FUE Hair Transplant To Hairline

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Greetings,

Here is a patient of mine who received just over 1100 grafts via FUE to the hairline and frontal scalp. The grafts were extracted manually using a 0.8mm extraction tip.

The grafted region and the donor regions are shown 1 week post procedure and as you can see there is almost no evidence of scarring in the donor region and very little to be seen in the recipient region other than the new transplanted grafts.

All the best,

Marc Dauer, M.D.

This is the recipient region pre FUE hair transplant and 1 week after just over 1100 grafts were placed in the hairline.

This is the recipient region pre FUE hair transplant and 1 week after just over 1100 grafts were placed in the hairline.

This is the donor region immediately post FUE hair transplant and 1 week afterward.

This is the donor region immediately post FUE hair transplant and 1 week afterward.

/by Los Angeles Hair Transplant Specialist

ARTAS Robotic Hair Transplant FUE- Is It Better Or Worse For The Donor Region?

Greetings,

As more and more physicians purchase the ARTAS robotic machine for automated FUE there seems to be much more information and misinformation regarding the benefits of FUE and specifically of the ARTAS machine performing the extractions. I am a self described “tech geek” and “gadget fanatic”. This is why when the robot was initially introduced I was very intrigued and wanted to immediately investigate it as it seemed like a perfect fit for my personality. What I found was grafts that did not looks as good as my manual FUE grafts and scars in the donor region that were significantly larger than my hand held FUE scars. It was so dramatic that I decided not to purchase the machine.

Regarding the scarring from the ARTAS FUE, most of the reasons for undergoing FUE in the first place is the elimination of the linear scar and the ability to cut the hair very short without any scarring evident. What I saw from the ARTAS was “moth-eaten” donor regions after a single procedure (see photos below) thus negating the possibility to even shave the hair short! In addition this moth eaten donor area after a single procedure would also preclude the patients from harvesting additional grafts from the same area, which is also a huge negative, as almost all people continue to need additional grafts over time as hair loss progresses with age.

What the ARTAS does provide to physicians who purchase it is the marketing “wow” factor of having a robot harvest their FUE grafts. This can be a powerful marketing tool and in many cases can even allow the physician to switch the patient out to a strip procedure if they realize that FUE is not for them. It also can take the physician completely out of the harvesting equation by delegating technicians to perform the entire FUE harvest without the physician even being in the room. Finally, manual FUE is an acquired art, and not every hair transplant surgeon is capable or proficient in this art, and the ARTAS machine allows everyone to get into the FUE game without knowing how to extract grafts manually.

In my practice, I perform all my FUE harvesting personally with a hand held punch that typically measures 0.9mm in diameter. I perform about 50/50 FUE and FUT and am equally proficient in both. My job as a hair transplant surgeon is to educate my patient as to the benefits and drawbacks of both FUE and FUT and to let them make the decision that works best for them.

My advice is to research extensively before choosing a physician. Make sure you have seen many results (both donor and recipient regions) of both procedures. Most importantly, don’t be fooled by the “marketing hype”. Choose a physician that you truly trust, as a competent and ethical physician will always afford the best chance of a great result.

All the best,

Marc Dauer, M.D.

This is a patient who had a small number of FUE grafts harvested via the ARTAS one time. The scarring is very evident.

This is a patient who had a small number of FUE grafts harvested via the ARTAS one time. The scarring is very evident.

This is a photo from the latest edition of the ISHRS magazine showing the difference between the holes from the ARTAS and a manual .8mm FUE punch.

This is a photo from the latest edition of the ISHRS magazine showing the difference between the holes from the ARTAS and a manual .8mm FUE punch.

 

This is a photo of one of my FUE patients 6 months after harvesting just over 1600 grafts with a 0.9mm punch tool.

