Posts

Precautions After Hair Transplant Procedures

Greetings,

There are many precautions that I advise my patients of post hair transplant procedures, and I give all my patients thorough instructions outlining these in detail. One precaution that is not as obvious but just as important is to watch your head getting in and out of cars and around other objects that are around your height. Because of the fact that your scalp is typically numb for a period of days to weeks after the procedure, there is some difficulty gauging the exact location of your scalp in relation to other objects. For this reason it is very common to hit your head by mistake and this can cause minor irritation to the transplanted grafts or major irritation if hit hard. It is very important to be extremely careful getting in and out of cars, in and out of the shower, and any other place that you can possibly hit your head. Keeping your head safe post hair transplant will keep your grafts safe and will lead to great growth of your new hair.

All the best,

Marc Dauer, MD

/by Los Angeles Hair Transplant Specialist

Platelet Rich Plasma (PRP) in Patients with Androgenic Alopecia

Greetings,

Today I will discuss the use of PRP in patients with genetic hair loss. Many physicians have been offering this to their patients, either alone, or in combination with a hair transplant procedure. In the most recent issue of the ISHRS Forum newsletter there is an interesting article that describes some of the different approaches that physicians are using to implement PRP into their Hair Restoration practices. What I found very interesting was some of the points of general agreement among Hair Transplant surgeons.

1) Ideal candidates for PRP are patients with thinning but not complete balding areas

2) Patient satisfaction after PRP injections may be between 70%-90% though no randomized clinical studies have been done and approximately 20% will be disappointed with their results.

3) Peak improvement after PRP would be seen at 2-6 months after injection and treatment must be continued to achieve long lasting results.

My opinion on these numbers is that I don’t feel given the very high price tag of the treatment  that there are high enough satisfaction numbers to warrant this treatment. Additionally the absence of hard data from randomized clinic trials leads me to believe that satisfaction numbers may even be lower and exact effects cannot be scientifically documented. Finally, we also don’t know about any possible long term negative side effects from the injections of PRP which may exist.

Until we have the hard scientific evidence I believe PRP injections into the scalp should not be considered not as a primary therapy for patients with genetic hair loss. It is important that we continue to research this treatment in a scientific manner and proceed cautiously before recommending this to our patients.

All the best,

Marc Dauer, M.D.

/by Los Angeles Hair Transplant Specialist

Keeping Grafts Moist Post Hair Transplant Procedure

Greetings,

Today I will discuss the importance of keeping the hair transplant grafts moist during and after the hair transplant procedure. It is imperative that the grafts are kept moist throughout the procedure as drying out of the grafts is one of the most common causes of poor growth. To that extent, my nurses are constantly spraying the grafts as they dissect them under the microscope, the grafts are submerged in saline before and after dissection, and my nurses use small “ring dishes” that have saline in them and allow the grafts to stay submerged in the saline even after they are taken out of the petri dish, but just before they are implanted.

Post hair transplant procedure, I give all my patients a specially formulated copper peptide solution that they use to spray the grafts every 4-6 hours to keep them moist, and I also cover the grafts in a generous amount of vaseline that functions to keep them moist and create an anaerobic environment which minimizes any possibility of infection.

All these steps contribute to great survival rates and thus great growth rates of the transplanted hair follicles.

I have included photos of the copper peptide solution and the graft ring dish holders below.

All the best,

Marc Dauer, M.D.

Copper Peptide Spray Graft Ring Holder

/by Los Angeles Hair Transplant Specialist

How Many Linear Donor Scars With Multiple Hair Transplant Procedures?

Greetings,

Today I want to address the question I am commonly asked, “will I have a different donor scar for each procedure?”. Every patient that has a hair transplant procedure, has more than one procedure. This is for 2 reasons. Firstly, the patient loves the results of the first procedure and at some point wants to add density to those results. Second, the hair we transplant is permanent hair and should never fall out, but the native hair that is present will erode over time, so additional procedures are usually needed to keep up with the continuing hair loss. In the strip procedure a small linear scar, usually between 1-3mm is left from the harvest of the hair from the back and sides of the scalp. When I perform additional procedures, I always make every attempt to resect the previous donor scar so that the patient does not have train track  like multiple scars in their scalp. Sometimes I see multiple stacked scars from other Doctors and it makes absolutely no sense to me that one would create an entirely new scar if the original scar was within normal limits. The instances where this is unfortunately not possible are where the previous donor scar is too wide and by resecting it we would not get any hair but just scar, or in a situation where the previous donor scar is too low or too high and taking it out would risk creating a much wider scar, or moving into an unsafe region of impermanent hair. The photos below show a patient who came to me from another physician with multiple strip scars from previous procedures and I consolidated the multiple scars into one fine scar that is much more cosmetically acceptable.

