First few weeks post Eyebrow Transplant. What to expect.

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Greetings,

Today I will discuss the first few weeks following Eyebrow Transplant surgery. Eyebrow Transplantation has become a much more popular procedure as of late. More people are discovering how effective and natural the procedure can be when performed by the right surgeon. I was one of the first surgeons in the country performing the procedure and as such have had the opportunity to perform a great number of cases. In addition, I have refined the overall technique in ways that greatly improve both the immediate post operative period and the final result.

In a typical Eyebrow Transplant procedure I will place between 100-300 single hair grafts per eyebrow. The number depends on the patients facial symmetry, gender, hair color, and eyebrow hair loss, among other factors. The entire procedure is performed under local anesthetic. In the immediate post operative period I tell patients that they should expect to see some swelling around the eyes and possibly even some bruising around the eyes. This typically peaks at around day 3 and resolves by day 5. Within 24 hours of the grafts being placed they form tiny scabs around the grafts that look like little grains of sand. Immediately after the procedure the patient gets a good idea of how the eyebrows will eventually look because I place the eyebrow hairs at about the same length as typical eyebrow hairs. Within a week most of the crusts fall out and a few of the transplanted hairs may fall out, but for the most part the patient is left with most of the new transplanted eyebrow hairs. Beginning in the second week the transplanted eyebrow hair grafts begin to fall out. Usually by the end of the first month, most of the transplanted eyebrow hair grafts have fallen out and the patient is left with eyebrows similar to what they had before the procedure. During this “in between” time the patient may continue to put on eyebrow makeup just as they did before the procedure.

At around 3 months post eyebrow transplant the new eyebrow hair grafts begin to grow in. Usually the patient will notice more hair between 4-6 months post operatively and at 12 months the patient will see the full result from the eyebrow transplant procedure. Below I will show a patient of mine pre operatively and 2 weeks post operatively to give you an idea of the typical look in the immediate post operative period.

If you have additional questions about Eyebrow Transplants please feel free to contact me.

All the best,

Marc Dauer, M.D.

/1 Comment/by Los Angeles Hair Transplant Specialist

Post Hair Transplant Timeline

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Greetings,

Today I will discuss the general timeline post hair transplant. Typically within 24 hours after the procedure tiny crusts that look like grains of sand form around the transplanted hairs whether they are on the scalp, eyebrow, face, or body. These tiny scabs begin to fall off around post op days 3-4 and are usually gone within 7-10 days. Keeping the grafts moist or applying an antibiotic ointment may loosen the crusts and have them fall off earlier. Most of the transplanted hairs being to fall out at around 2 weeks post operatively and usually by the end of the first month post transplant most of the transplanted hairs are all gone and the patient looks like they did prior the procedure. Typically , the hair begins to grow back at around 12 weeks. The patient usually does not notice any change until around 5-6 months, at which point approximately 50% of the new hair growth may be seen. Full growth is usually not achieved until 12 months post procedure and continued growth may be seen for up to 24 months post procedure. Patients who have undergone a second or third procedure may see a slightly delayed growth timeline.

I hope this information is helpful to all of those considering Hair Restoration.

All the best,

Marc Dauer, MD

/by Los Angeles Hair Transplant Specialist

Private Teaching For Physicians In Hair and Eyebrow Transplants

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Greetings,

I just completed a private teaching course with a very skilled physician from Saudi Arabia, Dr. Wissam Adada. He works in a well known medical institution in Riyadh, and came to my clinic to learn my approach and techniques in Hair and Eyebrow Restoration. I always enjoy these teaching opportunities because it allows me to work with a physician one to one and share my knowledge in the field. We had a nice combination of cases including an eyebrow transplant and a number of hair transplants both via follicular unit extraction using the new SAFE scribe and strip harvesting. I look forward to keeping in touch with Dr. Adada as his practice grows and continuing to be a resource for him in the field of Hair and Eyebrow Restoration.

