Posts

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

How Soon After A Hair Transplant Can I Go Back To Work?

Greetings,
A question I am often asked is how soon after a hair transplant procedure can one return to work. Part of the answer to this question lies in exactly what kind of work you do. After the hair transplant procedure you are not supposed to perform heavy lifting (over 25 pounds) for about 10 days. If your job involves heavy lifting or very vigorous work you should take a little time off. If your job is an office job you should be fine to return to work the next day. I have had multiple hair transplant procedures myself and I retuned to work performing hair transplants on others the day after my procedure. If you feel a need to conceal the fact that you have had the procedure from others, there are a few options. You can wear a hat (which we give to all our patients) immediately after the procedure. If you have a large amount of pre existing native hair you can creatively style your hair to cover the areas worked on. Typically the transplanted hairs form tiny scabs that look like little grains of sand. These scabs last for 5-7 days and then they fall off. After that your scalp looks very close to normal. The small transplanted hairs usually fall off within 3-4 weeks after the procedure and then begin to grow back at around 12 weeks. In fair skinned individuals their is some redness in the scalp that may persist for weeks before it resolves.
I hope this clarifies the immediate post procedure phase in hair transplant procedures.
All the best,
Marc Dauer, M.D.
/by Los Angeles Hair Transplant Specialist

Shock Loss In Hair Transplants- An Overview

Greetings,
Today I will discuss shock loss in hair transplant procedures. Shock loss is the loss of native hair that can occur in hair transplant procedures. It varies greatly from one practitioner to another and from one individual to another. The exact etiology of shock loss is not know, but it is thought that it is related to a temporary injury or minimization of vascular perfusion to the scalp. Individuals with a large amount of miniaturized hairs are more susceptible to shock loss. This is because miniaturized hair is hair that has already shrunken and is in its last phase before it is lost forever. The act of the hair transplant may hasten the departure of this unhealthy hair that is destined to fall out in the near future regardless. Women can also more susceptible to shock loss than male patients. Patients with a large degree of transplanted hair are less susceptible to shock loss as it is thought that the transplanted hair is more durable and less susceptible to temporary vascular insufficiency.
In my hair transplant procedures I take certain precautions to minimize shock loss. By using smaller custom cut blades I am creating a smaller opening in the scalp and thus less injury to the vascular bed. I also use tumescence, which is the injection of saline into the scalp, which elevates the skin and expands it, thus widening the playing field for  transplanting, and it pushes the vascular bed lower, thus protecting it from the small incisions. In most patients I use a small amount of epinephrine in the tumescence fluid which helps to minimize bleeding throughout the procedure. In women and men with a large degree of miniaturization I withhold the epinephrine in an attempt to minimize shock loss in these individuals.
Shock loss is a part of hair transplant procedures. I always tell my patients to expect to look about 5-10% thinner for about 3 months after the procedure until the hair begins to grow in. The healthy hair lost as a result of shock loss will come back with the new transplanted hair, and the unhealthy miniaturized hair lost is on its way out regardless. With the proper precautions and techniques we can minimize shock loss in our hair transplant patients.
All the best,
Marc Dauer, M.D.
/by Los Angeles Hair Transplant Specialist

Hair Transplant Donor Strip Scar Revision

Greetings,

Today I want to demonstrate an interesting case I just treated. This patient had 3 previous procedures with other physicians in the past and presented requesting more density and dissatisfaction with his donor scars from his previous procedures. On examination what I saw was 3 different strip scars from the previous Hair Transplants in different areas, and in some areas a large scar from the coalescing of the multiple scars. In my patients, I always include the old donor scar in the new incision when a patient comes back for more grafts. It is only in very rare cases (an example would be someone who has a very wide donor scar from a previous procedure) that I will take a fresh swath from a new area. The reason for taking out the old scar is so that you don’t end up with train track scars throughout the donor region. Also, multiple smaller scars can coalesce to form larger scars which can then become difficult to conceal with shorter hair. This patient had very elastic scalp which allowed me to take out all the old scars and create one new fine scar. In addition, I was able to get a good amount of donor hair from the sides, which had not yet been harvested from. I will demonstrate this patient’s photos below (pre procedure and 12 days later) and I look forward to showing his photos in 6-9 months when the area is even more healed than it is now, but in these photos you can see an appreciable difference already.

