Hello all, over the past few years I have been performing an increasing number of Hair Transplant / Hair Restoration procedures on younger individuals, so I thought that I would outline my general approach to these patients.
As the new technologies in Hair Transplantation have improved, the numbers of individuals seeking out a permanent treatment to hair loss have increased. This has included younger individuals who are anxious to treat their hair loss. Many times hair loss in younger individuals can have even more devastating psychological consequences than in older patients. These psychological issues must be as carefully managed as the medical plan to treat these patients. It is very important to take a thorough medical and psychological history to assess the patient’s psychological well being as well as their hopes and expectations. In most cases, I will not consider transplanting a patient younger than 25, as often the full extent of their eventual hair loss cannot be fully determined at such a young age, and therefore it is in the patients best interest to wait until their late 20’s when a more complete picture of the patients eventual hair loss is better determined.
Patients that have a more moderate degree of hair loss can still be candidates for Hair Transplantation in their mid 20’s, and in the right cases, by performing the Hair Transplant earlier, it allows the patient to “stay ahead” of the hair loss that they will be experiencing in the future. Barring any medical contraindications, I usually encourage all my young patients to begin on a regimen of Propecia and Rogaine. I also think there is some positive scientific evidence to support the benefits of Low Light Laser Therapy in these patients. Another issue I am commonly confronted with in regards to Hair Transplantation in younger patients, is hairline design. Many patients wish to have their hairlines restored to the hairlines they had as teenagers. I often encourage my patients of all ages to bring in photos of them in their youth to give me a complete picture of what the patient looked like before their hair loss set in. In designing a hairline in a younger individual, it is very important to explain to the patient that there is a very finite amount of donor hair in every patients “hair bank” (the permanent hair on the sides and in the back).
Sometimes the problem with bringing the patients hairline down too low is twofold. The first issue is that young patients with hair loss are set in motion to have a significant degree of hair loss as they get older. Medical therapies can help slow this progression, but rarely stop it all together. When the hairline is brought down too low, it then forces the Hair Transplant Surgeon in successive surgeries to spend large numbers of grafts to “fill in” the areas just behind these low hairlines, and sometimes this is at the expense of other balding areas that can no longer be addressed, because of the overall lack of donor hair. In addition, a hairline that may look natural on a 25 year old, will probably not look natural on a person in the 50’s or 60’s.
I tell all my younger patients to think as conservatively as possible on their first Hair Transplant. I tell them that they have a finite number of donor hairs in their “hair bank”, and that it is very important that every hair is used in the most effective manner, and placed in the exact appropriate location. Hairlines can always be brought down, but once they have been brought down too low, the patient is faced with either the prospect of permanently removing valuable transplanted hair in the hairline, or trying to fill in just behind the hairline, at the expense of balding areas on the top of the head. Just like hair loss is a progressive phenomenon, so too, the approach to Hair Transplantation is usually that a typical patient will undergo 2-4 Hair Transplant sessions over their lifetime. The transplanted hairs we put in will never fall out, but most patients will continue to have loss of their surrounding native hairs in the areas prone to genetic hair loss.
It is important to educate the patient that proceeding more conservatively on the first procedure can give the patient many more options as they get older, and as their hair loss progresses. I hope this clarifies some of my approach to Hair Transplantation / Hair Restoration in younger individuals. Please feel free to email me if you have any additional questions.
All the best,
Marc Dauer, M.D.
Managing the Best Cosmetic Result in Donor Regions
Hair Loss, Eyebrow Transplantation, Eyebrow Restoration, Hair Transplantation, Female Hair Loss, Hair RestorationHello all, in today’s blog I would like to discuss my approach to Donor regions using the traditional “Strip Method” of Hair Transplantation. The “Strip Method” of Hair Transplantation involves taking a narrow and superficial strip of skin and hair follicles from the “permanent hair” in the back and sides of one’s scalp. This is the most common and effective method for harvesting large numbers of grafts to be used in Hair Restoration procedures. The “donor” area in the back and sides can be closed in many different ways, but I have formulated my own technique for closure that I believe minimizes any resulting scar, and allows the patient to cut their hair extremely short without any sign that the patient has had a procedure. Firstly, I place dissolving sutures deep in the donor region to bring the skin edges together. This reduces the tension at the skin edges, which is a common factor that contributes to increased scarring. These sutures do not need to be taken out as they are absorbed back into the body after a period of weeks. I also place an additional layer of sutures at the skin edges that provides increased strength and durability to the closure. This layer of sutures is routinely taken out 2 weeks after the procedure. Finally, I also perform a “Tricophytic Closure” on most patients, which involves shaving approximately .25mm off the lower edge of the donor area. This temporarily transects the hair follicles at the lower edge of the donor and subsequently causes them to grow “through” the scar tissue, which further conceals the donor site. In patients that return for additional procedures, I routinely include the “old” donor scar from their previous procedure,
in their new donor incision, so that they are only left with one scar hidden in their hair. I will include a number of photos of my patients donor scars exposed so you can get an idea of what to expect.
