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Old Hair Transplant Plug Effect On Donor Region

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

/by Los Angeles Hair Transplant Specialist

Eyebrow Transplant In Patient with Ulerythema Ophryogenes

Greetings,

Today I would like to present the results of an eyebrow transplant I performed on a patient with Ulerythema Ophryogenes. This patient is a young man in his early 20’s who experienced the loss of the outer half of both his eyebrows. He was treated by Dermatology with a variety of topical medications which helped with the redness but did not grow back and of the eyebrow hair. I performed an eyebrow transplant placing approximately 250 grafts in each eyebrow and the results are shown below 12 months after the procedure. The patient is so happy with his results and states that this procedure has changed his life for the better. The lack of eyebrow hair was really affecting his self confidence and since the eyebrow transplant procedure he feels much better and more self confident.

All the best,

Marc Dauer, M.D.

Pre Eyebrow Transplant Procedure

Pre Eyebrow Transplant Procedure

Pre Eyebrow Transplant Procedure

Post Eyebrow Transplant

post eyebrow transplant

post eyebrow transplant

/1 Comment/by Los Angeles Hair Transplant Specialist

Hair Transplant Hairline Design

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

/by Los Angeles Hair Transplant Specialist

Celebrity Hair Transplants

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Greetings,

In the past few years more and more celebrities have gone public with their experiences of hair transplant procedures and how they have changed their lives for the better. In the past most famous people were reluctant to talk about their experiences, but as results have improved, more people are willing to discuss their experience with hair transplantation. Just recently A.J. McLean has come forward to show photos of his transformation through a hair transplant procedure and has discussed how it has changed his life. These celebrity “testimonials” will only serve to make more people aware of how amazing this procedure can be when performed properly by the “right” physician.

I personally have performed numerous procedures on well known individuals from all walks of life and I have seen the changes both aesthetically and psychologically. The changes I have seen are remarkable and I feel so lucky to be a part of this field that allows me to be involved in such amazing transformations.

Most importantly, do you due diligence prior to choosing your hair transplant surgeon and choose someone who’s results you are comfortable with, and who’s demeanor you connect with. If you feel comfortable with both of these things, there is a good chance you are choosing the right physician for your hair transplant procedure.

/1 Comment/by Los Angeles Hair Transplant Specialist

When To Have A Hair Transplant Procedure

Greetings,

I am often when the best time is to have a hair transplant procedure. There are many different ways to answer this question.

Firstly, I prefer not to operate on patients much younger than 25. My feeling is that in younger patients with severe hair loss, it may be difficult to ascertain the final degree of balding the patient will have, so it is important to proceed in a very conservative manner with younger patients. I also typically recommend a regimen of Propecia and Rogaine in younger patients to slow down the progression of the hair loss.

Some patients come to me and wonder if they have enough hair loss to undergo a procedure. Every case is different, but in general if you can see loss in any region of your scalp there is a good chance that you are a candidate for a hair transplant in that region.

Finally, I am always asked what time of the year is best for a hair transplant. The answer to this is any time of the year is a good time for a hair transplant. The ideal time rarely presents itself, so the best time to have a hair transplant is anytime you are able to carve out a day. For the first 10-12 days after the procedure I do not want my patients engaging in any strenuous activity. Also, for the first 3-4 months after the procedure I prefer that my patients wear a hat when they are in the sun for extended periods of time.

There are many factors that come info play when deciding the best time to have a hair transplant procedure. Most importantly, find the right Doctor that you connect with, and then the timing will work itself out.

All the best,

Marc Dauer, MD

/by Los Angeles Hair Transplant Specialist

Donor Density- How It Affects The Hair Transplant

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

/by Los Angeles Hair Transplant Specialist

What Age To Start Hair Transplants? How Young Is Too Young

Greetings,

Today I will discuss my approach to younger patients that seek out hair transplant procedures. It is very important that he hair transplant surgeon proceeds slowly and carefully in younger patients. It is not uncommon for young men in their early 20’s to approach me seeking hair transplantation. The issue is that in individuals this young it is very hard to accurately determine how severe their hair loss will ultimately be. Thus it is difficult to assess an accurate treatment plan over the long term, which is an essential component of our jobs as hair transplant surgeons. Since every individual only has a finite amount of donor follicles to donate to the areas of balding, we need to have a course of action for not only the amount of hair loss that the patient has at the moment, but the eventual end point of the patients hair loss in the future. This is so we can conserve donor hair for the future for the affected areas that will need it later. Sometimes young men in their early 20s wish to have their hairline restored to the way it was only a few years prior. This is not a good approach as is can result in an unnaturally low hairline later with not enough donor hair to fill in all the areas of baldness behind it.

I prefer to start my younger patients on Propecia and Rogaine which can help restore some hair, and in many cases greatly slow the progression of hair loss, especially in younger individuals. I have these patients follow up with me periodically so that I can assess their continuing degree of loss. In some cases I will perform a procedure in a patient as young as 25, but I will insist on a regimen of Propecia and Rogaine. Also, I create a very conservative hairline in these patients and don’t use too much donor hair, thus conserving donor hair for future procedures.

Hair loss can be psychologically debilitating for many and especially young individuals. As hair transpant surgeons it is our job to approach these patients in the proper manner, so that the right decision can be made as to when and how to proceed with the hair transplant procedure.

All the best,

Marc Dauer, M.D.

/by Los Angeles Hair Transplant Specialist

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