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FUE (Follicular Unit Extraction) Harvest to Transplant Into Eyebrow Scar

Greetings,

Today I will demonstrate a case I recently performed utilizing FUE (Follicular Unit Extraction) to harvest the individual follicles and subsequently transplanted the follicles into and eyebrow scar. Traditionally I would not usually perform FUE in an eyebrow transplant case as it only requires a small incision in order to harvest the number of follicles necessary in order to restore typical eyebrows to normal appearing density. In patients who insist on shaving their hair extremely short (#2 buzz cut or shorter) FUE is a better option in order to make sure that the scar does not show through. In a small FUE case I do not have to shave the entire donor area, and can shave a small strip of hair to harvest the donor follicles and then the patient can cover the donor region by combing the hair above over the shaved area. As you can see from these results the transplanted follicles into the scar grey very nicely and the patient was very happy with the final outcome. I have also used FUE to harvest follicles from the neck in order to transplant into mustache scars (in patients with cleft palate deformities and others) and other beard scars with excellent results. Below I have shown the before and after photos of this patient with the eyebrow scar.

All the best,

Marc Dauer, M.D.

/1 Comment/by Los Angeles Hair Transplant Specialist

Non-Physicians Performing Hair Transplant Procedures

Greetings,

With the advent of the NeoGraft machine and it’s accompanying marketing that includes ideas for the prospective “NeoGrafter” that an attending physician is only necessary in order to “lend” his license to the practice so that they be allowed to perform hair transplant procedures, it has opened up a new chapter in the discussion of what is acceptable to delegate in Hair Transplantation. Physicians performing Hair Transplants have delegated certain tasks for years including dissection of the grafts and placement of the grafts. In some practice they even practice the “stick and place” method where the nurse create the incision site and places the hair graft in the incision. In my practice I create each and every insertion site for the placement of the hair grafts. My thought is that the exact design is based on the creation of the receptor sites. The hairline design, as well as the angle and orientation of the hair growth are all affected by the creation of the receptor site. I believe that the surgeon should have the complete control of this step as it is the surgeon who will take full responsibility for the outcome of the procedure. For patients exploring the idea of having a Hair Transplant procedure it is important that they ask important questions such as, “what are the steps in the procedure that the physician will be performing, if any, and what are the steps that the physicians assistants will be performing?” Knowing as much information about the physician and the medical group that is performing your procedure will assist in making an informed decision, and hopefully one that will lead to positive results.

All the best,

Marc Dauer, M.D.

/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

International Society Of Hair Restoration Surgery Annual Meeting In Anchorage

Greetings,

I just returned from the International Society Of Hair Restoration Surgery annual meeting in Anchorage Alaska. It was an amazing meeting as usual, but this year there were many less attendees which made it even more intimate than ever before. I had the opportunity to meet and re-connect with many of my friends and colleagues and discuss the latest advancements in the field and compare and contrast what others are doing and what seems to be improving the process and results. I definitely took home many new ideas that I plan to implement into my practice ranging from a new low level laser light device I will be offering, to a new storage medium for my hair grafts.

Other things I plan to look into for the future will be Platelet Rich Plasma therapy. I also purchased the new Hair Check system which measures hair mass and I plan on using this on new patients to measure their hair mass prior to initiating treatment and also after treatment has been implemented. This is an amazing new tool which measures hair mass which is an excellent indicator of the amount of hair in any given region on the scalp. I will attach a few photos from the meeting and my day trip excursion to the glaciers.

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

The International Society Of Hair Transplant Surgeons Annual Meeting

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.

/by Los Angeles Hair Transplant Specialist

New Advancements In Hair Restoration

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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.

/1 Comment/by Los Angeles Hair Transplant Specialist

My first post

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Hello all, this is my first time posting a blog so I hope you’ll excuse my newbie status. I have been practicing Hair and Eyebrow Restoration for almost 5 years now and I must say it is one of the most gratifying fields to be involved in. I began my medical career in Head and Neck Surgery and subsequently transitioned into Emergency Room Medicine before finding my real calling in Hair and Eyebrow Transplantation. At the core of who I am, I am an artist. Whether I am drawing, playing guitar or piano, writing a song, or a short story, it is the expression of art that I truly enjoy. Hair and Eyebrow Transplantation affords me the opportunity to express myself artistically. Every patient is different and presents a new set of challenges. There is the constant management of expectations between what the patient wants, what’s best for the patient in the long run, and what is realistic for the patient. In the field of Hair and Eyebrow Restoration, managing all these together, while still maintaining the ultimate cosmetic result is a challenge, but one that I relish. I receive immense gratification in following up with my patients after their new hair has grown in. Seeing how the results can change peoples lives and better their self esteem is truly a gift.

I feel incredibly lucky to be in the field of Hair and Eyebrow Transplantation and I look forward to many posts in the upcoming days and years to discuss various cases and issues that I am presented with on a daily basis.

All the best, Marc Dauer, M.D.

/by Los Angeles Hair Transplant Specialist