Hello all, I have just returned from the International Society Of Hair Transplant Surgeons annual meeting in Boston Mass. As usual it was an amazing experience. It is always so great to gather with your peers and discuss all the different approaches to the conditions we treat. It inspires a constant re-evaulation of procedures and protocols that should always be evolving as technology and studies show new and improved ways of practicing our craft. It also serves as an excellent review of the fundamentals of the field of Hair Restoration, that though we may know and practice them regularly, they are always good to revisit. I also had the opportunity to catch up with many old friends, and students from my previous teaching lectures. I got to meet many great new people as well that I know I will keep in touch with for years to come. I feel so lucky to be able to work in a field that provides so much satisfaction to the people it touches, and yet provides so much satisfaction to me as their physician as well. Here is a photo from the entrance to the World Trade Center at the Seaport in Boston where the conference took place.
All the best,
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, I have recently returned from leading a teaching conference on Hair Restoration in Dubai on behalf of the American Academy of Aesthetic Medicine. This conference was very well attended with 25 attendees in all. This was my second time in Dubai so I did not have to do all the required sightseeing again. There are many wonders to see in Dubai. The attendees came from the U.K., South Africa, India, U.A.E., Syria, Iran, and the U.S. I met many very interesting individuals, some of whom I am sure I will stay in contact with for years to come. It is always enjoyable to teach my techniques and approach to Hair Restoration to others. It also helps me to review and stay up to date on the latest innovations in the field. I will post a few photos from the conference.
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, I returned a few weeks ago from a teaching conference in Bangkok, Thailand that was sponsored by the American Academy of Aesthetic Medicine where I was teaching physicians from all over the Far East, Australia, and the UK, the newest techniques in Hair and Eyebrow Transplantation. This was an incredibly gratifying experience for me, to be able to impart my knowledge of hair and eyebrow transplantation to other physicians. The hospital where the course took place was at Bangkok International 9 Hospital and it more like a Five Star Hotel than a typical US hospital. The nursing staff and physicians were incredibly helpful and knowledgeable and it was an absolute pleasure to work with them. The nurses there all wear the classic nurse uniform that nurses used to wear here in the 50’s (I think we should go back to that era in a fashion sense). Their equipment was all state of the art. They do a large amount of Cosmetic Surgery there so they were very well versed in many of the latest techniques. I have enclosed some pictures I took of the staff and participants in the lecture. I may be doing another in Kuala Lampour Malaysia in October so I will keep you posted or you can also check the website at http://www.aaamed.org.
All the best,
Marc Dauer, M.D.
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.