Latest / HKB Uncut | A Cosmetic Surgery Podcast / 29. Hair Transplants Aren't What They Used to Be

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29. Hair Transplants Aren't What They Used to Be · HKB Uncut | A Cosmetic Surgery Podcast

• 0:00
  SPEAKER_00: If I came in to you to see for a consult for my hair, like what's your approach on hair restoration?
• 0:05
  SPEAKER_00: Or if you look at, you know, Billy.
• 0:07
  SPEAKER_02: We would use your hair on a liver transplant patient that's immunosuppressed.
• 0:10
  SPEAKER_02: You could be the donor, but you can't do that.
• 0:17
  SPEAKER_01: Welcome to HKB Uncut, the health, knowledge, and beauty podcast.
• 0:22
  SPEAKER_00: On this show, we unpack the newest techniques and trends in cosmetic surgery, how to tune out the social media noise to make empowered decisions about your appearance, and what you need to know before you book a procedure.
• 0:32
  SPEAKER_00: I'm Dr.
• 0:32
  SPEAKER_00: Bill Cortez, and I'm Goro Fahardi.
• 0:35
  SPEAKER_00: We are board certified plastic surgeons and co-founders of HKB Cosmetics Surgery, an award-winning practice with 11 locations across six states.
• 0:43
  SPEAKER_01: In other words, when it comes to aesthetics and cosmetic surgery, we've pretty much done it all, and we want to share our knowledge and unique approach to aesthetics and beauty with you.
• 0:52
  SPEAKER_01: Whether you're interested in cosmetic surgery for yourself or want to separate fact from fiction in the classic surgery world.
• 0:58
  SPEAKER_01: We hope you'll tune in next week.
• 1:13
  SPEAKER_00: Tim, you do a tremendous amount of everything aesthetic surgery, but one I know one of your passions is hair.
• 1:18
  SPEAKER_00: When did you start doing hair and kind of what kind of led you to that?
• 1:23
  SPEAKER_02: Well, it's a good question because when I moved to Oklahoma City, I moved next door to one of the world's experts in hair replacement, one of the original guys, his name was O Tar Norwood, and he was my neighbor.
• 1:34
  SPEAKER_02: And the day after I passed my plastic surgery oral exams, I went over and knocked on his door.
• 1:39
  SPEAKER_02: And this is early on a Sunday morning, and I said, O Tar, will you teach me hair transplantation?
• 1:43
  SPEAKER_02: He said yes.
• 1:44
  SPEAKER_00: That's amazing.
• 1:45
  SPEAKER_02: So we kind of we got together and actually um shared some office space for a while and um met his staff and then one of his younger uh staff members and I then when he retired, then we kept going.
• 2:01
  SPEAKER_02: So Clara Prather and I have been doing this since 1994, 95.
• 2:07
  SPEAKER_00: That's amazing.
• 2:08
  SPEAKER_02: Yeah.
• 2:08
  SPEAKER_00: You know, when you approach or, you know, for the listener, you know, who's who's uh concerned about hair or hair restoration, you know, can you uh just kind of walk us through kind of what what you tell a patient?
• 2:20
  SPEAKER_00: Like if I came in to you to see for a consult for my hair, like what's your approach on hair restoration?
• 2:26
  SPEAKER_02: Or if you look at you know, Billy We would use your hair on a liver transplant patient that's immunosuppressed.
• 2:31
  SPEAKER_02: You could be the donor, but you can't do that.
• 2:35
  SPEAKER_02: So, well, so basically uh we do men and women.
• 2:38
  SPEAKER_02: Obviously, men, male hair loss is traditionally testosterone driven.
• 2:42
  SPEAKER_02: Testosterone binds to this sebaceous gland and the hair follicle.
• 2:46
  SPEAKER_02: So the guys you knew in high school that were losing hair, they had testosterone receptors near the hair follicles, and over time the testosterone binds to the receptor.
• 2:55
  SPEAKER_02: It's very analogous to your prostate gland, and things get inflamed, and the hair follicle suffers because of it because of it.
• 3:02
  SPEAKER_02: Guys that don't lose their hair don't have the testosterone receptors in the traditional forelock area where guys lose hair.
• 3:08
  SPEAKER_02: Um, Norwood classified male the patterns of hair loss, you know, tried to kind of quantify it and put it into categories as to patterns of loss.