All the best,

Marc Dauer, MD

Multiple Strip Scars From Previous Hair Transplant Procedures

Post Hair Transplant and Scar Revision

Multiple Strip Scars From Previous Hair Transplant

After Scar Revision During Hair Transplant Procedure

/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

One Week After FUE- Follicular Unit Extraction

Greetings,

Today I will show a patient of mine who received 1653 grafts via FUE using the SAFE system motorized manual punch with the .9mm hand piece. This patient was experiencing his hair loss primarily in the frontal scalp and this is where the majority of the grafts were placed. I believe the SAFE system which utilizes the blunt tip technology to extract the donor grafts in the best motorized piece of equipment for harvesting grafts via FUE. I also believe that the .9mm punch tip is ideal for extracting intact healthy grafts, while causing the least amount of scarring. Most punches for FUE are 1mm or larger, including the new ARTAS robot which only uses a 1mm punch at present. the difference between .9mm and 1mm may not seem like much, but when you multiply 1500 or 1600 times .1mm it adds up to a significant amount of increased scarring with the larger punch tip. In this patient I also used ACell which is an extracellular matrix (ECM) a natural biological material that can be implanted at the site of an injury or damaged tissue in order to stimulate healing. The graft stimulates the body’s own cells to form new tissue specific to that site (a process referred to as “Auto-cloning”). Therefore, instead of the body producing scar tissue, the body heals by remodeling with new tissue. I mixed the grafts to be implanted with ACell and saline and then at the end of the case I placed all the ACell and saline over the donor region and over the grafted region. The patient reported a minimal amount of crusting after the procedure both in the recipient and donor regions, and quick healing. The photos you will see show the patient immediately pre procedure and then then 7 days later. I will also be charting this patient’s progress throughout the next year with both photos and video. More to follow.

All the best,

Marc Dauer, M.D.

/by Los Angeles Hair Transplant Specialist

Hair Transplant Into A Mustache Scar

Greetings,

Today I want to discuss hair transplantation into a mustache scar. This patient was referred to me by a Plastic Surgeon and the patient had the mustache scar for many years and wished to conceal it with hair transplant grafts. I have performed hair transplants into scars all over the face and scalp. It proves very effective in minimizing the appearance of the scar. When scars form, they destroy the hair follicles in that area. When we place hair transplant grafts into the scar it makes the scar appear less noticeable as hair then begins to grow through the scar, like it did before the scar was formed. The growth rate of the hair follicles transplanted into scar is slightly less than hair transplants into normal tissue because of the decreased blood flow present in the scar. In typical healthy tissue we usually see growth rate of transplanted follicles around 90%. When transplanting into scar the growth rate may be somewhere between 70-80%. This still presents with a great opportunity to conceal scars by performing hair transplants into them. I will show the before and after mustache scar photos below and in future blogs I will address scars in other areas where I have performed hair transplants with excellent results.

