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Donor Scars In The Strip Harvest Procedure

Greetings,

In this blog entry I will discuss my approach to harvesting the donor strip in the strip harvest procedure. Firstly I always try and limit the width of my donor strip to no more than 15mm and this is usually in the area of the scalp with the most laxity. In areas of the scalp where there is less laxity I routinely taper the strip with even less width. The length of the strip is determined by the amount of follicles we are looking to harvest in the session. I only use sutures to close the donor strip. I believe the donor region heals much better with sutures rather than staples and a fine thread suture is definitely more comfortable to sleep on than a row of bulky metal staples on the back of the head. I routinely employ a tricophytic closure when closing the donor region. The involves shaving less than a mm off the lower edge of the donor closure. This transects the follicles on the skin edge thus causing hair to grow through the donor scar and making it even more invisible. In cases when I know the patient is coming back to see me in the near future for a repeat procedure I will not perform a trichophytic closure as you can permanently damage some donor follicles by performing this procedure, so in the interest of maintaining the maximum amount of donor follicles for future procedures I like to wait until the patient is close to the end of his treatment before I employ this technique. When patients present for a second or third procedure I always try to include the old donor scar within my new incision so that the patient is left with only a single linear scar as opposed to “train tracks” running through the back of their scalp. I have included some photos of typical donor scars on my patients.

All the best,

Marc Dauer, MD

/by Los Angeles Hair Transplant Specialist

Transplanting hair via FUE into mustache scar

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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

Lowering The Hairline In A Female Patient

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Greetings,

Today I would like to discuss lowering the hairline in a female patient. This is a procedure that has become more common recently with advances in Hair Restoration techniques and the ability to create density that was previously unattainable. In these cases patients report having a high hairline that has been present for their entire lives. In some cases there is thinning behind the hairline, but more often than not, the high hairline is the only issue. With the ability to transplant single hairs into recipient sites that measure .6mm-.8mm we can create cosmetic density in the hairline that rivals a completely normal hairline. Care is also taken to angle the hairs in the exact angle and orientation of the pre existing hairs so that one should not be able to identify any difference between pre existing native hair and the new transplanted hairs. In the case I am highlighting today, this patient has some thinning in her frontal scalp, which I addressed by transplanting hairs into the thinned out region. However her primary concern was her high hairline that had been present for her entire life. I lowered her hairline by just over a centimeter and kept the same design as her original hairline with the peak in the middle. Notice this patient had a very specific angle to her hair growth in the hairline which I maintained with the new transplanted hair grafts. Below you can see the pre operative photo and the immediate post operative photo that show the grafts placed in the new hairline. I hope this discussion provides some insight into this concept.

All the best,

Marc Dauer, M.D.

/1 Comment/by Los Angeles Hair Transplant Specialist

Letter of Appreciation From Visiting Physician

Greetings,

I periodically have physicians come to me from all over the world to spend time learning my techniques and approach to the field of Hair Restoration. I just received a letter from a physician who recently visited with me. This physician has been a practicing Head and Neck Surgeon for 25 years and he is looking to expand his practice to include Hair Restoration. Below is the letter.

Training with Dr. Marc Dauer and staff.
I would describe the week as full immersion . You taught the finest details regarding FUE and strip harvesting … And the transplanting itself is art!

But there was so much more involved.

Seeing you educate the patient (and me) with respect to the advantages and disadvantages of all options was invaluable.

You are confident, kind, empathetic, and engaging. You do not over promise. During the days there, previous patients consistently returned – thrilled with their results.

Your entire staff was outstanding, and patiently demonstrated and explained to me every step and question I had.

What I especially appreciated was the fact that each treatment was tailored to the patient’s specific needs, and not to the surgeon who might have only one single device or technique available.

Thank you for your very comprehensive training, for your friendship, and for your willingness to stay in touch. I would strongly recommend your training to any highly motivated individual.

Chris Peers MD

Goshen Indiana

/7 Comments/by Los Angeles Hair Transplant Specialist

Boards Exam Oral Examination

Greetings,

I just returned from being an oral examiner for the American Board Of Hair Restoration Surgery board exam in Houston over the weekend. It was my first time participating in a Oral Examination and it was extremely enjoyable. It was nice to gather and reconnect with my colleagues. It was also intellectually stimulating and great review to discuss and formulate new questions for future exams. I look forward to continuing my active participation in this valuable organization.

All the best,

Marc Dauer, M.D.

/9 Comments/by Los Angeles Hair Transplant Specialist

Rogaine and Propecia For Hair Loss

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Greetings,

Today I will discuss the usage of Rogaine and Propecia for hair loss. Rogaine is an over the counter medication that comes in a liquid form and a foam form and comes in 2% and 5% strengths. For male patients I typically recommend Rogaine foam 5% twice a day after showering and before bed. Rogaine typically works only in the crown region and is best at slowing down the rate of hair loss and in some cases taking the miniaturized hair (hair that is on it’s way out for good) and turning it back into healthy hair. The exact mechanism of Rogaine is unknown, but it is thought to promote increased blood flow to the scalp by relaxing the small blood vessels that supply the blood flow to the scalp. Rogaine 5% is approved for men, and only the 2% formulation is approved for use in women. The 5% formulation may have better efficacy in women, but it can cause hair growth on the face that is reversible when discontinued.

