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Principles of Crown Hair Restoration

Bernardino Arocha, M.D., ABHRS — Sun, 31 May 2009 21:00:00 GMT

Principles of Crown Hair Restoration

Two factors are operant in the crown of hair loss restoration candidates:

1. The crown, or top of head, is circular in shape so as Male Pattern Baldness advances, the crown radius increases. The area of the crown hair loss increases exponentially since it is equaled to πr2 as seen in the image below.

To see how this affects the demand on the number of follicular units required to achieve thin, medium and dense coverage of the crown see the table below:

Effect of Crown Diameter on area
Crown Diameter (cm)	Crown area (cm²)	% Change	# fu (T,M,D)
10	78.5	-	1570 2747 3925
12	113	44	2260 3955 5650
14	154	36	3080 5390 7700

2. Part of the crown is vertical so it becomes a billboard; with light hitting it appears thinner and see-through. Flat surfaces like the mid scalp and frontal zones can benefit from the shingling effect, hence less density is necessary.

But it is not as simple as just that, because Male Pattern Baldness, "MPB", can be chronically progressive, one has to leave a safe buffer reserve in case it is in the genes of the hair restoration patient.

That is not to say, crown restoration should not be attempted as it can be a viable hair loss treatment. A Crown Hair Transplant can be done safely and effectively in the proper patient as long as proper informed consent is given regarding the above operant factors. In the wrong patient hair islands can be created. These result when the crown is restored and subsequent hair loss creates a zone of alopecia hair loss around the island transplant. Again, hair characteristics play a pivotal role in hair restoration outcomes and should be discussed with your hair restoration professional.

To discuss options for reducing the effects of crowning and hair loss, contact Dr. Arocha for a consultation regarding Male Pattern Baldness at 713-526-4247 or in Dallas at 1-888-723-HAIR.

Learn more about Male Pattern Baldness and it's causes.

31-May-09 4:00 PM

The Hair Loss Headline - April 2009

Dr. Bernard Arocha — Tue, 28 Apr 2009 21:00:00 GMT

News from the industry’s top experts. All rights reserved.
Vol. 4 Number 1 April 2009

An update with Dr. Bernardino Arocha of Arocha Hair Restoration in Houston Texas. Dr. Arocha also makes himself available for Hair Restoration Surgery in Dallas. He is affiliated with the International Society of Hair Restoration Surgery and is a Diplomat of the American Board of Hair Restoration Surgery, as well as the American Academy of Cosmetic Surgery among others.

HH – Dr. Arocha, what’s new with you?
DA – I was interviewed on NBC-5 in Dallas on female hair loss – and the differences between male and female hair loss.
HH – Did they interview a patient?
DA – Yes and they did a great job. Her before and after results were shown.
HH – What was this patient’s main problem?
DA – She had female pattern baldness – hairloss due to genetics.
HH – Is that much like male pattern baldness and is it treated the same?
DA – The pattern in women is different than men. Men usually lose their hair in front, but women –usually retain the hair line and thin behind to include the frontal and mid scalp areas in Ludwig I and II.
HH – What were your challenges when she first came in to see you?
DA – She had severe thinning on the top of the head which is typical of female pattern hair loss for a women.
HH – Does this kind of surgery require different skills for women?
DA – Well, some 30 million across the U.S. suffer from hair loss and only recently are women seeking out transplantation as a choice. But more women than ever are going this way? The surgery itself can accelerate their hairloss, but I work with them and have refined the technique to minimize the extent of the injury due to surgery and maximize the density of the follicular units transplanted.
HH – Why did it take women so long to see a transplant doctor?
DA – I think it’s because they can get away with thinning hair longer – because of styling. Women don’t actually go completely bald – it’s more a progressive thinning. However a smaller percentage do progress to a more advanced stage a Ludwig III. This stage is characterized by more severe thinning on top and an unstable donor.
HH – What would you say to a female with thinning hair?
DA – The message is that the technology and science has advanced to where we can restore density where they need it, so it facilitates their styling options – while remaining natural and undetectable.

