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Does A Second Hair Transplant Leave A Second Donor Strip Scar?

Greetings,
Today I will discuss how I harvest my donor strip in patients undergoing their second hair transplant procedure. In almost all cases I include the old donor scar in my new strip in successive procedures so as not to leave the patient with multiple train tracks scars in their donor region. The only exception is the patient who has a wide donor scar and when trying to resect it will not give us enough donor hair for the procedure. This is one more reason why it is imperative that the donor area is treated properly on the initial procedure so that the patient has a small donor scar (between 1-3mm), and it can be excised on successive procedures while harvesting donor hair at the same time. I perform many special nuances in order to minimize the donor scar which include; trichophytic closure, using a thin suture to close as opposed to staples, not using cautery, and not taking too wide a donor strip which can lead to wide scars.
I hope this discussion clarifies the harvest of a donor strip in a successive procedure.
All the best,
Marc Dauer, MD
/by Los Angeles Hair Transplant Specialist

FUT- Strip harvest hair transplant versus FUE- follicular unit extraction hair transplant

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Greetings,

Sometimes when I meet a patient for the first time in consultation, they come to me with their mind made up as to which harvest procedure for the hair transplant they wish to undergo. Other times they come to me with no idea as to which harvest method for the hair transplant that they prefer. The Internet has been an amazing tool to educate patients regarding all aspects of hair transplant procedures, however there is a huge amount of misinformation in the Internet as well. Often it is difficult for the average consumer to differentiate between the truth and the fiction. To further complicate things, some Hair Transplant surgeons have their own agendas as well. These physicians may only be proficient in either FUT or FUE, and may then try to steer patients towards the procedure that they are more comfortable with. In other instances, the physician may have purchased an expensive piece of equipment that he needs to pay for, and then will steer patients towards the procedure which helps to pay off the equipment.

When I meet with patients the first thing I do is pay close attention to the hairstyle they wear when they come into my office. How short their hair is, how it is combed, product in the hair, hair color, etc. These are all clues that help me to understand the patient as an individual. In addition, between the family history of hair loss and the patients physical exam, I do my best to estimate how severe the patient’s hair loss will progress over time. I explain in depth the pros and cons of FUT hair transplant versus FUE hair transplant and tell the patient that I have no vested interest in which procedure the patient decides to have. I truly enjoy performing both FUT and FUE. My only interest is that the patient undergoes the procedure that suits them best. Not just in the short term but in the long term as well. That is part of my duty to my patients. I encourage my patients to take their time in deciding which procedure suits them best, so that they make the right decision. Not a quick decision that could prove to be wrong in the long term.

All the best,

Marc Dauer, MD

/by Los Angeles Hair Transplant Specialist

Hair Transplant Or Hair Transfer?

Greetings,

Today I wold like to discuss the term Hair Transplant Or Hair Transfer. This term has become synonymous with the process of moving hair follicles from the donor zone on the scalp to areas of thinning or balding. The term Hair Transplant has always bothered me, as the term transplant is typically used to describe the donation of an organ from one individual to another. The hair taken from one individual will not grow if placed on another person unless both individuals are identical twins. Therefore, in actuality the term hair transplant is a misnomer as we are never taking hair from one person to transplant onto another. What we are actually performing is a hair transfer. We move hair follicles from the permanent donor zone on the back and sides (this is the hair that is immune to the process of genetic balding) to the areas of thinning. I would like to encourage others to begin to use the term hair transfer when discussing the process we perform as I believe it will help more people to understand what is involved in the process we routinely call hair transplant procedures.

All the best,

Marc Dauer, MD

/1 Comment/by Los Angeles Hair Transplant Specialist

Hair Transplant Microscopic Dissection. All Microscopes Are Not Created Equal

Greetings,

Today I will discuss microscopic dissection in Hair Transplant procedures. Since the advent of Follicular Unit Hair Transplantation there are many different ways that physicians employ their staff to dissect the donor strip into individual follicular units in the process of hair transplant procedures, that is the groupings of hair that naturally occur on the scalp that we seek to move to the areas of thinning. There are many different types of microscopes that people use to dissect grafts and many different levels of magnification. Some physicians only have their staff use magnifying glasses on light boxes. I personally have my staff dissecting our grafts using brand new state of the art microscopes with 10x magnification and LED lighting. These microscopes are much more expensive than the typical microscopes but I believe they perform a superior job in dissecting the grafts. The 10x magnification is necessary to visualize the follicle in it’s entirety and allow for optimal dissection and the LED lighting provides excellent visualization while generating almost no heat (which typical lighting generates and can cause the grafts to dry out thus diminishing their chances of survival). Lessor magnification can result in the loss of intact follicles that cannot be visualized under lower magnification. This is turn can lead a lower survival of grafts in the hair transplant procedure.

In summary, state of the art high powered LED lit microscopes are more expensive, but superior in creating healthy follicular units for use in hair transplant procedures.

All the best,

Marc Dauer, MD

/by Los Angeles Hair Transplant Specialist

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

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

Causes Of Hair Loss in Women

Greetings,

On the heels of my appearance on “The Doctors” TV show discussing Hair Transplants for female patients, I have decided to write about different causes of hair loss in women. Common causes of hair loss in women can be traction alopecia, which results from constant pulling on the hair as in braiding or tight pony tails. Alopecia Areata, which is an autoimmune disease which results in smooth round patches of hair loss. Medications such as blood thinners, seizure medication, anti inflammatory medications, Beta blockers, prednisone, mood altering drugs, chemotherapy, oral contraceptives, thyroid medications, and illicit drugs such as cocaine, can all be causes of hair loss. Anemia, which is a low blood count can also cause hair loss. Other causes include thyroid disease, connective tissue diseases such as lupus, crash diets, stress, and post general anesthesia. Major events where big hormonal changes occur, such as childbirth and menopause, can also cause hair loss in females. Scars caused by trauma or other surgical procedures can also cause hair loss in those areas. Probably the most common cause of female hair loss is a genetic form of hair loss that is an inherited trait that can come from either the mother or father’s side of the family. This typically manifests as diffuse thinning in the scalp. Often the hairline can be preserved in these cases. Some of these causes of hair loss may be treated with medications or a hair transplant procedure but it is important to have a thorough medical work up and examination to determine the exact cause, and then we can determine the treatment.

All the best,

Marc Dauer, MD

/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