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Bad Strip Scars versus Trichophytic Closure Strip Scar

Greetings,

I recently saw a patient in consultation who had received 3 previous hair transplants from another physician and wanted to be evaluated for an additional procedure from me.

On examination of his donor area I was surprised to  find 3 separate strip scars. One for each procedure, stacked on top of each other. The effect was significant scarring in the donor area and an inability to harvest another strip scar secondary to the extensive scarring from the previous procedures.

For reference I have also attached a photo of one of my patient’s who had 2 strip procedures, but only one scar. This is because whenever I go back for additional procedures on a patient, I always attempt to harvest the new strip to include the old strip scar. In essence instead of creating train track multiple stacked scars, I keep the scar as a singular scar, thus minimizing the overall scarring to the donor region. In addition, I also performed a trichophytic closure in my patient, which allows the hair to grow through the scar, thus further concealing the scar.

It is imperative to treat the donor region with as much care as the recipient region. Donor hair is finite, and proper care and attention must be given to ensure that we can minimize donor scarring and maximize donor harvesting over the patient’s lifetime.

All the best,

Marc Dauer, M.D.

This is a photo of a patient who had multiple strip hair transplant procedures.

This is a photo of a patient who had multiple strip hair transplant procedures.

 

Hair transplant strip scar with trichophytic closure.

Hair transplant strip scar with trichophytic closure.

/by Los Angeles Hair Transplant Specialist

Temporal Peaks FUE Hair Transplant

Greetings,

The temporal peaks in both males and females are an important characteristic in hairline design and create and youthful aesthetic appearance. It is always important to keep in mind the overall donor supply in making the decision to restore the temporal peaks. One must also understand  that patients with curly hair will have a more noticeable difference to the character of the typically finer and straight temporal hair. Also, it is important the primarily single hair follicles are utilized.

This patient has abundant donor supply and wished to have his temporal peaks restored. He received approximately 150 grafts per temporal peak via FUE. Finer hairs from the inferior aspect of his occipital region were used to recreate the naturally finer temporal hair. He should see some additional density over the next 6 months, but he is already thrilled with his results.

All the best,

FUE Hair Transplant To Temporal Peaks

FUE Hair Transplant To Temporal Peaks

Marc Dauer, M.D.

/by Los Angeles Hair Transplant Specialist

Patient Letter Of Gratitude

Greetings,

Here is a letter I just received from a patient of mine who decided not to proceed with his hair transplant procedure.

I hope you enjoy reading.

All the best,

Marc Dauer, M.D.

Dr. Dauer:

This letter is a bit different than those you receive from patients who have undergone procedures. I have read testimonials given by others on your website and fully appreciate their words. While I think they are of great value, my experience with you, I think, adds to their comments as to your professionalism, dedication to your craft and concern for your patients. It is said that people show their true character under adverse circumstances. If so, I believe the following serves as an excellent example of the kind of doctor and person you are.

Before visiting you, I had been to a well-known clinic as well as a renowned plastic surgeon to consider my options. Frankly, at our initial contact, you were so engaging, it kind of caught me off guard. It became obvious from that meeting you were going to be the guy! During my consult, you couldn’t have been more personable or informative. There was no sales pitch or pressure put upon me. You freely gave of your time and encouraged me to ask questions (of which I had many). You made it clear that it was a personal determination and your goal was to educate me, answer my questions and provide me with whatever information was available so that I could make an intelligent decision. You thoughtfully and thoroughly described the procedures and what I might expect from them. I couldn’t have asked for a better explanation of what was involved. You also created a comfort level that made me feel as if I was talking to a nonjudgmental friend, someone whom I could confide and trust in what was, for me, a very difficult choice.