Patient Carol And Her Hair Loss Problem
HH – Carol – When did this all start for you?
Carol – I began noticing a thinning hair problem in my late 30’s. It settled down, but when I hit my mid-50’s – I noticed how thin it was.
HH – What did you try?
Carol – A number of alternatives – I tried Minoxydol, but looked into hairpieces and hair extensions – those types of things. I bought several wigs. In the summer, they were way too hot.
HH – Yes, they can be uncomfortable in the summer.
Carol – That’s right. And they look good in the short term.
HH – Then what?
Carol – Initially, I didn’t think hair transplantation wasn’t for me. I had known a few men who had transplantations back in the 1970’s and they look bad – and that always stuck with me.
HH – Interesting.
Carol – Yes, but as I looked into the other alternatives as mentioned, I started looking back into transplantation.
HH – Did you go to a dermatologist?
Carol – Yes – and he originally put me on Minoxidil. He had diagnosed me with pattern baldness. Ludwig 3 was diagnosed and that’s pretty severe. I began doing more homework – and talked to several transplant doctors.
HH – Then what?
Carol – I finally contacted Dr. Arocha and he confirmed that I had pattern baldness. I saw his work and was convinced this is what I wanted.
HH – How many sessions have you had?
Carol – One up to now.
HH – Does baldness run in your family?
Carol – My mother and two of her sisters have dark, thin and stringy hair and my father is bald. My thinness was on the crown and forward.
HH – Sounds like it was in the cards.
Carol – Now I know what men struggle with. I’m glad I did the transplant and it seems to look just great.

The Hair Loss Headline/Temecula, California.

28-Apr-09 4:00 PM

The Hair Loss Headline

Bernardino Arocha — Wed, 28 Jan 2009 21:00:00 GMT

An update with Dr. Bernardino Arocha of Arocha Hair Restoration in Houston Texas. Dr. Arocha also makes himself available in Dallas. He is affiliated with the International Society of Hair Restoration Surgery and is a Diplomate of the American Board of Hair Restoration Surgery, as well as the American Academy of Cosmetic Surgery among others.

HH – Dr. Arocha, it’s been a few months since we last spoke with you. How are things with Arocha Hair Restoration, which was then, a brand new company?

DA – Looks like the word has gotten out about our artistic approach to hair restoration.

HH – That’s great news. Tell us more.

DA –We have become a fulltime mega session center, performing the most challenging surgeries of the advanced stages of male pattern alopecia. These large mega sessions are performed while maintaining the highest standards of ultra-refined follicular unit transplantation. Some of these cases are as large as 6000 follicular units.

HH – That’s big!

DA – Yes. And I did someone with advance hair loss, a Norwood 7 with very limited donor density.

HH – To put it in general terms, a Norwood 7 is someone with extreme hair loss and someone most transplant doctors would not touch.

DA – That is correct, but my team and I enjoy the challenge.

HH – We’ll be talking to that person in this edition, but tell us more from your perspective.

DA – Well, this patient did have extreme hair loss – probably the most I’ve ever seen in my many years in this business, but I was still able to make thousands of transplanted grafts available. It was amazing and I’m proud. He seems very happy!

HH – So in essence, you can help just about anybody. It doesn’t matter how severe the hair loss problem. With the techniques you incorporate, anyone can be helped.

DA – That is true. Today, that is now possible, where I’d say – a few years ago, it wasn’t.

HH – Quite amazing. Also, you’ve seen a nice share of alternative transplants over the past few months. Tell us about that.

DA – Oh yes – eyebrows and some eyelashes.

HH – Tell us more about eyelashes – what’s a patient asking for?

DA – Some have a congenital absence or a sparse growth so we can increase their eyelash density and give the patient longer and more luxurious eyelashes.

HH – Where do you find donor eyelash hair?

DA – Behind the ear and some parts of the neck. Hair caliber always matches the patient’s needs.

HH – In 2008, do you see more alternative transplantation?

DA – Yes, I think there’s a growing awareness of the public to enhance the framing of the eyes, which makes alternative transplant more relevant.

HH – Sounds exciting! Thanks for your time today and we’ll be speaking with you before the end of the year.

Patient Jorge First Tried Everything Under The Sun…

HH – Jorge, how old were you when you first noticed you had a thinning hair problem?

Jorge – Around the age of 28, some 9 years ago.

HH – When you first began, what were your options? What have you tried?

Jorge – I was one of those who fell for the quick sell on TV and magazines. I used this shampoo that was actually made for horses, but the ad said it would also work on humans to make hair grow.

