Follicular Unit Transplantation- FUT- Strip Harvest Procedure. Staples versus Sutures Closure

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Donor Scar After FUT- Strip Harvest Hair Transplant Procedure

Greetings,

Today I would like to discuss the closure of the hair transplant donor strip in FUT, which is the strip harvest procedure. This is where we take a strip of hair from the donor zone and dissect it into individual follicular units for transplanting. In order to have an excellent result in the donor region (a fine linear donor scar, between 1-3mm in width) it is imperative to limit the width of the donor strip. Keeping the donor strip limited to a width of 10-15mm is usually safe for a fine scar result. Performing a trichophytic closure (which I have discussed in previous blog entries) can cause the hair to grow through the scar, further camouflaging it. Some physicians prefer to close the door region using staples. This technique is much quicker and easier for the physician. It is also much more uncomfortable for the patient. Sleeping on hard staples in the back of your scalp can be very painful. Staples are also painful to remove. I prefer to use a fine nylon suture which takes longer to place, but is much more comfortable to sleep on and is painless in it’s removal. I also believe that the healing with sutures is better than with staples. I typically have my patients leave their sutures in for 12-14 days before removing them. In hair transplantation there are always many different ways that each step of the process can be performed. It is imperative that the treating physician make decisions that are best for the patient in both the short term and long term.

All the best,

Marc Dauer, MD

/1 Comment/by Los Angeles Hair Transplant Specialist

Copper Peptide Spray For Better Post Procedure Hair Transplant Healing

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Greetings,

Today I want to discuss the immediate post procedure time frame and something I have found to make the healing process quicker and better. I have found over my many years of experience performing Hair Transplants that keeping the grafts moist and clean as much as possible in the immediate post Hair Transplant procedure phase has contributed greatly to better and quicker healing of the grafts. I also believe that the better and quicker healing contributes to greater growth potential of the grafts. This is also why I routinely apply a thin layer of antibiotic ointment to the grafts and the suture line immediately post hair transplant procedure. I have formulated my own compound of a copper peptide spray solution that I give to all my patients. I call my post hair transplant copper peptide solution “Heal Spray”. I dispense Heal Spray to all my patients post hair transplant procedure and instruct them to spray the grafts 3-5 times per day. I have found that this regimen loosens the crusts associated with the transplanted grafts and promotes quicker healing and return to normal appearing scalp. Patient’s also say the heal spray provides soothing to their scalp and helps to minimize the itching in the transplanted region. Patient’s who underwent previous hair transplant procedures without the heal spray and then have used it in subsequent procedures have reported significant satisfaction with the product and it’s positive effect on the entire healing process. I hope to share my heal spray with other hair transplant surgeons in the near future. Until then we look forward to sharing it with all of our patients.

All the best,

Marc Dauer, M.D.

/by Los Angeles Hair Transplant Specialist

PRP and Hair Transplant Procedures

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Greetings,

I have recently begun to experiment using PRP, which is platelet rich plasma, in certain hair transplant procedures. PRP has been used in wound healing for a number of years. Recently some have begun to use it in conjunction with Hair Transplant procedures. The PRP is obtained from the patient prior to the procedure via a blood draw. The blood is then spun down to separate the red blood cells from the PRP. The PRP contains growth factors that aid in healing. We have been experimenting injecting the PRP into the donor region, bathing the grafts to be transplanted in the PRP, and then spraying the PRP onto the scalp for better post operative healing. So far the initial results have been promising. I still cannot definitively state that I see a superior result using the PRP compared with procedures performed without it, but I will continue to investigate and look forward to having more information moving forward. I also plan to offer it to my patients who are interested, though letting them know that we are still in the experimental phase. I look forward to discussing this further in the future.

All the best,

Marc Dauer, MD

/1 Comment/by Los Angeles Hair Transplant Specialist

Hair Transplants and Patients on Antithrombotic (Blood- Thinner) Therapy

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Greetings,

I recently read an interesting article written by Dr. Yagyu from Japan that discusses guidelines for patients who are on antithrombotic therapy and interested in having a hair restoration procedure.

