FUE (Follicular Unit Extraction) versus FUT (The Strip Harvest Procedure)

Greetings,
I am often asked by prospective patients which harvesting procedure is preferable for hair transplantation. Follicular unit extraction or the strip harvest procedure? My answer is that it depends on the individual. If a person needs the option to cut his hair down to a number 1 or a number 2 buzz cut then follicular unit extraction is the needed procedure so as to avoid a visible linear scar. If the person is comfortable leaving their hair at a number 3 or preferably number 4 cut or longer,  then the strip harvest procedure is absolutely an option. Typical linear scars from strip harvest procedures should measure between 1 and 3 mm in width and the length is determined by the amount of hair follicles needed to be harvested. This is in contrast to tiny white dots that are left in the donor region after the follicles are harvested in follicular unit extraction. Neither procedure is scarless. There is no such thing as a scarless hair transplant procedure. In fact, the scarring from follicular unit extraction in the donor region is greater when measured in surface area then the scarring from the strip harvest procedure. The difference is that in the strip harvest procedure the scarring is concentrated in a linear scar which is more noticeable when the hair is very short as opposed to the diffuse pinpoint scarring which is the result of follicular unit extraction. Some patients who have been overharvested in follicular unit extraction still do not have the option to cut their hair very short as the confluence of many pinpoint scars can start to show as “moth eaten” scalp with a short haircut. Also, it is usually not advisable to cut the hair down to a number zero haircut after follicular unit extraction hair transplants as you will probably see the tiny white dots left from the extraction of the follicles. To be clear, when follicles are removed from the donor area in follicular unit extraction one by one, they do not grow back in the donor area. They are taken out and moved to another area where they then begin to grow.
In follicular unit extraction every third or every fourth hair follicle is randomly extracted so as not to create bald patches in the donor area. Because of this it is important to draw the hair follicles from the entire safe donor area. This means that the entire donor area is affected in the first hair transplant procedure. This is in contrast to the strip harvest procedure where only about a 1 to 1 1/2 cm wide area is extracted by a length that is determined by the amount of hair follicles needed to harvest, typically leaving behind a 1 to 3 mm linear scar with untouched robust donor area above and below the strip scar. When the patient returns for a second procedure the physician should harvest the second strip from the same area removing the original strip scar so as to leave the patient with only one strip scar even after multiple hair transplant procedures. If for some reason the strip scar widens and the physician is not able to extract the old scar, there is still untouched donor zone above and below the original strip scar allowing the physician to either take a new strip in a new area or begin follicular unit extraction in the surrounding areas around the original strip scar. What this means is that the ultimate donor zone in a patient will probably be contain more follicles if the patient begins with the strip harvest procedure versus follicular unit extraction. This also means that patients who are predicted to experience severe hair loss should strongly consider leaving their hair a little bit longer and undergoing the strip harvest procedure to begin with, in order to maximize the number of donor hair follicles from their permanent donor zone.
When harvesting follicles in follicular unit extraction, the patient must shave their head down to a number zero cut in order to extract the follicles, versus the strip harvest procedure which allows the patient to leave their hair longer and use the existing hair to cover up the strip scar.
In follicular unit extraction the physician can choose the larger follicular units i.e. the two, three, and four haired follicular units, while in the strip harvest procedure you only get what’s in the strip which may typically ends up being 2/3 one hair and two haired follicles. What this means is that the hair count can possibly be slightly higher in follicular unit extraction.
Follicular unit extraction can be much more variable than the strip harvest procedure because a high degree of skill and efficiency required to extract the follicles intact. This is in contrast to the strip harvest procedure which involves less handling of the hair follicles. Because of this we often see more variable rates of growth in the hands of inexperienced practitioners practicing follicular unit extraction. It is imperative that the prospective patient see multiple results of the physician you are considering with the follicular unit extraction procedure as well as the strip harvest procedure.
In summary there is no right or wrong when comparing follicular unit extraction and the strip harvest a procedure. Both are excellent procedures and both can provide excellent results in the hands of an experienced hair transplant surgeon. What’s most important is that the patient chooses the procedure that suits them the best both in the short term and the long run.
All the best,
Marc Dauer, M.D.

Hair Transplant Grafts Placed Into Scarring Alopecia

Greetings,

Today I will discuss a patient of mine who presented with a form of scarring alopecia called Lichen Planopilaris. This resulted in the loss of all the hair follicles in the frontal and mid scalp as well as the eyebrows and sideburns. The patient initially thought that the hair loss was androgenic alopecia, but after my examination and subsequent scalp biopsy the diagnosis was confirmed. It is imperative that the hair transplant surgeon has a thorough knowledge of all the forms of alopecia as different causes result in different outcomes and some are candidates for hair transplants and others not.