HH – That’s interesting. Go on.

Jorge – Another product I tried was called Topik.

HH – Never heard of it.

Jorge – It’s like artificial hair. You spray it on your bald spot and it was supposed to make it disappear.

HH – You sound like a person who wanted to solve your problem, but was getting nowhere.

Jorge – Absolutely. It was very frustrating. Eventually I got smart and began interviewing with several hair transplant doctors.

HH – What was that like?

Jorge – They seemed like they were trying to oversell. I didn’t feel right.

HH – And Dr. Arocha?

Jorge – I still had the problem and finally found out about Dr. Arocha. He told me like it was. I felt very comfortable. He was very convincing without being overbearing. And, when I first called-in, I didn’t talk to salespeople like the other times; I talked to Dr. Arocha directly.

HH – What was the procedure like?

Jorge – Fine, no problems whatsoever.

HH – Did you have a lot of donor area?

Jorge – I was a severe case you might say. He still got the job done.

HH – If I were to look at you, what would I see?

Jorge – You wouldn’t know it. And, it has been a positive for my self-esteem.

HH – What kind of work do you do?

Jorge – Real Estate. I would say it affected me when I was bald and I use to feel I was missing something – but not now. Now I put on a suit with a nice head of hair.

HH – Jorge, thanks for sharing today.

Severe Hair loss Patient Omar Tells Us About His Experience

HH – Omar, you had hair loss at an early age, didn’t you.

Omar – Yes, it began when I was 18.

HH – Just out of high school. What did you do?

Omar – I started using Rogaine and it didn’t do much for me. At 19, I began to have severe hair loss. It was pretty bad. I wound up being an extreme hair loss patient for Dr. Arocha.

HH – What the industry calls a “Norwood 7.” So here you are at 19. Did Rogaine work at all?

Omar – No, in fact, it made it worse.

HH – What did you then do?

Omar – I went the transplant mode. I originally talked to Bosley. Being 19 and in college, the costs seemed substantial and they really weren’t convincing. Also at the time, they weren’t doing follicular unit grafting. They were taking slaps and it didn’t look natural. You had 4 or 5 hairs coming out of one spot and it isn’t what I was looking for.

HH – How did you come across Dr. Arocha?

Omar – My brother told me about him and I did some research. Found out he was one of the leading transplant surgeons out there.

HH – Now, you had extreme hairloss as mentioned earlier. Dr Arocha says you were probably the most severe hairloss case he’s ever had. How did you initial consultation go?

Omar – Very comfortable. Very confidant. He talked to me about it and how he was going to do the procedure.

HH – And you knew all along your case was a little different. What the industry calls a “Norwood 7” – a case in which a normal transplant surgeon wouldn’t want to touch.

Omar – That’s right but it appeared I lucked out with Dr. Arocha. He did tell me I was one of the worst cases he’d ever came across.

HH – That takes some guts! What did he tell you as far as the amount of hair he could get – so-called donor hair?

Omar – As much as he could get, but the goal was 2500 grafts. He wound up getting me 3,500 grafts.

HH – That’s amazing given your hair loss.

Omar – Yes it is. He really knows what’s he’s doing. The results were a lot more astonishing then we expected. We were expecting frontal and partial to mid-scalp but we ended up getting full-frontal and full mid-scalp. It’s still progressing and getting better and better every day.

HH – Omar – It sounds great and good luck to you.

The Hair Loss Headline. Published 2008/Temecula, California.

28-Jan-09 3:00 PM

Post-Surgical Hair Loss

Bernardino Arocha — Mon, 21 Jul 2008 16:00:00 GMT

Post-surgical hair loss, although rare, can arise from two etiologies: accelerated hair loss and post-surgical effluvium. There is a theoretical risk of post –surgical shock loss. It is logical that attendant with surgery there may be an increase incidence of hair loss after surgery. After all, there is an increase in blood flow to the surgical site post procedure. That is why the recipient area is red or erythematous after surgery. This bathes the area with DHT along with the necessary oxygen and nutrients required for healing and life of the tissue. This however, technically is not post-surgical shock loss, but accelerated hair loss. The risk of this occurring is dependent on the genetic predisposition of the hair in the recipient area and the extend of miniaturization of these hairs.

