Posts

Copper Peptide Spray For Better Post Procedure Hair Transplant Healing

, ,

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

Transplanting hair via FUE into mustache scar

, ,

Greetings,

Today I will discuss a very interesting case I just performed. This patient presented with a skin graft in his mustache region from a previous accident that required extensive Plastic Surgery. He was left with a large scar  and no ability to cover the scar as it would only grow a scant amount of hair. The patient prefers to wear a goatee but it is very unnatural with only one side growing hair. In this case I performed follicular unit extraction otherwise know as FUE by harvesting the hairs from his beard on the neck individually with a .8mm punch. I harvested the neck hairs as these will most closely resemble the beard hairs we are meant to recreate. After I harvested all the beard hairs via FUE we placed the grafts individually to recreate a mustache.The angles and orientation of the grafts placed in the mustache were made to mimic the angles of the hairs on the unaffected part of the mustache. Typically there is a slightly lower growth rate of grafts transplanted into scar tissue, but these patients usually have excellent cosmetic results. Below you can see the pre operative photo and the post operative photo and the immediate difference that is seen with the transplanted grafts present over the scar.

All the best,

Marc Dauer, M.D.

/1 Comment/by Los Angeles Hair Transplant Specialist

New Hair Transplant Video Patient Testimonial

, ,

Greetings,

Here is a new hair transplant vedio patient testimonial discussing his experience before, during, and after his hair transplant procedure. It is very informative for anyone considering the procedure.

All the best,

Marc Dauer, M.D.

/by Los Angeles Hair Transplant Specialist

FUE (Follicular Unit Extraction) To Cover Donor Strip Scars In Hair Transplantation

, , ,

Greetings all,

Today I would like to discuss the issue of donor strip scars and how to approach them when they are too wide, or noticeable, or the patient just wishes to cut their hair very short. In the world of Hair Restoration today there are many physicians trying to push the envelope of grafts in a single session. Physicians trying to perform 4000, 5000, or even 6000 grafts in a single session. Using the strip method, the only way to achieve these numbers is by taking a donor strip that is very wide. This puts undue tension on the skin closure and can then result in very wide donor scars. Sometimes though, even under the best of circumstances and a proper closure, a wider than expected donor scar can also occur. I have been seeing more and more of these patients from other physicians recently.

After much experience I am finding that when you attempt to excise these scars, often times they will just come back again. The best approach to this situation is to harvest grafts via FUE ( Follicular Unit Extraction) and then transplant the grafts into the scarred areas that are devoid of hair or have very little hair in them. Typically the grafts grow nicely through the scar tissue and provide hair coverage of the scar which acts to conceal the scar thus making it more feasible to cut the hair short.

I have included photos below of a patient who had multiple strip scars from a procedure performed by another physician. The ‘before’ photos show the donor area shaved and the donor scars. The ‘after’ photo shows the FUE punctate sites (these heal in about a week) and the hair immediately transplanted into the donor scars. A difference in the donor scars with hair transplanted into them is immediately visible and when the hair grows in this should provide nice coverage to the donor scars and allow the patient to cut their hair much shorter than was possible before.

/1 Comment/by Los Angeles Hair Transplant Specialist

How To Avoid Post Operative Swelling In Hair Transplant Procedures

, , ,

Greetings,

In years past patients who underwent hair transplant procedures experienced a significant amount of facial swelling in the forehead and around the eyes post procedure. Typically the swelling occurred at around 3 days post operatively after the hair transplant and usually resolved by around 6 days post operatively. Oral steroids have been used in the past to combat this swelling and definitely helped to reduce the swelling in many instances, but taking oral steroids, even in small doses, can subject the patient to other possible complications. This led the hair transplant community to look for other options. In the context of any hair transplant procedure I use what is called “tumescence” to allow for easier graft placement. Tumescence is where saline fluid is injected into the scalp in the regions where the new hair is to be transplanted. This accomplishes a few different things. Firstly, it compresses the vasculature down below which then allows us to cause less vascular injury when placing the grafts. Also, it stretches the scalp which also causes less bleeding, thus allowing for better visualization. Finally the stretching of the scalp also “widens the playing field” of the area to receive the hair transplants, thus allowing us to place the grafts closer together. When the scalp shrinks back to it usual size this helps to create optimal density. What I now routinely do is mix in a small amount of injectable steroid solution, diluted in the saline that is to be used for tumescence. In addition, I no longer give any oral steroids. Since there is no downside to diluting such a small amount of steroid into the tumescence fluid, this make it much safer for the patient then taking oral steroids and the results have shown that greater than 90% of my patients experience no post operative swelling after a hair transplant procedure. In the rare case that swelling does occur, it is then possible to treat with oral strides if so desired. This truly has been a major advance in the field and one that greatly benefits the patients and decreases possible complications.

