Donor Density- How It Affects The Hair Transplant

Greetings,

Today I will discuss donor density and how it affects the hair transplant procedure. Donor density is the amount of follicles per cm squared in the donor region. A secondary factor relating to density is the hair count, which is the number of hairs in the donor region. This is determined by finding the average follicular density per cm squared and then the average number of hairs per follicle and multiplying the two numbers. The average scalp has between 60-100 follicular units per cm squared and the average hair count is between 2.3-2.7 hairs per follicle. If the majority of the follicles are 2 hair follicles as opposed to 3 hair follicles then the overall hair count will be less. This is why not only the number of follicles is important, but the average number of hairs per follicle as well. The higher the hair count and follicle count, the greater the donor density. The greater the donor density the more hair that can be moved from the donor region to the areas of thinning. The donor region is an unchangeable area whether we do FUE or FUT to harvest the donor hair in the hair transplant procedure. This is why a high donor density and high donor hair count will lead to the ability to move more donor follicles to the areas of thinning.

I hope this helps to clarify donor density and how it impacts a hair transplant procedure.

All the best,

Marc Dauer, MD

/by Los Angeles Hair Transplant Specialist

What Age To Start Hair Transplants? How Young Is Too Young

Greetings,

Today I will discuss my approach to younger patients that seek out hair transplant procedures. It is very important that he hair transplant surgeon proceeds slowly and carefully in younger patients. It is not uncommon for young men in their early 20’s to approach me seeking hair transplantation. The issue is that in individuals this young it is very hard to accurately determine how severe their hair loss will ultimately be. Thus it is difficult to assess an accurate treatment plan over the long term, which is an essential component of our jobs as hair transplant surgeons. Since every individual only has a finite amount of donor follicles to donate to the areas of balding, we need to have a course of action for not only the amount of hair loss that the patient has at the moment, but the eventual end point of the patients hair loss in the future. This is so we can conserve donor hair for the future for the affected areas that will need it later. Sometimes young men in their early 20s wish to have their hairline restored to the way it was only a few years prior. This is not a good approach as is can result in an unnaturally low hairline later with not enough donor hair to fill in all the areas of baldness behind it.

I prefer to start my younger patients on Propecia and Rogaine which can help restore some hair, and in many cases greatly slow the progression of hair loss, especially in younger individuals. I have these patients follow up with me periodically so that I can assess their continuing degree of loss. In some cases I will perform a procedure in a patient as young as 25, but I will insist on a regimen of Propecia and Rogaine. Also, I create a very conservative hairline in these patients and don’t use too much donor hair, thus conserving donor hair for future procedures.

Hair loss can be psychologically debilitating for many and especially young individuals. As hair transpant surgeons it is our job to approach these patients in the proper manner, so that the right decision can be made as to when and how to proceed with the hair transplant procedure.

All the best,

Marc Dauer, M.D.

/by Los Angeles Hair Transplant Specialist

What Is Good Donor Hair and How Does It Influence Hair Transplant Results

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Greetings,
Today I will discuss donor hair quality and how it influences the results in Hair Transplant procedure. It has been said that .1mm of increased diameter of the hair follicle can create up to a 30% increase in cosmetic density. This means that an individual with coarse hair will achieve greater cosmetic density from the same number of transplanted follicles as opposed to one with thin hair. Other factors that contribute to cosmetic density achieved with hair transplants are hair to skin color contrast (dark hair on light skin shows thinning more than light hair on light skin) and curly hair versus straight hair (curly hair shows more fullness than straight hair).
These are some factors that contribute to the ultimate cosmetic density that is achieved in a hair transplant procedure.
All the best,
Marc Dauer, MD
/by Los Angeles Hair Transplant Specialist

Does A Second Hair Transplant Leave A Second Donor Strip Scar?

Greetings,
Today I will discuss how I harvest my donor strip in patients undergoing their second hair transplant procedure. In almost all cases I include the old donor scar in my new strip in successive procedures so as not to leave the patient with multiple train tracks scars in their donor region. The only exception is the patient who has a wide donor scar and when trying to resect it will not give us enough donor hair for the procedure. This is one more reason why it is imperative that the donor area is treated properly on the initial procedure so that the patient has a small donor scar (between 1-3mm), and it can be excised on successive procedures while harvesting donor hair at the same time. I perform many special nuances in order to minimize the donor scar which include; trichophytic closure, using a thin suture to close as opposed to staples, not using cautery, and not taking too wide a donor strip which can lead to wide scars.
I hope this discussion clarifies the harvest of a donor strip in a successive procedure.
All the best,
Marc Dauer, MD
/by Los Angeles Hair Transplant Specialist

How Soon After A Hair Transplant Can I Go Back To Work?

