B B B u s i i n n e e s s s s s s E d d d d u u c c a a t t t t i i i o o o n n n n f f f f o o o o o r r r M M M M e e e e d d d d i i i c c c a a a a l P r a cti tio n e r s Macrene Alexiades- Armenakas, MD Clinician, Researcher, Entrepreneur Plus: Employee Selection Laser Vein Treatment July/August 2013 $5.00 Volume 9, Number 4 medestheticsmagazine.com NEW WHAT’S Removal Plumes? in Hair Restoration LURKING in Laser Hair ADVANCES
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Macrene Alexiades- Armenakas, MD4d1hkmgkfyq3nu45k2kso51x.wpengine.netdna-cdn.com/...Innovations abound in the field of hair restoration. THE ART AND SCIENCE of hair restoration has
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from the donor site—usually the back of the head—and
cutting it into individual grafts under the microscope. The
surgeon then implants these individual grafts of one, two or
three hairs into the bald areas of the scalp, in a pattern that
mimics natural hair growth. Over the next year these grafts
begin producing hair that blends in with existing hair.
Follicular Unit Extraction (FUE) harvests very small sam-
ples of hair—as small as one to four follicles at a time—with
a micropunch method. This eliminates the horizontal scar
at the back of the head that’s produced by strip surgery.
Initially, grafts harvested with this method had a high failure
rate. “One problem was that when using a sharp punch
you can damage a lot of the follicles, because the follicles
underneath the surface of the skin, their direction and
confi guration, don’t always match with the hair that’s com-
ing out of the skin,” explains Dr. Harris. In an attempt not
to damage the follicles, surgeons using the original punch
technique would penetrate only 2mm to 2.5mm, resulting
in more bruising and trauma.
Dr. Harris developed the SAFE system for FUE, which
uses a blunt-tipped dissection device powered by a small
motor. The SAFE system extracts hair follicles at a depth
of 4mm. “This allows us to separate those follicles a little
bit better and makes it easier to get the grafts out of the
skin,” he explains. The system also speeds up the extraction
process. “We’ve been using the motorized version of the
SAFE system for around 3½ years now, and it’s allowed us
to speed up the process,” Dr. Harris says. “If the conditions
are right I can dissect maybe a thousand grafts an hour by
hand.” A typical transplant might involve from 1,000 to
3,000 or more grafts.
Dr. Bauman and Richard Chaffoo, MD, FACS, use the
Neograft (neograft.com), a rotating, mechanical punch aid-
ed by suction to extract individual hair grafts. “The Neograft
system harvests up to 600 grafts per hour,” says Dr. Chaf-
foo. “There are no sutures and the graft sites heal within a
week of transplant surgery leaving no visible scar, allowing
patients to wear their hair quite short.” He uses the device
to restore receding hairlines, reconstruct eyebrows and
camoufl age existing scars.
The latest innovation in FUE is the ARTAS Robotic
System (Restoration Robotics, restorationrobotics.com),
which takes the physical act of harvesting grafts out of the
doctor’s hands and turns it over to a robot. The robot aids
in mapping the grafts, then performs the procedure quickly
and automatically, under the supervision of the physician.
“The robot has defi nitely brought in a new way for doc-
tors who want to provide this procedure to be involved,”
says Dr. Harris. “When you do it by hand, it’s a fairly taxing,
time-consuming process, removing grafts one at a time.
It requires some training to do. You need excellent vision
and eye-hand coordination. Frankly, not all physicians want
or are interested in investing the months and years that it
takes to learn this. For them, acquiring a robot would be an
excellent option. With a couple of days of training, they can
extract grafts at a very rapid rate, of very high quality.”
Once the grafts are harvested, no robot as yet will
implant them for the physician. That takes skill, and a
signifi cant bit of artistry. “The most important part is not
really the tool or the technique,” says Dr. Bauman. “It’s
how we recreate a natural-looking hairline and density by
mimicking the natural patterns of hair growth. It’s not just
‘close your eyes and plant the hair.’ Every single follicle
has to be angled in the right orientation and positioned
to get the right-looking result.” He estimates he spent
10,000 hours developing the necessary skill.
Treatments for Women
Traditional advertisements for hair restoration have tar-
geted men. From famous actors to sports stars, bald men
are everywhere, so it’s a common and familiar condition.
But one of the fastest growing patient populations for hair
loss clinics is women.
Dr. Ziering estimates that about 50% of the patients he
sees are women, and about 20% of his surgical patients
are women. “We also do eyebrow replacement surgery
and about 75% of those patients are women.”
While many men face androgen-related male-pattern
hair loss, there’s no one mechanism responsible for
the majority of women’s hair loss. “Some of the treat-
ments that men use, such as Propecia, may not work for
women,” says Dr. Harris. Hair loss in women may be due
GROWING POSSIBILITIES
24 JULY/AUGUST 2013 | MedEsthetics
PH
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Before After
Hair transplant surgery results have improved dramatically with new devices that aid in harvesting grafts. This patient underwent surgery using the Neograft system.