All the best,

Marc Dauer, M.D.

This is a photo of multiple strip scars created by another Hair Transplant surgeon.

This is a photo of multiple strip scars created by another Hair Transplant surgeon.

This is a photo after the multiple scars were removed and consolidated into a single fine line strip scar.

This is a photo after the multiple scars were removed and consolidated into a single fine line strip scar.

/by Los Angeles Hair Transplant Specialist

Hair Loss That Is Not Genetic In Origin

Greetings,

Today I want to discuss a patient who recently presented to me for a consultation for his hair loss. He stated that he had been gradually losing his hair over the past 10-15 years and now it had reached a point where all the hair in the frontal and mid scalp had fallen out. He was seeking a hair transplant.

Most of the cases of male hair loss I see in my practice are typical genetic hair loss which responds amazingly well to the hair transplant procedure. In this case, a close examination of the scalp revealed that the skin in the frontal and mid scalp was completely smooth and devoid of sweat glands that you normally see in healthy skin, including balding regions of the scalp. In addition the hair follicles on the periphery of the balding regions showed tiny red dots of inflammation surrounding them and they were easy to pull out. The patient also showed hair loss on his sideburns and eyebrows. I suspected a scarring form of alopecia and referred the patient to a dermatologist for a scalp biopsy and confirmation of my diagnosis.

On biopsy the diagnosis of Lichen Ploanopilaris was confirmed. This is an inflammatory scarring alopecia of the scalp that presents clinically in this exact manner. The biopsy also showed that the LPP appeared to be inactive. The patient came back to me and I explained that we could do a very small hair transplant procedure of test grafts in 3-4 different locations of the scalp to see if the transplanted grafts grew well. If they grew well, we could then proceed to a larger procedure to create some degree of cosmetic density in the areas of hair loss. I also explained to the patient that even if the transplanted hair grew well, there was still a chance that the LPP could reactivate in the future and destroy the transplanted grafts.

The patient decided to move forward with the hair transplant test grafts and we should know in 3-4 months if the growth is successful. I will continue to update you on the progress of this interesting case.

All the best,

Marc Dauer, M.D.

Lichen Planopilaris of the scalp.

Lichen Planopilaris of the scalp.

/by Los Angeles Hair Transplant Specialist

What Is The Best Age For A Hair Transplant?

Greetings,

I am often asked what is the best age for a hair transplant? The answer is that this is different for everyone.

In the past 2 days my patient’s ages were 28 and 83. Mt 28 year old patient was just beginning to thin in his hairline region and was requesting increased density to keep up with his recent hair loss.

My 83 year old patient had undergone multiple hair transplant procedures in the past and was requesting additional density in his frontal and mid scalp. He is a very healthy 83 year old taking no medications and with no major medical conditions. He still had good donor supply and was deemed an excellent candidate for an additional hair transplant procedure. I harvested 1000 grafts via the strip method and the hair transplant procedure went very smoothly.

My 28 year old patient had undergone a small hair transplant procedure with another doctor a few years ago and was requesting additional density in the hairline and frontal scalp. He had robust donor supply and his previous hair transplant procedure was performed using the strip harvest procedure. I harvested a new strip, including the old scar (so the patient still has only one scar), and transplanted just over 1500 grafts into the frontal and mid scalp.

So to answer the original question, the best age for a hair transplant can be anywhere from 25-85. It is the time when there is enough thinning in any particular region of the scalp that transplanting hair in between the native hair will lead to an increase in hair density. This is something that must be evaluated by an experienced hair transplant surgeon, but when done properly in the “right” time, this procedure can lead to excellent results.

All the best,

Marc Dauer, M.D.

/by Los Angeles Hair Transplant Specialist

Hair Cloning- Are We There Yet?

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Greetings,

Today I will discuss hair cloning as it seems everyone is talking about it these days. It is one of the most common questions that I receive on a daily basis as a hair transplant surgeon.