• 3:17
  SPEAKER_02: We see a lot of female hair loss now with women taking testosterone supplements because they too have testosterone receptors on the hair follicles, they just never manifested enough systemic testosterone levels to harm the follicles.
• 3:30
  SPEAKER_02: Uh women's hair loss can also be more autoimmune related.
• 3:34
  SPEAKER_02: Those are a different subset, and those are more difficult to treat with transplant because, for the most part, hair loss is a crop problem, not a soil problem.
• 3:44
  SPEAKER_02: If it makes sense that the corn, the root of the plant is inflamed at the root, it's not that the soil is not healthy.
• 3:51
  SPEAKER_02: When you get into autoimmune diseases in women, um, all those T cell-mediated things, that's oftentimes more of a soil problem, and you have to be careful on grafting because you don't want to graft hair that isn't going to survive or do well.
• 4:04
  SPEAKER_02: The ideal patient's going to be somebody that's um, you know, his genetics well enough that he can you can predict his hair loss moving forward.
• 4:11
  SPEAKER_02: If you have a 21-year-old kid who's already got really serious loss, that's not likely to be the guy that you're going to be able to complete over a lifetime.
• 4:18
  SPEAKER_02: You could get some grafts early, but you don't want to leave a patch of hair, and then when he's 50, you can't keep up with the loss.
• 4:25
  SPEAKER_02: So the ideal patients a little older, mid-30s or older, you can gauge how much hair they have in the areas where they don't lose their hair, the number of hair follicles per square centimeter, um, and look at the quality of the hair, if it's wavy, if it's straight, their hair color, skin color contrast, the pattern of loss that you're trying to feel, how big their head is, and then how many hairs per square centimeter you have, and you can kind of algorithmically figure out how many transplants they're gonna have in their lifetime and should they start, you know, are they a good candidate?
• 4:55
  SPEAKER_02: Because the goal would be having the guy look normal until he dies.
• 4:59
  SPEAKER_02: You don't want to put a patch of hair and then have it not look good.
• 5:01
  SPEAKER_02: You know, 30 years later, I'll be gone and you'll be regretting the advice I gave you.
• 5:06
  SPEAKER_01: What's your typical approach, Dr.
• 5:08
  SPEAKER_01: Love?
• 5:08
  SPEAKER_01: Do you do you have them immediately go straight to kind of the transplant?
• 5:14
  SPEAKER_01: Or do you say, hey, let's start with this shampoo, let's start with this medication, let's do these alternative treatments prior to the platelets work, um the LVD lights work, but they've been shown to kind of be temporary.
• 5:29
  SPEAKER_02: Um the the still the single best thing you could do for a male patient is a milligram of phenasterite a day to block that testin from testosterone from binding to the receptor and slow the loss and then manage it moving forward.
• 5:43
  SPEAKER_02: The the regenerative therapies that we have that are helpful are more selectively maybe approach applied to like postpartum loss in women who haven't reached the point where they're a transplant candidate, or in those patients who have autoimmune issues where you're not comfortable that they're a really good surgery candidate.
• 5:59
  SPEAKER_02: Most guys are gonna spend the money on transplants.
• 6:03
  SPEAKER_02: They're not gonna spend money on something that's a temporary, you know, fix.
• 6:08
  SPEAKER_02: Um but the one thing that's affordable is a milligram of finasterides about 90 cents a day.
• 6:13
  SPEAKER_02: And if you take a milligram of finasteride starting young enough, you can slow the loss.
• 6:18
  SPEAKER_02: If you ever stop it, you'll catch up with the loss where you would have been.
• 6:22
  SPEAKER_02: But that's pragmatically still the best, most efficient thing.
• 6:26
  SPEAKER_02: Everything else, topicals, LED lights, um, and any of the new biologic, you know, stimulators like platelet-derived products, and there's three of them your own, you can put it in a jar and inject it, or you can put it in a jar and rub it on there.
• 6:39
  SPEAKER_02: And any of the other topicals, monoxidyl and those types of things, they become a little bit labor-intensive.
• 6:46
  SPEAKER_02: They leave residue.
• 6:47
  SPEAKER_02: You can do it at night and wash it out in the morning.
• 6:49
  SPEAKER_02: But if you put it on your hair in the morning, oftentimes your hair kind of looks oily.
• 6:52
  SPEAKER_02: But the main thing is just the practicality of how often are in your life you're gonna spend time trying to protect your hair.