In this case the biopsy also showed that the scarring alopecia had “burnt out” and was no longer active. We decided to do 3 small areas with test grafts to see if they would grow before considering a more expansive procedure. What we found was excellent growth in all the test areas after only 12 weeks. After discussing with the patient and letting him know that there still is a chance that we won’t see the same growth rate that is seen in healthy scalp, and the patient decided to proceed with a more extensive procedure.

Below you can see the photo before the test grafts and the test grafts that have grown. I will continue to provide updates on this very interesting case.

All the best,

Marc Dauer, M.D.

This is a patient with scarring alopecia who had test grafts placed into 3 different areas.

This is a patient with scarring alopecia who had test grafts placed into 3 different areas.

Hair Transplant Comfort During The Procedure

Greetings,

Today I want to discuss comfort during the hair transplant procedure. Since I have had multiple hair transplant procedures myself I understand exactly how it feels to sit in the hair transplant chair for 5-8 hours for a procedure. Because of this, I designed a custom memory foam cushion to sit on top of my exam chairs to provide the maximum amount of comfort during the procedure. This makes the chair feel like a soft bed as opposed to a typical exam chair, which is not necessarily made with the idea of sitting in it for hours at a time. The feedback from this memory foam cushion has been amazing and it’s just one more small detail that makes the entire day of the hair transplant procedure that much more comfortable. My thinking is that the day of the procedure should feel more like a day at the spa as opposed to an uncomfortable experience.

All the best,

Marc Dauer, MD

Hair Transplant Patient Testimonial

Greetings,

Here is a new hair transplant patient testimonial of one of my recent patients. This particular patient is a well known actor and he describes his experience undergoing the procedure both the day of and the subsequent healing period. I also describe my surgical approach to this particular patient.

I hope you enjoy watching.

All the best,

Marc Dauer, M.D.

Keeping Grafts Moist Post Hair Transplant Procedure

Greetings,

Today I will discuss the importance of keeping the hair transplant grafts moist during and after the hair transplant procedure. It is imperative that the grafts are keep moist throughout the procedure as drying out of the grafts is one of the most common causes of poor growth. To that extent, my nurses are constantly spraying the grafts as they dissect them under the microscope, the grafts are submerged in saline before and after dissection, and my nurses use small “ring dishes” that have saline in them and allow the grafts to stay submerged in the saline even after they are taken out of the petri dish, but just before they are implanted.

Post hair transplant procedure, I give all my patients a specially formulated copper peptide solution that they use to spray the grafts every 4-6 hours to keep them moist, and I also cover the grafts in a generous amount of vaseline that functions to keep them moist and create an anaerobic environment which minimizes any possibility of infection.

All these steps contribute to great survival rates and thus great growth rates of the transplanted hair follicles.

I have included photos of the copper peptide solution and the graft ring dish holders below.

All the best,

Marc Dauer, M.D.

Copper Peptide Spray Graft Ring Holder

How Many Linear Donor Scars With Multiple Hair Transplant Procedures?

Greetings,

Today I want to address the question I am commonly asked, “will I have a different donor scar for each procedure?”. Every patient that has a hair transplant procedure, has more than one procedure. This is for 2 reasons. Firstly, the patient loves the results of the first procedure and at some point wants to add density to those results. Second, the hair we transplant is permanent hair and should never fall out, but the native hair that is present will erode over time, so additional procedures are usually needed to keep up with the continuing hair loss. In the strip procedure a small linear scar, usually between 1-3mm is left from the harvest of the hair from the back and sides of the scalp. When I perform additional procedures, I always make every attempt to resect the previous donor scar so that the patient does not have train track  like multiple scars in their scalp. Sometimes I see multiple stacked scars from other Doctors and it makes absolutely no sense to me that one would create an entirely new scar if the original scar was within normal limits. The instances where this is unfortunately not possible are where the previous donor scar is too wide and by resecting it we would not get any hair but just scar, or in a situation where the previous donor scar is too low or too high and taking it out would risk creating a much wider scar, or moving into an unsafe region of impermanent hair. The photos below show a patient who came to me from another physician with multiple strip scars from previous procedures and I consolidated the multiple scars into one fine scar that is much more cosmetically acceptable.

All the best,

Marc Dauer, M.D.

This is a photo of multiple strip scars created by another Hair Transplant surgeon.

This is a photo of multiple strip scars created by another Hair Transplant surgeon.

This is a photo after the multiple scars were removed and consolidated into a single fine line strip scar.

This is a photo after the multiple scars were removed and consolidated into a single fine line strip scar.

Eyebrow Transplant Testimonial

Hair Loss That Is Not Genetic In Origin

Greetings,

Today I want to discuss a patient who recently presented to me for a consultation for his hair loss. He stated that he had been gradually losing his hair over the past 10-15 years and now it had reached a point where all the hair in the frontal and mid scalp had fallen out. He was seeking a hair transplant.