My procedure was scheduled for Monday morning. That Sunday night, for personal reasons, I came to the conclusion that this wasn’t the right time for me to undergo a transplant. I dreaded the thought of the conversation that would take place the next morning.  I was bitterly conflicted- I couldn’t sleep! I knew that you had arranged your schedule so as to be able to devote the entire day to my procedure and I figured (correctly) that it would be too late for you to call off those who would assist you. When we met, I couldn’t believe your empathy and understanding, most particularly when I spoke of my reservations and apprehensions. You were the consummate professional. Although I know you must have been greatly disappointed, you patiently listened to what I had to say and made it clear that if I was less than completely ready and comfortable with undergoing the procedure, we wouldn’t do it that day. This meant that, in essence, you wound up eating a full day’s work and virtually your entire fee. Your compassion and class was extraordinary! Through no fault of yours, I actually felt as if I was letting you down, not because of any pressure applied upon me (quite the contrary), but rather because your were so gracious about it- that goes for your staff as well, who couldn’t have been nicer or more congenial, even after I delivered the bad news.

Your kindness and consideration did not go unnoticed. I consider myself lucky to have found you. I can’t imagine anyone having handled this situation at significant personal expense, with any greater compassion and understanding. Hopefully, the time will come when I’ll be ready to go forward, make the move and have the opportunity to comment upon your skills much like others have done.

You put your patient’s concerns and best interests above personal financial benefit and convenience. I felt the very least I could do was memorialize how grateful I am for the way you handled the situation and give others the benefit of my thoughts. If they are looking for someone to perform hair restoration who truly cares about his or her patients, they couldn’t find a better doctor and, just as importantly, a better person.

Sincerely,

Stu Glovin

/by Los Angeles Hair Transplant Specialist

Pre Hair Transplant Procedure Anxiety

Greetings,

Today I want to talk about something that everyone experiences to some extent. Pre-hair transplant procedure anxiety. I have undergone 3 procedures myself, and know exactly what to expect, and yet I still experienced some degree of anxiety prior to each procedure. Everyone is different and comes into this procedure with a different perspective. Some are more excited and less nervous and some are the other way around. I am very sensitive to this in my interactions with my patients. I will always do everything in my power to re-assure the patient and let them know that they are in great hands. I will also give my patients as much information as possible regarding what to expect throughout the procedure and post procedure time period. In addition, unlike many other clinics that perform hair restoration procedures, we are not trying to “sell” our services. That means starting with myself, who performs each and every consultation without the assistance of a “patient advisor”, “counselor” or “sales person”, my job is to educate the prospective patient, answer their questions, and give them realistic expectations as to what they can look forward to if they decide to undergo the procedure.  In no way and at no time will I or anyone in my practice pressure the prospective patient into moving forward with the procedure if they are not comfortable with it. I would prefer that a patient not move forward if they are not completely comfortable with all the aspects that it entails. Again, I can educate, help to alleviate irrational fears, and provide moral support throughout the process. I can also attest to the fact that almost every single patient of mine tells me a year after their procedure that their only regret is not having the procedure performed sooner and enjoying the results for longer. But at the end of the day, the prospective patient needs to be psychologically ready to move forward.

The video below is of a patient of mine who considered canceling his procedure on the day of his procedure, and he describes the day in detail and his subsequent decision to undergo the procedure.

I hope you enjoy watching.

All the best,

Marc Dauer, M.D.

/by Los Angeles Hair Transplant Specialist

New Hair Transplant Testimonial By Physician Patient

Greetings,

Here is a new hair transplant testimonial by a patient of mine who happens to be an Emergency Room physician. It is interesting to hear the perspective of a physician who has undergone the procedure himself.

I hope you enjoy watching.

All the best,

Marc Dauer, M.D.

/by Los Angeles Hair Transplant Specialist

New Hair Transplant Video Testimonial

Greetings,

I recently had the pleasure of seeing one of my patients who is just over 1 year after his first hair transplant procedure. He is thrilled with his results and shares his experience in the video below.

I hope you enjoy watching.

All the best,

Marc Dauer, M.D.

/by Los Angeles Hair Transplant Specialist

New Hair Transplant Video Testimonial

Greetings,

Here is a new hair transplant video testimonial by actor Grainger Hines.

Grainger describes his experience undergoing the Hair Transplant procedure and how it has changed his life.

I hope you enjoy watching.

All the best,

Marc Dauer, M.D.

/by Los Angeles Hair Transplant Specialist

ARTAS Robotic Hair Transplant FUE- Is It Better Or Worse For The Donor Region?