• 6:59
  SPEAKER_02: Most guys would rather spend, you know, let's say over five years they're gonna spend$1,500 or$2,000 on something that isn't a fix, they'd probably rather have that in graphs.
• 7:10
  SPEAKER_02: So we offer it, but not typically for the male who's fixable.
• 7:14
  SPEAKER_01: So how do how does a male who comes in, they're like, all right, doc, I've tried all this stuff, I'm ready for the transplant, how do they, how do you teach them about how many graphs they're gonna end up getting, how many rounds of of transplantation they're gonna have to do, how quickly can they do each round?
• 7:32
  SPEAKER_01: And am I gonna be able to have a full head of hair again?
• 7:35
  SPEAKER_02: Right.
• 7:36
  SPEAKER_02: I think certainly patient selection and then a plan and uh in um educating the patient on expectation regarding that plan.
• 7:46
  SPEAKER_02: And a lot of it's predictable again based on their age.
• 7:49
  SPEAKER_02: There's usually somebody in the family that you can kind of correlate.
• 7:53
  SPEAKER_02: You have a pretty good idea of where they're headed in terms of their hair loss.
• 7:56
  SPEAKER_02: You can look at family pictures, but there's usually somebody in there.
• 7:59
  SPEAKER_02: Sometimes they're one-off or they're adopted and they don't know.
• 8:03
  SPEAKER_02: But you can gauge um a lot based on the amount of hair they have.
• 8:07
  SPEAKER_02: And so there's guys that I started 30 years ago that would look like G.
• 8:11
  SPEAKER_02: You would have never known that they had started off with relatively early loss, but they had so many hair.
• 8:17
  SPEAKER_01: Do you think I can look like Dr.
• 8:18
  SPEAKER_01: Dr.
• 8:19
  SPEAKER_01: G, Dr.
• 8:20
  SPEAKER_01: Love?
• 8:20
  SPEAKER_01: You think I can get enough?
• 8:22
  SPEAKER_02: That if they have enough donor hair and they have the resources to do it, I don't have enough donor to fill.
• 8:28
  SPEAKER_02: Pragmatically, I think the average person is gonna do two transplants in their lifetime, and you want to pace those out and optimize where you put the graphs to get the most coverage.
• 8:37
  SPEAKER_02: So most people are gonna prioritize forelock over vertex because of the practicality of grooming and appearance issues.
• 8:44
  SPEAKER_02: Economics come into play.
• 8:46
  SPEAKER_02: You know, most people don't have a money tree.
• 8:48
  SPEAKER_02: Our pricing is very competitive because we're good and it's kind of an issue of the heart, but this is something that we want to be uh have available to people.
• 8:57
  SPEAKER_02: Adding technology with robotics and stuff sounds cool, but it doesn't add quality, it adds cost.
• 9:02
  SPEAKER_02: And we can get more into that when we get into technical stuff here in a minute.
• 9:06
  SPEAKER_00: Yeah, that that that's actually where I wanted to take this.
• 9:09
  SPEAKER_00: Um, Tim.
• 9:10
  SPEAKER_00: I was curious about kind of your um just generalized approach, but also your your your thoughts on kind of what is the state of the art when we think about the way that this is done, you know, whether it's strip or or FUE or robotic assisted.
• 9:26
  SPEAKER_00: Walk us through kind of maybe like the the history of that and kind of what you've done, what's coming, and maybe what's in the future.
• 9:33
  SPEAKER_02: Right.
• 9:33
  SPEAKER_02: Well, if you look at where it started, I think the first trair transplant was done in Germany in like 1833 or something.
• 9:41
  SPEAKER_02: Point is that modern day stuff evolved from larger graphs that were three to five millimeters, and it was kind of like trying to figure out can we do this?
• 9:49
  SPEAKER_02: And then they've gotten smaller and smaller, and the recipient site creation, whether it's done better, sharp or with a laser and all the things that have come and gone.
• 9:58
  SPEAKER_02: But practicality is still design of the hairline, creation of a plan that works for the patient long term regarding meeting and expectation.
• 10:08
  SPEAKER_02: So the ideal patient, if somebody could answer the phone, is um, you know, wavy hair on a guy with a good hair color, skin color contrast looks better than your dark hair on his white skin.
• 10:21
  SPEAKER_02: Dark, straight hair on a big white head is harder to camouflage than uh good hair color contrast.
• 10:26
  SPEAKER_02: Waviness covers better age of the patient and number of hairs you have available, and then their resources.