This is a photo of one of my FUE patients 6 months after harvesting just over 1600 grafts with a 0.9mm punch tool.ARTAS

/by Los Angeles Hair Transplant Specialist

Bad Hair Transplant

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Greetings,

Here is a patient who had a previous hair transplant strip procedure with a large chain Hair Transplant operation by a physician who had been performing hair transplants for over 30 years. The patient came to me requesting more density in the frontal scalp, but also complaining of a wide strip scar that was elevated with severe numbness. He also complained because the Physician who had performed his last procedure created a second strip scar deviating at one point from the first. He wanted me to take out the unsightly scar and consolidate the 2 scars into one.

When I started to dissect out the strip I noticed small blue thread and assumed it was a small retained suture that dipped below and was missed in the suture removed. To my amazement what I then discovered was that almost the entire length of the strip scar was closed below the skin with non absorbable nylon sutures. These are sutures that are only to be used on the skin surface and removed. They were placed into the subcutaneous layer below the skin and created a significant amount of scarring and was also giving the patient numbness. I removed the suture, which was caked in scarring at this point, and consolidated the 2 scars into one. The results are shown in the photos.

This should be a warning and reminder to prospective patients that when choosing your hair transplant surgeon make sure to do tremendous research into the person performing your procedure. Experience and focus on the singular discipline of hair restoration are imperative, but just as important is the fact that your surgeon should not have a cavalier attitude towards hair transplants, no matter how long they have been performing the procedure, and must convey and strong sense of sensitivity and respect for the art and science of the procedure, as well as keeping up to date on the latest developments in the field. The field of Hair Transplant surgery is the wild west and there are more unqualified individuals performing bad procedures than good. You only have one chance to do things right, so take the time to chose the proper physician who will give you the greatest chance of successfully achieving your goals.

Respectfully,

Marc Dauer, M.D.

Showing the strip scar before revision.

Showing the strip scar before revision.

This shows the nylon suture retained in the tissue below the skin and the scarring.

This shows the nylon suture retained in the tissue below the skin and the scarring.

Sutures found in the strip scar

Here is the strip scar immediately after revision and removal of the scarred tissue and retained suture material.

Here is the strip scar immediately after revision and removal of the scarred tissue and retained suture material.

/by Los Angeles Hair Transplant Specialist

Consumer Alert Warning Regarding Hair Transplants

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Greetings,

With the growing field of hair and eyebrow restoration procedures, and the abundance of new “automating” machines, companies are “pitching” doctors as not needing to know anything about hair transplantation, just buy the machine and we will provide some medical assistants to perform the entire procedure. This is taking place everywhere and I am seeing more and more cases of patients undergoing botched procedures in dermatology and plastic surgery practices that have no experience doing hair and eyebrow transplant procedures. I have posted some of these botched procedures and will continue to do so. It is imperative that the consumer stay vigilant and only go to an individual that specializes exclusively in hair and eyebrow restoration in order to increase the likelihood of an excellent result.

Now the International Society of Hair Restoration Surgery has also issued a warning to consumers regarding unqualified individuals performing hair and eyebrow restoration. Just because you are going to see a Physician does not mean that the individual is well versed in hair and eyebrow transplants. Make sure your treating physician can show you at least 100 before and after photos of their own patients that look good to you before considering the physician for your procedure.

You can find the full text of the ISHRS press release below.

All the best,

Marc Dauer, M.D.

http://www.ishrs.org/content/consumer-alert

Seeking Hair Restoration Surgery?  

Be sure that a properly trained licensed physician or properly trained licensed allied health professional practicing within the scope of his or her license is responsible for your treatment.


The International Society of Hair Restoration Surgery (ISHRS) is concerned about the growing risk to patients of unlicensed technicians performing substantial aspects of hair restoration surgery.  The use of unlicensed technicians to perform aspects of hair restoration surgery which should only be performed by a properly trained and licensed physician or properly trained and licensed allied health professional (e.g., nurse, nurse practitioner, physician assistant) practicing within the scope of his or her license,  places patients at risk of: (i) misdiagnosis; (ii) failure to diagnose hair disorders and related systemic diseases; and (iii) can result in the performance of unnecessary or ill advised surgery all of which jeopardizes patient safety and outcomes.  There may also be a risk that unlicensed technicians may not be covered by malpractice insurance.

