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Factors Affecting Cosmetic Density In Hair Transplants

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Greetings,

Today I want to address the factors that affect cosmetic density in hair transplants. Firstly there are the anatomic factors. The single most important factor anatomically is the caliber of the hair. An increase in just .1mm of the diameter of the hair follicle can add up to 30% increased cosmetic density. The other anatomic factors that contribute are skin color to hair color contrast (the more contrast, the more you see through the hair), and curly versus straight hair (curly hair looks thicker than straight hair).

Then there is the follicles per cm squared, which is the amount of follicles transplanted in any given area. Normal non balding scalp can have a density of between 60-100 follicles per cm squared. The minimum density that should be transplanted into any bald area should be at least 30 follicles per cm squared. As we transplant more follicles per cm squared we achieve greater cosmetic density. It requires a much higher degree of skill to transplant a high number of follicles per cm squared.

In summary, there are both anatomic and surgical factors that contribute to cosmetic density. It is imperative that prospective patients looking at pre and post hair transplant photos take the anatomic characteristics into account when considering hair transplant results.

All the best,

Marc Dauer, M.D.

/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

Beard FUE Harvest

Greetings,

Here is a patient of mine who was a norwood 6 with extensive hair loss. He had 3 previous strip harvest procedures with excellent results and was looking to add density to the crown region. Unfortunately the patient was no longer a candidate for another strip harvest procedure so we decided to harvest follicles via FUE from the scalp and the neck portion of the beard. The beard donor site is shown after 8 days and the patient describes the experience in his own words.

I hope you enjoy watching.

All the best,

Marc Dauer, M.D.

/by Los Angeles Hair Transplant Specialist

Botched Eyebrow Transplant Repair

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Greetings,

I recently saw a patient in consultation that had an eyebrow transplant procedure performed in the office of a very well known physician. The issue is that the physician did not perform the procedure. In fact, the physician is not trained in hair transplantation at all and does not even perform hair transplant or eyebrow transplant procedures himself. What he did was have a medical assistant perform the entire procedure, from beginning to end, and the physician did not perform any aspect of it. The medical assistant performed the harvest using the neograft automated FUE machine and then created the recipient sites and placed the grafts. The patient ended up having 2 procedures like this.

The entire procedure was an epic failure. Only about 20 hairs grew from both procedures on each eyebrow and the hairs that grew were growing straight out from the skin in unsightly directions. The donor area in the back of the head was also significantly scarred from the attempted extraction of many hundreds of hair follicles.

In addition, the patient also had an eyebrow tattoo performed in the same physicians office prior to the 2 eyebrow transplants which created even more scarring in the eyebrow.

To have a medical assistant perform the entire hair or eyebrow transplant procedure is not only unethical, it is against the law in many states including California.  Unfortunately this represent a growing trend in the field of hair and eyebrow transplantation. More and more companies are pitching “automated” devices to harvest hair follicles and selling physicians who have no experience in the field with a new device to increase their revenue growth. Their pitch is that you don’t need to know anything about hair and eyebrow transplants, just buy the machine and the company will supply per diems technicians to do the rest. This is the result of that.

I performed an eyebrow transplant procedure on the patient and placed approximately 300 follicles per eyebrow. The results are shown a week after the procedure. In a few months I will updated with follow up photos. Because of all the scarring from the previous eyebrow tattoo and botched eyebrow transplants, the patient will have less growth yield than someone with healthy tissue. She should still have an excellent result and I already told her she should expect to have a second procedure in 9-12 months to increase the density.

This should be a lesson to anyone considering hair or eyebrow transplants. Make sure you go to a physician who specializes EXCLUSIVELY in hair transplants or if you are going to have an eyebrow transplant someone who does many of these procedures, and that they have dozens if not hundreds of results to show you. Just because the physician is skilled in another field does not make them an excellent hair or eyebrow transplant surgeon.

All the best,

Marc Dauer, M.D.