Greetings,
A question I am often asked is how soon after a hair transplant procedure can one return to work. Part of the answer to this question lies in exactly what kind of work you do. After the hair transplant procedure you are not supposed to perform heavy lifting (over 25 pounds) for about 10 days. If your job involves heavy lifting or very vigorous work you should take a little time off. If your job is an office job you should be fine to return to work the next day. I have had multiple hair transplant procedures myself and I retuned to work performing hair transplants on others the day after my procedure. If you feel a need to conceal the fact that you have had the procedure from others, there are a few options. You can wear a hat (which we give to all our patients) immediately after the procedure. If you have a large amount of pre existing native hair you can creatively style your hair to cover the areas worked on. Typically the transplanted hairs form tiny scabs that look like little grains of sand. These scabs last for 5-7 days and then they fall off. After that your scalp looks very close to normal. The small transplanted hairs usually fall off within 3-4 weeks after the procedure and then begin to grow back at around 12 weeks. In fair skinned individuals their is some redness in the scalp that may persist for weeks before it resolves.
I hope this clarifies the immediate post procedure phase in hair transplant procedures.
All the best,
Marc Dauer, M.D.
/by Los Angeles Hair Transplant Specialist

Shock Loss In Hair Transplants- An Overview

Greetings,
Today I will discuss shock loss in hair transplant procedures. Shock loss is the loss of native hair that can occur in hair transplant procedures. It varies greatly from one practitioner to another and from one individual to another. The exact etiology of shock loss is not know, but it is thought that it is related to a temporary injury or minimization of vascular perfusion to the scalp. Individuals with a large amount of miniaturized hairs are more susceptible to shock loss. This is because miniaturized hair is hair that has already shrunken and is in its last phase before it is lost forever. The act of the hair transplant may hasten the departure of this unhealthy hair that is destined to fall out in the near future regardless. Women can also more susceptible to shock loss than male patients. Patients with a large degree of transplanted hair are less susceptible to shock loss as it is thought that the transplanted hair is more durable and less susceptible to temporary vascular insufficiency.
In my hair transplant procedures I take certain precautions to minimize shock loss. By using smaller custom cut blades I am creating a smaller opening in the scalp and thus less injury to the vascular bed. I also use tumescence, which is the injection of saline into the scalp, which elevates the skin and expands it, thus widening the playing field for  transplanting, and it pushes the vascular bed lower, thus protecting it from the small incisions. In most patients I use a small amount of epinephrine in the tumescence fluid which helps to minimize bleeding throughout the procedure. In women and men with a large degree of miniaturization I withhold the epinephrine in an attempt to minimize shock loss in these individuals.
Shock loss is a part of hair transplant procedures. I always tell my patients to expect to look about 5-10% thinner for about 3 months after the procedure until the hair begins to grow in. The healthy hair lost as a result of shock loss will come back with the new transplanted hair, and the unhealthy miniaturized hair lost is on its way out regardless. With the proper precautions and techniques we can minimize shock loss in our hair transplant patients.
All the best,
Marc Dauer, M.D.
/by Los Angeles Hair Transplant Specialist

Custom Cut Recipient Blade Sizes In Hair Transplant Procedures

Greetings,

Today I will discuss the custom cut recipient blade sizes in hair transplant procedures  that I use to create the recipient sites for my hair transplant grafts. I have a machine which allows me to cut custom sized blades. Typically my blades range in size from .5mm-1.1mm and I have blade sizes in every size in between in .05mm increments. This allows me to use the smallest possible blade for the patients natural follicular units. The hair type and caliber are defining characteristics that determine which size blade to use. Typically I try to find the smallest possible blade which still allows for easy placement. An extra .1mm opening may not seem like much, but when multiplied by 1500-3000, which is the number of recipient sites I create in a typical hair transplant procedure, an extra .1mm can add up to significantly more injury to the scalp and circulation, which in most cases is not necessary. I also custom cut my blades with a 45 degree angle at the end and I angle the deepest portion of the blade so that it is at the superior aspect of the incision. This means that the blade also causes less injury to the scalp circulation and positions the graft at a more acute angle which gives a better final result. Minimizing damage to the scalp and the vascular bed minimizes scar tissue in the scalp and thus minimizes the potential of “shock loss” (which I will address in another blog entry).

I hope this blog entry clarifies why the blade size is very important in Hair Transplant Procedures.