The ISHRS believes the following aspects of hair restoration surgery should only be performed by a licensed physician or licensed allied health professional practicing within the scope of his or her license:

  • Preoperative diagnostic evaluation and consultation
  • Surgery planning
  • Surgery execution including:
    • Donor hair harvesting
    • Hairline design
    • Recipient site creation
  • Management of other patient medical issues and possible adverse reactions

To help insure patients have information needed to make informed decisions about who performs their hair restoration surgery, the ISHRS urges potential patients to ask the following questions as well as questions regarding costs, risks, and short and long-term benefits and planning:
Patients Should Ask These Questions:

  1. Who will evaluate my hair loss and recommend a course of treatment?  What is their education, training, licensure, and experience in treating hair loss?
  2. Who will be involved in performing my surgery, what role will they play, and what is their education, training, licensure, and experience performing hair restoration surgery?
  3. Will anyone not licensed by the state be making incisions or harvesting grafts during my surgery?  If so, please identify this person, explain their specific role and why they are legally permitted to perform it.
  4. Is everyone involved in my surgery covered by malpractice insurance?

 

             

 

Be your own best advocate. Protect yourself.

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International Society of Hair Restoration Surgery
A non-profit medical association
303 West State Street, Geneva, IL 60134 USA
www.ISHRS.org

The International Society of Hair Restoration Surgery is a non-profit medical association exempt from federal income tax pursuant to Internal revenue Code Section 501(c)(3). The mission of the ISHRS is to achieve excellence in medical and surgical outcomes by promoting member education, international collegiality, research, ethics, and public awareness.

/by Los Angeles Hair Transplant Specialist

Neck Hair Follicular Unit Extraction – FUE

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Greetings,

I am often asked when is it a good time to use beard / neck hair for a hair transplant. Firstly the only way to harvest beard hair is via FUE. Also, since beard hair is slightly courser than scalp hair it should not be used in the hairline but for filler throughout the rest of the scalp. It can also be used effectively for beard augmentation or to cover beard scars. Beard follicles are typically 1 or 2 hairs as opposed to scalp which has larger follicular units. It also requires a high degree of FUE proficiency in order to be successful at harvesting intact grafts from the beard via FUE. Also, I prefer to only harvest from below the jaw line as it does leave very slight white dots after the grafts has been harvested. These dots are very hard to see in most individuals, however I prefer to leave these dots below the jaw line which makes them even harder to  find. Neck hair is a good alternative when looking for this type of hair or when the scalp donor is exhausted. It needs to be harvested with a high degree of efficiency and placed properly for maximum results.

All the best,

Marc Dauer, M.D.

/by Los Angeles Hair Transplant Specialist

When Is The Right Time To Have A Hair Transplant?

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Greetings,

Today I want to discuss a question I am commonly asked which is “when is the right time to have a hair transplant procedure?” The answer is different for every person. Each time I examine a prospective patient I try and estimate the full extent to which the hair loss will progress over the patient’s lifetime. This is imperative in order to understand how much donor hair the person will have available for the amount of balding area that will present over time. The individual needs to understand and internalize the amount of hair loss they will eventually have and try best as possible to see if they can be happy with a realistic result based on their supply to demand ratio. Young patients may not want to know their eventual hair loss amount or may want to proceed with a treatment plan that does not take this into account. This is not an option, as it is our job as hair restoration surgeons to educate the individual and only do what is right for the patient both in the short term and long term.

In general, I like to wait until the patient is at least 25 before performing the hair restoration procedure unless hair loss is taking a severe toll on the patient’s psychological health and I believe that the eventual loss of hair will not preclude the individual from being a good candidate for the procedure. In addition, that the prospective patient has a good grasp on what is a realistic result both in the short term and long term.

