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

FUE (Follicular Unit Extraction) To Cover Donor Strip Scars In Hair Transplantation

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Greetings all,

Today I would like to discuss the issue of donor strip scars and how to approach them when they are too wide, or noticeable, or the patient just wishes to cut their hair very short. In the world of Hair Restoration today there are many physicians trying to push the envelope of grafts in a single session. Physicians trying to perform 4000, 5000, or even 6000 grafts in a single session. Using the strip method, the only way to achieve these numbers is by taking a donor strip that is very wide. This puts undue tension on the skin closure and can then result in very wide donor scars. Sometimes though, even under the best of circumstances and a proper closure, a wider than expected donor scar can also occur. I have been seeing more and more of these patients from other physicians recently.

After much experience I am finding that when you attempt to excise these scars, often times they will just come back again. The best approach to this situation is to harvest grafts via FUE ( Follicular Unit Extraction) and then transplant the grafts into the scarred areas that are devoid of hair or have very little hair in them. Typically the grafts grow nicely through the scar tissue and provide hair coverage of the scar which acts to conceal the scar thus making it more feasible to cut the hair short.

I have included photos below of a patient who had multiple strip scars from a procedure performed by another physician. The ‘before’ photos show the donor area shaved and the donor scars. The ‘after’ photo shows the FUE punctate sites (these heal in about a week) and the hair immediately transplanted into the donor scars. A difference in the donor scars with hair transplanted into them is immediately visible and when the hair grows in this should provide nice coverage to the donor scars and allow the patient to cut their hair much shorter than was possible before.

/1 Comment/by Los Angeles Hair Transplant Specialist

How To Avoid Post Operative Swelling In Hair Transplant Procedures

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Greetings,

In years past patients who underwent hair transplant procedures experienced a significant amount of facial swelling in the forehead and around the eyes post procedure. Typically the swelling occurred at around 3 days post operatively after the hair transplant and usually resolved by around 6 days post operatively. Oral steroids have been used in the past to combat this swelling and definitely helped to reduce the swelling in many instances, but taking oral steroids, even in small doses, can subject the patient to other possible complications. This led the hair transplant community to look for other options. In the context of any hair transplant procedure I use what is called “tumescence” to allow for easier graft placement. Tumescence is where saline fluid is injected into the scalp in the regions where the new hair is to be transplanted. This accomplishes a few different things. Firstly, it compresses the vasculature down below which then allows us to cause less vascular injury when placing the grafts. Also, it stretches the scalp which also causes less bleeding, thus allowing for better visualization. Finally the stretching of the scalp also “widens the playing field” of the area to receive the hair transplants, thus allowing us to place the grafts closer together. When the scalp shrinks back to it usual size this helps to create optimal density. What I now routinely do is mix in a small amount of injectable steroid solution, diluted in the saline that is to be used for tumescence. In addition, I no longer give any oral steroids. Since there is no downside to diluting such a small amount of steroid into the tumescence fluid, this make it much safer for the patient then taking oral steroids and the results have shown that greater than 90% of my patients experience no post operative swelling after a hair transplant procedure. In the rare case that swelling does occur, it is then possible to treat with oral strides if so desired. This truly has been a major advance in the field and one that greatly benefits the patients and decreases possible complications.

All the best,

Marc Dauer, M.D.

/by Los Angeles Hair Transplant Specialist

Facial Hair Transplants

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Greetings,

Today I would like to discuss Facial Hair Transplants. Many people of varying ethnicities have varying amounts of facial hair due to hereditary factors or even due to facial scarring secondary to trauma or surgical intervention. Facial hair transplants are also beneficial in female to male transgender patients to allow the individual to grow more of a full beard. It is possible to take hair from the head and transplant it to areas of the face where the patient may desire more hair. It is possible to harvest the donor hair for facial hair transplantation by either the strip harvesting method or follicular unit extraction. The hairs placed on the face are almost entirely single hair follicles and they are placed in receptor sites that are created with a custom size blade that measures between .5mm-.7mm depending on the caliber of the individuals hair. It is imperative that the receptor site angles are created almost parallel to the skin to make the new hair grow in as naturally as possible. Is it also very important to follow the changing directions of facial hair as you move along to different areas of the face. The growth timeline is very similar to other areas where we perform hair transplantation in that most of the transplanted hairs initially stay for about 2-4 weeks and then fall out. The new hairs then begin to grow in at 3-4 months and about 50% growth is seen at 6 months and full growth is seen at around 12 months. Below I have shown an example of a patient with almost no hair in the goatee region. The first photo shows the patient before the procedure with the transplanted areas marked out. The second photo is immediately after the procedure and the third photo is 10 days after the procedure with many of the transplanted hairs still present and appear to be growing. Most of these grafts will fall out in the next few weeks and they will begin to grow back at 3-4 months post operatively. I hope to post a follow up photo at 9-12 months.

All the best,

Marc Dauer, MD

This is a pre op photo of a beard transplant.

This Photo is 2 weeks post operatively after a beard transplant.

Immediately Post Op Beard Transplant

/by Los Angeles Hair Transplant Specialist

How Many Hair Transplant Procedures Will I Need?

