Hair Transplant

DR. EPSTEIN:  Hi!  I am Dr. Epstein.  I am here with my patient who is now eight days post-op.  We did 1,603 FUE grafts.  He had some pretty prominent frontal temporal recession.  You can see in just eight days how nicely he has grown in.  You see all these hairs in here.  This is where the grafts were placed.  He had a very high frontal temporal recession so most of this is transplants.  The same here.  

Let's take a look at the donor area because remember this was the incision-less technique.

He is back at work.  We had buzzed this.  He hair has obviously been growing back pretty quickly but you can see there is absolutely zero, really just about no detectable scarring.  He has a little bit of thinning right along the side but that is the area where the hairs were shaved.  Overall he looks great.

No one has been able to tell you had anything done, right? 

PATIENT:  Not at all. 

DR. EPSTEIN:  That's great!  Any words? 

PATIENT:  Great!  The staff is great and ultimately I will come back for more hair in the future.

DR. EPSTEIN:  This is Dr. Epstein with an FUE patient.

Posted by Jeffrey Epstein, MD, FACS

DR. EPSTEIN:  Hi!  I am Dr. Epstein.  I am with a patient who is now 10 months from a reparative procedure.  He had a bunch of hairline grafts.  He was unhappy with the unnaturalness of these some 1-hair grafts but mostly 2-hair grafts, 3-hair grafts and even some 4-hair grafts placed along the hairline.

As you can see from his before photograph, it was a very straight looking hairline, somewhat artificial looking.  You can see he was also concerned about the lack of density here.

What we did on him was we removed around 350 of these grafts right along the hairline.

Here is his picture from a couple of days post-op.  You can see all these little dots where the grafts were removed and here he is today 10 months later.

You can see he looks obviously more natural.  It is a more regular pattern.  It does not look like a solid line anymore.  He has a little bit of a little indentation in there and were are going to go ahead and do a little bit of work.  There is a little bit of lack of grafts there.

You can see overall he is happy.  He has gotten a nice improvement.

The plan is we will do a little more grafting on him but we do not need to do any more punch reductions or punch removals in his case.

To remove these grafts I use 0.8 mm or 1 mm FUE-type punch and we extract each graft one at a time.  The result is obviously what we see.  He is happy.

PATIENT:   I am definitely happy!

Posted by Jeffrey Epstein, MD, FACS

Hi!  I'm Dr. Epstein.  I am with a patient who had an FUE procedure.  He is just about a year out.  You can see he had a quite high hairline and what we did was basically bring down his hairline.

Here he is today.  You can see basically all these are FUE grafts.

He is here today for another procedure.  We are going to go ahead and reinforce this area.  He is very happy.  You can see all the grafts that we went ahead and filled.

Let's show the donor area.  You can see he has healed up really nicely.  He does not have an unlimited supply of donor hair but certainly enough for us to work with and we are going to go ahead get the 400 to 450 that we are going to do today.  That should not be a problem.

This is Dr. Epstein.  I am with a patient one year after an FUE procedure.  He is very happy and we are ready to do some more filling in.

Posted by Jeffrey Epstein, MD, FACS

DR. EPSTEIN:  This is Dr. Epstein.  I am here with an unusual case today, David, who hails from north Florida. 

David is 34 years old now.  When he was two years old he experienced a scalp burn.  He lost around 50% of his scalp.  Between the ages of 5 and 11 he underwent at least 6 or 7 procedures to reconstruct his scalp.  It has done a pretty good job and basically he has some hair coverage. 

What he does not like, and I understand this, is that he has still a fair amount of scarring up here.  You can see along this side as well.

What he basically has undergone is tissue expansion on this side and they brought this tissue expanded flap forward but it still did not make it all the way.  They also went ahead and did some type of flap, like a temporal parietal flap or a Juri flap from here and rotated around but he has this divergent direction of hair growth.  He has some scarring still here.  Lastly on this side he had some type of advancement done here as well on this peninsula but obviously it is not complete.

What I have explained to David is that what is really good in his situation is his donor hair is like top 10%.  He has really good hair with which to work.  We just have to figure out how we can move it from here up to here.

We have come up with a plan with what we are going to do.  Because he has a lot of scarring here, we do not feel that the hair grafts are going to have a very good chance of growing here plus it is scarred skin and is never going to look good.  We are going to do another cycle of tissue expansion.  We are actually going to put two balloons in, that is I anticipate two balloons.  One balloon is going to go up here and it is going to blow it up so this area is all stretched out.  What that will do is permit me to bring in this whole flap forward, cut out all the scar tissue probably up to here.

What we are going to do on this side is we are going to expand this area back here even though he has a scar there which will stretch out a little bit but at least we will get this and we will bring this forward so we get this down to like here.

Posted by Jeffrey Epstein, MD, FACS

Hi!  I'm Dr. Epstein.  We are all done with the hairline advancement procedure.  Her hairline is 5.5 cm.  It was over 8 cm so we have taken out around 3 cm. 

It is going to be a beautiful advancement.   Everything is just the way we wanted it.  I was even able to bring this forward a little bit.

If she decides, we can do a little bit of hairline grafting right along here and round out the temple areas when everything is healed.

This is done!

Posted by Jeffrey Epstein, MD, FACS

Hi!  I'm Dr. Epstein.  I am here with a patient who is a year and a half status post around 600 grafts to the perioral region, essentially the mustache and goatee regions. 

The patient has somewhat of an interesting history.  He was born with a cleft lip, surgery was done as a very young child.  He was left with a scar that was repaired later on but he was still left with what he felt was a visible and un-esthetic scar.  In addition, he had some fair amount of thinness throughout the whole goatee region. 

Let's take a closer look.  This is his before picture.  You see how thin his mustache was, very little in the goatee area. 

Now this is him today.  You can see we did a nice job in restoring the density throughout the mustache and the goatee areas.

He is here for a touch up.  He is still a little bit thin right here through the scar as well as here; but overall he has gotten a very, very nice result.  He is very happy with the naturalness as well as the density we achieved and the significant improvement.

Let me show you the donor area.  This also has healed up really nice.  He wears his hair quite short.  If you look really closely you can actually see the fine line scar right there.

In today's procedure what we are going to do is use that same scar.  I am going to cut out that old scar and just do some more filling in here.  In addition to help increase the percentage of hair growth in the scar area, we are going to be injecting some PRP (platelet-rich plasma), which is very high in growth factors.  We take a little bit of blood from him at the start of the procedure.  It helps with the donor site healing as well but I do not think we can get much better with that donor site result.  It was done with absorbable sutures so did not need to have them removed.

We are going to use some PRP injected actually into the area to help increase the take of the grafts.

Posted by Jeffrey Epstein, MD, FACS

Posted by Jeffrey Epstein, MD, FACS

Before		After
Before		After
Before		After
Before and after laryngochondroplasty (shaving of Adam's apple) along with one-step surgical hairline advancement in a MTF transgender patient

Posted by Jeffrey Epstein, MD, FACS

Absolutely. Typically a procedure of anywhere from a few hundred grafts to over 3,000 hair grafts can create chest hair or other body hair where there was not hair before. Of course, it is important that the surgeon create recipient sites typically in a cross patch pattern to provide the most deliberately irregular pattern of growth for the hairs. If the chest hair growth pattern is too regular, than there is a chance it will appear unnatural. It is important that the surgeon create a very irregular pattern of growth in order for the hairs to look the most natural.