Factors Affecting Cosmetic Density In Hair Transplants

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Greetings,

Today I want to address the factors that affect cosmetic density in hair transplants. Firstly there are the anatomic factors. The single most important factor anatomically is the caliber of the hair. An increase in just .1mm of the diameter of the hair follicle can add up to 30% increased cosmetic density. The other anatomic factors that contribute are skin color to hair color contrast (the more contrast, the more you see through the hair), and curly versus straight hair (curly hair looks thicker than straight hair).

Then there is the follicles per cm squared, which is the amount of follicles transplanted in any given area. Normal non balding scalp can have a density of between 60-100 follicles per cm squared. The minimum density that should be transplanted into any bald area should be at least 30 follicles per cm squared. As we transplant more follicles per cm squared we achieve greater cosmetic density. It requires a much higher degree of skill to transplant a high number of follicles per cm squared.

In summary, there are both anatomic and surgical factors that contribute to cosmetic density. It is imperative that prospective patients looking at pre and post hair transplant photos take the anatomic characteristics into account when considering hair transplant results.

All the best,

Marc Dauer, M.D.

/by Los Angeles Hair Transplant Specialist

Female Hairline Lowering

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Greetings,

Here is a a female patient of mine who has a genetically high hairline and thinning of hair in the existing hairline. I slightly lowered the hairline and increased the density in the existing hairline. Female patients have a very different hairlines than male patients and it is imperative that this is taken into account when creating the recipient sites for the transplanted hairs. The photo below shows the patient pre operatively and then 2 weeks post procedure. Some of the transplanted grafts have already shed, which is normal. They will begin to grow back at about 12 weeks. From the “after” photo you can see the very specific angle and orientation of the transplanted grafts to match exactly the existing hair that that when the hairs grow out they are all flowing in the same directions as the native hair. The goal is that you should not be able to tell any difference between the transplanted hair and the native hair.

All the best,

Marc Dauer, M.D.

This is photos of a female patient who received a hair transplant to lower the hairline.

This is photos of a female patient who received a hair transplant to lower the hairline.

/by Los Angeles Hair Transplant Specialist

Corrective Eyebrow Transplant

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Greetings,

Here is another patient that presented to me after undergoing an eyebrow transplant in Canada by a hair transplant surgeon who has been performing hair transplants for many years but has not performed many eyebrow transplant procedures. Her results showed very sparse density of hairs and unsightly 2 haired follicles present in the eyebrow. The patient was very dissatisfied and presented for a corrective eyebrow transplant. I placed just under 400 single hair follicles per eyebrow and the results are shown immediately post procedure. The patient should have significant density with a completely natural result after 7-9 months.

All the best,

Marc Dauer, M.D.

This shows a botched eyebrow transplant and then immediately post eyebrow transplant repair.

This shows a botched eyebrow transplant and then immediately post eyebrow transplant repair.

This shows a botched eyebrow transplant and then immediately post eyebrow transplant repair.

This shows a botched eyebrow transplant and then immediately post eyebrow transplant repair.

/by Los Angeles Hair Transplant Specialist

Beard FUE Harvest

Greetings,

Here is a patient of mine who was a norwood 6 with extensive hair loss. He had 3 previous strip harvest procedures with excellent results and was looking to add density to the crown region. Unfortunately the patient was no longer a candidate for another strip harvest procedure so we decided to harvest follicles via FUE from the scalp and the neck portion of the beard. The beard donor site is shown after 8 days and the patient describes the experience in his own words.

I hope you enjoy watching.

All the best,

Marc Dauer, M.D.

/by Los Angeles Hair Transplant Specialist

Corrective Eyebrow Transplant

Greetings,

Here is a patient of mine who flew in from Australia who had received a less than satisfactory result from a previous eyebrow transplant with a highly experienced hair transplant surgeon, but unfortunately not so experienced eyebrow transplant surgeon.