/by Los Angeles Hair Transplant Specialist

New F.U.E. S.A.F.E System

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Greetings all,

For the past few months I have been using a new machine for my FUE procedures called the “New F.U.E. S.A.F.E System”. For those of you who are not familiar, FUE stands for “Follicular Unit Extraction”. It is the process where donor follicles are taken out one by one, instead of removing them via the “Strip Method”, where a strip of donor scalp is removed and dissected under the microscope into individual follicles. There are a number of advantages and disadvantages to FUE vs. Strip Harvesting but I will not get into this discussion here. FUE is typically described in marketing and promotional advertisements as a “scarless” procedure. This is not actually true. What is true is that FUE causes many “micro scars” in the areas where the follicles are removed. In most cases these micro scars heal well and only leave a small dot of hypo-pigmentation in each spot where a follicle is removed. This is usually cosmetically insignificant as the area where the donor hair is removed is usually covered by the remaining hair in that region. The other issue with FUE is that in the past there has been a high rate of transection with the removal of the follicles. This means that in the process of removing the follicle, the structural integrity of the follicle is compromised, thus giving the follicle a much lower percentage chance of growth. The goal is a system where there is a low rate of transection and where the follicle is exposed to the lowest amount of trauma possible. There are many new automated and manual systems available now for FUE and I did extensive research into all of them and decided that the SAFE system was the way to go. The thing I really like about this system is that the punch that is used to extract the donor follicle has a blunt tip as opposed to a sharp tip that most of the other systems use. What this means is that since the tip is not sharp there is a much lower incidence of transection. Since donor follicles are very finite in each individual (the average person has about 8000 donor follicles), a lower transection rate of even 10-20% can result in hundreds or possibly even thousands of saved follicles. In addition, because the tip is not sharp, I believe it causes less trauma to the underlying vasculature, which can protect the scalp for future procedures. Also, because this system is motorized, like a small drill, it allows you to “score” the follicles much quicker, thus allowing more follicles to be harvested in a session. With this system, you still have to manually extract the follicles, manually trim the follicles, and manually implant the follicles, but the automation in the drill definitely speeds up the process. FUE is good for some patients and has it’s advantages and disadvantages. We are now able to transplant up to 1200 follicles in a day with the new FUE system, as opposed to significantly lower numbers before this system. In addition, FUE allows us to harvest chest hair, back hair, and beard hair for donor follicles. What is most important, is that every patient throughly understands all the advantages and disadvantages of both harvesting techniques before deciding which route to take in their own hair restoration journey.

Marc Dauer, M.D.

/1 Comment/by Los Angeles Hair Transplant Specialist

Discomfort associated with Hair Transplantation procedures

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Greetings all, a very common question I am asked is, “how painful is a hair transplant procedure?” Most people imagine it like a trip to the dentists office or some sort of extremely painful process. In reality, it is not like that at all. That is not to say there is no pain associated with the procedure. The level of pain however is very tolerable, and most would quantify it as minimal. To begin with, I use a vibrating mechanism when administering my anesthesia (all local anesthetic) which greatly reduces the discomfort associated with the injections. Because the brain perceives vibratory sensations quicker than painful sensations, by using the vibration it greatly reduces the discomfort associated with the injections. Once the numbing injections are complete, the patient should then be pain free for the duration of the procedure. After the procedure I prescribe pain pills for my patients, but most tell me they don’t even need to take them longer than a day or two. By day 3 most of the discomfort is gone. I can attest to all of this because I have had the procedure myself, so I am not only speaking from my experience as the treating physician, but also as the patient. I hope this clarifies any confusion related to this topic.

All the best,

Marc Dauer, MD

/1 Comment/by Los Angeles Hair Transplant Specialist

New Advancements In Hair Restoration

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The Latest Advancements In Hair Restoration

Eyebrow Hair Restoration and Concealment of Scarring with Hair Transplantation

By Marc Dauer, M.D., ABHRS

Hair Restoration has come a long way from the unsightly large “plugs” of yesteryear. Today we practice Follicular Unit Transplantation which allows us to relocate hair follicles in the same way they naturally occur. This technique has also allowed us to transplant hair to other areas of the body besides the scalp.

Follicular Unit Transplantation is the general term to describe transplantation of naturally occurring follicular units. Typically hair grows in clusters of 1,2,3, and 4 hair follicular units. There are two main techniques used to harvest these follicular units. The first and most commonly used method is called “The Strip Method”. This involves taking a narrow strip of hair (usually not to exceed 1.5 cm in width) from some region in the permanent hair zone (in men this is in the occipital and parietal regions of the scalp) and dissecting the strip under magnification into individual follicular units. The other technique used in harvesting is Follicular Unit Extraction. This involves using a biopsy punch tool, usually between .6mm-1.2mm, and extracting the individual follicular units from the permanent hair zone for transplantation into another area.

Eyebrows are one of the most important defining characteristics of the face. Often you don’t even realize the full impact that eyebrows make until you see a person without them. With the Follicular Unit Transplantation, it is now possible to restore natural looking eyebrows that will last a lifetime.

Eyebrow hair loss can occur for several reasons in women and men. Physical trauma (such as burns or lacerations), medical treatments (such as chemotherapy or radiation therapy), excessive plucking, and even menopause, can all contribute to eyebrow hair loss. In the past some people opted for eyebrow tattoos to recreate lost eyebrow hair. Eyebrow transplants can be implanted over eyebrow tattoos to recreate natural looking eyebrows.

