Category Archives: SURGERY

FUE Hair Transplantation-Challenges for surgeons

Derm SurgRecent Publication on FUE Hair Surgery-Dermatologic Surgery

Hair surgery techniques to redistribute hair to areas of alopecia include scalp reduction surgery; scalp and rotation flaps, advancement flaps, and free flaps; FUT by strip harvesting; and FUT by the follicular unit extraction (FUE) technique. The more aggressive hair surgical techniques such as flaps and scalp reduction are largely abandoned for cosmetic cases, but are used primarily in reconstructive surgerical cases from trauma and infection. The most common surgical method for hair transplantation is FUT either by the Strip technqiue or by FUE.

With the recent worldwide  interest of hair transplantation using FUE, many hair surgeons, plastic surgeons, dermatologists, and medical spa physicians are jumping on board. The introduction of this surgical technique into cosmetic practices is accelerated by certain FUE device manufacturers promoting a “turnkey” model for increasing the surgeons income.

But with the recent increase in physician training in FUE,  and an increase in consumer interest, new and different  challenges in the hair restoration field have emerged. The primary controversy is physicians with no formal training with this newer hair transplantation technique, and even worse physicians without any training or experience in hair transplantation; are contracting with non-physicians or hair technicians to perform the entire FUE surgical hair transplantation.


Irvine based hair transplant surgeon, Dr. Ken Williams, recently published in Dermatologic Surgery an article on this subject is entitiled: Current  Practices and Controversies in Cosmetic Hair Restoration.

In his paper, Williams “raises concern for the future viability, practice, and art of hair restoration surgery. The concept of physicians with outdated, minimal, or even no knowledge of hair restoration to allow nonphysicians (hair technicians) to perform hair surgery from start to finish is unethical and potentially criminal. In the view of many surgeons in the hair restoration specialty,it is inappropriate to advocate these “new” hair technician responsibilities.”

Even the worldwide medical society of hair surgeons, the International Society of Hair Restoration Surgery , has decided to establish best practices and standards by stating donor harvesting and expanding the duties of hair technicians is a “serious disservice to the patient.”

Todays medical literature reveals ample science-based evidence of the efficacy and reliable clinical outcomes of hair restoration surgery through the last few decades with Strip and FUE surgical techniques. Modern day hair transplantation began in the fifties using a now outdated technique where a 4mm circular manual punch removed  large pieces of scalp tissue containing numerous hair follicles causing an unnatural look. Today,  individual follicular units are removed and transplanted with motorized or robotic devices with a punch the size of the tip of a pen-1mm, and all patients can enjoy restoration of their hairlines with their own natural hairline.

Before Hair Surgery-Norwood 5-6

Before Hair Surgery-Norwood 5-6

After FUE Surgery

After FUE Surgery


Register to Attend FUE Palooza 2013


Attention Hair Restoration Physicians

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The International Society of Hair Restoration Surgery and Dr. James Harris are pleased to announce 2013 FUE-Palooza to be held in Denver, Colorado, USA, this August 3-4, 2013.

This is a one-of-a-kind hands-on experience to learn about and try various mechanized tools used for follicular unit extraction (FUE). Compare and contrast popular devices and decide for yourself which tool or tools suit you the best.

This workshop sold out last year. This course is anticipated to be in high demand, so if you are interested, we encourage you to register early.

Faculty and devices to be covered:

The program and registration form can be found at:

A.J. From Backstreet Boys Gets Hair Restoration Surgery“Some Girls get there boobs done some guys get abb implants all to make them happy!  This was the one thing I did and I couldn’t be happier thank u dr G!!!!” McLean, 35, wrote as the cation to an Instagram pic he posted showing the before and after results of his hair restoration surgery.


Facial Hair Restoration Surgery

6_facial-hair-styles-101_flashThere is a growing demand for hair restoration surgery in recipient areas other than the scalp.  According to the 2011 ISHRS practice census, 93% of  the recipient regions where new hair was transplanted into were the scalp; and  7% of procedures had non-scalp recipient sites. The non-scalp recipient sites are:

Slowly becoming more popular are procedures involving surgical hair restoration of the beard and mustache.   Beard growth typically occurs dramatically during puberty and continues to increase in density until the mid-thirties. The common causes for decreased follicular density in the beard and mustache areas include:

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Surgical facial hair restoration procedures are performed under local anesthesia with an oral sedative if desired by the patient. The procedure roughly takes 2 to 5 hours depending on the number of grafts harvested. For the first 5 days after the procedure, tiny crusts form around each transplanted hair, and careful attention the transplanted area must be given. By the second day, patients are able to travel home and resume non-strenuous activities. The transplanted hairs will begin to fall out at around 4 weeks, and then start to regrow at 3-4 months.