More and more of my eyebrow transplant procedures are repairs of previous unsatisfactory eyebrow transplant procedures. Make sure that your eyebrow transplant surgeon can show you at least 50 before and after photos of their eyebrow transplant results before you even consider that physician for your procedure. The art of eyebrow transplantation is very different from standard hair transplantation and without the appropriate training and artistic eye you could end up with less than satisfactory results.

All the best,

Marc Dauer, M.D.

This is a patient who had a prior poor eyebrow transplant corrected with proper placement and density of hairs.

This is a patient who had a prior poor eyebrow transplant corrected with proper placement and density of hairs.

/by Los Angeles Hair Transplant Specialist

Botched FUE To Temporal Peaks

Greetings,

Here is a patient who was treated by another hair transplant surgeon who agreed to place 300 FUE grafts into each temporal peak. The temporal peaks are definitely a sign of a youthful hairline, but special care needs to be taken in these areas for many reasons. Firstly, the natural hair in this region is finer than the other scalp hair and it also does not grow long like the other scalp hair. For this reason you must explain to the patient that if you are going to transplant hair into this area, since the typical donor hair comes from the back and sides of the scalp, the new temporal transplanted hair will be coarser and will grow long. Also in a patient with curly hair it can look very unnatural. In addition,  the hair lies extremely flat in these regions so it is imperative that the angles for the grafts are made as acute to the skin as possible so the hair does not grow outward. In a very young patient with significant hair loss I think it is a bad idea to address the temporal peaks because without knowing how severe the ultimate hair loss will be you can end up wasting grafts on an area that will ultimately be less important if you have to sacrifice density in more important areas, ie. the frontal and mid scalp.

Getting back to this patient, he was 26 years old with significant hair loss in the frontal scalp when he presented to this hair transplant surgeon who agreed to place 300 FUE grafts into each temporal peak, and not even address the thinning frontal scalp! Here are his results after 2 years which show less than 30 grafts growing on each side. The patient was so disappointed he ended up having scalp micro pigmentation in the area,  but I personally do not believe this helps the situation at all. I think the scalp micro pigmentation looks very unnatural and I believe it can also harm adjacent hair follicles and create permanent scarring in the tissue. His photos are below.

Lesson to learn from this. BEWARE of physicians claiming to be FUE experts unless you have seen many before and after photos of their patients who they have specifically performed FUE on. In addition, be very careful before deciding to transplant into the temporal peaks, especially in the younger patient. Unfortunately many hair transplant surgeons in this field will do anything you are willing to pay them to do, but this is not always the right thing. Do you diligent research before having your hair transplant procedure.

All the best,

Marc Dauer, M.D.

This is a failed FUE transplant into temporal peaks with subsequent scalp micro pigmentation.

This is a failed FUE transplant into temporal peaks with subsequent scalp micro pigmentation.

This is a failed FUE transplant into temporal peaks with subsequent scalp micro pigmentation.

This is a failed FUE transplant into temporal peaks with subsequent scalp micro pigmentation.

/by Los Angeles Hair Transplant Specialist

My Other Passion..

Greetings,

I am so passionate about Hair and Eyebrow Restoration, but I also have other passions in my life. One of which is music. I have been making music for most of my life. I recently had the pleasure of producing and performing on my third album with the talented Minnie Driver called “Ask Me To Dance”. A few weeks ago we performed selections from our new album on “The Today Show” and “Kelly and Michael In The Morning”. I won’t bore you with links to the videos of the performances, (you can search them out online if you are interested), but here are a couple of photos.

I used to want to keep the different facets of my life completely segmented, but now I realize that both my medical career and music career are just different facets of my artistic desire to create.

All the best,

Minnie Driver and Doc Dauer on The Today Show

Minnie Driver and Doc Dauer on The Today Show

 

Minnie Driver and Doc Dauer on Kelly and Michael

Minnie Driver and Doc Dauer on Kelly and Michael

Marc Dauer, M.D.

