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Greetings,

Today I will discuss the general timeline post hair transplant. Typically within 24 hours after the procedure tiny crusts that look like grains of sand form around the transplanted hairs whether they are on the scalp, eyebrow, face, or body. These tiny scabs begin to fall off around post op days 3-4 and are usually gone within 7-10 days. Keeping the grafts moist or applying an antibiotic ointment may loosen the crusts and have them fall off earlier. Most of the transplanted hairs being to fall out at around 2 weeks post operatively and usually by the end of the first month post transplant most of the transplanted hairs are all gone and the patient looks like they did prior the procedure. Typically , the hair begins to grow back at around 12 weeks. The patient usually does not notice any change until around 5-6 months, at which point approximately 50% of the new hair growth may be seen. Full growth is usually not achieved until 12 months post procedure and continued growth may be seen for up to 24 months post procedure. Patients who have undergone a second or third procedure may see a slightly delayed growth timeline.

I hope this information is helpful to all of those considering Hair Restoration.

All the best,

Marc Dauer, MD

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.

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.

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

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.

Greetings, I have just returned from leading a teaching conference on Hair Restoration on behalf of the American Academy of Aesthetic Medicine in Kuala Lumpur, Malaysia. This was my second visit to Malaysia. The attendees came from Malaysia, Singapore, and India. It was a slightly smaller conference so it really gave me an opportunity to spend a good deal of individual time with all the physician attendees, which was gratifying personally. Kuala Lumpur is an amazing city with incredible architecture. I will post a photo of the twin towers at night, and one of me and the attendees. I look forward to hosting another conference in KL in March 2011.

All the best,

Marc Dauer, M.D.