Greetings,

As more and more physicians purchase the ARTAS robotic machine for automated FUE there seems to be much more information and misinformation regarding the benefits of FUE and specifically of the ARTAS machine performing the extractions. I am a self described “tech geek” and “gadget fanatic”. This is why when the robot was initially introduced I was very intrigued and wanted to immediately investigate it as it seemed like a perfect fit for my personality. What I found was grafts that did not looks as good as my manual FUE grafts and scars in the donor region that were significantly larger than my hand held FUE scars. It was so dramatic that I decided not to purchase the machine.

Regarding the scarring from the ARTAS FUE, most of the reasons for undergoing FUE in the first place is the elimination of the linear scar and the ability to cut the hair very short without any scarring evident. What I saw from the ARTAS was “moth-eaten” donor regions after a single procedure (see photos below) thus negating the possibility to even shave the hair short! In addition this moth eaten donor area after a single procedure would also preclude the patients from harvesting additional grafts from the same area, which is also a huge negative, as almost all people continue to need additional grafts over time as hair loss progresses with age.

What the ARTAS does provide to physicians who purchase it is the marketing “wow” factor of having a robot harvest their FUE grafts. This can be a powerful marketing tool and in many cases can even allow the physician to switch the patient out to a strip procedure if they realize that FUE is not for them. It also can take the physician completely out of the harvesting equation by delegating technicians to perform the entire FUE harvest without the physician even being in the room. Finally, manual FUE is an acquired art, and not every hair transplant surgeon is capable or proficient in this art, and the ARTAS machine allows everyone to get into the FUE game without knowing how to extract grafts manually.

In my practice, I perform all my FUE harvesting personally with a hand held punch that typically measures 0.9mm in diameter. I perform about 50/50 FUE and FUT and am equally proficient in both. My job as a hair transplant surgeon is to educate my patient as to the benefits and drawbacks of both FUE and FUT and to let them make the decision that works best for them.

My advice is to research extensively before choosing a physician. Make sure you have seen many results (both donor and recipient regions) of both procedures. Most importantly, don’t be fooled by the “marketing hype”. Choose a physician that you truly trust, as a competent and ethical physician will always afford the best chance of a great result.

All the best,

Marc Dauer, M.D.

This is a patient who had a small number of FUE grafts harvested via the ARTAS one time. The scarring is very evident.

This is a patient who had a small number of FUE grafts harvested via the ARTAS one time. The scarring is very evident.

This is a photo from the latest edition of the ISHRS magazine showing the difference between the holes from the ARTAS and a manual .8mm FUE punch.

This is a photo from the latest edition of the ISHRS magazine showing the difference between the holes from the ARTAS and a manual .8mm FUE punch.

 

This is a photo of one of my FUE patients 6 months after harvesting just over 1600 grafts with a 0.9mm punch tool.

This is a photo of one of my FUE patients 6 months after harvesting just over 1600 grafts with a 0.9mm punch tool.ARTAS

/by Los Angeles Hair Transplant Specialist

Female Hairline Lowering

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Greetings,

Here is a a female patient of mine who has a genetically high hairline and thinning of hair in the existing hairline. I slightly lowered the hairline and increased the density in the existing hairline. Female patients have a very different hairlines than male patients and it is imperative that this is taken into account when creating the recipient sites for the transplanted hairs. The photo below shows the patient pre operatively and then 2 weeks post procedure. Some of the transplanted grafts have already shed, which is normal. They will begin to grow back at about 12 weeks. From the “after” photo you can see the very specific angle and orientation of the transplanted grafts to match exactly the existing hair that that when the hairs grow out they are all flowing in the same directions as the native hair. The goal is that you should not be able to tell any difference between the transplanted hair and the native hair.

All the best,

Marc Dauer, M.D.

This is photos of a female patient who received a hair transplant to lower the hairline.

This is photos of a female patient who received a hair transplant to lower the hairline.