What then is post-surgical shock loss or effluvium? This type of post-surgery hair loss can result after the procedure and arises from trauma to the miniaturized hair. It usually manifests about 3 months post procedure. This trauma to the weaken hair in the recipient area occurs when the angling of the sites is off. It is imperative that the angle and direction of hair growth be fallowed accurately.

Significant post-surgical hair loss in the post-surgical period is at best a rare event; in fact, I have not seen it for the last 4-5 years. The reasons are related to advances in surgical techniques and pharmacologic therapies. First and foremost is the creation of precise angles of the recipient sites, while fallowing the exact direction of hair growth. Secondly, the use of very small needles and cut to size blades, that minimize the size of the sites created, hence the extent of tissue and possible follicular injury if there is native hair remaining. Lastly, the use of finesteride diminishes the DHT by 70% hence protecting the native and transplanted hair from any post-surgical increase in circulating DHT. The use of minoxidil 5% acts synergistically to further protect the native miniaturized hair and possibly stimulate the growth of the transplanted hair. Furthermore, the growth of the transplanted hair with its increased caliber is of greater contribution to the hair mass and volume than the native thinner caliber miniaturized hairs. I do recall one patient about 6 years ago that had some shock loss post-surgically. He was managed with finesteride, minoxidil 5%, reassurance and time. He of course not only recovered but also had an outstanding hair restoration outcome. The patient got his smile back in about four months post-procedure as his hair transplant commenced to grow in.

21-Jul-08 11:00 AM

Hair Restoration Post-Surgical Recovery

Bernardino Arocha — Tue, 15 Apr 2008 14:00:00 GMT

The state of the art follicular unit transplantation is the ultra-refined follicular unit transplantation, using follicular units (fu s)that have been trimmed of the excess tissue under the binocular microscope. These follicular units have all the essential anatomic parts that ensure its rapid growth, while avoiding any excess tissue. These ultra-refined fu s allow the creation of the smallest sites. These minimal sites are important for two reasons:

1. They allow the creation of very closely placed sites, hence greater density

2. The small sites facilitate the rapid healing, so as to minimize the post-surgical recovery and hasten rapid resolution of any trace of the procedure.

.9 mm sites in the hairline allow the creation of density with one procedure. Note these are coronal sites that fix the exit angle of the hair to create precise angling.

Close up of the hairline only one day after the procedure. Note that the patient has a wet look, yet his hair already looks improved; there is less visible bald scalp.

This Before photo was taken only a day prior to the procedure.

So impressed was the patient, Ben Howard, that he told the Morning News anchor on Fox 26, that he looked improved immediately after the procedure. While he was correct, we do not wish to set such a high expectation. We are happy to settle for 3-4 months for results to be apparent. That is regarded as an early response in the industry.

15-Apr-08 9:00 AM

Meet the Experts: Hair Transplant Surgeon, Dr. Bernardino Arocha is Raising Eyebrows

Bernardino Arocha — Sat, 01 Mar 2008 22:00:00 GMT

Dr Bernardino Arocha is Founder and President of Arocha Hair Restoration in Houston, Texas. He is an avid art collector and painter and attributes much of his success as a cosmetic surgeon to his artistic flair. In this in-depth interview, he explains how a natural hairline is designed using facial geometry and explores the new field of eyebrow transplants; who needs them and how to get them? He is talking with Penny Moss, host of HairLossNewsMakers.com.

NHJ: Dr. Arocha, how did you first become interested in art?

BA: Growing up in New Jersey, I enjoyed visiting the great museums in the New York City area and watching theater in Central Park. Later in college, I studied art history and I enjoyed painting as a hobby. My favorite medium is oil and canvas. I also do a little bit of collecting.

NHJ: Is this artistic background your secret to designing natural hair transplants?

BA: (Laughs) you’ll have to ask my patients. I have completed a fellowship in Hair Restoration Surgery which gave me the opportunity to train with some of the leading hair restoration surgeons in the world. From them, I learned many useful principles and techniques. Over the years I have enhanced and refined them and, to return to your question, I like to think my artistic instinct contributes to my hairline designs and helps make my work look natural.

NHJ: You are very involved with temporal peak transplants and creating a “natural hairline.” What are the special things a hair transplant surgeon do to achieve the most “natural hairline”?