• 10:31
  SPEAKER_02: In regards to technique, if you look at the transplant literature, there's unequivocal, the best quality graft is still a hand-cut graft.
• 10:40
  SPEAKER_02: It's under magnification and you're hand-cutting the graft.
• 10:42
  SPEAKER_02: And the reason for that is the part that you want, which is the follicle, and the follicle units which are associated with sebaceous glands, need to stay paired or need to be cut single based on that microscopic anatomy.
• 10:55
  SPEAKER_02: So when you do a FUT, which is a strip harvest, you get it under the microscope and you can see the follicles that are ideally suited to be a single-hair graft, those that are better to be a two-hair graft, and we still occasionally do three-hair graphs on people of color with wavy hair.
• 11:10
  SPEAKER_02: You can get three hairs in a graph and it won't look doll-like.
• 11:13
  SPEAKER_02: You can't do that on some people because it the eye will pick up that those three hairs are a little bit close together when they heal.
• 11:20
  SPEAKER_02: So, but from the standpoint of graph cutting, where our big advantage is is Clara has been doing this for 35 years, and she's probably cut two million graphs in her lifetime.
• 11:31
  SPEAKER_02: And so let's look at the technology and what it brings to bear.
• 11:34
  SPEAKER_02: The technology basically replaces the technician who's really skilled with eye hand and tries to use technology to replace the graft cutting.
• 11:44
  SPEAKER_02: And the problem with that is the what you need, the follicle is buried two and a half millimeters below the skin.
• 11:50
  SPEAKER_02: And the robot or whatever visualization system that use on the punch graft, whether it's hand-driven or motor-driven, unfortunately can't line up the angle of that circular knife with exactly where the follicle is.
• 12:04
  SPEAKER_02: And the problem is you get wastage of grafts.
• 12:06
  SPEAKER_02: And everything in the hair transplant literature is about grading out graft quality.
• 12:11
  SPEAKER_02: You've got to cut around the graft with a circular punch, and then you have to extract it.
• 12:16
  SPEAKER_02: And there's risk for transection of the follicle with a circular knife, and then you have traction issues and injury to the follicle that can happen when you pull it out.
• 12:26
  SPEAKER_02: Once you have a graft in a dish and the solution to preserve it, then putting the grafts in is a little bit more pragmatically not disputed as to how you do it.
• 12:36
  SPEAKER_02: And respecting the hairline and the creation and the angle of graft placement is very important.
• 12:40
  SPEAKER_02: But the big the biggest controversy in hair transplant is how you harvest.
• 12:45
  SPEAKER_02: And I think that the technology-driven harvesting techniques have come from the broadening of the field into practitioners who don't know how to necessarily operate or don't know how to cut grafts, traditionally aren't comfortable with a scalpel and need technology to replace it.
• 13:02
  SPEAKER_02: That sounds very dogmatic.
• 13:03
  SPEAKER_02: We do FUE some, but the problems you get into with FUE is oftentimes you're going to have to shave the entire back of the head.
• 13:11
  SPEAKER_02: You're going to have to space out 3,000.9 millimeter holes over a big area.
• 13:16
  SPEAKER_02: And over time you get a moth-eaten appearance from that because those 3,001 millimeter holes don't heal.
• 13:22
  SPEAKER_02: They remain hairless.
• 13:24
  SPEAKER_02: If you harvest with a single incision, you do a trichophytic closure like on a facelift here, and your hair is going to grow through your incision line.
• 13:32
  SPEAKER_02: My incisions are usually one to one half millimeters wide, and oftentimes when you go back to re-excise to that same site on their second and third transplant, I've got hair growing through my incision line.
• 13:42
  SPEAKER_02: So if you look at scar mass and do 3,000 times one millimeter versus 1500, what do you 150 millimeters times one, the scar burden with my linear incision is less than the scar burden with FUE.
• 13:56
  SPEAKER_02: Also, once you've done FUE, you burden, you debulk the donor site enough to where at some point in time you can't go back and keep harvesting because then you've thinned the donor site.
• 14:07
  SPEAKER_02: With an FUT, I'm going to reuse that incision.
• 14:10
  SPEAKER_02: And you may say, well, I pulled the hairline up a little bit.
• 14:13
  SPEAKER_02: I've made the space smaller, but I haven't reduced the number of hairs per square centimeter in that donor site.
• 14:18
  SPEAKER_02: So it makes it very reusable.
