Eyebrow Restoration
FUE (Follicular Unit Extraction) Harvest to Transplant Into Eyebrow Scar
Greetings,
Today I will demonstrate a case I recently performed utilizing FUE (Follicular Unit Extraction) to harvest the individual follicles and subsequently transplanted the follicles into and eyebrow scar. Traditionally I would not usually perform FUE in an eyebrow transplant case as it only requires a small incision in order to harvest the number of follicles necessary in order to restore typical eyebrows to normal appearing density. In patients who insist on shaving their hair extremely short (#2 buzz cut or shorter) FUE is a better option in order to make sure that the scar does not show through. In a small FUE case I do not have to shave the entire donor area, and can shave a small strip of hair to harvest the donor follicles and then the patient can cover the donor region by combing the hair above over the shaved area. As you can see from these results the transplanted follicles into the scar grey very nicely and the patient was very happy with the final outcome. I have also used FUE to harvest follicles from the neck in order to transplant into mustache scars (in patients with cleft palate deformities and others) and other beard scars with excellent results. Below I have shown the before and after photos of this patient with the eyebrow scar.
All the best,
Marc Dauer, M.D.
Before Photo Showing Scar In The Eyebrow
Post FUE and Transplanted Hair Follicles Into Eyebrow Scar
Non-Physicians Performing Hair Transplant Procedures
Greetings,
With the advent of the NeoGraft machine and it’s accompanying marketing that includes ideas for the prospective “NeoGrafter” that an attending physician is only necessary in order to “lend” his license to the practice so that they be allowed to perform hair transplant procedures, it has opened up a new chapter in the discussion of what is acceptable to delegate in Hair Transplantation. Physicians performing Hair Transplants have delegated certain tasks for years including dissection of the grafts and placement of the grafts. In some practice they even practice the “stick and place” method where the nurse create the incision site and places the hair graft in the incision. In my practice I create each and every insertion site for the placement of the hair grafts. My thought is that the exact design is based on the creation of the receptor sites. The hairline design, as well as the angle and orientation of the hair growth are all affected by the creation of the receptor site. I believe that the surgeon should have the complete control of this step as it is the surgeon who will take full responsibility for the outcome of the procedure. For patients exploring the idea of having a Hair Transplant procedure it is important that they ask important questions such as, “what are the steps in the procedure that the physician will be performing, if any, and what are the steps that the physicians assistants will be performing?” Knowing as much information about the physician and the medical group that is performing your procedure will assist in making an informed decision, and hopefully one that will lead to positive results.
All the best,
Marc Dauer, M.D.
Eyebrow Transplant Results At 7 Month Mark
Greetings,
Here is a patient of mine who I performed an eyebrow transplant on 7 months ago. Here are her results. She is extremely happy and we will be performing a secondary “touch up” procedure to increase the density slightly and fill in a few spots. These results are typical with my special technique for eyebrow transplantation.
All the best,
Marc Dauer, MD
Before Eyebrow Transplant
After Eyebrow Transplant
Right Eyebrow Before Transplant
Right Eyebrow After Transplant
Left Eyebrow Before Transplant
Left Eyebrow After Transplant
International Society Of Hair Restoration Surgery Annual Meeting In Anchorage
Greetings,
I just returned from the International Society Of Hair Restoration Surgery annual meeting in Anchorage Alaska. It was an amazing meeting as usual, but this year there were many less attendees which made it even more intimate than ever before. I had the opportunity to meet and re-connect with many of my friends and colleagues and discuss the latest advancements in the field and compare and contrast what others are doing and what seems to be improving the process and results. I definitely took home many new ideas that I plan to implement into my practice ranging from a new low level laser light device I will be offering, to a new storage medium for my hair grafts.
Other things I plan to look into for the future will be Platelet Rich Plasma therapy. I also purchased the new Hair Check system which measures hair mass and I plan on using this on new patients to measure their hair mass prior to initiating treatment and also after treatment has been implemented. This is an amazing new tool which measures hair mass which is an excellent indicator of the amount of hair in any given region on the scalp. I will attach a few photos from the meeting and my day trip excursion to the glaciers.
