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,
Today I want to discuss a question I am commonly asked which is “when is the right time to have a hair transplant procedure?” The answer is different for every person. Each time I examine a prospective patient I try and estimate the full extent to which the hair loss will progress over the patient’s lifetime. This is imperative in order to understand how much donor hair the person will have available for the amount of balding area that will present over time. The individual needs to understand and internalize the amount of hair loss they will eventually have and try best as possible to see if they can be happy with a realistic result based on their supply to demand ratio. Young patients may not want to know their eventual hair loss amount or may want to proceed with a treatment plan that does not take this into account. This is not an option, as it is our job as hair restoration surgeons to educate the individual and only do what is right for the patient both in the short term and long term.
In general, I like to wait until the patient is at least 25 before performing the hair restoration procedure unless hair loss is taking a severe toll on the patient’s psychological health and I believe that the eventual loss of hair will not preclude the individual from being a good candidate for the procedure. In addition, that the prospective patient has a good grasp on what is a realistic result both in the short term and long term.
I always tell my patients when they ask me, “do I need to do the hair transplant now?”. No one needs to do this at any point. This is an elective procedure that people undergo in order to make them feel better about themselves. To reclaim a piece of the person that they once had. Something that was once part of their body and their appearance, that was taken away from them. When you get to the point that you don’t like looking in the mirror anymore at what you see on your scalp, then that is the right time to have a hair transplant procedure (assuming you are chosen as a good candidate and you have realistic expectations).
The psychological component of hair restoration surgery is one of the largest factors involved and it is our duty as hair restoration surgeons to educate our patients and allow them to make the best educated decision for themselves both in the short term and long run.
All the best,
Marc Dauer, M.D.
Greetings,
Here is a patient of mine who received just under 2600 grafts via FUT to the frontal and mid scalp. The results are shown at 10 months.
The patient describes his experience and how his results have changed his self confidence.
I hope you enjoy watching.
All the best,
Marc Dauer, MD
Greetings,
Here is patient of mine describing his experience and showing his results 9 months after his procedure. His results are already impressive and he is very happy. He should get more density over the next 3-6 months as the transplanted hairs continue to thicken.
I hope you enjoy watching.
All the best,
Marc Dauer, M.D.
Greetings,
Here is a patient of mine 7 months after I completed his hair transplant of approximately 2500 grafts. The harvest was performed via FUT. The patient’s growth is extremely robust for the 7 month mark and he should still see more increased cosmetic density over the next 6-7 months. He is thrilled with the results as they stand and looking forward to more hair growing in.
I hope you enjoy watching.
All the best,
Marc Dauer, M.D.
Greetings,
Here is a follicular unit extraction hair transplant patient of mine who describes the results from his procedure and how it has changed his appearance.
I hope you enjoy watching.
All the best,
Marc Dauer, M.D.
Greetings,
Here is a new hair transplant patient testimonial of a patient of mine. The video was taken immediately after the patient’s procure and also 2 weeks later. The patient describes in his own words what the procedure was like as well as the immediate post procedure time period. I hope you enjoy watching.
All the best,
Marc Dauer, M.D.
Greetings,
Today I will address the question of who is a good candidate for hair restoration surgery. To begin with, it should be determined that the loss of hair is due to genetic causes and that the donor area (the sides and back of the scalp) are not affected by hair loss and have robust density of hair present. The next major factor is determining the patient’s eventual total loss of hair (their genetic hair loss pattern) and eventual total donor reserves. This allows us to approximate how much donor hair will be available over the patient’s lifetime and how much donor hair they will require to cover the eventual area of hair loss. This is most important in younger individuals who are usually destined to lose significantly more hair over time. This also allows the patient to have an idea of what they can expect not only in the short term, but in the long run as well. Some patients would opt not to proceed with hair restoration surgery if they know that they cannot cover their entire head with a thick mane of hair, and others would be more comfortable with this. It is our job as hair restoration surgeons to educate the patients as to their realistic expectations in the short term and long term so that they make the proper decision now and one that they will be happy with later on in life. Too often I meet patients who were “sold” an unrealistic bill of goods by an unscrupulous hair restoration surgeon and they subsequently end up regretting their decision to have had the procedure in the first place because they had no idea that their hair loss would progress to such an extent.
In summary, responsible hair restoration surgeon should educate their patient as to all the possibilities and allow them to make the informed decision as to how to proceed with hair restoration surgery, or not to proceed. This is an amazing procedure when performed properly on the proper patient, and having had 3 hair transplants myself, I am a walking testimonial of this fact along with thousands of my patients. But make sure you have all the facts before making the decision for yourself to ensure that it something that you are happy with in the long run.
All the best,
Marc Dauer, M.D.
Greetings,
Here is a patient of mine who received 2418 grafts to the frontal and mid scalp 8 months ago. The patient discusses his experience in the video and how the hair transplant procedure impacted his appearance.
I hope you enjoy watching.
All the best,
Marc Dauer, M.D.