I always tell my patients when they ask me, “do I need to do the hair transplant now?”. No one needs to do this at any point. This is an elective procedure that people undergo in order to make them feel better about themselves. To reclaim a piece of the person that they once had. Something that was once part of their body and their appearance, that was taken away from them. When you get to the point that you don’t like looking in the mirror anymore at what you see on your scalp, then that is the right time to have a hair transplant procedure (assuming you are chosen as a good candidate and you have realistic expectations).

The psychological component of hair restoration surgery is one of the largest factors involved and it is our duty as hair restoration surgeons to educate our patients and allow them to make the best educated decision for themselves both in the short term and long run.

 

All the best,

 

Marc Dauer, M.D.

/by Los Angeles Hair Transplant Specialist

Pitting in Hair Transplant Procedure

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Greetings,

Today I will demonstrate a phenomenon known as “pitting”. This occurs when the transplanted grafts are placed too deeply and it causes the hairs to look like they are growing out of a hole or a pit. This is a completely unnatural look and can easily be avoided by placing the grafts properly with a small amount of tissue protruding above the skin. In the case of this patient, his previous procedure was performed at an unnamed large hair transplant chain operation and 2 different  nurses were used to place each side of the hairline. In this case the left side had extensive pitting and the right side did not show the same amount (see the photos below). This is one more reason why quality control is so important in hair transplant procedures. We as physicians are only as good as the nurses placing the grafts and unqualified nurses placing the grafts can lead to results like you see here. My nursing staff have been with me over 10 years each and they have all been working in the field of hair transplant surgery for over 15 years each. Most of my nurses have worked on my scalp personally, and I trust them implicitly, as I am smart enough to know that my results are only as good as they are, and they are great.

All the best,

Marc Dauer, M.D.

This photo shows "pitting" from a previous hair transplant.

This photo shows “pitting” from a previous hair transplant.

This is from the same patient the other side of the frontal scalp that does not show significant pitting.

This is from the same patient the other side of the frontal scalp that does not show significant pitting.

/by Los Angeles Hair Transplant Specialist

Hair Transplant Patient Testimonial and Results

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Greetings,

Here is a patient of mine who received just under 2600 grafts via FUT to the frontal and mid scalp. The results are shown at 10 months.

The patient describes his experience and how his results have changed his self confidence.

I hope you enjoy watching.

All the best,

Marc Dauer, MD

/by Los Angeles Hair Transplant Specialist

New Hair Transplant Patient Testimonial

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Greetings,

Here is  patient of mine describing his experience and showing his results 9 months after his procedure. His results are already impressive and he is very happy. He should get more density over the next 3-6 months as the transplanted hairs continue to thicken.

I hope you enjoy watching.

All the best,

Marc Dauer, M.D.

/by Los Angeles Hair Transplant Specialist

Follicular Unit Extraction- FUE Grafts- Are They Are The Same?

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Greetings,

Today I will discuss the grafts from FUE and how they can differ. Firstly there is the size of the tool used to extract the grafts. Even though many tools claim to be a certain size some are measured from the internal diameter and some from the outside diameter. This may not see like that much difference but an extra .1mm of punch size can leave significantly more pinpoint scarring in the donor region. Many of the automated systems including the ARTAS robotic system tend to use larger punch sizes (1mm and even larger) which can leave significantly more scarring in the donor region. I use a sharp tip that measures .9mm from the outer diameter. For very course curly hair types I also have sizes that go up to 1.05mm when necessary and when extraction body or beard hair I also have tips as small as .8mm. The .9mm is an excellent “work horse” tip that allows for beautiful graft extractions in experienced hands. I have a photo of the grafts from my FUE patient yesterday and as you can see they are all intact and most are multi hair follicular units which is another advantage of FUE in that it allows you to choose the larger follicular units and leave the smaller ones behind.

Not all FUE hair transplant surgeons are created equal and it is of utmost importance that you see good examples of your surgeons FUE results and grafts prior to proceeding with this type of procedure.

All the best,

Marc Dauer, M.D.

FUE grafts extracted with a 0.9mm punch tool.

FUE grafts extracted with a 0.9mm punch tool.

 

/by Los Angeles Hair Transplant Specialist