This is a botched eyebrow transplant with pre existing eyebrow tattoo present.

This is a botched eyebrow transplant with pre existing eyebrow tattoo present.

This is a botched eyebrow transplant with pre existing eyebrow tattoo showing the hairs growing in different directions incorrectly.

This is a botched eyebrow transplant with pre existing eyebrow tattoo showing the hairs growing in different directions incorrectly.

 

This is a botched eyebrow transplant with pre existing eyebrow tattoo immediately post corrective eyebrow transplant procedure.

This is a botched eyebrow transplant with pre existing eyebrow tattoo immediately post corrective eyebrow transplant procedure.

 

This is one week after approximately 300 grafts were placed in each eyebrow to correct a botched eyebrow transplant procedure.

This is one week after approximately 300 grafts were placed in each eyebrow to correct a botched eyebrow transplant procedure.

 

This is one week after approximately 300 grafts were placed in each eyebrow to correct a botched eyebrow transplant procedure.

This is one week after approximately 300 grafts were placed in each eyebrow to correct a botched eyebrow transplant procedure.

 

 

/by Los Angeles Hair Transplant Specialist

Consumer Alert Warning Regarding Hair Transplants

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Greetings,

With the growing field of hair and eyebrow restoration procedures, and the abundance of new “automating” machines, companies are “pitching” doctors as not needing to know anything about hair transplantation, just buy the machine and we will provide some medical assistants to perform the entire procedure. This is taking place everywhere and I am seeing more and more cases of patients undergoing botched procedures in dermatology and plastic surgery practices that have no experience doing hair and eyebrow transplant procedures. I have posted some of these botched procedures and will continue to do so. It is imperative that the consumer stay vigilant and only go to an individual that specializes exclusively in hair and eyebrow restoration in order to increase the likelihood of an excellent result.

Now the International Society of Hair Restoration Surgery has also issued a warning to consumers regarding unqualified individuals performing hair and eyebrow restoration. Just because you are going to see a Physician does not mean that the individual is well versed in hair and eyebrow transplants. Make sure your treating physician can show you at least 100 before and after photos of their own patients that look good to you before considering the physician for your procedure.

You can find the full text of the ISHRS press release below.

All the best,

Marc Dauer, M.D.

http://www.ishrs.org/content/consumer-alert

Seeking Hair Restoration Surgery?  

Be sure that a properly trained licensed physician or properly trained licensed allied health professional practicing within the scope of his or her license is responsible for your treatment.


The International Society of Hair Restoration Surgery (ISHRS) is concerned about the growing risk to patients of unlicensed technicians performing substantial aspects of hair restoration surgery.  The use of unlicensed technicians to perform aspects of hair restoration surgery which should only be performed by a properly trained and licensed physician or properly trained and licensed allied health professional (e.g., nurse, nurse practitioner, physician assistant) practicing within the scope of his or her license,  places patients at risk of: (i) misdiagnosis; (ii) failure to diagnose hair disorders and related systemic diseases; and (iii) can result in the performance of unnecessary or ill advised surgery all of which jeopardizes patient safety and outcomes.  There may also be a risk that unlicensed technicians may not be covered by malpractice insurance.

The ISHRS believes the following aspects of hair restoration surgery should only be performed by a licensed physician or licensed allied health professional practicing within the scope of his or her license:

  • Preoperative diagnostic evaluation and consultation
  • Surgery planning
  • Surgery execution including:
    • Donor hair harvesting
    • Hairline design
    • Recipient site creation
  • Management of other patient medical issues and possible adverse reactions

To help insure patients have information needed to make informed decisions about who performs their hair restoration surgery, the ISHRS urges potential patients to ask the following questions as well as questions regarding costs, risks, and short and long-term benefits and planning:
Patients Should Ask These Questions:

  1. Who will evaluate my hair loss and recommend a course of treatment?  What is their education, training, licensure, and experience in treating hair loss?
  2. Who will be involved in performing my surgery, what role will they play, and what is their education, training, licensure, and experience performing hair restoration surgery?
  3. Will anyone not licensed by the state be making incisions or harvesting grafts during my surgery?  If so, please identify this person, explain their specific role and why they are legally permitted to perform it.
  4. Is everyone involved in my surgery covered by malpractice insurance?

