Sara Wasserbauer MD

Medical Hair Restoration

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Posts tagged: therapy

Concered About Thinning and Irritation On Hair Transplant Donor Scar

I had a transplant about one year ago to hide a scar from a brow lift. Unfortunately, the scar is still very visible, but what I’m most worried about is the dramatic thinning of my hair along the donor scar line and below it. In fact, right now, I have an irritation, the second one in a month, that is about an inch wide. This one burns and appears infected. My doctor thinks it was just an ingrown hair, but I’ve never had one like this ever! Could I be having thinning hair and irritations because of my hair transplant. Will it stop? Is it likely my hair will ever regrow what I’ve lost since the hair transplant?
-John
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As for your donor area, it does sound like you have local infection and inflammation at the site.  This could have started, as your doctor said, with an ingrown hair and may have spread to the surrounding area.  It could also be what doctors call an “inclusion body” like a stitch that did not dissolve and is instead working it’s way towards the surface.  Again, I cannot tell without examining you, but either way, having your doctor treat the area either with incision and drainage or with antibiotics is a wise idea.  Shock loss can happen in the donor area from the brief interruption in blood supply during the surgery, but it never fails to re-grow.  Your situation is slightly different since your hair has thinned, so it is difficult to predict if you will regain the thickness in that area.  Unfortunately, if it has been a year, your chances of re-growth are lower, but it IS likely to stop.  Rogaine can help grow the hair thicker in that area, and laser treatments (like with a hood laser in a doctor’s office) may also be beneficial.

The important thing is to not give up!  Hair takes time to grow, and I never stop a treatment for lack of effect before I have given it at least a year to work.  Also, if your doctor does a lot of hair transplantation, he or she has likely seen something like this in the past, and I can guarantee they want to help.  Good luck and I hope that helps!

Warm Regards,
Dr. Sara Wasserbauer

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FUE Hair Transplant Primer

As one of the few docs who does FUE routinely in my practice, I think it is interesting that all sorts of new methods for automating the process are being introduced. There have been many iterations of these machines and while none has yet panned out perfectly, I do see some hope on the horizon! For those of you who are novices to the idea here is a comparison of the two techniques;

TRADITION! The traditional FUT (Follicular Unit Transplantation) or “Strip” technique takes a thin strip of hair from the back and sides of your head. The two sides are brought back together leaving a thin line typically 1-2mm wide as the scar. Often, a “trichophytic closure” is used which allows the hair to grow through the scar, rendering the scar all but invisible. This scar is typically visible only if you buzz your hair shorter than a #2 on a pair of standard clippers (or if you shave your head with a razor.) It is typically NOT visible if you cut the hair at a #3 on clippers (or if you leave it even longer). This goes for wet and dry hair I find.

Traditional hair transplant methods result in stitches for about 7-10 days and obtain up to several thousand grafts per session. The surgery usually takes 8-10 hours (plan on being there the whole day although smaller sessions can end earlier). There is typically nothing visible in the donor areas (back and sides of the head), even immediately after the the procedure! Good surgeons typically charge $4-5 per graft giving it a variable price tag but usually in the $5-$13K range. (Cut-rate grafts are no bargain!) Most hair surgeons agree that this method is generally best for those looking for a single large session and as close to a full correction as possible in a single surgery.

FUE! Follicular Unit Extraction (FUE) also takes grafts from the back and sides of the patient’s head individually. Depending on how the patient prefers it, you can either shave the whole head or small “micro-strips” can be shaved for optimal camouflage – but some level of shaving has to be done because the hair has to be short for effective removal. The scars are small – about 1mm in diameter, and if you shaved the head they would look like little dots scattered all over the head. You actually have more scar area with this method, but since it is not in a LINE it is much harder to see!

FUE transplants take a full day as well (8-10 hours) and requires that the patient lies face down and on their side for long periods while the grafts are being removed. Recovery takes about 3-5 days and while there are no stitches, you do have a number of little tiny scabs all over your head which can be covered with hair (or just open if the patient can shave their whole head to start with.) If you shave your whole head, I like to compare the look to being hit with a shot gun, but it heals to a bunch of tiny little pink spots very quickly so amazingly, the patients who choose this option do not seem to mind! Surgeons who practice this technique typically can obtain 500-1000 grafts in a single session and charge $20 or more per graft. The range is large since the success of the procedure depends largely on patient variables that cannot be fully determined until the surgery starts. Most hair surgeons agree that this method is generally best for those looking for a single small session or several smaller sessions to achieve a full correction.

Hope that helps everyone!

Cheers!

Dr. Sara

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Xandrox – Has a Higher Dosage of Minoxidil Proven To Be More Effective?