• 14:21
  SPEAKER_02: Now, if you're hell bent on doing FUE, you can still do a strip technique, mark your strip, do your FUE in that strip, cut it out and close it, and have the best of both worlds.
• 14:32
  SPEAKER_02: And on the remnants that are left, you still need Claire or Tim to cut them.
• 14:35
  SPEAKER_02: You don't want to waste any hair, if that makes sense.
• 14:38
  SPEAKER_02: So FUE is replacing one of the four critical components, and it's replacing the most critical, which is the person who has the IN coordination.
• 14:48
  SPEAKER_01: How many graphs can you typically get with the strip method?
• 14:51
  SPEAKER_02: Well, I mean, I think if you were going to Turkey and they've got eight people working on you, and you're there for 14 hours, and you do a mega session.
• 15:03
  SPEAKER_02: Um, but I've gotten away from we usually do about 3,000 graphs per session.
• 15:09
  SPEAKER_02: And again, those could be one to three hair follicles.
• 15:11
  SPEAKER_02: So generally I think people are getting around 6,000 hairs.
• 15:15
  SPEAKER_02: But you got patient fatigue, you've got recipient site fatigue, and you've got technical fatigue, technician fatigue.
• 15:22
  SPEAKER_02: You can only make so many holes up here before you've burdened that recipient site to where you may get so much swelling and venous congestion that you get poor graph take.
• 15:32
  SPEAKER_02: We've fortunately never had a case with bad graph take, and we've never got I mean, no infections, not to say that it couldn't happen, and you got to monitor people, but you do them just like you're doing a major surgery and you take all those precautions.
• 15:46
  SPEAKER_02: But part of that is just exercising some judgment on.
• 15:48
  SPEAKER_02: We've all been there in surgery, and you know after a while you've worn your out your welcome.
• 15:53
  SPEAKER_02: It's like operating on anything that's you don't want to overstress the recipient site.
• 15:58
  SPEAKER_02: And so our average day is 3,000 graphs, and again, probably around 6,000 hairs.
• 16:04
  SPEAKER_01: And what's the length of time for that procedure?
• 16:07
  SPEAKER_02: It's usually about a six-hour day.
• 16:09
  SPEAKER_02: And it's local though, right?
• 16:11
  SPEAKER_02: Yeah, well, we give 20 of them if they want it, and we put bicarbonate local to where it doesn't sting when we numb them up.
• 16:17
  SPEAKER_02: It's a very pleasant day.
• 16:19
  SPEAKER_02: We used to have a movie catalog and a TV, and now they can just watch on their phone or their iPad if they want to entertain themselves.
• 16:25
  SPEAKER_02: We try to discourage them from doing business on their phone while they're but it's you know, most of them can be done under straight local.
• 16:32
  SPEAKER_02: It's just kind of a long day.
• 16:34
  SPEAKER_02: And I think the early part's a little anxiety-provoking.
• 16:37
  SPEAKER_02: So if you give them a little bit of volume and they snooze for the first couple hours, then we feed them a little breakfast and we keep working and they eat a little lunch and and they go home.
• 16:45
  SPEAKER_00: What's the what's the course afterwards?
• 16:47
  SPEAKER_00: Can you walk uh well, how do you walk your patient through, say, hey, this is what it's going to be like?
• 16:51
  SPEAKER_00: What's the natural course for like that transferred hair?
• 16:53
  SPEAKER_02: I've had it done twice.
• 16:55
  SPEAKER_02: And uh you want to sleep elevated, so you minimize as much as you can the swelling.
• 17:00
  SPEAKER_02: Gravity's not your friend.
• 17:01
  SPEAKER_02: I use a little airline pillow, so I wasn't resting back on my donor site.
• 17:06
  SPEAKER_02: Uh, we usually hit them again with Marcane right before they leave.
• 17:09
  SPEAKER_02: I offer expril, but nobody wants to spend$600 on a long acting local.
• 17:13
  SPEAKER_02: They'd rather have the graphs.
• 17:14
  SPEAKER_02: Um and Advilin Tylenol and usually one opiate prescription.
• 17:18
  SPEAKER_02: Now we've got Journavax.
• 17:20
  SPEAKER_02: If they want to do Journavax instead of a, you know, one prescription.
• 17:24
  SPEAKER_02: But we never nobody, I mean, it's having had it done, you know, it's one of those things that sends not to bug you too much until you turn the lights out, and it's time to, you know, you can go to sleep, and then you notice it more, and it's tight.