All the best,

Marc Dauer, MD

/1 Comment/by Los Angeles Hair Transplant Specialist

Hair Transplant Procedures In Patients With Old Plugs

Hair Transplant Procedures In Patients With Old Plugs

Greetings,

It is not unusual for me to see patients presenting for consultation who have plugs from the old way of performing hair transplant surgery. The plugs were groupings of 5-15 hairs that were punched out of the back of the scalp, and subsequently punched into the areas of thinning. They were very unnatural and looked like “dolls hair” because hair does not naturally grow in clusters of 5-15 hairs. Natural hair follicles are typically 1-4 hairs per follicle, with only single hair follicles present in the hairline. These plugs were harvested using a primitive version of the harvesting procedure we now call follicular unit extraction or FUE. The major difference is that the punch tool used to harvest the plugs measured between 2mm-5mm in diameter, while the new tools I use to harvest my FUE follicles measure between .8mm-1mm in diameter. Besides the unnatural look that these plugs left in the recipient zone, they also caused a huge amount of scarring in the donor zone. Often times these patients donor density can be decreased up to 50-75% from their original density. For these patients wearing their hair very short is not an option as their donor density has been so depleted that they must wear their hair longer in order to cover up the thinness. In most cases the best way to treat these patients is to perform a strip harvest procedure and go right through the old plug zone. If there are areas that are unscathed (sometimes the sides are untouched) the patient will have more yield from these regions. Regardless, depending on the amount of scarring and door depletion, we can often harvest between 1500-2000 grafts from these individuals by taking a maximum safe sized donor strip. In some cases, this procedure may be performed more than once. We can then transplant single hair follicles into the hairline, camouflaging the plugs, and transplant follicular units into the pluggy areas throughout, creating a much more natural look. In some cases we can also perform FUE to plugs in the hairline to remove them completely or to reduce the number of hairs in the plug, and then recycle the follicles further back on the scalp.

The technology in hair transplant procedures has come a long way since the days of the old plugs. The good news is that using the latest technology at our disposal we can improve the look of the old hair transplant plug procedures.

All the best,

Marc Dauer, MD

/by Los Angeles Hair Transplant Specialist

Hair Transplant Donor Strip Scar Revision

Greetings,

Today I want to demonstrate an interesting case I just treated. This patient had 3 previous procedures with other physicians in the past and presented requesting more density and dissatisfaction with his donor scars from his previous procedures. On examination what I saw was 3 different strip scars from the previous Hair Transplants in different areas, and in some areas a large scar from the coalescing of the multiple scars. In my patients, I always include the old donor scar in the new incision when a patient comes back for more grafts. It is only in very rare cases (an example would be someone who has a very wide donor scar from a previous procedure) that I will take a fresh swath from a new area. The reason for taking out the old scar is so that you don’t end up with train track scars throughout the donor region. Also, multiple smaller scars can coalesce to form larger scars which can then become difficult to conceal with shorter hair. This patient had very elastic scalp which allowed me to take out all the old scars and create one new fine scar. In addition, I was able to get a good amount of donor hair from the sides, which had not yet been harvested from. I will demonstrate this patient’s photos below (pre procedure and 12 days later) and I look forward to showing his photos in 6-9 months when the area is even more healed than it is now, but in these photos you can see an appreciable difference already.

All the best,

Marc Dauer, MD

Multiple Strip Scars From Previous Hair Transplant Procedures

Post Hair Transplant and Scar Revision

Multiple Strip Scars From Previous Hair Transplant

After Scar Revision During Hair Transplant Procedure

/by Los Angeles Hair Transplant Specialist

FUT- Strip harvest hair transplant versus FUE- follicular unit extraction hair transplant

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Greetings,

Sometimes when I meet a patient for the first time in consultation, they come to me with their mind made up as to which harvest procedure for the hair transplant they wish to undergo. Other times they come to me with no idea as to which harvest method for the hair transplant that they prefer. The Internet has been an amazing tool to educate patients regarding all aspects of hair transplant procedures, however there is a huge amount of misinformation in the Internet as well. Often it is difficult for the average consumer to differentiate between the truth and the fiction. To further complicate things, some Hair Transplant surgeons have their own agendas as well. These physicians may only be proficient in either FUT or FUE, and may then try to steer patients towards the procedure that they are more comfortable with. In other instances, the physician may have purchased an expensive piece of equipment that he needs to pay for, and then will steer patients towards the procedure which helps to pay off the equipment.

When I meet with patients the first thing I do is pay close attention to the hairstyle they wear when they come into my office. How short their hair is, how it is combed, product in the hair, hair color, etc. These are all clues that help me to understand the patient as an individual. In addition, between the family history of hair loss and the patients physical exam, I do my best to estimate how severe the patient’s hair loss will progress over time. I explain in depth the pros and cons of FUT hair transplant versus FUE hair transplant and tell the patient that I have no vested interest in which procedure the patient decides to have. I truly enjoy performing both FUT and FUE. My only interest is that the patient undergoes the procedure that suits them best. Not just in the short term but in the long term as well. That is part of my duty to my patients. I encourage my patients to take their time in deciding which procedure suits them best, so that they make the right decision. Not a quick decision that could prove to be wrong in the long term.

All the best,

Marc Dauer, MD

/by Los Angeles Hair Transplant Specialist