Greetings,
Here is a new hair transplant video testimonial by actor Grainger Hines.
Grainger describes his experience undergoing the Hair Transplant procedure and how it has changed his life.
I hope you enjoy watching.
All the best,
Marc Dauer, M.D.
Posts
Greetings,
As more and more physicians purchase the ARTAS robotic machine for automated FUE there seems to be much more information and misinformation regarding the benefits of FUE and specifically of the ARTAS machine performing the extractions. I am a self described “tech geek” and “gadget fanatic”. This is why when the robot was initially introduced I was very intrigued and wanted to immediately investigate it as it seemed like a perfect fit for my personality. What I found was grafts that did not looks as good as my manual FUE grafts and scars in the donor region that were significantly larger than my hand held FUE scars. It was so dramatic that I decided not to purchase the machine.
Regarding the scarring from the ARTAS FUE, most of the reasons for undergoing FUE in the first place is the elimination of the linear scar and the ability to cut the hair very short without any scarring evident. What I saw from the ARTAS was “moth-eaten” donor regions after a single procedure (see photos below) thus negating the possibility to even shave the hair short! In addition this moth eaten donor area after a single procedure would also preclude the patients from harvesting additional grafts from the same area, which is also a huge negative, as almost all people continue to need additional grafts over time as hair loss progresses with age.
What the ARTAS does provide to physicians who purchase it is the marketing “wow” factor of having a robot harvest their FUE grafts. This can be a powerful marketing tool and in many cases can even allow the physician to switch the patient out to a strip procedure if they realize that FUE is not for them. It also can take the physician completely out of the harvesting equation by delegating technicians to perform the entire FUE harvest without the physician even being in the room. Finally, manual FUE is an acquired art, and not every hair transplant surgeon is capable or proficient in this art, and the ARTAS machine allows everyone to get into the FUE game without knowing how to extract grafts manually.
In my practice, I perform all my FUE harvesting personally with a hand held punch that typically measures 0.9mm in diameter. I perform about 50/50 FUE and FUT and am equally proficient in both. My job as a hair transplant surgeon is to educate my patient as to the benefits and drawbacks of both FUE and FUT and to let them make the decision that works best for them.
My advice is to research extensively before choosing a physician. Make sure you have seen many results (both donor and recipient regions) of both procedures. Most importantly, don’t be fooled by the “marketing hype”. Choose a physician that you truly trust, as a competent and ethical physician will always afford the best chance of a great result.
All the best,
Marc Dauer, M.D.
This is a patient who had a small number of FUE grafts harvested via the ARTAS one time. The scarring is very evident.
This is a photo from the latest edition of the ISHRS magazine showing the difference between the holes from the ARTAS and a manual .8mm FUE punch.
This is a photo of one of my FUE patients 6 months after harvesting just over 1600 grafts with a 0.9mm punch tool.ARTAS
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.
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.
Greetings,I am often asked by prospective patients which harvesting procedure is preferable for hair transplantation. Follicular unit extraction or the strip harvest procedure? My answer is that it depends on the individual. If a person needs the option to cut his hair down to a number 1 or a number 2 buzz cut then follicular unit extraction is the needed procedure so as to avoid a visible linear scar. If the person is comfortable leaving their hair at a number 3 or preferably number 4 cut or longer, then the strip harvest procedure is absolutely an option. Typical linear scars from strip harvest procedures should measure between 1 and 3 mm in width and the length is determined by the amount of hair follicles needed to be harvested. This is in contrast to tiny white dots that are left in the donor region after the follicles are harvested in follicular unit extraction. Neither procedure is scarless. There is no such thing as a scarless hair transplant procedure. In fact, the scarring from follicular unit extraction in the donor region is greater when measured in surface area then the scarring from the strip harvest procedure. The difference is that in the strip harvest procedure the scarring is concentrated in a linear scar which is more noticeable when the hair is very short as opposed to the diffuse pinpoint scarring which is the result of follicular unit extraction. Some patients who have been overharvested in follicular unit extraction still do not have the option to cut their hair very short as the confluence of many pinpoint scars can start to show as “moth eaten” scalp with a short haircut. Also, it is usually not advisable to cut the hair down to a number zero haircut after follicular unit extraction hair transplants as you will probably see the tiny white dots left from the extraction of the follicles. To be clear, when follicles are removed from the donor area in follicular unit extraction one by one, they do not grow back in the donor area. They are taken out and moved to another area where they then begin to grow.In follicular unit extraction every third or every fourth hair follicle is randomly extracted so as not to create bald patches in the donor area. Because of this it is important to draw the hair follicles from the entire safe donor area. This means that the entire donor area is affected in the first hair transplant procedure. This is in contrast to the strip harvest procedure where only about a 1 to 1 1/2 cm wide area is extracted by a length that is determined by the amount of hair follicles needed to harvest, typically leaving behind a 1 to 3 mm linear scar with untouched robust donor area above and below the strip scar. When the patient returns for a second procedure the physician should harvest the second strip from the same area removing the original strip scar so as to leave the patient with only one strip scar even after multiple hair transplant procedures. If for some reason the strip scar widens and the physician is not able to extract the old scar, there is still untouched donor zone above and below the original strip scar allowing the physician to either take a new strip in a new area or begin follicular unit extraction in the surrounding areas around the original strip scar. What this means is that the ultimate donor zone in a patient will probably be contain more follicles if the patient begins with the strip harvest procedure versus follicular unit extraction. This also means that patients who are predicted to experience severe hair loss should strongly consider leaving their hair a little bit longer and undergoing the strip harvest procedure to begin with, in order to maximize the number of donor hair follicles from their permanent donor zone.When harvesting follicles in follicular unit extraction, the patient must shave their head down to a number zero cut in order to extract the follicles, versus the strip harvest procedure which allows the patient to leave their hair longer and use the existing hair to cover up the strip scar.In follicular unit extraction the physician can choose the larger follicular units i.e. the two, three, and four haired follicular units, while in the strip harvest procedure you only get what’s in the strip which may typically ends up being 2/3 one hair and two haired follicles. What this means is that the hair count can possibly be slightly higher in follicular unit extraction.Follicular unit extraction can be much more variable than the strip harvest procedure because a high degree of skill and efficiency required to extract the follicles intact. This is in contrast to the strip harvest procedure which involves less handling of the hair follicles. Because of this we often see more variable rates of growth in the hands of inexperienced practitioners practicing follicular unit extraction. It is imperative that the prospective patient see multiple results of the physician you are considering with the follicular unit extraction procedure as well as the strip harvest procedure.In summary there is no right or wrong when comparing follicular unit extraction and the strip harvest a procedure. Both are excellent procedures and both can provide excellent results in the hands of an experienced hair transplant surgeon. What’s most important is that the patient chooses the procedure that suits them the best both in the short term and the long run.All the best,Marc Dauer, M.D.