All the best,

Marc Dauer, M.D.

/by Los Angeles Hair Transplant Specialist

How Many Hair Transplant Procedures Will I Need?

, ,

Greetings all,

Some of the most common questions I get from prospective patients are “can I only do one procedure?” and “how many procedures will I need?” These are excellent questions which I would like to address. To begin with, androgenic hair loss, otherwise known as male patterned hair loss, is a progressive condition and one which continues throughout your life. Is it true that as you age, the amount and degree of loss can slow down and even stabilize, but every patient must understand clearly that they will continue losing hair throughout their lives. Younger patients with more severe loss may lose their hair more quickly than older patients with mild to moderate loss but it can still vary from individual to individual. Usually in the course of a consultation I will discuss with the patient other family members (father, grandfathers, uncles, etc.) who experienced similar loss at their age and ask them how that person’s loss progressed. Sometimes that can offer some insight into how quickly and severely the individual’s hair loss will progress. There are other factors on examination, like miniaturization of existing follicles, that can provide some insight into how the individual’s hair loss will progress. Miniaturization is the process where a healthy hair follicle becomes a small, fine, almost “baby- hair”. This is typically the last step before the hair follicle falls out forever, and extensive miniaturization can be a precursor to extensive baldness. Medical treatments for androgenic alopecia include Rogaine and Propecia (Finasteride). Both of these medications can help not only to possibly regrow some hair, but to turn miniaturized follicles into healthy follicles again and to slow the progression of hair loss. Also, the studies have clearly shown that patients who use both Rogaine and Propecia together have a better result than patients who use either independently. Researchers are not sure why, but apparently there is some synergistic action between the 2 medications. Propecia is a pill which is taken once a day in a 1mg formulation and Rogaine comes as a foam or liquid is concentrations of 2% and 5%. I typically recommend the 5% foam formulation as it is easier to place on the scalp and is less greasy. Also, Rogaine has only shown results in helping hair loss in the crown region. Usually younger patients who are in line to experience much more hair loss are going to get the most benefit from using these medications. Another factor in determining the number of procedures is the severity of hair loss. Patients who have severe degrees of hair loss (Norwood 6 or 7) are usually confronted with a choice. Since I do not believe in transplanting many more than 3000  follicles in a single session (I will address my reasons for this in another blog), a severely bald patient will have the choice to either cover their entire head with a lower density of hair follicles, which may result in them wanting a secondary procedure for increased density throughout. Or to cover the entire hairline and mid scalp with higher density and leave the crown alone and then possibly cover the crown in a secondary procedure. Either way, in a severely bald individual, this is going to be a decision the patient will have to make. Finally, what I tell patients is that everyone who has the procedure, sees the difference, loves the difference, and wants more. The typical patient will undergo 2-4 procedures in a lifetime. I usually won’t consider performing a second procedure until around 8-9 months after the initial procedure. This allows me to see the new hair growth and also allows the donor area to relax, thus making it safer to harvest a strip from again. Every patient is different and must be individually evaluated in order to formulate a comprehensive plan tailored to them.

