Greetings,
Here is a patient of mine who I perfumed a hair transplant of 2258 grafts via FUT. The patient has very fine, straight hair, which is the least ideal hair type when trying to maximize cosmetic density, but despite this the results are still significant and the patient is pleased.
The patient also had a previous procedure with another physician and discusses the difference between my procedure and his previous one.
I hope you enjoy watching.
All the best,
Marc Dauer, M.D.
Greetings,
Today I will discuss the difference in hair type for hair transplants. Based on studies 0.1mm increase in the diameter of the hair follicle can add up to 30% increased cosmetic density. This means that the greatest factor affecting cosmetic density is the thickness of the hair follicle. People with coarse hair will have a much better cosmetic result than people with fine hair with the same number of follicles. In addition, curly hair will yield a better cosmetic result than straight hair. Also, the less color contrast between the hair and the scalp (grey hair on light skin versus dark hair on white skin) the better the cosmetic result.
The analogy I typically use it to imagine a forest of trees in front of you. If the trees are thick with large wavy branches you will see through less of the forest than thin trees with small flimsy branches. This is the same with hair. Coarse curly hair will always yield a better cosmetic result than fine straight hair.
This is not to say that people with fine straight hair are not good candidates for the procedure, on the contrary they can be excellent candidates. Prospective hair transplant patients need to know this information in order to prepare themselves for realistic expectation of the outcome of their hair transplant procedure.
All the best,
Marc Dauer, M.D.
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 donor region immediately post FUE hair transplant and 1 week afterward.
Greetings,
Here is a patient of mine who received a hair transplant from another physician over 10 years ago. The grafts then were placed primarily in the hairline. The patient lost more native hair and presented to me with a thinned out hairline and very little hair in the mid scalp region. I transplanted just over 2000 grafts via FUT to increase the density in the hairline and the mid scalp.
The “after” photos are shown approximately 1 year after the patient’s procedure.
The patient is thrilled with his results.
All the best,
Marc Dauer, M.D.
Before and After Hair Transplant Photos
Before and After Hair Transplant Photos
Before and After Hair Transplant Photos
Before and After Hair Transplant Photos
Greetings,
Here is a patient of mine who just returned for his 9 month follow up after receiving 1372 grafts to the hairline via FUT. The objective was to fill in and define the existing thinning hairline.
The patient is already thrilled with his results and he should see some additional cosmetic density over the next 3-6 months as the transplanted hairs thicken in diameter.
All the best,
Marc Dauer, M.D.
Hair Transplant To The Hairline
Hair Transplant To The Hairline
Hair Transplant To The Hairline
Hair Transplant To The Hairline
Greetings,
Here is a patient of mine who wanted empty patches in his beard and mustache filled in. I used a 0.8mm FUE punch to extract hair follicles from the neck and transplanted these follicles into the beard and mustache. The results are shown after 6 months and the patient is thrilled.
All the best,
Marc Dauer, M.D.
Beard FUE Hair Transplant
Beard FUE Hair Transplant
Beard FUE Hair Transplant
Beard FUE Hair Transplant
Greetings,
Today I want to address the factors that affect cosmetic density in hair transplants. Firstly there are the anatomic factors. The single most important factor anatomically is the caliber of the hair. An increase in just .1mm of the diameter of the hair follicle can add up to 30% increased cosmetic density. The other anatomic factors that contribute are skin color to hair color contrast (the more contrast, the more you see through the hair), and curly versus straight hair (curly hair looks thicker than straight hair).
Then there is the follicles per cm squared, which is the amount of follicles transplanted in any given area. Normal non balding scalp can have a density of between 60-100 follicles per cm squared. The minimum density that should be transplanted into any bald area should be at least 30 follicles per cm squared. As we transplant more follicles per cm squared we achieve greater cosmetic density. It requires a much higher degree of skill to transplant a high number of follicles per cm squared.
In summary, there are both anatomic and surgical factors that contribute to cosmetic density. It is imperative that prospective patients looking at pre and post hair transplant photos take the anatomic characteristics into account when considering hair transplant results.
All the best,
Marc Dauer, M.D.