BA: When you achieve a natural hairline in a hair transplant, we're talking it being undetectable from what occurs in nature. This is achieved primarily by the proper placement of the hairline. Leonardo DaVinci determined that the face is divided into thirds. The distance between the chin and the nose should be a third of the left of the total face, as is the distance from the bottom of the nose to the eyebrows and then from the eyebrows to where the hairline should be. Also, you need to create a “transition zone” between the hairless skin at the top of the forehead and the area where hair begins to grow normally. I will be about one half centimeter to one centimeter deep, using single hairs, with the finer hairs being the very first and second rows and then one and two hair follicular units from the mid to the end of that transition zone. This hairline in the transition zone needs to be what call, “irregularly irregular.” In fact, I find that it can never be too irregular. Dr. Jennifer Martinick in Australia has coined the term “snail tracking across the forehead” to refer to this irregular pattern as opposed to a straight hairline which would look very unnatural.

NHJ: Are there any ethnic differences to consider when designing the hairline?

BA: Yes, there are differences between people from Europe, Africa and people from the Far East. With African Americans for example, hairlines can be a little straighter across, with less of a frontal temporal angle.

NHJ: How can a patient be sure to get exactly what he or she expects?

BA: It's critical to visit with your prospective surgeon to see as many before and after pictures as necessary to determine if you like their work. You should ask specifically to see pictures of people like yourself so you can determine whether your expectations can be matched by the surgeon’s skill and techniques.

NHJ: When we spoke last week, you told me about eyebrow transplant procedures. Who is a candidate for this technique and what kind of results can be achieved?

BA: The most common causes of eyebrow loss are repeated plucking of the eyebrows and physical trauma. Many of my patients come to see me as result of accidents, surgical procedures, chemotherapy or burns. All these causes of eyebrow loss are amenable to surgical restoration. Although we can help most people, there are some situations where we powerless to intervene. One prominent example is trichotillomania, an obsessive-compulsive disorder where patients pull hairs out from the scalp and eyebrows, and sometimes even the eyelashes. Regrettably, we can’t help alopecia areata/ totalis patients either. These are genetic auto-immune disorders whereby the body makes antibodies against its own hair follicles.

NHJ: How quickly do you see the benefits of an eyebrow restoration?

BA: It takes about eight months for an eyebrow transplant to completely grow in. Often patients repeat the procedure if they want really thick eyebrows.

NHJ: A lot of people don’t know that eyebrows and eyelashes can be restored. Is this a relatively new surgical procedure?

BA: Yes it is. After I was invited to appear on Fox TV last July, I received a lot of inquiries because most people didn't know we could do this.

NHJ: What is the difference between an eyebrow and an eyelash restoration?

BA: For the eyebrow, we use very acute angling sites so that the hair comes in almost flush to the skin. We create the sites at an angle of 0-10 degrees in so that the hair doesn't stick up, and the curvature of the hair needs to bend towards the skin. In an eyelash, the curvature needs to be the opposite; away from the skin, so that the eyelash curves upward.

NHJ: Where do you get these hairs from?

BA: Sometimes we need fine hairs, as in a woman with fine facial hair in the eyebrow area. That type of hair tends to grow around the ear and in the temporal area. Conversely, to find a good match for a man with thick facial hair, we would probably go to the occipital area, in the back of the head, where the hair tends to be thicker.

NHJ: Thank you for telling our readers about this exciting work. If someone wants to learn more about eyebrow and eyelash restoration surgery, how can they contact you?

BA: I can be found on the web at www.arochahairrestoration.com.

1-Mar-08 4:00 PM

Surgical Treatment of Advanced Stage Male Pattern Hair Loss

Bernardino Arocha — Wed, 20 Feb 2008 21:00:00 GMT

There is an inverse relationship between the severity of hair loss and the amount of donor available. That is the more severe the hair loss the less donor available for the hair restoration procedure. The average Caucasian individual is born with 50,000 fu (follicular units) on their heads. The average density is 100 fu./cm squared. An individual with advanced stage hair loss, Norwood 6 or 7, usually has on average between 230- 300 cm square of bald scalp. To restore this individual to his original density would require about 30,000 fu (300x100). That is more follicular units than the total remaining on the heads of these follicular unit challenged individuals. Fortunately, it is not necessary to achieve such density. It has been shown that the threshold for visible detection of thinning for the human eye is below 50-fu/cm sq. Even then, 15,000 fu is required to stay above the threshold of detection of thinning. Employing modern hair restoration techniques, one is able to obtain very pleasing outcomes for the majority of these individuals with advanced hair loss, while employing much lower numbers of follicular units.