• 17:36
  SPEAKER_02: So I um elevation, um get them out happy, not um hurting, and then start them alternating every four hours on advil tylenol, and judicious use of an opiate for the first few days.
• 17:49
  SPEAKER_00: And then how about so then after, when can they like wash their hair and put a hat on?
• 17:53
  SPEAKER_02: Usually if they're coming in from out of town before they go to the airport, they come in the next morning and Claire will shampoo them and show them around.
• 18:00
  SPEAKER_02: If they live local, that's easy.
• 18:02
  SPEAKER_02: We can communicate virtually.
• 18:04
  SPEAKER_02: Um we do sutures and they come out at 10 days on the donor site.
• 18:09
  SPEAKER_02: But you can uh on mine I showered lightly the next day.
• 18:12
  SPEAKER_02: You just kind of suds up water and putts the graft and pour gently.
• 18:16
  SPEAKER_02: You don't want to scrub.
• 18:17
  SPEAKER_02: And for the first week, you're not you're showering, but you're not spraying the water right on your head, and you're just kind of trying to treat them gently.
• 18:24
  SPEAKER_00: You know, I I tell patients that it's like um when you take a beautiful tulip out of the ground and take it with the bulb and put it somewhere.
• 18:32
  SPEAKER_00: Um, can you explain kind of what happens with the hair?
• 18:35
  SPEAKER_00: So you do the hair, the hair transfer, then what happens after that first two, three weeks?
• 18:39
  SPEAKER_00: What what what do they get hair immediately?
• 18:41
  SPEAKER_00: What does it look like?
• 18:42
  SPEAKER_02: Yeah, well, so most, I mean, I think you would tell there are times that I'm sure that we haven't had the effluvium or the follicle shed, but I mean it's logical that you've taken it and you transplanted it.
• 18:54
  SPEAKER_02: And at any one time, if you rub your hand through your head and hair comes out that looks pretty normal looking, that's just your hair going into resting phase, and about 10% of your hair follicles are doing that cyclically throughout the year.
• 19:06
  SPEAKER_02: You can kind of put them all on the same shedding calendar by having manipulated them.
• 19:11
  SPEAKER_02: So we tell people to expect that little two millimeter stub of hair that we trimmed when we put the graft in will probably shed when the scabs come off at 10 days.
• 19:22
  SPEAKER_02: And then usually hair is going to be about an inch and a half long by six months.
• 19:26
  SPEAKER_02: So on both of my transplants, my barb, my guy that cuts my hair, felt like he was trimming grafts for the first time about six months post-transplant.
• 19:35
  SPEAKER_02: And it's variable.
• 19:36
  SPEAKER_02: I mean, I think it's probably better to tell people that this is a 12 to 18 month.
• 19:42
  SPEAKER_02: You know, um, if you've got somebody who's older or have some other health issues, but generally speaking, they're going to see growth at six, and when we tell them it should be pretty full by 12 to 14.
• 19:52
  SPEAKER_02: And in terms of repeating an episode, we've got an ex-marine we did last week that he wants we wanted the front done, and he wants to get this back as soon as he can.
• 20:02
  SPEAKER_02: So we kind of staged it differently.
• 20:04
  SPEAKER_02: Instead of spreading all of his grafts over the whole area and then doing that a second time in a year, we're gonna we did the front, and then we're gonna come back and do the back sooner because it's the recipient site swelling and stiffness that has to go away before it's ready to be grafted again.
• 20:22
  SPEAKER_02: So if you're gonna repeat grafts in the same area, I would say we do it at a year.
• 20:26
  SPEAKER_02: But the key there is the scalp has to be expansile, the scalp has to be have capacity.
• 20:32
  SPEAKER_02: You know, the best scalp is the spongy one that can expand in it and receive that extra volume.
• 20:38
  SPEAKER_02: Mine's real thin and tight.
• 20:40
  SPEAKER_02: So if she would, Claire would put a graft in and one would pop up.
• 20:43
  SPEAKER_02: So the really good patients are they have that thick, spongy scalp and there has a lot of capacity, kind of like the venous system.
• 20:49
  SPEAKER_02: You know, it can dilate and accept the volume.
• 20:52
  SPEAKER_02: And so you just have to gauge if you're gonna do a series on people, the timing to where you don't do them sooner too soon and they waste their effort.
• 21:00
  SPEAKER_00: When they're when they're all done, Tim, what do you what do you recommend that they do afterwards?
