Surgical Hair Restoration of the Frontal Hairline

Robert Barretto (FUE Surgery 2105 grafts-Actual Patient of Dr.Ken Williams)

Hair loss is inevitable, and many men in their 30’s and 40’s can expect to lose their frontal hair in the few years ahead. Men already experiencing a premature aging to their appearance because of the loss of the frontal hairline (FHL), readily recognize the deficit of this critical landmark as the hallmark of an older or less youthful appearance.  But help is here in the form of surgical hair restoration, where hair is taken from the back of your head and transplanted to the balding areas of the scalp.

Recreating the FHL is one of the most common surgical procedures performed. The design and restoration of the FHL is intended to reframe the face and restore a youthful appearance. The surgical goal for this part of the face is for the casual observer to view the frontal hairline ascend into the mid scalp with a cosmeticly appealing density. The FHL is considered the area of the scalp most looked at during casual conversations, or more importantly in pictures.


There are two techniques used by hair restoration surgeons to transplant hair from one denser region of the scalp to less dense area.  These two techniques are known as Follicular Unit Extraction (FUE) and the Strip. There are advantages and disadvantages to each of these procedures and patients need to be aware of the differences. After understanding the differences in the surgical techniques, patients then need to find a competent hair surgeon  who can assist in the final decision making process.

“Surgical frontal hair restoration using the FUE technique is the most desired type of hair surgery. FUE  surgery gives a natural look and is minimally invasive.” Dr. Ken Williams


Many plastic surgeons, cosmetic surgeons, med spa owners, and even non-physicians such as aestheticians who own skin clinics,  advertise they perform hair surgery. The reality is there are many charlatans in the hair surgical field who have no business being in hair restoration surgery.  There are hair surgeons in private practice who have not obtained regular continuing education and training to be competent hair surgeons. Or even worse, as is documented in medical literature, these physicians purchased a hair transplant device without having any training and hire hair technicians to perform the entire hair surgery. Patients need to ask the question who actually performs the hair restoration procedure as well as the training and expertise of the physician. 


After deciding on the best hair surgeon and the ideal surgical technique for you as a patient, the next hair design decision involves determining the FHL placement. This is typically the distance from the glabella (the region of the forhead between the eyes) to the FHL.  The priority should be to recreate this height so it is age appropriate, and that it takes into consideration the progressive nature of hair loss and natural aging process.

Many patients believe they need the same placement of the FHL they once possessed during high school or college.  Although the request may be sincere, a low placement of the FHL will look unnatural, and should be avoided at all costs. The problem with too youthful of a placement of the FHL is it fails to give a natural appearance, and it requires more hair grafts. Thus, more grafts used to create a low lying FHL will deplete the donor site of follicles potentially needed at subsequent surgeries.

The second surgical decision to make is what should be the shape of the FHL look like. Some patients have a natural bell shape to their FHL while other possess a more rounded appearance. The bell curved hairline is for patients with a narrower head and where temporal hair loss is prominent. The bell shape also conserves valuable grafts because of a smaller surface area.  A round design is typically used for patients with a wider head and more stable temporal hair.

fhl design

(Illustration from HairTransplant 360- Sam Lam, M.D.)

The good news is hope is available for balding men and women with hair restorative surgery.   But according to Irvine, California hair restoration surgeon,  Dr. Ken Williams,  “The most important decision once you recognize you need surgery, is stabilization of any future hair loss with a consistent medical treatment program.”  He adds, “Laser therapy, Rogaine, a DHT inhibitor like finasteride are key components to any future hair surgery.”

For men and women suffering from hair loss, or are interested in hair restoration surgery, call Dr. Ken Williams and his staff for a personal and professional consultation. The Orange County Hair Restoration center, is conveniently located in the beautiful city of Irvine, California, adjacent to the Newport and Laguna Beach coasts. Our office number is 949-333-2999

logo-hair-restoration copy


NFL Football Great Wes Welker Talks FUE Hair Surgery

Walker footballNFL great and wide receiver for the Denver Broncos, Wes Welker, went public today helping  his hair surgeon, Dr. Robert Leonard, promote public awareness of hair loss surgical restoration.

The story began almost a year ago when Walker underwent hair transplant surgery in New England with a procedure called Follicular Unit Extraction (FUE). FUE is a surgical hair procedure that is a relatively newer surgical technique compared to the traditional Strip method of hair transplantation that leaves a donor linear scar. Using this surgical technique, patients are able to use their own natural hair and transplant it to areas of baldness in men and women.

The surgical procedure is an advance surgical procedure that requires excellent hand-eye skills and much patience.


Using the FUE surgical technique, individual hair follicles are removed “one-by-one” from the back of the scalp, and relocated to balding areas of the scalp. The procedure is performed under local anesthetic with optional light sedation if requested. The entire procedure for a large 2000 graft case typically takes 12 hours to perform. Hair survival rates approach 90-95%, and after waiting nine to twelve months, patient experience their own hair follicles emerging on previous bald areas of the  scalp.


There are only a handful of surgeons that actually perform FUE hair surgery. There is a growing concern among veteran hair transplant surgeons in the International Society of Hair Restoration Surgery (ISHRS), that new physicians entering the hair restoration field are hiring non-physicians to perform the entire hair transplant surgery. With little or no experience, physicians are allowing technicians to perform surgery.

Irvine hair restoration surgeon, Dr. Ken Williams, expresses his concerns, ” Technicians are not trained to monitor patients under sedation, give anesthesia, remove human tissue, or create the hair design.” Williams adds, “there are many surgeons who have purchased a FUE device, called NeoGraft, and are not following standard hair transplant practices. They allow technicians to perform the entire surgery and they are hurting patients.”

OC Hair Restoration Center is located in Irvine, California. The principle hair surgeon is Dr. Ken Williams, a leading FUE surgeon in the Western United States and whose hair surgical practice is primarily FUE based. He enthusiastically promotes FUE  “as a great procedure for younger men and athletes who want a shorter post-operative down time and who want to wear their hair short.  There is no donor linear scar with the procedure.”

For a consultation call (949) 333-2999 or visit our website at www.iimcs.org

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

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.


FUE Technology Workshop 2012

Dr Ken Williams of The Irvine Institute of Medicine & Cosmetic Surgery is honored to attend and speak at the FUE Technology Workshop and Hands on Experience in Denver, Colorado on August 4th and 5th.  The workshop is sponsored by The International Society of Hair Restoration Surgery and Hair Sciences Center of Colorado for hair restoration surgeons from beginner to advanced, who desire the opportunity to learn about mechanized FUE devices. There will be live FUE surgeries demonstrated by Dr Williams and other FUE practicing surgeons, as well as hands-on training and lectures.

Faculty and devices that will be covered:

James A. Harris, MD – ARTAS
Robert H. True, MD, MPH – Motorized sharp punch FUE system
Ken L. Williams, DO – Neograft
William D. Yates, MD – Powered SAFE System for FUE
John P. Cole, MD – Feller Motorized FUE punch
Scott Boden, MD and Bradley R. Wolf, MD – Hands-on lab/silicone models with various instruments
Ken Washenik, MD, PhD, Clinic Host

Automated FUE Hair Restoration: Patient Results

36 year-old male came into The Irvine Institute of Medicine & Cosmetic Surgery concerned about hair loss in his frontal hairline.  2000 grafts using Automated FUE technology were recommended to recreate and lower the frontal hairline.  2021 grafts were harvested from the donor site and transplanted to the frontal hairline.  The pictures above show the dramatic difference at only 7 months post op, with final surgical results at 12 to 18 months.