I have a couple questions about minoxidil.  I know the common potencies are 2% and 5%.  Why not go higher?  I found a website called minoxidil.com that offers something called Xandrox with 15% minoxidil.  Is this legitimate or just a scam?  Has anything over 5% proven to make no more of a difference?  The website is run by a Doctor Richard Lee, have you ever heard of him? – John
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Dear John,

Thank you for taking the time to write.  I have not heard of Dr. Richard Lee, but it is easy to check a physician’s credentials if you know in what state they are licensed.  As for the minoxidil, all the science shows us is the efficacy for the 2% and the 5% formulations.  Going higher usually increases the risk of side effects, and it might not be more effective.  Remember that minoxidil was originally a medication for blood pressure that was taken orally (at much higher doses, incidentally).  Pfizer decided to investigate it as a hair loss drug when patients began reporting the strange side effect of unwanted hair growth!  So these drugs are not without effects on other body systems.

One of the reasons Dr. Lee is able to make his own formulation with a higher potency of minoxidil (and to give it a name) is that minoxidil is now generic.  Once the patent expired and it became available over the counter, physicians and compounding pharmacists could then use it as an ingredient in their own proprietary formulations.  ScalpMed and Avacor are good examples of this in practice, and they work because their ingredients (i.e. minoxidil!) are proven to work!  You can even report the FDA approval for it on your labeling.  It is often the case, however, that the active ingredient can be obtained more cheaply in the generic form at your local pharmacy.

Your question is not a new one, however, and you are not the only person who is asking it.  If SOME is good, is not MORE simply better?  I can tell you that over the years I have had patients try every new formulation out there and report back to me, and never once have I had a home run.  If something was better, we would all be using it, doctors and patients alike, all over the world.  There is not some great conspiracy among hair doctors to keep the REAL hair remedies for ourselves.  Which is why my final advice to you would be that it is probably okay to go ahead and try it.  If it works, great!  I want to be the first person you tell about it!

Good luck, John!  Let us know how it goes.

Warm Regards,
Dr. Sara Wasserbauer

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How Does The Doctor Keep Track of The Grafts In a Hair Transplant Procedure?

I have already signed up to have a hair transplant at the end of July for 3500 follicular unit grafts and I began to wonder how do I know for sure that is the amount of grafts I will receive? Is each hair counted as it is placed in my head? ~ Hector
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Dear Hector,

Thank you for taking the time to write! This is an area that causes great confusion to patients, so let me try and clarify as best I can.

Hairs grow on your head in clumps of 1, 2 or 3 hairs (and sometimes even 4 or 5 but this is more rare). These clumps are a “follicular unit” and they are what is cut into “grafts” for your hair restoration procedure. (Yes, hair surgery is the only specialty where getting more “FUs” is a good thing!) Hair surgeons often use the terms “follicular unit” and “graft” interchangeably since, ideally, they are the same thing. However, this can lead to confusion for the patient.

Here is the problem; if a two-hair graft is cut into individual hairs, it can be implanted as TWO single hair grafts – even though originally it was supposed to be one single graft with two hairs! You see how easy it is to double the number of “grafts,” you just need to cut apart each hair in the “follicular unit”, even if it existed in a clump in its natural state. This is not the best situation for the patient since they will not get as much density in their final result. Only in rare cases would a surgeon resort to this (like for a hairline where single hairs are necessary to make it look natural) and a reputable surgeon would discuss this with you ahead of time.

So here is how you know for sure how many GRAFTS you will receive: ASK! A reputable hair surgeon will keep track of exactly how many grafts (and whether they are singles, doubles, or triples) your surgery yields for you. The grafts are counted before they are placed in your head since this is how the surgeon knows how many sites (holes) to make. If we did not do that as surgeons – then you would end up “going home with a hole in your head” I always like to joke… If you want to know how many individual HAIRS there are, you would just need to do the math. For example;

100 single hair grafts = 100 hairs
100 double hair grafts = 200 hairs
100 triple hair grafts = 300 hairs
Total GRAFTS= 300
but total HAIRS = 600

So the “take-home messages” here are; 1) that follicular units=grafts (ideally), and 2) that you can simply ASK to see the documentation of how many you get. Surgeons need an accurate count in order to make the right number of sites/”holes” to put them into – so this number is routinely documented very closely and entered into your chart. I hope that helps and good luck with your surgery!

Warm Regards,
Dr. Sara Wasserbauer

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Laser Hair Therapy

We are pleased to offer the Revage Laser System for both male and female patients! Using Rotational PhotoTherapy (RPT), the system contains 30 laser diodes that rotate 180 degrees around the scalp. By increasing the contact of the laser energy with the hair follicles. The Revage Laser is safe, fast, and painless, and is suitable for all hair types and skin colors. Call 925-939-4763 us today!

Learn more about Laser Hair Therapy

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