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Custom Cut Recipient Blade Sizes In Hair Transplant Procedures

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

/1 Comment/by Los Angeles Hair Transplant Specialist

Hair Transplant Procedures In Patients With Old Plugs

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

/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

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

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