All the best,
Marc Dauer, M.D.
Eyebrow Transplants in Younger Patients
Eyebrow Transplantation, Eyebrow Restoration, Female Hair Loss, Hair RestorationHello all, I recently have been performing an increasing number of eyebrow hair transplants in younger patients. Patients can lose their eyebrow hair for various reasons, the most common being, over plucking of the eyebrow hair. It is very important that patients understand that if they pluck out any of the new eyebrow hairs they have had transplanted, they may not grow back. That is why I draw out the shape of the new eyebrows I will be creating, prior to placement of the new eyebrow hairs. This gives the patient a chance to agree with the plan or advise as to how they would want the eyebrow hairs placed differently. The best method is always to use any existing eyebrow hairs as a road map to help guide the design of the new eyebrows. I also tell patients to bring photos of themselves with eyebrows, and to bring photos of celebrities or friends who have eyebrows that they like. This helps formulate my overall design plan for the individual patient. Please don’t hesitate to contact me if you have any additional questions about eyebrow transplants.
All the best,
Marc Dauer, M.D.
Eyebrow Transplantation / Restoration
Hair Loss, Eyebrow Transplantation, Eyebrow Restoration, Hair Transplantation, Female Hair Loss, Hair RestorationHi all, I figured I would dedicate this blog entry to Eyebrow Transplantation / Restoration since it is such a large aspect of my medical practice. Â Eyebrows are one of the most important and visible characteristics on a persons face. Often we don’t even realize the importance of eyebrows until we see someone who does not have them. The method of restoring eyebrows through eyebrow transplantation is a very meticulous process through which initially “the right” hairs need to be identified for transplantation. This is done by carefully examining the characteristics of the persons hair and finding the location of the hair on the individual that most closely resembles eyebrow hair. Often this hair is found in the area behind the ear where the hair is usually a little finer, but in certain individuals it can be found elsewhere as well. I then harvest the “donor” hairs, most often through the standard “strip excision” (more info on this can be found on my website), or through FUE (which involves taking each follicle out individually). Once the donor hair is prepared it is important to draw out the shape of the eyebrows so that the patient and myself agree on where the new eyebrow hair will be placed. I often tell patients to bring in pictures of themselves in their youth, so I can use these in reference when I am designing the new eyebrows. In order to create natural looking eyebrows, they must correspond to the patients facial symmetry. Once we have agreed on the shape of the eyebrows, I carefully make tiny receptor sites with a hand cut custom blade approximately 1mm in diameter which is fashioned to fit the patients hair diameter perfectly. Â It is imperative the the sites and placement of the grafts are made with care so that the new hairs grow in the proper direction. Since eyebrows hairs change directions depending on where they are located in the eyebrow, this process of placing the new eyebrow hairs requires a significant degree of experience to be performed properly. Sometimes the new eyebrow hairs stay and begin to grow right after the Eyebrow Transplant procedure. Other times, the new hairs fall out and then start to grow back at around 6-8 weeks. Full growth is usually seen by about 9 months after the procedure. I have many patients who are completely satisfied after one procedure, and others that opt for a second “touch up” procedure to provide some increased density. I see many patients who have eyebrow tattooing. If they are happy with the shape of the tattoo, I can place the new eyebrow hair over the exisitng tattoo. If the shape of the tattoo is wrong, I usually recommend that the patient have the tattoo removed prior to Eyebrow Transplantation. Eyebrow Transplantation / Restoration is extremely gratifying for me, because it requires a strong artistic and aesthetic sensibility, and can really make a major change in a persons appearance. If you are considering this procedure and live outside Southern California, please feel free to email me photos of your eyebrows and I can review them with you via an email consult, or we can do a video consult with iChat if you are a mac user. I hope this provides you with some basic information on Eyebrow Transplantation / Restoration.
All the best,
Marc Dauer, M.D.
