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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

Body Hair FUE for Hair Transplant

Greetings,

Here is a video I put together showing FUE to extract chest hair for Hair Transplantation into the scalp. I hope it is informative and helpful video of Body Hair FUE for Hair Transplant.

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