There is no question that hair cloning will forever change the course of hair transplant procedures and hair loss in general. The obvious questions is, we can clone a sheep? Why can’t we clone a single hair follicle?

The answer unfortunately is much more complicated. The ability to clone individual hair follicles at all is a very challenging prospect, and then try to create the ability to clone numbers of follicles that would be needed in practical use with economics that would make it cost effective, and we’re a long way away. Whether that means 10 years, 15 years or even 20 years, who knows. What is does mean is that we as hair transplant surgeons need to plan our patients treatment  plans based on the fact that we will not have hair cloning for the foreseeable future.

There are certainly many entities working on hair cloning. The entity to figure it out first will make billions from it. It will allow us to create skin so we will no longer need to harvest skin grafts from the body. It will completely change the course of medicine and will probably lead to other organ cloning abilities.

What I find interesting is the question of will we be injecting cloned stem cells from other hair follicles that just grow into new permanent hair? Or will be still place individual hair follicles like we do now that are just created via genetic engineering in the lab? Either way, the closer we get to hair cloning the more exciting things will become in the field of hair transplant surgery.

All the best,

Marc Dauer, M.D.

/by Los Angeles Hair Transplant Specialist

Propecia and Hair Loss

Greetings,

Today I will discuss Propecia otherwise known as Finasteride and it’s role in preventing hair loss. Propecia works by inhibiting type 2 5- alpha reductase which converts testosterone to DHT. DHT is what binds to the receptors in susceptible hair follicles and causes them to fall out. By inhibiting the formation of DHT we are decreasing the amount of hair loss. Propecia works especially well in the crown and mid scalp and not as well in the hairline.

Unfortunately many people have reported sexual side effects from the use of propecia. Numerous blind studies seem to show not much difference between the sexual side effects caused by placebo versus the actual medication but despite this the complaints persist.

In my practice I give all my patients a detailed information packet that describes all the benefits of Propecia and the possible disadvantages of using it. I recommend it to my patients but ask them to clear it with their personal physician prior to starting.

I also tell my patients that propecia will not affect the transplanted hair, as this hair is immune to genetic hair loss, but it will allow you to keep the native hair longer, and in some cases bring miniaturized hair that is on its way out, back to life. This will extend the time between procedures and make the overall hair appear denser for a longer period of time.

If you decide to stop propecia after taking it, you will lose any benefit that the medication afforded to you.

All the best,

Marc Dauer, MD

/by Los Angeles Hair Transplant Specialist

Hair Transplant Donor Scar Revision

Today I will discuss about Hair Transplant Donor Scar Revision. A patient who came to me with a wide donor scar and 2 separate donor scars from 2 previous hair transplant procedures all performed by another physician. In my practice I never create a second scar unless it is absolutely necessary. This is another reason why it is so important to me that I create the smallest donor scar possible, so that when the patient returns for the next procedure I can include the previous scar in the new donor strip and get an adequate amount of donor hair follicles as well as leaving the patient with only a single strip scar.

Unfortunately  when this patient presented to me he had 2 separate scars and in some areas where there was only one scar it was much larger than it should be. What I did was consolidate the 2 scars into a single scar and took out the larger scar and made it much smaller. The photos below demonstrate the before and after of this patients donor scar.

My specialized technique of suturing the donor scar with a fine suture, as well as trichophytic closure, and fluid injected into the donor region, allow me to create the smallest possible donor scar in my hair transplant patients.

All the best,

Marc Dauer, M.D.

R Hair Transplant Scar Pre Revision

R Hair Transplant Scar Pre Revision

R Hair Transplant Scar Post Revision

R Hair Transplant Scar Post Revision
L hair transplant scar pre- revision

L hair transplant scar pre- revision

L Hair Transplant Scar Post Revision

L Hair Transplant Scar Post Revision

/by Los Angeles Hair Transplant Specialist

New Hair Transplant Patient Testimonial

Greetings,

Below please find a new hair transplant patient testimonial. The video was taken 9 months after the patient’s first procedure. The patient describes his thought process in choosing his doctor, and then his subsequent procedure experience and the recovery afterward.

I hope you enjoy watching.

All the best,

Marc Dauer, MD

/by Los Angeles Hair Transplant Specialist