The key to successful hair restoration outcomes then lies in the use of these state of the art hair restoration techniques, since it is always the patient with the most need that has the least donor available for hair transplantation. The average individual has between 4-10,000 fu available. No one ever complains about getting too much hair, hence it is usually best to do the largest session the patient can afford and the available donor can support. With favorable hair characteristics, and reasonable patient expectations we can achieve excellent results in as little as one to two procedures.

It is imperative that the patient has realistic expectations, which includes that the crown area will likely not be able to be covered with any significant density. My preference is to focus on restoring the hairline, frontal forelock, frontal region and mid scalp region. The crown is left to pharmacologic therapy, hair system or comb over from anteriorly transplanted hair. The exception is for the fortunate few with great donor density that permits harvesting in excess of 4000 fu. The breakdown of a 4000 fu transplant is to do between 1500 to 2100 fu in the hairline and frontal forelock areas, and the remaining 2000 fu is distributed between the remaining frontal and mid scalp regions. The densities created are 50-70 fu/cm2 for the hairline/forelock, and about 20 fu/cm2 for the frontal core and mid scalp areas.

The crown area is determined by pie x r2 (3.14 times radius squared) . Hence, the area increases exponentially with the increase in radius. For example a crown with a radius of 5 cm has an area of about 78 cm2, and a crown with a radius of 6 cm has an area of 110 cm2, thus the area increases about 50% for an increment of 1 cm in radius. To obtain even a thin coverage we need a density of at least 20 fu/cm2 so the total required for the 5cm crown is 1600 fu and 2200 fu for the 6 cm one. To secure a medium density we need 30 fu/cm2, so2400 and 3300 fu respectfully. An astounding, 4000 and 5500 fu is required to obtain a dense (no apparent thinning requiring 50 fu/cm2). So clearly it fallows that before we are able to address the crown loss, we need to satisfy the hairline/frontal/mid scalp areas, before proceeding cautiously to decrease the size of the crown hair loss. In the crown area, we work from the periphery to the center, it is important to restore the hair lost first, last. In other words, we start to restore from the periphery and work in towards the center.

The advanced stage Norwood 7 typically requires between 5000-6000 fu to satisfy even thin crown coverage. Hence, all advance stage Norwood’s require mega sessions.

The term mega session in hair restoration has been an upward moving target. Not too long ago 1000 to 1500 fu was considered a mega session. The use of binocular microscopy to sliver and trim the follicular units has greatly improved our donor yields, on average increasing donor yields by about 25%. Optimal donor harvesting delivers higher yields while conserving this limited resource. Hence, today we are able to offer properly selected patients the option of maximizing their hair restoration outcomes with cases that have surged to the five to six thousand levels. Indeed Rome was not build in a day, but it is nice to have the option to minimize the need for multiple procedures, while maximizing our patient’s hair restoration outcomes.

Before After

Before After

20-Feb-08 3:00 PM

Hair Transplants Have Come a Long Way

Dr. Bernardino Arocha — Tue, 16 Oct 2007 19:45:00 GMT

Dr Arocha was recently interviewed by the Houston Chronicle.

For men valiantly engaged in the battle of the bald, a two-pronged attack is usually what the doctor will order.

First, a product that will stop further hair loss, such as the oral drug Propecia or the topical solution Rogaine.

Second, either relocating hair from the back of your head onto the top, or investing in a modern-day hairpiece.

Click here to read Dr. Arocha's Hair Transplant full interview.

16-Oct-07 2:45 PM

Facial Aesthetic Hair Transplantation

Bernardino Arocha — Mon, 23 Apr 2007 13:00:00 GMT

Modern hair transplantation specialists can offer comprehensive hair restoration services. That is, the qualified hair restoration specialist is not limited to treating the typical pattern hair loss patient, but can offer alternative hair transplantation that includes Facial Aesthetic Hair Transplantation. Facial Aesthetic Hair Transplantation includes the reconstruction or restoration of eyebrows, eyelashes, temporal peaks, sideburns, moustache and beard.

