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Greetings,
Here is a new testimonial of a patient of mine, filmed 2 weeks after his second hair transplant procedure. The patient describes his experience from his first to second procedure and how his hair transplant procedure has changed his life. Enjoy watching.
All the best,
Marc Dauer, M.D.
Greetings,
In a few weeks I will be traveling to attend the (International Society Of Hair Restoration Surgery) ISHRS annual meeting in San Francisco. I always look forward to these meetings to see my old friends and hear from my respected colleagues on the latest and greatest in the field of Hair Restoration Surgery. In addition, I usually present lectures and conduct teaching workshops at these meetings and this year I will be conducting a Board Review course and teaching the FUE (Follicular Unit Extraction) course. I plan on blogging from San Francisco and writing about the new advances I find interesting. I look forward to reporting my findings in a few weeks.
All the best,
Marc Dauer, MD
Greetings,
Today I will discuss a bad hair transplant procedure result that I recently saw in consultation. The patient was on vacation in Pakistan and responded to an advertisement for an inexpensive hair transplant procedure. The patient subsequently was told that he would receive 2000 grafts (which would equate to about 5000 hairs with typical density) for $500. The patient underwent the procedure and stated that he experienced significant pain during and after the hair transplant procedure. I took the photo below approximately 18 months after his hair transplant procedure in Pakistan. What you see in the photo is very sparse growth of grafts. A patient with no hair in the frontal scalp receiving 2000 grafts should have exponentially more hair growth then you see in the photo. You also see an aggressive hairline design, which means that they placed the hairline lower than it should have been placed in a patient with severe hair loss undergoing a first hair transplant procedure. I always tell my patients undergoing their initial procedure that I would prefer to be more conservative with the hairline and create greater density than getting aggressive with the hairline thus having to spread the same number of grafts over a larger area subsequently getting a lower density result. You can always lower the hairline in successive procedures, but once the hairline is placed too low, you have a problem. There are also 2 hair grafts present in the hairline. This should never be. Only single hair grafts should be placed in the hairline to create a completely natural result. Finally, if you look closely it appears that many of the grafts are emerging from a small crater around them. As if they are not flush with the skin, but coming out of a little hole. This is called “pitting” and occurs when the grafts are placed to deep. This also should not occur in a well done hair transplant procedure.
Unfortunately there are many more unqualified physicians performing hair transplants, or delegating the essential functions of the hair transplant procedure to unqualified personnel, then there are qualified Hair Transplant surgeons performing great work. The consumer needs to beware of these unscrupulous practitioners, both in the US and abroad in order to avoid a result like you see here. This patient can have repair work to fix this, but if it had been performed correctly initially, the corrective work would not be necessary. Unfortunately in this case the damage is already done, but hopefully others can learn from this and not make the same mistake.
All the best,
Marc Dauer, MD
Greetings,
I decided to commission an animated video which would convey all the basic Hair Transplant Information that anyone interested in Hair Restoration and Hair Transplants should know. It was an enjoyable project for me to create the text copy for the video and I believe it answers many of the basic questions that people interested in Hair Transplants may have. I hope you enjoy this video titled “Hair Restoration and Me”.
All the best,
Marc Dauer, M.D.
Greetings,
Today I will discuss the effect of the old hair Transplant “plug” method on the donor region. The old hair transplant plugs have been gone for a number of years, but I still see a number of individuals who had this procedure performed years ago and need corrective work to repair their results. The purpose of this blog entry is to discuss the effect of this procedure on the donor region. The old hair transplant plugs involved taking a punch graft from the donor region and punching the same graft into the area of balding on the scalp. These plugs were harvested using punches ranging in size from 2.0mm-5.0mm. The plugs consisted of between 4-20 hairs per plug. This was in essence the same technique we use today for FUE, however with FUE today most physicians use punches ranging from .8mm-1.1mm. These much smaller size FUE punches allow us to harvest the natural follicular unit, which ranges from 1-5 hairs per follicle. As you can see from the photo, the old plugs cause a tremendous amount of scarring in the donor region and deplete the amount of donor hair that is available for future procedures. In these cases the best course of action to harvest additional donor supply is to find the least harvested region in the permanent donor zone, and perform a strip harvest procedure. In this way, we can remove some of the plug scarring and yet still obtain good donor hair. Below I have included donor photos of the patient who had large plugs and another photo of a patient 7 days after 1600 grafts were harvested via FUE utilizing a .9mm punch tool. The difference is dramatic.
All the best,
Marc Dauer, MD
Donor Site Of Old Technology Punch Plug Extraction
7 Days After 1600 Grafts Harvested via FUE
Greetings,
Today I will discuss hairline design in hair transplant procedures. The hairline is one of the most important aspects of the hair transplant procedure as is it the most visible aspect to both everyone looking at the individual from the front, and the individual looking at themselves in the mirror. An unnatural hairline is a giveaway for a bad hair transplant procedure. The goal in a proper hair transplant hairline design is to create a new hairline that looks completely natural and undetectable to the human eye. It cannot look like a good hair transplant. It must look as if nothing has been done and the hair has been there forever. This is the artistic component of the hair transplant procedure. The most important factor in achieving the objective of a natural hairline, is the placement of only single hair grafts in the hairline. Additionally, the hairline must be created in an irregular pattern in order to not to draw any attention to straight lines which do not appear in natural hairlines. Also, the hairline must be created in the proper location (not too low, which can look unnatural as well) and taking into account future hair loss so that enough donor hair is present for future procedures. I always prefer to create a more mature hairline with greater density than a lower hairline that has lower density.