 

             

 

Be your own best advocate. Protect yourself.

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International Society of Hair Restoration Surgery
A non-profit medical association
303 West State Street, Geneva, IL 60134 USA
www.ISHRS.org

The International Society of Hair Restoration Surgery is a non-profit medical association exempt from federal income tax pursuant to Internal revenue Code Section 501(c)(3). The mission of the ISHRS is to achieve excellence in medical and surgical outcomes by promoting member education, international collegiality, research, ethics, and public awareness.

/by Los Angeles Hair Transplant Specialist

FUE- Follicular Unit Extraction Video

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Greetings,

Today I want to share a new patient testimonial of a patient of mine who had FUE, follicular unit extraction of just over 1550 grafts into the frontal scalp. The patient discusses his experience with the procedure and the donor area is shown after 2 weeks with almost no sign of any procedure.

I hope you enjoy watching.

All the best,

Marc Dauer, MD

/by Los Angeles Hair Transplant Specialist

FUE Hair Transplant Patient Testimonial

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Greetings,

Here is a patient of mine who underwent an FUE hair transplant. He explains the entire process from his prospective.

It is an enjoyable and educational video.

All the best,

Marc Dauer, M.D.

/by Los Angeles Hair Transplant Specialist

FUE Hair Transplant Into Previous Strip Scar

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Greetings,

Here is a video of a patient of mine who received FUE grafts to the frontal scalp, the crown, and into a previous strip scar (created by another physician) to help conceal the strip scar. The results are shown after 7 months and already look dramatic. The patient will have additional cosmetic coverage over the next 7 months as additional transplanted hair grow in a nd continue to thicken in diameter. I hope you enjoy watching.

All the best,

Marc Dauer, M.D.

/by Los Angeles Hair Transplant Specialist

Hair Transplant Grafts Placed Into Scarring Alopecia

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Greetings,

Today I will discuss a patient of mine who presented with a form of scarring alopecia called Lichen Planopilaris. This resulted in the loss of all the hair follicles in the frontal and mid scalp as well as the eyebrows and sideburns. The patient initially thought that the hair loss was androgenic alopecia, but after my examination and subsequent scalp biopsy the diagnosis was confirmed. It is imperative that the hair transplant surgeon has a thorough knowledge of all the forms of alopecia as different causes result in different outcomes and some are candidates for hair transplants and others not.

In this case the biopsy also showed that the scarring alopecia had “burnt out” and was no longer active. We decided to do 3 small areas with test grafts to see if they would grow before considering a more expansive procedure. What we found was excellent growth in all the test areas after only 12 weeks. After discussing with the patient and letting him know that there still is a chance that we won’t see the same growth rate that is seen in healthy scalp, and the patient decided to proceed with a more extensive procedure.

Below you can see the photo before the test grafts and the test grafts that have grown. I will continue to provide updates on this very interesting case.

All the best,

Marc Dauer, M.D.

This is a patient with scarring alopecia who had test grafts placed into 3 different areas.

This is a patient with scarring alopecia who had test grafts placed into 3 different areas.

/by Los Angeles Hair Transplant Specialist

FUE Hair Transplant Video

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Greetings,

Here is a video documenting a patient of mine’s FUE (follicular unit extraction) hair transplant harvest. The grafts were placed into the patient’s previous strip scar (which was created by another doctor), and the frontal scalp and hairline. The results are dramatic and are shown 7 months after the patient’s procedure. I hope you enjoy watching.

All the best,

Marc Dauer, M.D.

/by Los Angeles Hair Transplant Specialist