The procedures we perform as Hair Transplant Surgeons are typically completely elective and as such do not warrant putting the individual in any sort of medical danger. Along these lines, we are often approached by patients who may be taking antithrombotic medications including aspirin, coumadin, and plavix for a variety of medical conditions. In the past, the thinking has been that since we are usually transplanting into the scalp or face, and since the areas are so vascular (which is part of the reason why there is such good growth of follicular grafts and such a low incidence of infection) that it would not be a good idea to transplant someone who is on one of these antithrombotic medications, as it would be difficult to control the bleeding and thus difficult to create sites for the transplanted hair and place the grafts as well. This study by Dr. Yagyu included 25 patients with cardiovascular disease who underwent 46 hair transplant procedures. Risk factors in these patients included coronary artery stents, prosthetic heart valves, and atrial fibrillation. The conclusions based on the results showed that in these patients low dose aspirin “does not cause hemorrhagic tendency and it can be continued before hair transplantation”. The study also determined that low dose coumadin also does not interfere with surgery and can be continued before a hair transplant procedure. My own experience with a patient taking Plavix prior to undergoing an eyebrow transplant procedure, was that in this specific case, there were no complications associated with the patient taking an antithrombotic medication.

It is always imperative to weigh the risks against the rewards associated with any patient undergoing a surgical procedure, but the results of this study are very positive in regards to patients who require antithrombotic therapy and wish to undergo a hair transplant procedure.

All the best,

Marc Dauer, M.D.

/by Los Angeles Hair Transplant Specialist

News On Growing Hair In Mice

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Greetings,

Recently there has been a lot of discussion in regards to an article in CBS news (see below) that discusses researchers growing hair on mice. My thoughts on this are that this is one of the first in a series of studies that hopefully down the line will lead us to the ability to clone our own hair in a laboratory setting. I still believe we are at least 20 years away from being able to do this in a practical and economical way, but this is definitely the future of Hair Transplantation. The ability to clone one’s own hair will negate the need to harvest the hair from the individual either via FUE or FUT and will also give us unlimited supply for any demand. Again I believe we are at least 20 years away from this, but this is definitely the future of Hair Transplantation and I look forward to being a part of this exciting future. Here is a link to the article.

http://www.cbsnews.com/8301-504763_162-57416401-10391704/researchers-successfully-grow-hair-on-bald-mouse-humans-next/

All the best,

Marc Dauer, MD

/1 Comment/by Los Angeles Hair Transplant Specialist

Eyebrow Transplant Results At 7 Month Mark

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Greetings,

Here is a patient of mine who I performed an eyebrow transplant on 7 months ago. She is extremely happy and we will be performing a secondary “touch up” procedure to increase the density slightly and fill in a few spots. These results are typical with my special technique for eyebrow transplantation.

All the best,

Marc Dauer, MD

/1 Comment/by Los Angeles Hair Transplant Specialist

FUE Into Previous Strip Scar From FUT

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Greetings,

In this blog I will demonstrate a patient who came to me after he underwent the strip harvest procedure from another physician and his donor scar was wider than he expected and he could no longer wear his hair at the short length he wanted. In some cases these wide scars can be revised by excising them and closing them again under less tension than they were previously closed. In this case, the physician who performed the original procedure had already attempted to revise the donor scar and was unsuccessful in reducing it’s size. I recommended to the patient that I perform Follicular Unit Extraction (FUE) by harvesting follicles ones by one  with a special tool and then placing these harvested follicles into the strip scar to cover it with hair. Here are the results after 9 months. It made a significant difference to the donor scar and the patient is very happy as he can now wear his hair shorter and not be conscious of his wide donor scar. I have treated a large number of patients like this and it remains a good option for those with wide donor scars who wish to wear their hair shorter.