Hair Loss after Surgical Procedures
Hair Loss, Hair Transplantation, Female Hair Loss, Hair RestorationHello all, lately I have been treating an increasing number of patients who have suffered hair loss after various surgical procedures. The most common cases that I treat are loss of the sideburns after face lift procedures. I have also treated patients who have undergone previous brow lift procedures where their hairlines were brought up too high, or a scar was left in front of the hairline. In addition, patients who have had cranial surgery are often left with patches of hair loss secondary to the surgery. In all these cases, hair can be harvested from the patients “donor” region (usually in the back of the scalp, and if necessary, on the sides as well), and this donor hair can be used to graft to the areas that require coverage. This includes scars in the scalp, eyebrows, mustache, and beard regions. The end result is a completely natural appearance with coverage of the pre-existing scars. These hair transplants are effective because there is rich blood supply to the face and scalp, which allows hair transplants to grow well through most scars. In the photo section of my website I have posted some of my patients who are in this category of hair loss. I also have additional photos available for viewing in my office.
All the best,
Marc Dauer, M.D.
Hair Transplantation / Hair Restoration in Younger Patients
Hair Loss, Hair Transplantation, Hair RestorationHello all, over the past few years I have been performing an increasing number of Hair Transplant / Hair Restoration procedures on younger individuals, so I thought that I would outline my general approach to these patients.
As the new technologies in Hair Transplantation have improved, the numbers of individuals seeking out a permanent treatment to hair loss have increased. This has included younger individuals who are anxious to treat their hair loss. Many times hair loss in younger individuals can have even more devastating psychological consequences than in older patients. These psychological issues must be as carefully managed as the medical plan to treat these patients. It is very important to take a thorough medical and psychological history to assess the patient’s psychological well being as well as their hopes and expectations. In most cases, I will not consider transplanting a patient younger than 25, as often the full extent of their eventual hair loss cannot be fully determined at such a young age, and therefore it is in the patients best interest to wait until their late 20’s when a more complete picture of the patients eventual hair loss is better determined.
Patients that have a more moderate degree of hair loss can still be candidates for Hair Transplantation in their mid 20’s, and in the right cases, by performing the Hair Transplant earlier, it allows the patient to “stay ahead” of the hair loss that they will be experiencing in the future. Barring any medical contraindications, I usually encourage all my young patients to begin on a regimen of Propecia and Rogaine. I also think there is some positive scientific evidence to support the benefits of Low Light Laser Therapy in these patients. Another issue I am commonly confronted with in regards to Hair Transplantation in younger patients, is hairline design. Many patients wish to have their hairlines restored to the hairlines they had as teenagers. I often encourage my patients of all ages to bring in photos of them in their youth to give me a complete picture of what the patient looked like before their hair loss set in. In designing a hairline in a younger individual, it is very important to explain to the patient that there is a very finite amount of donor hair in every patients “hair bank” (the permanent hair on the sides and in the back).
Sometimes the problem with bringing the patients hairline down too low is twofold. The first issue is that young patients with hair loss are set in motion to have a significant degree of hair loss as they get older. Medical therapies can help slow this progression, but rarely stop it all together. When the hairline is brought down too low, it then forces the Hair Transplant Surgeon in successive surgeries to spend large numbers of grafts to “fill in” the areas just behind these low hairlines, and sometimes this is at the expense of other balding areas that can no longer be addressed, because of the overall lack of donor hair. In addition, a hairline that may look natural on a 25 year old, will probably not look natural on a person in the 50’s or 60’s.
I tell all my younger patients to think as conservatively as possible on their first Hair Transplant. I tell them that they have a finite number of donor hairs in their “hair bank”, and that it is very important that every hair is used in the most effective manner, and placed in the exact appropriate location. Hairlines can always be brought down, but once they have been brought down too low, the patient is faced with either the prospect of permanently removing valuable transplanted hair in the hairline, or trying to fill in just behind the hairline, at the expense of balding areas on the top of the head. Just like hair loss is a progressive phenomenon, so too, the approach to Hair Transplantation is usually that a typical patient will undergo 2-4 Hair Transplant sessions over their lifetime. The transplanted hairs we put in will never fall out, but most patients will continue to have loss of their surrounding native hairs in the areas prone to genetic hair loss.
It is important to educate the patient that proceeding more conservatively on the first procedure can give the patient many more options as they get older, and as their hair loss progresses. I hope this clarifies some of my approach to Hair Transplantation / Hair Restoration in younger individuals. Please feel free to email me if you have any additional questions.
All the best,
Marc Dauer, M.D.
My first post
Hair Loss, Eyebrow Transplantation, Hair TransplantationHello 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.