/by Los Angeles Hair Transplant Specialist

FUE (Follicular Unit Extraction) versus FUT (The Strip Harvest Procedure)

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Greetings,
I am often asked by prospective patients which harvesting procedure is preferable for hair transplantation. Follicular unit extraction or the strip harvest procedure? My answer is that it depends on the individual. If a person needs the option to cut his hair down to a number 1 or a number 2 buzz cut then follicular unit extraction is the needed procedure so as to avoid a visible linear scar. If the person is comfortable leaving their hair at a number 3 or preferably number 4 cut or longer,  then the strip harvest procedure is absolutely an option. Typical linear scars from strip harvest procedures should measure between 1 and 3 mm in width and the length is determined by the amount of hair follicles needed to be harvested. This is in contrast to tiny white dots that are left in the donor region after the follicles are harvested in follicular unit extraction. Neither procedure is scarless. There is no such thing as a scarless hair transplant procedure. In fact, the scarring from follicular unit extraction in the donor region is greater when measured in surface area then the scarring from the strip harvest procedure. The difference is that in the strip harvest procedure the scarring is concentrated in a linear scar which is more noticeable when the hair is very short as opposed to the diffuse pinpoint scarring which is the result of follicular unit extraction. Some patients who have been overharvested in follicular unit extraction still do not have the option to cut their hair very short as the confluence of many pinpoint scars can start to show as “moth eaten” scalp with a short haircut. Also, it is usually not advisable to cut the hair down to a number zero haircut after follicular unit extraction hair transplants as you will probably see the tiny white dots left from the extraction of the follicles. To be clear, when follicles are removed from the donor area in follicular unit extraction one by one, they do not grow back in the donor area. They are taken out and moved to another area where they then begin to grow.
In follicular unit extraction every third or every fourth hair follicle is randomly extracted so as not to create bald patches in the donor area. Because of this it is important to draw the hair follicles from the entire safe donor area. This means that the entire donor area is affected in the first hair transplant procedure. This is in contrast to the strip harvest procedure where only about a 1 to 1 1/2 cm wide area is extracted by a length that is determined by the amount of hair follicles needed to harvest, typically leaving behind a 1 to 3 mm linear scar with untouched robust donor area above and below the strip scar. When the patient returns for a second procedure the physician should harvest the second strip from the same area removing the original strip scar so as to leave the patient with only one strip scar even after multiple hair transplant procedures. If for some reason the strip scar widens and the physician is not able to extract the old scar, there is still untouched donor zone above and below the original strip scar allowing the physician to either take a new strip in a new area or begin follicular unit extraction in the surrounding areas around the original strip scar. What this means is that the ultimate donor zone in a patient will probably be contain more follicles if the patient begins with the strip harvest procedure versus follicular unit extraction. This also means that patients who are predicted to experience severe hair loss should strongly consider leaving their hair a little bit longer and undergoing the strip harvest procedure to begin with, in order to maximize the number of donor hair follicles from their permanent donor zone.
When harvesting follicles in follicular unit extraction, the patient must shave their head down to a number zero cut in order to extract the follicles, versus the strip harvest procedure which allows the patient to leave their hair longer and use the existing hair to cover up the strip scar.
In follicular unit extraction the physician can choose the larger follicular units i.e. the two, three, and four haired follicular units, while in the strip harvest procedure you only get what’s in the strip which may typically ends up being 2/3 one hair and two haired follicles. What this means is that the hair count can possibly be slightly higher in follicular unit extraction.
Follicular unit extraction can be much more variable than the strip harvest procedure because a high degree of skill and efficiency required to extract the follicles intact. This is in contrast to the strip harvest procedure which involves less handling of the hair follicles. Because of this we often see more variable rates of growth in the hands of inexperienced practitioners practicing follicular unit extraction. It is imperative that the prospective patient see multiple results of the physician you are considering with the follicular unit extraction procedure as well as the strip harvest procedure.
In summary there is no right or wrong when comparing follicular unit extraction and the strip harvest a procedure. Both are excellent procedures and both can provide excellent results in the hands of an experienced hair transplant surgeon. What’s most important is that the patient chooses the procedure that suits them the best both in the short term and the long run.
All the best,
Marc Dauer, M.D.
/by Los Angeles Hair Transplant Specialist