One of the advances that make this all possible is the use of the binocular microscope to create one and two hair follicular unit grafts. These single and two hair follicles are the building blocks that permit the creation of very natural appearing transplanted hairs that show no visible scars. Thus, this permits the creation of hair artwork. Armed with these follicular units we can employ very small blades to create sites. These sites can be placed very close together, allowing the creation of hair density with only one pass. We can control the angle of the sites created. We employ very acute angling in the creation of eyebrows, temporal peaks, and facial hair, so the transplanted hair lies down.

Before photo showing the china pencil drawing of the left temporal peak and side burn which is to be transplanted. Sites were created using a 1.25mm blade at a very acute angle.

After photo showing left cosmetic sideburn enhancement detail. Note that the hairs are growing flushed to the skin. Also note that this marked improvement is only 2 weeks after the procedure!

Before photo with the right temporal peak which is to be restored. Note china pencil drawing of the hairline and right temporal peak to be restored.

A natural appearing right temporal peak obtained only four months after the procedure adds definition to the face. This excellent result serves the important function of framing the side of the face. Note the much-rejuvenated patient sporting a crew cut.

This woman has only one hair remaining in her right eyebrow, resulting from many years of excessive eyebrow plucking.

Immediate improvement in the reconstructed eyebrow obtained one week after the procedure by leaving the hair long in the transplanted follicular units. Note that the surface epithelium of the follicular unit grafts is now flaking off.

The advances in modern hair restoration surgery are forging the advancement of hair artwork; hence we can embellish and rejuvenate our patients with suitable improvements to their faces that include eyebrows, eyelashes, temporal peaks and facial hair. Not only are the improvements groundbreaking, they are also very timely.

Watch Dr. Arocha's Facial Aesthetic Hair Transplant Surgery Video on Telemundo.

Interested in learning more? Contact Arocha Hair Restoration to setup your personal Hair Replacement Consultation.

23-Apr-07 8:00 AM

Post-Surgical Scars in Hair Restoration Surgery

Bernardino Arocha — Mon, 12 Mar 2007 16:00:00 GMT

Anytime surgery is performed or skin is wounded a scar results. Scars are the body’s attempt at healing. Scars result from any surgical procedure, whether it is an FUE or Strip Harvest. Certain individual characteristics, such as increased scalp laxity, predispose to wider scar formation. However, scars can be minimized by the practice of maintaining the tension on the skin surface to a minimum.

Minimal linear scar resulting from traditional strip harvest. Note that it is less than .5 mm, faintly visible and of course covered by hair.

“Bird shot” pattern of diffuse FUE scars. Note that some of the FUE punctate scars are about 1mm. Of course these scars are also covered by hair, hence usually not visible unless the hair is trimmed very short.

FUEs are performed employing a small punch either 1 or .75 mm to score the follicle, the wound is very small, but it is left to heal without primary closing, hence it does so by secondary intention which means that a small scar will result. In FUEs there are numerous punctate scars producing a “bird shot” pattern of diffuse punctate scars.

Traditional Strip Harvest should produce a linear scar, however, it should only be faintly visible if the principle of minimizing surface tension is adhered to. In addition, the use of tricophytic closure renders the faintly visible scar invisible by having the hair grow through the scar. State of the art strip harvesting employs use of a two layer closing, the deep layer serves to minimize surface tension. The superficial layer gently brings the surface margins together, allowing the healing of the wound with minimal tension. The third step, is the beveling of the lower wound edge, this causes the hair to grow through the scar.

Typical invisible scar resulting from a strip harvest in a hair restoration ultra mega session.

Another example of an invisible strip harvest scar resulting from a tricophytic closure of a strip donor harvest in a mega mega session.

It takes the wound about 6 months to mature. Weight lifting before the wound has matured can widen scars because of the increase in skin surface tension from the weight lifting.

Very fine scar less than 1mm resulting from a 2 -layer closure of a strip harvest in an ultra mega session. Note small point bleeds due to suture removal just before photo.

Photo showing widening of the prior fine scar, taken after a few months of heavy weight lifting. The scar is now 2-3 mm wide.

