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.

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

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.

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.

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

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

Hello all, this sunday I am headed to Bangkok, Thailand to teach Doctors from Asia the latest techniques in Hair Restoration Surgery. The conference is sponsored by the American Academy of Aesthetic Medicine. There are physicians attending from Australia, China, and Thailand. It has been very enjoyable putting my lecture slides together. The process has allowed me to review my notes and texts on the processes of hair loss and the latest techniques in Hair Transplant Surgery. While I am in Bangkok I also plan on visiting some of the large Hair Transplant Clinics there to see how their practices are set up and observe their techniques. Dr. Viroj Vong of Bangkok has been kind enough to lend me some of his hair transplant nurses to assist me on the practical portion of the conference where I will be performing transplant procedures on about 12 patients over 3 days. Considering the fact that I typically only do one Hair Transplant procedure per day in my office, this should definitely be a challenge, but one that I am looking forward to. I hope to post pictures of Bangkok and the people I meet there during the conference.

All the best,

Marc Dauer, M.D.

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.

Hi all, I figured I would dedicate this blog entry to Eyebrow Transplantation / Restoration since it is such a large aspect of my medical practice.  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.  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.

Hello 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.