• 21:04
  SPEAKER_00: Obviously, they're gonna do propecia, right?
• 21:07
  SPEAKER_00: And then are they doing any and that's it, okay.
• 21:10
  SPEAKER_02: Practically, I mean we use plated, and if we've got some we've had several people that were like burn scars or bad outcomes before, we will pre-treat with nanofat and platelets.
• 21:21
  SPEAKER_02: We've had several people that like we're we're putting hair in a skin graft on a scalp, and we thicken it up with micro nano and give it three to six months and beef it up to where we've really got something reliable to graft into.
• 21:35
  SPEAKER_02: Like we've got a girl right now that had a she had her hair lightened and it was a persulfate hydrogen peroxide burn, and she's got about a four by three centimeter area, and it's just like thin epidermis on bone.
• 21:48
  SPEAKER_02: We're gonna have to build her out.
• 21:50
  SPEAKER_02: So we'll get it done, but you know, you have to kind of prepare the recipient site.
• 21:56
  SPEAKER_01: And for your out of town patients, you know, how how long?
• 22:00
  SPEAKER_01: Do you tell them to stay in town for before they can fly, travel?
• 22:03
  SPEAKER_01: Travel the state.
• 22:04
  SPEAKER_02: They're usually here.
• 22:05
  SPEAKER_02: They fly in, we do them, we see them the next morning and they go home.
• 22:08
  SPEAKER_01: And Tim, what's your advice for you know individuals looking for this?
• 22:14
  SPEAKER_01: Is this something that, you know, every man with hair loss should do?
• 22:18
  SPEAKER_02: Yeah, that's a good question because I've got a couple of guys that have turned into friends that Claire kind of convinced me we ought to do them.
• 22:24
  SPEAKER_02: You kind of have to read the room.
• 22:26
  SPEAKER_02: These guys were one guy's a a big livestock guy in Western Oklahoma, and he's this cowboy, and he didn't have a lot of donor hair, but he was so happy to get a little bit of hair.
• 22:38
  SPEAKER_02: So we went back and showed case examples so he could really visualize, recognizing that he didn't have a lot of hair, but a little bit of hair to him.
• 22:46
  SPEAKER_02: So if if you feel like you can communicate that, I think meeting the expectation is the key.
• 22:51
  SPEAKER_02: I think that not everybody's gonna have a head of hair like Dr.
• 22:54
  SPEAKER_02: Garov there, because they don't have that amount of hair to move.
• 22:58
  SPEAKER_02: Maybe they never had that hair to begin with, but you just gotta, just like any other surgical plan and any other surgery that we do, you gotta get to know people and establish the plan and communicate, and it works out.
• 23:10
  SPEAKER_01: You know, I've had one myself, um, Tim, and I'll tell you when I when I consult with our male patients, I let them know that it's kind of a no-brainer in all honesty.
• 23:20
  SPEAKER_01: If they're willing to take the little bit of downtime that's associated with the procedure and they have a little bit of money, I think it's well worth it, to be honest with you.
• 23:29
  SPEAKER_02: Yeah, I think the male patient, um, hair, upper eyelids, something on the neck, gynecomastia, and liposuction of their abdomen and love handles.
• 23:39
  SPEAKER_02: I mean, there's some things that you can do that are bona fide, you know, true things that can really benefit you to make you look younger and more relevant.
• 23:50
  SPEAKER_02: Um, you know, the myelovate thing in men has been remarkable because nobody wants beard hair back here behind their ear.
• 23:58
  SPEAKER_02: And you see all these male facelift patients that come in, and I see a lot of them because I'm doing their hair and they're really happy with how they look from the front, but the problem is they've got beard back here.
• 24:07
  SPEAKER_02: So um guys tend not to be as indulgent for sure as women.
• 24:12
  SPEAKER_02: Hair is an easier sell, oftentimes, than anything on face.
• 24:16
  SPEAKER_02: But usually the hair guy, I saw one the other day, he's kind of a guy of some notoriety here in town.
• 24:22
  SPEAKER_02: He came in for face and he's had one hair transplant done years ago.
• 24:27
  SPEAKER_02: So I went the other direction and go, I get well, let's work on your neck, but why don't you put some more hair up there?
• 24:31
  SPEAKER_02: But those are things that are just easy, and generally, guys are gonna look eight to ten years younger, and it's a real natural thing.
• 24:38
  SPEAKER_02: It's like I said to you, like you said, I think it's kind of a no-brainer.