Most of the cases of male hair loss I see in my practice are typical genetic hair loss which responds amazingly well to the hair transplant procedure. In this case, a close examination of the scalp revealed that the skin in the frontal and mid scalp was completely smooth and devoid of sweat glands that you normally see in healthy skin, including balding regions of the scalp. In addition the hair follicles on the periphery of the balding regions showed tiny red dots of inflammation surrounding them and they were easy to pull out. The patient also showed hair loss on his sideburns and eyebrows. I suspected a scarring form of alopecia and referred the patient to a dermatologist for a scalp biopsy and confirmation of my diagnosis.

On biopsy the diagnosis of Lichen Ploanopilaris was confirmed. This is an inflammatory scarring alopecia of the scalp that presents clinically in this exact manner. The biopsy also showed that the LPP appeared to be inactive. The patient came back to me and I explained that we could do a very small hair transplant procedure of test grafts in 3-4 different locations of the scalp to see if the transplanted grafts grew well. If they grew well, we could then proceed to a larger procedure to create some degree of cosmetic density in the areas of hair loss. I also explained to the patient that even if the transplanted hair grew well, there was still a chance that the LPP could reactivate in the future and destroy the transplanted grafts.

The patient decided to move forward with the hair transplant test grafts and we should know in 3-4 months if the growth is successful. I will continue to update you on the progress of this interesting case.

All the best,

Marc Dauer, M.D.

Lichen Planopilaris of the scalp.

Lichen Planopilaris of the scalp.

What Is The Best Age For A Hair Transplant?

Greetings,

I am often asked what is the best age for a hair transplant? The answer is that this is different for everyone.

In the past 2 days my patient’s ages were 28 and 83. Mt 28 year old patient was just beginning to thin in his hairline region and was requesting increased density to keep up with his recent hair loss.

My 83 year old patient had undergone multiple hair transplant procedures in the past and was requesting additional density in his frontal and mid scalp. He is a very healthy 83 year old taking no medications and with no major medical conditions. He still had good donor supply and was deemed an excellent candidate for an additional hair transplant procedure. I harvested 1000 grafts via the strip method and the hair transplant procedure went very smoothly.

My 28 year old patient had undergone a small hair transplant procedure with another doctor a few years ago and was requesting additional density in the hairline and frontal scalp. He had robust donor supply and his previous hair transplant procedure was performed using the strip harvest procedure. I harvested a new strip, including the old scar (so the patient still has only one scar), and transplanted just over 1500 grafts into the frontal and mid scalp.

So to answer the original question, the best age for a hair transplant can be anywhere from 25-85. It is the time when there is enough thinning in any particular region of the scalp that transplanting hair in between the native hair will lead to an increase in hair density. This is something that must be evaluated by an experienced hair transplant surgeon, but when done properly in the “right” time, this procedure can lead to excellent results.

All the best,

Marc Dauer, M.D.

Hair Cloning- Are We There Yet?

Greetings,

Today I will discuss hair cloning as it seems everyone is talking about it these days. It is one of the most common questions that I receive on a daily basis as a hair transplant surgeon.

There is no question that hair cloning will forever change the course of hair transplant procedures and hair loss in general. The obvious questions is, we can clone a sheep? Why can’t we clone a single hair follicle?

The answer unfortunately is much more complicated. The ability to clone individual hair follicles at all is a very challenging prospect, and then try to create the ability to clone numbers of follicles that would be needed in practical use with economics that would make it cost effective, and we’re a long way away. Whether that means 10 years, 15 years or even 20 years, who knows. What is does mean is that we as hair transplant surgeons need to plan our patients treatment  plans based on the fact that we will not have hair cloning for the foreseeable future.

There are certainly many entities working on hair cloning. The entity to figure it out first will make billions from it. It will allow us to create skin so we will no longer need to harvest skin grafts from the body. It will completely change the course of medicine and will probably lead to other organ cloning abilities.

What I find interesting is the question of will we be injecting cloned stem cells from other hair follicles that just grow into new permanent hair? Or will be still place individual hair follicles like we do now that are just created via genetic engineering in the lab? Either way, the closer we get to hair cloning the more exciting things will become in the field of hair transplant surgery.

All the best,

Marc Dauer, M.D.

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Los Angeles Hair Transplant Specialist

Marc Dauer, MD provides professional hair transplant and restoration and eyebrow hair transplantion, using follicular unit
transpantaton
. Our offices are located in Beverly Hills, California and we serve the Los Angeles area, including Santa Monica,
West Hollywood, West Los Angeles, Culver City, Brentwood, Bel Air, Beverly Hills, Hollywood, Manhattan Beach, Redondo Beach, Malibu, and beyond.
Dr. Dauer is board certified and a member of the prestigious International Society of Hair Restoration Surgeon. our hair restoration center focuses on natural
and long lasting results for people suffering from hair loss. For hair restoration, hair transplants, Los Angeles hair loss treatments, eyebrow restoration, sideburns,
treatment for male pattern baldness, and treatment for female pattern baldness, transplantaton for scarring,consider Dr. Dauer.

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