All the best,

Marc Dauer, MD

/by Los Angeles Hair Transplant Specialist

Copper Peptide Spray For Better Post Procedure Hair Transplant Healing

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Greetings,

Today I want to discuss the immediate post procedure time frame and something I have found to make the healing process quicker and better. I have found over my many years of experience performing Hair Transplants that keeping the grafts moist and clean as much as possible in the immediate post Hair Transplant procedure phase has contributed greatly to better and quicker healing of the grafts. I also believe that the better and quicker healing contributes to greater growth potential of the grafts. This is also why I routinely apply a thin layer of antibiotic ointment to the grafts and the suture line immediately post hair transplant procedure. I have formulated my own compound of a copper peptide spray solution that I give to all my patients. I call my post hair transplant copper peptide solution “Heal Spray”. I dispense Heal Spray to all my patients post hair transplant procedure and instruct them to spray the grafts 3-5 times per day. I have found that this regimen loosens the crusts associated with the transplanted grafts and promotes quicker healing and return to normal appearing scalp. Patient’s also say the heal spray provides soothing to their scalp and helps to minimize the itching in the transplanted region. Patient’s who underwent previous hair transplant procedures without the heal spray and then have used it in subsequent procedures have reported significant satisfaction with the product and it’s positive effect on the entire healing process. I hope to share my heal spray with other hair transplant surgeons in the near future. Until then we look forward to sharing it with all of our patients.

All the best,

Marc Dauer, M.D.

/by Los Angeles Hair Transplant Specialist

Post Hair Transplant Scabs- How to Minimize

Greetings,

Today I will discuss the scabs that form on the transplanted grafts immediately after the Hair Transplant procedure. Typically the crusts around the transplanted grafts form overnight. In my typical treatment I place a thin layer of antibiotic ointment on the grafts immediately post procedure. I also give all of my patients a copper peptide containing solution that I have formulated and call “Heal Spray”. I instruct my patients to spray on the grafts every 3-4 hours for the first 3-5 days. I have found that the copper peptide solution serves not only to keep the grafts moist, but it also loosens the crusts sooner and allows for quicker healing time and shedding of all the scabs. I also give my patients a special shampoo I have formulated called “Thicken” that contains a number of follicle thickening agents as well as coltar, which is used to treat a variety of different forms of inflammation and seems to calm the scalp down and reduce inflammatory properties that can cause scalp irritation. I encourage my patients to wash their hair with the Thicken shampoo beginning day 1 after their procedure by mixing a small amount of shampoo and water in a bowl and pouring it over the head. The Heal spray combined with the Thicken shampoo tends to get rid of most of the crusts around the transplanted follicles in 5-7 days which allows for a quicker return to normal appearance and a better growth potential of the grafts.

All the best,

Marc Dauer, M.D.

/by Los Angeles Hair Transplant Specialist

The Illusion Of Density

Greetings,

Today I will discuss an important concept in Hair Transplant Procedures known as “the illusion of density”. The typical density of follicles in a non balding scalp or healthy donor region is anywhere between 60-100 follicles per cm2. Usually the number is in the 70-85 range. Keep in mind that when I state follicles, the follicles may be single hair, 2 hair, 3, hair, or even 4 hair follicular units. Every individual has a different amount of each, but the average is about 2.5 hairs per follicle, with some having a slightly higher number and some slightly lower. The general rule is that once thinning of hair is noticeable in any particular region, the individual has already lost 50% of the original amount of hair that was present in the region. That is why we can create the illusion of density by re-creating slightly more than 50% of the original hair that was present in any given region. The reason why this is so important is that in many individuals they will go on to lose a large amount of hair over a lifetime. This can lead many male patients to end up as norwood 6 or 7, which means they end up losing most of the hair on the top of their head. The only difference between Norwood 6 and 7 is whether the donor hair fringe on the sides stays high, or gradually lowers over time as well. So clearly there would never be enough hair in the donor region to re create the original amount of density over such a large area. By meticulously and artistically placing the follicles with discrete angles and orientations, and creating a hairline that allows for future hair loss and conservation of donor follicles for this future loss, we can re- create completely natural hairlines, with less hair than was originally present. Hair caliber and curl are major determining factors in the final cosmetic result with an increase in hair caliber by .1mm possibly adding up to 30% to the overall cosmetic density of the final result. Also, skin to hair contrast has a major effect on the final cosmetic density as well.

This is why it is so important to have a strong grasp on the artistic elements that allow us to create this natural hairline and placing the hairline in a location that conserves donor hair for future hair loss.

All the best,

Marc Dauer, MD

/by Los Angeles Hair Transplant Specialist