Propecia is an oral medication that is taken once a day. It works by blocking the conversion of testosterone into DHT which can cause hair loss. The effect of taking the medication is that it can regrow hair in some instances and can also convert miniaturized hair that is on the verge of falling out forever into healthy hair, that is cosmetically significant. Propecia is not indicated for use in women.

There have been many claims about Propecia recently, and various side effects it may cause. I typically have all my patients that are considering Propecia read a detailed explanation of all the benefits and possible side effects prior to beginning to take the propecia. I have seen excellent results with patients using propecia, and in my experience younger patients tend to respond the best to this medication.

There is also anecdotal evidence that propecia and rogaine together produce a more significant effect than either medication independent of the other. The exact cause is unknown, but there seems to be some sort of synergy between the two medications.

/399 Comments/by Los Angeles Hair Transplant Specialist

Dr. Dauer Discussing Female Hair Loss on The Doctors TV Show

Greetings,

Here is a clip of me discussing Female Hair Loss and different reasons why women seek out Hair Restoration procedures.

All the best,

Marc Dauer, MD

/by Los Angeles Hair Transplant Specialist

Hairline Design In Hair Transplantation

Greetings,
The hairline design is probably the most important facet of Hair Transplantation. It has the power to make a Hair Transplant look completely natural or completely unnatural. It is crucial that the transplanted hairs are oriented in the proper angle and orientation. You should not be able to tell the difference between the transplanted hair and any native hair that is present in the area. In addition, the hairline should be placed in a location that takes into account future hair loss and the patients eventual donor reserve. This means that in younger patients with more extensive hair loss, it is imperative to not place the hairline too low, as you could create the problem of running out of donor hair in the future. Every millimeter that you lower the hairline requires an exponentially large number of hairs to fill in behind it. I always tell my patients we can lower the hairline in the future if the continuing hair loss allows for more aggressive hairline advancement, but once the hairline is too low, it becomes a big problem that can be fixed, but requires a fair amount of intervention to do so. It is better not to create the problem in the first place. Also, keen attention must be paid to the patients facial symmetry, hair color to skin contrast, and hair type (curly hair versus straight hair). The new hairline must be created in an irregular pattern so that there are no straight lines at any point in the hairline. With all of these factors taken into consideration, combined with the artistry of the Hair Restoration Surgeon, a completely natural hairline may be achieved.

All the best,

Marc Dauer, MD

/by Los Angeles Hair Transplant Specialist

New Hair Transplant Video Patient Testimonial

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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

Norwood 3V Question From A Patient

Here is a question I received from a prospective patient and my answer.

Question: My wife keeps telling me that I need a hair transplant so here I am doing some research. Here’s my situation, I am 31 years old and seem to be a 3V on that baldness scale. One of my friends is taking propecia a says it’s great stuff, but I am afraid of the side effects that I keep reading about. Is it even worth having a hair transplant if I don’t take Propecia to stop the rest of my hair from falling out?  I’ve also read that once I start this process I might have to go through several surgeries and if I don’t take Propecia I can still look bald in time. Please advise. Thank you.

Answer:

This is an excellent question. Firstly, there have been reports of sexual side effects with Propecia, but the vast majority of people taking Propecia report no adverse side effects and the benefits of taking Propecia, especially in younger patients, are significant. In my practice, I have all patients read and sign a detailed Propecia consent form that discusses in depth the benefits of Propecia as well as all the possible side effects and any associated risks. I let the patients know if they start to feel any of the adverse side effects to discontinue the medication. In addition, to patients who are thinning in the crown region, which it sounds like you are, I also recommend Rogaine 5% foam twice a day. Studies have shown that patients who use Rogaine and Propecia together experience a synergy between the 2 medications which show more positive results than either medication taken independent of the other. I routinely perform a video microscopy on the scalp with my patients and if I see a large amount of miniaturization of follicles I may also recommend low light laser therapy. I have become a fan of the new LaserCap which, with it’s ease of use, provides excellent compliance among patients. I have seen great results with it low light laser therapy in patients who have a large amount of miniaturization. Finally, in order for me to determine if you are a candidate for Hair Transplant surgery I would need to see you in consultation or look at your photos, but if you are a 3V it sounds like you likely could be a candidate. I always tell my patients that you will definitely have between 2-4 procedures in your lifetime to keep up with continuing hair loss. The number of procedures is affected by the rate of your future hair loss, which Propecia, Rogaine, and Laser Therapy can markedly slow down. I hope this answers your questions.

All the best,

Marc Dauer, M.D.

/by Los Angeles Hair Transplant Specialist