• 24:42
  SPEAKER_02: But you have to, you know, you have to educate them.
• 24:44
  SPEAKER_00: You know what the I I agree though, guys.
• 24:46
  SPEAKER_00: I mean, that for the guy, the male aesthetic, and and women too, but males tend to manifest it more by uh restoration of the hairline or or replenishment of hair, like it is like it's one of the the key uh features that we have.
• 25:01
  SPEAKER_00: And so when you address that, I mean it's pretty cool when they come back.
• 25:04
  SPEAKER_00: And I mean, Tim, you probably have countless number of stories when they come back and they're just like they're just happy, they're smiling, they're confident.
• 25:10
  SPEAKER_00: Like, I mean, it's a it's a good feeling.
• 25:12
  SPEAKER_00: I mean, I'm sure you you get that sensation when you and you look at their before after, you're like, whoa, this is a good thing.
• 25:17
  SPEAKER_02: Yeah, and you know, the other thing too is is that they're like one of my best friends, we did him 25 years ago, and he's got that wavy hair.
• 25:25
  SPEAKER_02: And you know, Tommy could tolerate it, benefit from another graph, but he's just so happy with that he has because it's it's enough hairline for his age, it looks very normal, and it does, you know, he's not you didn't you identify him as being bald, you just kind of identify him as age appropriate with an attractive hairline, if that makes sense.
• 25:44
  SPEAKER_01: So I just need to roll to OKC then to have you do my second one.
• 25:48
  SPEAKER_02: Well, so the thing to remember on the second one, I scrubbed all day, so I you know I'm I'm a mess, but I got pretty shiny right here, and you're gonna have some temporary shock loss on a second because now you're kind of, you know, you the first one when you're pretty thin, you're grafting into, you know, pretty bald scalp, and there's not much negative if you get some temporary fallout.
• 26:09
  SPEAKER_02: So, second transplants and women, you have to make sure you educate them to what to expect when they do take a step back.
• 26:16
  SPEAKER_02: I have a really good friend from church that I see at the golf course, and she was already wearing a wig, and we did her, but even though she had progressed to the point where she had worn a wig, even that little bit of a temporary setback at six weeks really was a crisis for her.
• 26:30
  SPEAKER_02: Now she doesn't wear a wig and she's really happy.
• 26:32
  SPEAKER_02: But expectations on second transplants are a little bit different than first transplants, particularly with women, particularly with the girls.
• 26:41
  SPEAKER_02: You gotta they got gyped, they're not supposed to have to have this surgery.
• 26:45
  SPEAKER_02: But she still loves me, and I saw her at church on Sunday, so we're fine.
• 26:50
  SPEAKER_00: Well, that what a what a great um episode talking about hair and hair restoration.
• 26:54
  SPEAKER_00: Tim, you're a you're an expert in this man.
• 26:57
  SPEAKER_01: Really enjoyed listening to you and hearing you talk about this.
• 27:00
  SPEAKER_02: Well, I've got some ideas on how maybe we can broaden it.
• 27:03
  SPEAKER_02: I think replicating Clara is going to be difficult.
• 27:06
  SPEAKER_02: I think replicating a FUE within the FUT excision pattern is a way to broaden accessibility for HKB as a whole, because I think teaching the hairline creation and the recipient site and graph placement is an easier technical thing to teach than graph cutting.
• 27:25
  SPEAKER_02: And if you could use the technology and get good quality on the graft harvesting and still then benefit with a linear excision and use your facelift closure, then we've kind of got a way to broaden the applicability.
• 27:45
  SPEAKER_02: So I'm working on that.
• 27:47
  SPEAKER_02: We have to get a group of surgeons that would be willing to spend an hour doing the harvesting because FUE is a little bit more, it's a little bit boring because you're so repetitive in the harvesting motion in comparison to cutting the strip, if that makes sense.
• 28:02
  SPEAKER_00: We appreciate everybody um joining us today and look forward to talking again soon.
• 28:07
  SPEAKER_02: All right, well, thanks for having me.
• 28:12
  SPEAKER_01: Thank you for listening to HKB Uncut.
• 28:15
  SPEAKER_01: If you enjoyed this episode, please subscribe to us on Apple, Spotify, or YouTube.
• 28:19
  SPEAKER_00: To book a surgery consultation or med spa appointment with our team, visit our website at hkbsurgery.com or head to the links in our show notes.