/by Los Angeles Hair Transplant Specialist

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

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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.
/by Los Angeles Hair Transplant Specialist

Botched Eyebrow Transplant Repair

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Greetings,

I recently saw a patient in consultation that had an eyebrow transplant procedure performed in the office of a very well known physician. The issue is that the physician did not perform the procedure. In fact, the physician is not trained in hair transplantation at all and does not even perform hair transplant or eyebrow transplant procedures himself. What he did was have a medical assistant perform the entire procedure, from beginning to end, and the physician did not perform any aspect of it. The medical assistant performed the harvest using the neograft automated FUE machine and then created the recipient sites and placed the grafts. The patient ended up having 2 procedures like this.

The entire procedure was an epic failure. Only about 20 hairs grew from both procedures on each eyebrow and the hairs that grew were growing straight out from the skin in unsightly directions. The donor area in the back of the head was also significantly scarred from the attempted extraction of many hundreds of hair follicles.

In addition, the patient also had an eyebrow tattoo performed in the same physicians office prior to the 2 eyebrow transplants which created even more scarring in the eyebrow.

To have a medical assistant perform the entire hair or eyebrow transplant procedure is not only unethical, it is against the law in many states including California.  Unfortunately this represent a growing trend in the field of hair and eyebrow transplantation. More and more companies are pitching “automated” devices to harvest hair follicles and selling physicians who have no experience in the field with a new device to increase their revenue growth. Their pitch is that you don’t need to know anything about hair and eyebrow transplants, just buy the machine and the company will supply per diems technicians to do the rest. This is the result of that.

I performed an eyebrow transplant procedure on the patient and placed approximately 300 follicles per eyebrow. The results are shown a week after the procedure. In a few months I will updated with follow up photos. Because of all the scarring from the previous eyebrow tattoo and botched eyebrow transplants, the patient will have less growth yield than someone with healthy tissue. She should still have an excellent result and I already told her she should expect to have a second procedure in 9-12 months to increase the density.

This should be a lesson to anyone considering hair or eyebrow transplants. Make sure you go to a physician who specializes EXCLUSIVELY in hair transplants or if you are going to have an eyebrow transplant someone who does many of these procedures, and that they have dozens if not hundreds of results to show you. Just because the physician is skilled in another field does not make them an excellent hair or eyebrow transplant surgeon.

All the best,

Marc Dauer, M.D.

This is a botched eyebrow transplant with pre existing eyebrow tattoo present.

This is a botched eyebrow transplant with pre existing eyebrow tattoo present.

This is a botched eyebrow transplant with pre existing eyebrow tattoo showing the hairs growing in different directions incorrectly.

This is a botched eyebrow transplant with pre existing eyebrow tattoo showing the hairs growing in different directions incorrectly.

 

This is a botched eyebrow transplant with pre existing eyebrow tattoo immediately post corrective eyebrow transplant procedure.

This is a botched eyebrow transplant with pre existing eyebrow tattoo immediately post corrective eyebrow transplant procedure.

 

This is one week after approximately 300 grafts were placed in each eyebrow to correct a botched eyebrow transplant procedure.

This is one week after approximately 300 grafts were placed in each eyebrow to correct a botched eyebrow transplant procedure.

 

This is one week after approximately 300 grafts were placed in each eyebrow to correct a botched eyebrow transplant procedure.

This is one week after approximately 300 grafts were placed in each eyebrow to correct a botched eyebrow transplant procedure.

 

 

/by Los Angeles Hair Transplant Specialist

Eyebrow Hair Transplant via FUE

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Greetings,

This is a male patient who cuts his hair very short and wanted more density in the outer half of his eyebrows. I harvested the donor follicles from the scalp using FUE so that the patient would not have a strip scar and the results are shown after 8 months.

Respectfully,

Marc Dauer, M.D.

Eyebrow transplant utilizing grafts harvested via FUE.

Eyebrow transplant utilizing grafts harvested via FUE.

Eyebrow transplant utilizing grafts harvested via FUE.

Eyebrow transplant utilizing grafts harvested via FUE.

/by Los Angeles Hair Transplant Specialist