Greetings,
Here is a patient who had a previous hair transplant strip procedure with a large chain Hair Transplant operation by a physician who had been performing hair transplants for over 30 years. The patient came to me requesting more density in the frontal scalp, but also complaining of a wide strip scar that was elevated with severe numbness. He also complained because the Physician who had performed his last procedure created a second strip scar deviating at one point from the first. He wanted me to take out the unsightly scar and consolidate the 2 scars into one.
When I started to dissect out the strip I noticed small blue thread and assumed it was a small retained suture that dipped below and was missed in the suture removed. To my amazement what I then discovered was that almost the entire length of the strip scar was closed below the skin with non absorbable nylon sutures. These are sutures that are only to be used on the skin surface and removed. They were placed into the subcutaneous layer below the skin and created a significant amount of scarring and was also giving the patient numbness. I removed the suture, which was caked in scarring at this point, and consolidated the 2 scars into one. The results are shown in the photos.
This should be a warning and reminder to prospective patients that when choosing your hair transplant surgeon make sure to do tremendous research into the person performing your procedure. Experience and focus on the singular discipline of hair restoration are imperative, but just as important is the fact that your surgeon should not have a cavalier attitude towards hair transplants, no matter how long they have been performing the procedure, and must convey and strong sense of sensitivity and respect for the art and science of the procedure, as well as keeping up to date on the latest developments in the field. The field of Hair Transplant surgery is the wild west and there are more unqualified individuals performing bad procedures than good. You only have one chance to do things right, so take the time to chose the proper physician who will give you the greatest chance of successfully achieving your goals.
Respectfully,
Marc Dauer, M.D.
Showing the strip scar before revision.
This shows the nylon suture retained in the tissue below the skin and the scarring.
Here is the strip scar immediately after revision and removal of the scarred tissue and retained suture material.
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:
- Who will evaluate my hair loss and recommend a course of treatment? What is their education, training, licensure, and experience in treating hair loss?
- 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?
- 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.
- 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.
Greetings,
Today I will demonstrate a phenomenon known as “pitting”. This occurs when the transplanted grafts are placed too deeply and it causes the hairs to look like they are growing out of a hole or a pit. This is a completely unnatural look and can easily be avoided by placing the grafts properly with a small amount of tissue protruding above the skin. In the case of this patient, his previous procedure was performed at an unnamed large hair transplant chain operation and 2 different nurses were used to place each side of the hairline. In this case the left side had extensive pitting and the right side did not show the same amount (see the photos below). This is one more reason why quality control is so important in hair transplant procedures. We as physicians are only as good as the nurses placing the grafts and unqualified nurses placing the grafts can lead to results like you see here. My nursing staff have been with me over 10 years each and they have all been working in the field of hair transplant surgery for over 15 years each. Most of my nurses have worked on my scalp personally, and I trust them implicitly, as I am smart enough to know that my results are only as good as they are, and they are great.
All the best,
Marc Dauer, M.D.
This photo shows “pitting” from a previous hair transplant.
This is from the same patient the other side of the frontal scalp that does not show significant pitting.
Greetings,
There are many different variables that come into play when creating a completely natural hairline through hair transplant surgery. The most important is the artistic capability of the hair transplant surgeon. Below is a photos of a patient of mine showing his hairline design immediately post procedure and a close up photo of the transplanted hairline 1 year later. The result is a completely natural hairline that appears natural even when pulled back.
All the best,
Marc Dauer, M.D.
Close up hair transplant hairline photo
Greetings,
Here is a new hair transplant patient testimonial of a patient of mine. The video was taken immediately after the patient’s procure and also 2 weeks later. The patient describes in his own words what the procedure was like as well as the immediate post procedure time period. I hope you enjoy watching.
All the best,
Marc Dauer, M.D.