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Greetings all,

Some of the most common questions I get from prospective patients are “can I only do one procedure?” and “how many procedures will I need?” These are excellent questions which I would like to address. To begin with, androgenic hair loss, otherwise known as male patterned hair loss, is a progressive condition and one which continues throughout your life. Is it true that as you age, the amount and degree of loss can slow down and even stabilize, but every patient must understand clearly that they will continue losing hair throughout their lives. Younger patients with more severe loss may lose their hair more quickly than older patients with mild to moderate loss but it can still vary from individual to individual. Usually in the course of a consultation I will discuss with the patient other family members (father, grandfathers, uncles, etc.) who experienced similar loss at their age and ask them how that person’s loss progressed. Sometimes that can offer some insight into how quickly and severely the individual’s hair loss will progress. There are other factors on examination, like miniaturization of existing follicles, that can provide some insight into how the individual’s hair loss will progress. Miniaturization is the process where a healthy hair follicle becomes a small, fine, almost “baby- hair”. This is typically the last step before the hair follicle falls out forever, and extensive miniaturization can be a precursor to extensive baldness. Medical treatments for androgenic alopecia include Rogaine and Propecia (Finasteride). Both of these medications can help not only to possibly regrow some hair, but to turn miniaturized follicles into healthy follicles again and to slow the progression of hair loss. Also, the studies have clearly shown that patients who use both Rogaine and Propecia together have a better result than patients who use either independently. Researchers are not sure why, but apparently there is some synergistic action between the 2 medications. Propecia is a pill which is taken once a day in a 1mg formulation and Rogaine comes as a foam or liquid is concentrations of 2% and 5%. I typically recommend the 5% foam formulation as it is easier to place on the scalp and is less greasy. Also, Rogaine has only shown results in helping hair loss in the crown region. Usually younger patients who are in line to experience much more hair loss are going to get the most benefit from using these medications. Another factor in determining the number of procedures is the severity of hair loss. Patients who have severe degrees of hair loss (Norwood 6 or 7) are usually confronted with a choice. Since I do not believe in transplanting many more than 3000  follicles in a single session (I will address my reasons for this in another blog), a severely bald patient will have the choice to either cover their entire head with a lower density of hair follicles, which may result in them wanting a secondary procedure for increased density throughout. Or to cover the entire hairline and mid scalp with higher density and leave the crown alone and then possibly cover the crown in a secondary procedure. Either way, in a severely bald individual, this is going to be a decision the patient will have to make. Finally, what I tell patients is that everyone who has the procedure, sees the difference, loves the difference, and wants more. The typical patient will undergo 2-4 procedures in a lifetime. I usually won’t consider performing a second procedure until around 8-9 months after the initial procedure. This allows me to see the new hair growth and also allows the donor area to relax, thus making it safer to harvest a strip from again. Every patient is different and must be individually evaluated in order to formulate a comprehensive plan tailored to them.

All the best,

Marc Dauer, MD

/by Los Angeles Hair Transplant Specialist

Donor Scars in “Strip Harvesting”- How to Prevent and Treat

Greetings,

Today I would like to discuss donor scars in the “strip harvesting” technique in hair restoration surgery and how to approach them. The trend in many clinics is towards larger procedures which many patients request. Most people would like to get as much done as possible in one sitting, and for the clinic this can mean larger fees. However, this is not always in the best interest of the patient for many reasons. Firstly, there is a diminishing return in graft growth as the grafts are kept outside of the body for long periods of time. In “mega-sessions” of 3000+ follicles, this tends to become an issue. In addition, the only way to harvest 3000+ follicles in most people, is take a width of donor strip that exceeds 1.7 cm and in many cases even 2.0 cm. The studies have clearly shown that with donor strips this wide, even if all the other necessary precautions are taken in wound closure, there is a much higher incidence of scar widening, hair shock, and various other problems that can be encountered in the donor region. It is for this very reason that the largest case size I will perform is about 3000 follicles in a single session, and this is usually only on a first time patient with excellent donor density. More often, my large procedures are in the 2500-2800 graft range. I limit the width of my donor strip to 1.5 cm maximum, and try to keep it between 1.0-1.3cm whenever possible. The studies have shown that when the donor strip is kept below 1.2cm there is a very low risk of scar widening or any other complications. In patients with low scalp laxity, or even hyper-elastic scalp, it is sometimes necessary to place deep retention dissolvable sutures to decrease the tension on the skin edges. This can also decrease the incidence of scar widening. Typically on repeated procedures, the scalp tends to lose elasticity, which should make the physician think twice about how wide a donor strip to take in these cases. The typical donor scar should be between 1mm-3mm when everything goes as planned. Sometimes even though all the rules are followed the patient can still end up with a donor scar that is wider than we would like. In these cases the first step is usually to resect and revise the donor scar by just taking out the old scar and trying to limit the width to 10mm or less. If that is not possible, or the patient requests another option, a great way to treat this is by harvesting follicles by FUE (Follicular Unit Extraction), which involves using a special tool to harvest one follicle at a time, and then placing the grafts into the scar. Transplanted hair follicles grow very well through most scars and this treatment can be effective in minimizing the appearance of a wide donor scar. I hope this brief overview clearly explains how I approach “strip harvesting” in Hair Restoration Surgery.

All the best,

Marc Dauer, MD

/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

Hair Transplant Teaching Course In Dubai

Greetings all,

I returned a few weeks ago from another course in Hair Transplantation I was teaching in Dubai. The physicians attending this course were very knowledgeable and it was a real pleasure to teach this group. The course was held in Sharjah, which is the state next to Dubai and the facility where we conducted the course was an excellent venue. As I’ve stated in previous posts, it is always enjoyable for me to teach my techniques to other physicians. It makes me constantly review the current standards, as well as always looking for new and improved ways to better the overall experience for the patient. It also gives me a chance to gain some understanding of how the field of Hair Transplantation is perceived in other parts of the world. I will attach a photo of the group from this course. I am planning to go back to Dubai in June to teach another course. In the meantime, I will try my best to update my blog more often and I also hope to start including some videos as well. If anyone ever has a question they want me to answer in my blog, please feel free to email me and I will do my best to address it.

All the best,

Marc Dauer, MD

/by Los Angeles Hair Transplant Specialist