Hairline design is probably the most important aspect of creating a completely natural looking hair transplant. It is a very artistic process and one in which every physician will envision differently. It is of the utmost importance that you choose a physician who is skilled in the art of creating natural hairlines and that you have seen the results to confirm the point.
I will show a few examples of my hairline creations below in order to illustrate the point.
All the best,
Marc Dauer, MD
Greetings,
Today I will discuss donor density and how it affects the hair transplant procedure. Donor density is the amount of follicles per cm squared in the donor region. A secondary factor relating to density is the hair count, which is the number of hairs in the donor region. This is determined by finding the average follicular density per cm squared and then the average number of hairs per follicle and multiplying the two numbers. The average scalp has between 60-100 follicular units per cm squared and the average hair count is between 2.3-2.7 hairs per follicle. If the majority of the follicles are 2 hair follicles as opposed to 3 hair follicles then the overall hair count will be less. This is why not only the number of follicles is important, but the average number of hairs per follicle as well. The higher the hair count and follicle count, the greater the donor density. The greater the donor density the more hair that can be moved from the donor region to the areas of thinning. The donor region is an unchangeable area whether we do FUE or FUT to harvest the donor hair in the hair transplant procedure. This is why a high donor density and high donor hair count will lead to the ability to move more donor follicles to the areas of thinning.
I hope this helps to clarify donor density and how it impacts a hair transplant procedure.
All the best,
Marc Dauer, MD
Greetings,
Today I will discuss the custom cut recipient blade sizes in hair transplant procedures that I use to create the recipient sites for my hair transplant grafts. I have a machine which allows me to cut custom sized blades. Typically my blades range in size from .5mm-1.1mm and I have blade sizes in every size in between in .05mm increments. This allows me to use the smallest possible blade for the patients natural follicular units. The hair type and caliber are defining characteristics that determine which size blade to use. Typically I try to find the smallest possible blade which still allows for easy placement. An extra .1mm opening may not seem like much, but when multiplied by 1500-3000, which is the number of recipient sites I create in a typical hair transplant procedure, an extra .1mm can add up to significantly more injury to the scalp and circulation, which in most cases is not necessary. I also custom cut my blades with a 45 degree angle at the end and I angle the deepest portion of the blade so that it is at the superior aspect of the incision. This means that the blade also causes less injury to the scalp circulation and positions the graft at a more acute angle which gives a better final result. Minimizing damage to the scalp and the vascular bed minimizes scar tissue in the scalp and thus minimizes the potential of “shock loss” (which I will address in another blog entry).
I hope this blog entry clarifies why the blade size is very important in Hair Transplant Procedures.
All the best,
Marc Dauer, MD
Hair Transplant Procedures In Patients With Old Plugs
Greetings,
It is not unusual for me to see patients presenting for consultation who have plugs from the old way of performing hair transplant surgery. The plugs were groupings of 5-15 hairs that were punched out of the back of the scalp, and subsequently punched into the areas of thinning. They were very unnatural and looked like “dolls hair” because hair does not naturally grow in clusters of 5-15 hairs. Natural hair follicles are typically 1-4 hairs per follicle, with only single hair follicles present in the hairline. These plugs were harvested using a primitive version of the harvesting procedure we now call follicular unit extraction or FUE. The major difference is that the punch tool used to harvest the plugs measured between 2mm-5mm in diameter, while the new tools I use to harvest my FUE follicles measure between .8mm-1mm in diameter. Besides the unnatural look that these plugs left in the recipient zone, they also caused a huge amount of scarring in the donor zone. Often times these patients donor density can be decreased up to 50-75% from their original density. For these patients wearing their hair very short is not an option as their donor density has been so depleted that they must wear their hair longer in order to cover up the thinness. In most cases the best way to treat these patients is to perform a strip harvest procedure and go right through the old plug zone. If there are areas that are unscathed (sometimes the sides are untouched) the patient will have more yield from these regions. Regardless, depending on the amount of scarring and door depletion, we can often harvest between 1500-2000 grafts from these individuals by taking a maximum safe sized donor strip. In some cases, this procedure may be performed more than once. We can then transplant single hair follicles into the hairline, camouflaging the plugs, and transplant follicular units into the pluggy areas throughout, creating a much more natural look. In some cases we can also perform FUE to plugs in the hairline to remove them completely or to reduce the number of hairs in the plug, and then recycle the follicles further back on the scalp.
The technology in hair transplant procedures has come a long way since the days of the old plugs. The good news is that using the latest technology at our disposal we can improve the look of the old hair transplant plug procedures.
All the best,
Marc Dauer, MD