All the best,
Marc Dauer, MD
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
Donor Scars in “Strip Harvesting”- How to Prevent and Treat
Greetings,
Today I would like to discuss donor scars in the “strip harvesting” technique in hair restoration surgery and how to approach them. The trend in many clinics is towards larger procedures which many patients request. Most people would like to get as much done as possible in one sitting, and for the clinic this can mean larger fees. However, this is not always in the best interest of the patient for many reasons. Firstly, there is a diminishing return in graft growth as the grafts are kept outside of the body for long periods of time. In “mega-sessions” of 3000+ follicles, this tends to become an issue. In addition, the only way to harvest 3000+ follicles in most people, is take a width of donor strip that exceeds 1.7 cm and in many cases even 2.0 cm. The studies have clearly shown that with donor strips this wide, even if all the other necessary precautions are taken in wound closure, there is a much higher incidence of scar widening, hair shock, and various other problems that can be encountered in the donor region. It is for this very reason that the largest case size I will perform is about 3000 follicles in a single session, and this is usually only on a first time patient with excellent donor density. More often, my large procedures are in the 2500-2800 graft range. I limit the width of my donor strip to 1.5 cm maximum, and try to keep it between 1.0-1.3cm whenever possible. The studies have shown that when the donor strip is kept below 1.2cm there is a very low risk of scar widening or any other complications. In patients with low scalp laxity, or even hyper-elastic scalp, it is sometimes necessary to place deep retention dissolvable sutures to decrease the tension on the skin edges. This can also decrease the incidence of scar widening. Typically on repeated procedures, the scalp tends to lose elasticity, which should make the physician think twice about how wide a donor strip to take in these cases. The typical donor scar should be between 1mm-3mm when everything goes as planned. Sometimes even though all the rules are followed the patient can still end up with a donor scar that is wider than we would like. In these cases the first step is usually to resect and revise the donor scar by just taking out the old scar and trying to limit the width to 10mm or less. If that is not possible, or the patient requests another option, a great way to treat this is by harvesting follicles by FUE (Follicular Unit Extraction), which involves using a special tool to harvest one follicle at a time, and then placing the grafts into the scar. Transplanted hair follicles grow very well through most scars and this treatment can be effective in minimizing the appearance of a wide donor scar. I hope this brief overview clearly explains how I approach “strip harvesting” in Hair Restoration Surgery.
All the best,
Marc Dauer, MD
The International Society Of Hair Transplant Surgeons Annual Meeting
Hello all, I have just returned from the International Society Of Hair Transplant Surgeons annual meeting in Boston Mass. As usual it was an amazing experience. It is always so great to gather with your peers and discuss all the different approaches to the conditions we treat. It inspires a constant re-evaulation of procedures and protocols that should always be evolving as technology and studies show new and improved ways of practicing our craft. It also serves as an excellent review of the fundamentals of the field of Hair Restoration, that though we may know and practice them regularly, they are always good to revisit. I also had the opportunity to catch up with many old friends, and students from my previous teaching lectures. I got to meet many great new people as well that I know I will keep in touch with for years to come. I feel so lucky to be able to work in a field that provides so much satisfaction to the people it touches, and yet provides so much satisfaction to me as their physician as well. Here is a photo from the entrance to the World Trade Center at the Seaport in Boston where the conference took place.
All the best,
Marc Dauer, M.D.
My first blog
Hello all, this is my first time posting a blog so I hope you’ll excuse my newbie status. I have been practicing Hair and Eyebrow Restoration for almost 5 years now and I must say it is one of the most gratifying fields to be involved in. I began my medical career in Head and Neck Surgery and subsequently transitioned into Emergency Room Medicine before finding my real calling in Hair and Eyebrow Transplantation. At the core of who I am, I am an artist. Whether I am drawing, playing guitar or piano, writing a song, or a short story, it is the expression of art that I truly enjoy. Hair and Eyebrow Transplantation affords me the opportunity to express myself artistically. Every patient is different and presents a new set of challenges. There is the constant management of expectations between what the patient wants, what’s best for the patient in the long run, and what is realistic for the patient. In the field of Hair and Eyebrow Restoration, managing all these together, while still maintaining the ultimate cosmetic result is a challenge, but one that I relish. I receive immense gratification in following up with my patients after their new hair has grown in. Seeing how the results can change peoples lives and better their self esteem is truly a gift.
I feel incredibly lucky to be in the field of Hair and Eyebrow Transplantation and I look forward to many posts in the upcoming days and years to discuss various cases and issues that I am presented with on a daily basis.
All the best, Marc Dauer, M.D.
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