Greetings,I am often asked by prospective patients which harvesting procedure is preferable for hair transplantation. Follicular unit extraction or the strip harvest procedure? My answer is that it depends on the individual. If a person needs the option to cut his hair down to a number 1 or a number 2 buzz cut then follicular unit extraction is the needed procedure so as to avoid a visible linear scar. If the person is comfortable leaving their hair at a number 3 or preferably number 4 cut or longer, then the strip harvest procedure is absolutely an option. Typical linear scars from strip harvest procedures should measure between 1 and 3 mm in width and the length is determined by the amount of hair follicles needed to be harvested. This is in contrast to tiny white dots that are left in the donor region after the follicles are harvested in follicular unit extraction. Neither procedure is scarless. There is no such thing as a scarless hair transplant procedure. In fact, the scarring from follicular unit extraction in the donor region is greater when measured in surface area then the scarring from the strip harvest procedure. The difference is that in the strip harvest procedure the scarring is concentrated in a linear scar which is more noticeable when the hair is very short as opposed to the diffuse pinpoint scarring which is the result of follicular unit extraction. Some patients who have been overharvested in follicular unit extraction still do not have the option to cut their hair very short as the confluence of many pinpoint scars can start to show as “moth eaten” scalp with a short haircut. Also, it is usually not advisable to cut the hair down to a number zero haircut after follicular unit extraction hair transplants as you will probably see the tiny white dots left from the extraction of the follicles. To be clear, when follicles are removed from the donor area in follicular unit extraction one by one, they do not grow back in the donor area. They are taken out and moved to another area where they then begin to grow.In follicular unit extraction every third or every fourth hair follicle is randomly extracted so as not to create bald patches in the donor area. Because of this it is important to draw the hair follicles from the entire safe donor area. This means that the entire donor area is affected in the first hair transplant procedure. This is in contrast to the strip harvest procedure where only about a 1 to 1 1/2 cm wide area is extracted by a length that is determined by the amount of hair follicles needed to harvest, typically leaving behind a 1 to 3 mm linear scar with untouched robust donor area above and below the strip scar. When the patient returns for a second procedure the physician should harvest the second strip from the same area removing the original strip scar so as to leave the patient with only one strip scar even after multiple hair transplant procedures. If for some reason the strip scar widens and the physician is not able to extract the old scar, there is still untouched donor zone above and below the original strip scar allowing the physician to either take a new strip in a new area or begin follicular unit extraction in the surrounding areas around the original strip scar. What this means is that the ultimate donor zone in a patient will probably be contain more follicles if the patient begins with the strip harvest procedure versus follicular unit extraction. This also means that patients who are predicted to experience severe hair loss should strongly consider leaving their hair a little bit longer and undergoing the strip harvest procedure to begin with, in order to maximize the number of donor hair follicles from their permanent donor zone.When harvesting follicles in follicular unit extraction, the patient must shave their head down to a number zero cut in order to extract the follicles, versus the strip harvest procedure which allows the patient to leave their hair longer and use the existing hair to cover up the strip scar.In follicular unit extraction the physician can choose the larger follicular units i.e. the two, three, and four haired follicular units, while in the strip harvest procedure you only get what’s in the strip which may typically ends up being 2/3 one hair and two haired follicles. What this means is that the hair count can possibly be slightly higher in follicular unit extraction.Follicular unit extraction can be much more variable than the strip harvest procedure because a high degree of skill and efficiency required to extract the follicles intact. This is in contrast to the strip harvest procedure which involves less handling of the hair follicles. Because of this we often see more variable rates of growth in the hands of inexperienced practitioners practicing follicular unit extraction. It is imperative that the prospective patient see multiple results of the physician you are considering with the follicular unit extraction procedure as well as the strip harvest procedure.In summary there is no right or wrong when comparing follicular unit extraction and the strip harvest a procedure. Both are excellent procedures and both can provide excellent results in the hands of an experienced hair transplant surgeon. What’s most important is that the patient chooses the procedure that suits them the best both in the short term and the long run.All the best,Marc Dauer, M.D.
Greetings,
I recently saw a patient in consultation that had an eyebrow transplant procedure performed in the office of a very well known physician. The issue is that the physician did not perform the procedure. In fact, the physician is not trained in hair transplantation at all and does not even perform hair transplant or eyebrow transplant procedures himself. What he did was have a medical assistant perform the entire procedure, from beginning to end, and the physician did not perform any aspect of it. The medical assistant performed the harvest using the neograft automated FUE machine and then created the recipient sites and placed the grafts. The patient ended up having 2 procedures like this.
The entire procedure was an epic failure. Only about 20 hairs grew from both procedures on each eyebrow and the hairs that grew were growing straight out from the skin in unsightly directions. The donor area in the back of the head was also significantly scarred from the attempted extraction of many hundreds of hair follicles.
In addition, the patient also had an eyebrow tattoo performed in the same physicians office prior to the 2 eyebrow transplants which created even more scarring in the eyebrow.
To have a medical assistant perform the entire hair or eyebrow transplant procedure is not only unethical, it is against the law in many states including California. Unfortunately this represent a growing trend in the field of hair and eyebrow transplantation. More and more companies are pitching “automated” devices to harvest hair follicles and selling physicians who have no experience in the field with a new device to increase their revenue growth. Their pitch is that you don’t need to know anything about hair and eyebrow transplants, just buy the machine and the company will supply per diems technicians to do the rest. This is the result of that.
I performed an eyebrow transplant procedure on the patient and placed approximately 300 follicles per eyebrow. The results are shown a week after the procedure. In a few months I will updated with follow up photos. Because of all the scarring from the previous eyebrow tattoo and botched eyebrow transplants, the patient will have less growth yield than someone with healthy tissue. She should still have an excellent result and I already told her she should expect to have a second procedure in 9-12 months to increase the density.
This should be a lesson to anyone considering hair or eyebrow transplants. Make sure you go to a physician who specializes EXCLUSIVELY in hair transplants or if you are going to have an eyebrow transplant someone who does many of these procedures, and that they have dozens if not hundreds of results to show you. Just because the physician is skilled in another field does not make them an excellent hair or eyebrow transplant surgeon.
All the best,
Marc Dauer, M.D.
This is a botched eyebrow transplant with pre existing eyebrow tattoo present.
This is a botched eyebrow transplant with pre existing eyebrow tattoo showing the hairs growing in different directions incorrectly.
This is a botched eyebrow transplant with pre existing eyebrow tattoo immediately post corrective eyebrow transplant procedure.
This is one week after approximately 300 grafts were placed in each eyebrow to correct a botched eyebrow transplant procedure.
This is one week after approximately 300 grafts were placed in each eyebrow to correct a botched eyebrow transplant procedure.
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.
This shows the nylon suture retained in the tissue below the skin and the scarring.
Here is the strip scar immediately after revision and removal of the scarred tissue and retained suture material.