The hair to be transplanted into the eyebrows is usually harvested from either the mid occipital region or the nape in the posterior auricular region. In both cases the hair in these areas is of finer quality, thus more accurately resembling natural eyebrow hair. With an artistic eye, and keen attention paid to the individuals facial characteristics, the boundaries of the new eyebrows are drawn in so that the patient can see the shape of their new eyebrows. Once the design is completed the area to be transplanted is anesthetized with local anesthetic containing epinephrine and then tumesced with saline solution. The tumescence allows the grafts to be placed closed together, while elevating the skin further away from the underlying vasculature, thus resulting in less vascular damage. Small recipient sites are made with a solid core 22 gauge needle, with care taken to limit the depth to the size of the follicle to be transplanted. Grafts placed too deeply may result in excessive bruising and/ or cyst formation or scarring. Only single hair follicular units are placed in the eyebrows.

/1 Comment/by Los Angeles Hair Transplant Specialist

Hair Restoration Conference in Kuala Lumpur, Malaysia

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Greetings, I have just returned from leading a teaching conference on Hair Restoration on behalf of the American Academy of Aesthetic Medicine in Kuala Lumpur, Malaysia. This was my second visit to Malaysia. The attendees came from Malaysia, Singapore, and India. It was a slightly smaller conference so it really gave me an opportunity to spend a good deal of individual time with all the physician attendees, which was gratifying personally. Kuala Lumpur is an amazing city with incredible architecture. I will post a photo of the twin towers at night, and one of me and the attendees. I look forward to hosting another conference in KL in March 2011.

All the best,

Marc Dauer, M.D.

/1 Comment/by Los Angeles Hair Transplant Specialist

Dubai Hair Transplant Teaching Conference

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Greetings all, in more recent news, I have just returned from Dubai teaching a course in Hair Transplant Surgery. The attending physicians came from Iran, Iraq, Syria, Lebanon, Dubai, and the United States. It was very interesting to hear the practice experiences of the attending Cosmetic Surgeons in their respective countries. One physician from Iraq described how he treated Saddam Hussein’s wife, who then brought him to treat Saddam himself. He went on to treat Saddam for a period of 5 years, all the while his 6 brothers were killed by Saddam’s people. He wears a Rolex watch that Saddam gave him as a gift. Another physician who currently practices in Iran described in great detail how the current political and social issues there have affected his practice and his personal life. The city of Dubai is a sight to behold. The infrastructure is modern and well planned. The malls are all like the nicest stores on Rodeo Drive or 5th Avenue. I went to the top of the tallest building in the world (2 1/2 times the size of the Empire State Building!), went skiing in the indoor ski resort, and saw the world’s only 7 star hotel. I also had the chance to meet some new prospective patients and follow up with some of my existing patients who live in the Middle East. I may be going back to Dubai in the next few months to perform cases on private patients there and will keep you updated on these activities. I have posted some photos of my trip below.

All the best,

Marc Dauer, M.D.

Conference Attendees

Skiing Indoor In Dubai

Tallest Building In The World

/1 Comment/by Los Angeles Hair Transplant Specialist

Malaysia Hair Transplant Teaching Conference

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Greetings all, it has been a long time since I have posted so there is a lot to catch up on. In October I conducted a training course in Kuala Lumpur, Malaysia, under the auspices of the American Academy of Aesthetic Medicine, for Cosmetic Surgeons interested in pursuing Hair Transplant Surgery. The Physicians that attended came from all over the world including Pakistan, Hong Kong, China, England, Malaysia, and the United States. The clinic where we performed the course was a beautiful state of the art new facility called Health Pathway. It was very gratifying to teach the physicians my personal approach and techniques in Hair Restoration, and to hear about their practice experiences in their respective countries. I also had the opportunity to demonstrate an Eyebrow Transplant on of the attending physicians who had a scar in his eyebrow. The family that operates Health Pathway went out of their way to show me the city and entertain me during my stay, and I am grateful to them for this. The city of Kuala Lumpur is quite impressive. The architecture is modern and beautiful with some of the largest and most advanced buildings in the world. The endless palm trees provide for a beautiful landscape beyond the towering skyscrapers. I have posted some photos below from my trip.

All the best,

Marc Dauer, M.D.

Kuala Lumpur Skyline

Conference Attendees

/by Los Angeles Hair Transplant Specialist

Managing the Best Cosmetic Result in Donor Regions

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Hello 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.

/by Los Angeles Hair Transplant Specialist