All the best,

Marc Dauer, MD

/by Los Angeles Hair Transplant Specialist

Donor Scars in “Strip Harvesting”- How to Prevent and Treat

Greetings,

Today I would like to discuss donor scars in the “strip harvesting” technique in hair restoration surgery and how to approach them. The trend in many clinics is towards larger procedures which many patients request. Most people would like to get as much done as possible in one sitting, and for the clinic this can mean larger fees. However, this is not always in the best interest of the patient for many reasons. Firstly, there is a diminishing return in graft growth as the grafts are kept outside of the body for long periods of time. In “mega-sessions” of 3000+ follicles, this tends to become an issue. In addition, the only way to harvest 3000+ follicles in most people, is take a width of donor strip that exceeds 1.7 cm and in many cases even 2.0 cm. The studies have clearly shown that with donor strips this wide, even if all the other necessary precautions are taken in wound closure, there is a much higher incidence of scar widening, hair shock, and various other problems that can be encountered in the donor region. It is for this very reason that the largest case size I will perform is about 3000 follicles in a single session, and this is usually only on a first time patient with excellent donor density. More often, my large procedures are in the 2500-2800 graft range. I limit the width of my donor strip to 1.5 cm maximum, and try to keep it between 1.0-1.3cm whenever possible. The studies have shown that when the donor strip is kept below 1.2cm there is a very low risk of scar widening or any other complications. In patients with low scalp laxity, or even hyper-elastic scalp, it is sometimes necessary to place deep retention dissolvable sutures to decrease the tension on the skin edges. This can also decrease the incidence of scar widening. Typically on repeated procedures, the scalp tends to lose elasticity, which should make the physician think twice about how wide a donor strip to take in these cases. The typical donor scar should be between 1mm-3mm when everything goes as planned. Sometimes even though all the rules are followed the patient can still end up with a donor scar that is wider than we would like. In these cases the first step is usually to resect and revise the donor scar by just taking out the old scar and trying to limit the width to 10mm or less. If that is not possible, or the patient requests another option, a great way to treat this is by harvesting follicles by FUE (Follicular Unit Extraction), which involves using a special tool to harvest one follicle at a time, and then placing the grafts into the scar. Transplanted hair follicles grow very well through most scars and this treatment can be effective in minimizing the appearance of a wide donor scar. I hope this brief overview clearly explains how I approach “strip harvesting” in Hair Restoration Surgery.

All the best,

Marc Dauer, MD

/by Los Angeles Hair Transplant Specialist

New F.U.E. S.A.F.E System

, , , , ,

Greetings all,

For the past few months I have been using a new machine for my FUE procedures called the “New F.U.E. S.A.F.E System”. For those of you who are not familiar, FUE stands for “Follicular Unit Extraction”. It is the process where donor follicles are taken out one by one, instead of removing them via the “Strip Method”, where a strip of donor scalp is removed and dissected under the microscope into individual follicles. There are a number of advantages and disadvantages to FUE vs. Strip Harvesting but I will not get into this discussion here. FUE is typically described in marketing and promotional advertisements as a “scarless” procedure. This is not actually true. What is true is that FUE causes many “micro scars” in the areas where the follicles are removed. In most cases these micro scars heal well and only leave a small dot of hypo-pigmentation in each spot where a follicle is removed. This is usually cosmetically insignificant as the area where the donor hair is removed is usually covered by the remaining hair in that region. The other issue with FUE is that in the past there has been a high rate of transection with the removal of the follicles. This means that in the process of removing the follicle, the structural integrity of the follicle is compromised, thus giving the follicle a much lower percentage chance of growth. The goal is a system where there is a low rate of transection and where the follicle is exposed to the lowest amount of trauma possible. There are many new automated and manual systems available now for FUE and I did extensive research into all of them and decided that the SAFE system was the way to go. The thing I really like about this system is that the punch that is used to extract the donor follicle has a blunt tip as opposed to a sharp tip that most of the other systems use. What this means is that since the tip is not sharp there is a much lower incidence of transection. Since donor follicles are very finite in each individual (the average person has about 8000 donor follicles), a lower transection rate of even 10-20% can result in hundreds or possibly even thousands of saved follicles. In addition, because the tip is not sharp, I believe it causes less trauma to the underlying vasculature, which can protect the scalp for future procedures. Also, because this system is motorized, like a small drill, it allows you to “score” the follicles much quicker, thus allowing more follicles to be harvested in a session. With this system, you still have to manually extract the follicles, manually trim the follicles, and manually implant the follicles, but the automation in the drill definitely speeds up the process. FUE is good for some patients and has it’s advantages and disadvantages. We are now able to transplant up to 1200 follicles in a day with the new FUE system, as opposed to significantly lower numbers before this system. In addition, FUE allows us to harvest chest hair, back hair, and beard hair for donor follicles. What is most important, is that every patient throughly understands all the advantages and disadvantages of both harvesting techniques before deciding which route to take in their own hair restoration journey.

Marc Dauer, M.D.

/1 Comment/by Los Angeles Hair Transplant Specialist