There are few risks or adverse events associated with these procedures.  Complications are few and excellent cosmetic outcomes are the usual results once the hair regrows. There are two surgical techniques used to remove the donor hair from the back of the scalp.  The most common hair surgical procedure excises a linear  strip from the back of the head. The second most common technique is Follicular Unit Extraction (FUE) where individual hair units are removed “one-follicle-at-a-time.” Both techniques are safe with excellent results, but a hair surgeon must be able to give you an opinion as to which technique may be better suited for you.

New FUE Device Added to Hair Surgery Practice


OC Hair Restoration Advances FUE Hair Surgery with Cole Device

Dr Ken Williams, of The Irvine Institute of Medicine & Cosmetic Surgery, recently traveled to the Atlanta suburb of Alpharetta, Georgia, to train with  Dr. John Cole on his recent and newly acquired motorized and computerized FUE device,  the Programmable Power Cole Isolation Device (PCID).

According to Dr. Williams, the PCID FUE device designed by Dr. Cole  is the latest and most advance motorized FUE device in the hair surgical marketplace.  ” Dr. Cole’s device is the best FUE device I have ever used when performing FUE surgery.  The punches are the best and the forces and torque used are ideal when harvesting hair follicles.”  He adds,  “this means my patients will have less follicular transection and a better results.  It also means less musculoskeletal strains, aches, and pain for me.”


Dr. Cole describes his device as, “…the only programmable unit available for Follicular Unit Extraction (FUE). The unit features a touch screen computer that sends input to the controller. The controller manages the custom-made hand piece.The hand piece accommodates our new surrounded punches, which are much sharper than anything else on the market.”

Dr Williams is so impressed with the PCID with its advance technology and ultra sharp punches, that he decided to make it his primary harvesting device for performing FUE hair surgery.  Dr. Williams notes a significant increase in his harvesting rates with a reduction in the follicular transection rate.  As Dr. Cole describes it, the PCID device is like an “advance race car.  The other FUE devices are fine but they are like tractors.”

Dr. Williams is a board certified primary care physician practicing hair surgery in Orange County, California since 2009. He was one of the first hair restoration practices in California to provide primarily FUE hair restoration surgery.  He is a clinical professor of family medicine at Western University in Pomona, California, and is an active member of the International Society of Hair Restoration Surgery.

Dr. Williams is one of a handful of surgeons in the United States actively engaged in teaching FUE to his peers.  At OC Hair Restoration, Dr Williams is the primary surgeon performing the hair restoration procedure harvesting hair grafts, creating recipients sites, administering and monitoring anesthesia, and placement of the follicular grafts. Unlike other hair restoration offices that hire technicians to harvest grafts and perform hair surgery without a medical license, Dr. Williams is active in all phases of hair surgery with his patients.

Click Here to watch a video demonstration of the PCID.


ISHRS Annual Meeting: Course Faculty

At the annual scientific meeting held in the in the Bahamas, the International Society of Hair Restoration Surgery (ISHRS) held their twentieth year of education, research, and collegiality at the Atlantis Resort on Paradise island.  The event was attended by almost one thousand physicians and associated professionals in the hair restoration field.

The annual meeting included didactical and hands-on courses, live surgery workshops, seminars, scientific sessions, and poster presentations.  The meeting was highlighted by lectures by Dr. Ralf Paus from the University of Manchester who spoke on “emerging therapies and strategies to induce hair growth,” and Dr. Bruce Morgan from Harvard University who discussed hair morphogenesis and follicular regeneration.

A workshop and hands-on course teaching Follicular Unit Extraction (FUE) to new physicians was given by hair transplant surgeons teaching both manual and motorized FUE techniques.   The course faculty was composed of international surgeons such as Dr Alex Ginsburg of Israel; Jose Lorenzo of Spain; Jean Devroye of Belgium; and  U.S. trained hair transplant surgeons such as Dr. Ken Williams of Irvine, California; James Harris, of Denver, Colorado; John Cole, of Atlanta, Georgia; William Rassman, of Los Angeles, California; and Sanusi Umer, of Torrance, California.


29 year-old male came into The Irvine Institute of Medicine & Cosmetic Surgery concerned about hair loss in his frontal hairline.  The patient began losing his widows peak at 22 years-old, he began taking Propecia several years later.  Patient desired to recreate his widows peak to restore his youthful looks. 1817 grafts were harvested from the donor site and transplanted to the frontal hairline using Follicular Unit Transplantation (FUT) Linear STRIP technique.  After the transplant procedure patient began using Rogaine 5% foam twice a day in addition to taking Propecia, as recommended by Dr. Ken Williams. The pictures above show the dramatic difference at only 9 months post op, with final surgical results at 12 to 18 months.