient a higher density of hair, as opposed to a lower hairline and lower density of hair. My patients are very happy with this plan and the results it affords them.
All the best,
Marc Dauer, M.D.
Visiting Physician for Hair Transplant Course
Greetings,
I just completed a private Hair Transplant teaching course with Dr. Alejandro Jaime Ledesma from Mexico. It was a pleasure hosting Dr. Ledesma in my clinic for the week and I know he will put to good use the knowledge he gained during our time together. As always, it is enjoyable for me to conduct these teaching courses, especially one to one, as it allows me to impart quality private instruction to physicians entering the field of Hair Transplant Surgery. I am greatly looking forward to attending the annual meeting of the International Society of Hair Restoration Surgery in Anchorage, Alaska in a few weeks. it is always a great opportunity to hear the latest and greatest in the field, and to reconnect with old friends, colleagues, and students. I will post my thoughts of the conference in a few weeks.
All the best,
Marc Dauer, M.D.
First few weeks post Eyebrow Transplant. What to expect.
Greetings,
Today I will discuss the first few weeks following Eyebrow Transplant surgery. Eyebrow Transplantation has become a much more popular procedure as of late. More people are discovering how effective and natural the procedure can be when performed by the right surgeon. I was one of the first surgeons in the country performing the procedure and as such have had the opportunity to perform a great number of cases. In addition, I have refined the overall technique in ways that greatly improve both the immediate post operative period and the final result.
In a typical Eyebrow Transplant procedure I will place between 100-300 single hair grafts per eyebrow. The number depends on the patients facial symmetry, gender, hair color, and eyebrow hair loss, among other factors. The entire procedure is performed under local anesthetic. In the immediate post operative period I tell patients that they should expect to see some swelling around the eyes and possibly even some bruising around the eyes. This typically peaks at around day 3 and resolves by day 5. Within 24 hours of the grafts being placed they form tiny scabs around the grafts that look like little grains of sand. Immediately after the procedure the patient gets a good idea of how the eyebrows will eventually look because I place the eyebrow hairs at about the same length as typical eyebrow hairs. Within a week most of the crusts fall out and a few of the transplanted hairs may fall out, but for the most part the patient is left with most of the new transplanted eyebrow hairs. Beginning in the second week the transplanted eyebrow hair grafts begin to fall out. Usually by the end of the first month, most of the transplanted eyebrow hair grafts have fallen out and the patient is left with eyebrows similar to what they had before the procedure. During this “in between” time the patient may continue to put on eyebrow makeup just as they did before the procedure.
At around 3 months post eyebrow transplant the new eyebrow hair grafts begin to grow in. Usually the patient will notice more hair between 4-6 months post operatively and at 12 months the patient will see the full result from the eyebrow transplant procedure. Below I will show a patient of mine pre operatively and 2 weeks post operatively to give you an idea of the typical look in the immediate post operative period.
If you have additional questions about Eyebrow Transplants please feel free to contact me.
All the best,
Marc Dauer, M.D.
Post Hair Transplant Timeline
Greetings,
Today I will discuss the general timeline post hair transplant. Typically within 24 hours after the procedure tiny crusts that look like grains of sand form around the transplanted hairs whether they are on the scalp, eyebrow, face, or body. These tiny scabs begin to fall off around post op days 3-4 and are usually gone within 7-10 days. Keeping the grafts moist or applying an antibiotic ointment may loosen the crusts and have them fall off earlier. Most of the transplanted hairs being to fall out at around 2 weeks post operatively and usually by the end of the first month post transplant most of the transplanted hairs are all gone and the patient looks like they did prior the procedure. Typically , the hair begins to grow back at around 12 weeks. The patient usually does not notice any change until around 5-6 months, at which point approximately 50% of the new hair growth may be seen. Full growth is usually not achieved until 12 months post procedure and continued growth may be seen for up to 24 months post procedure. Patients who have undergone a second or third procedure may see a slightly delayed growth timeline.
I hope this information is helpful to all of those considering Hair Restoration.
All the best,
Marc Dauer, MD
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