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All the best,

Marc Dauer, MD

/by Los Angeles Hair Transplant Specialist

Transplanting hair via FUE into mustache scar

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Greetings,

Today I will discuss a very interesting case I just performed. This patient presented with a skin graft in his mustache region from a previous accident that required extensive Plastic Surgery. He was left with a large scar  and no ability to cover the scar as it would only grow a scant amount of hair. The patient prefers to wear a goatee but it is very unnatural with only one side growing hair. In this case I performed follicular unit extraction otherwise know as FUE by harvesting the hairs from his beard on the neck individually with a .8mm punch. I harvested the neck hairs as these will most closely resemble the beard hairs we are meant to recreate. After I harvested all the beard hairs via FUE we placed the grafts individually to recreate a mustache.The angles and orientation of the grafts placed in the mustache were made to mimic the angles of the hairs on the unaffected part of the mustache. Typically there is a slightly lower growth rate of grafts transplanted into scar tissue, but these patients usually have excellent cosmetic results. Below you can see the pre operative photo and the post operative photo and the immediate difference that is seen with the transplanted grafts present over the scar.

All the best,

Marc Dauer, M.D.

/1 Comment/by Los Angeles Hair Transplant Specialist

Lowering The Hairline In A Female Patient

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Greetings,

Today I would like to discuss lowering the hairline in a female patient. This is a procedure that has become more common recently with advances in Hair Restoration techniques and the ability to create density that was previously unattainable. In these cases patients report having a high hairline that has been present for their entire lives. In some cases there is thinning behind the hairline, but more often than not, the high hairline is the only issue. With the ability to transplant single hairs into recipient sites that measure .6mm-.8mm we can create cosmetic density in the hairline that rivals a completely normal hairline. Care is also taken to angle the hairs in the exact angle and orientation of the pre existing hairs so that one should not be able to identify any difference between pre existing native hair and the new transplanted hairs. In the case I am highlighting today, this patient has some thinning in her frontal scalp, which I addressed by transplanting hairs into the thinned out region. However her primary concern was her high hairline that had been present for her entire life. I lowered her hairline by just over a centimeter and kept the same design as her original hairline with the peak in the middle. Notice this patient had a very specific angle to her hair growth in the hairline which I maintained with the new transplanted hair grafts. Below you can see the pre operative photo and the immediate post operative photo that show the grafts placed in the new hairline. I hope this discussion provides some insight into this concept.

All the best,

Marc Dauer, M.D.

/1 Comment/by Los Angeles Hair Transplant Specialist

Rogaine and Propecia For Hair Loss

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Greetings,

Today I will discuss the usage of Rogaine and Propecia for hair loss. Rogaine is an over the counter medication that comes in a liquid form and a foam form and comes in 2% and 5% strengths. For male patients I typically recommend Rogaine foam 5% twice a day after showering and before bed. Rogaine typically works only in the crown region and is best at slowing down the rate of hair loss and in some cases taking the miniaturized hair (hair that is on it’s way out for good) and turning it back into healthy hair. The exact mechanism of Rogaine is unknown, but it is thought to promote increased blood flow to the scalp by relaxing the small blood vessels that supply the blood flow to the scalp. Rogaine 5% is approved for men, and only the 2% formulation is approved for use in women. The 5% formulation may have better efficacy in women, but it can cause hair growth on the face that is reversible when discontinued.

Propecia is an oral medication that is taken once a day. It works by blocking the conversion of testosterone into DHT which can cause hair loss. The effect of taking the medication is that it can regrow hair in some instances and can also convert miniaturized hair that is on the verge of falling out forever into healthy hair, that is cosmetically significant. Propecia is not indicated for use in women.

There have been many claims about Propecia recently, and various side effects it may cause. I typically have all my patients that are considering Propecia read a detailed explanation of all the benefits and possible side effects prior to beginning to take the propecia. I have seen excellent results with patients using propecia, and in my experience younger patients tend to respond the best to this medication.

There is also anecdotal evidence that propecia and rogaine together produce a more significant effect than either medication independent of the other. The exact cause is unknown, but there seems to be some sort of synergy between the two medications.

/399 Comments/by Los Angeles Hair Transplant Specialist