In Conclusion, minimally noticeable scars can be achieved in modem hair restoration surgery no matter which method of harvesting is employed. The critical sine qua non of minimizing post-surgical scars is the principle of keeping the tension vectors on the wound as small as possible. The great results in minimizing scars can be further enhanced by the tricophytic closure so the resulting scar is usully nearly invisible.

Interested in learning more? Contact Arocha Hair Restoration to setup your personal Hair Replacement Consultation.

12-Mar-07 11:00 AM

Sound Nutrition for Luxurious Hair

Bernardino Arocha — Tue, 16 Jan 2007 22:45:00 GMT

The Human Body is a marvelous fine tuned machine; a pivotal factor in its continual smooth functioning is the provision of adequate and balanced nutrition. This is also essential for a healthy head of hair. Nutritional aberrations can lead to hair loss.

Iron deficiency can cause a kind of diffuse hair loss known as telogen effluvium. Iron deficiency can result from inadequate intake of foods rich in iron and in post pubescent women from excessive menstruation.

Dieting, especially crash dieting, can lead to diffuse hair shedding some months after the start of the diet. Protein and Protein/ Caloric malnutrition, known as Kwashiorkor and Marasma cause hair loss also. Insufficient essential fatty acid intake can cause telogen effluvium. Hair loss is also a feature of zinc and biotin deficiencies. Biotin deficiency can result from ingestion of too much raw egg whites. Body builders beware when trying to supplement the lean protein intake by consuming egg whites in proteins shakes.

To maintain a healthy and luxurious head of hair, it is essential to have a balanced diet that includes carbohydrates, protein, fats, zinc and vitamins. Consume foods rich in iron such as oatmeal, cream of wheat, raisin bran cereal, baked potato, green leafy vegetables, liver, meat, and dates or prunes to replenish body iron stores. Be certain to consume adequate omega-3 fatty acids. Excellent sources of these essential fatty acids are wild salmon, sardines, herring or mackerel, and freshly ground flax seeds.

To ensure a healthy, luxurious head of hair with a good lustre and sheen eat sensibly. Whether you have had a hair restoration procedure , or are blessed with a full head of hair, eating a balanced diet as discussed above will maximize the quality of your hair. What's more such good living may booster your health!

16-Jan-07 4:45 PM

Lateral Slits

Bernardino Arocha — Mon, 18 Dec 2006 18:00:00 GMT

Lateral or coronal slits allow the precise control of the exit angle between the hair and the scalp skin. Sagital or parallel slits permit the hair to move up and down in the groove created by the blade, hence the exit angle between the hair and the skin can vary between 10 and 15 degrees. The use of lateral slits are of great advantage in hair transplantation involving areas that demand more precise and acute angles. These areas include the eyebrows, temporal peaks, pubic and facial hair . The lateral slits are made with very small blades that make very small and shallow incisions, this expedites the healing and permits the placing of very close sites so as to maximize the density.

18-Dec-06 12:00 PM

Megasessions

Bernardino Arocha — Mon, 18 Dec 2006 18:00:00 GMT

The average Caucasian individual is born with 50,000 fu (follicular units) on their scalp. The average density is 100 fu./cm squared. An individual with advance hair loss, Norwood 6 or 7, usually has on average about 300 cm square of bald scalp. To restore this individual to his original density would require about 30,000 fu (300x100). That is more follicular units than the total remaining on the heads of these follicular unit challenged individuals. Fortunately, it is not necessary to achieve such density. It has been shown that the threshold for detection of thinning for the human eye is below 50 fu/cm sq. Even then, 15,000 fu is required to stay above the threshold of detectability of thinning. Employing modern hair restoration techniques, one is able to obtain very pleasing outcomes for the majority of these individuals with advance hair loss, while employing much lower numbers of follicular units.

The key to successful hair restoration outcomes then lies in the use of these state of the art hair restoration techniques, since it is always the patient with the most need that has the least donor available for hair transplantation. No one ever complains about getting too much hair, hence it is usually best to do the largest session the patient can afford. With favorable hair characteristics, and reasonable patient expectations we can achieve excellent results in as little as one to two procedures.

The term megasession in hair restoration has been an upward moving target. Not too long ago 1000 to 1500 fu was considered a megasession. The use of binocular microscopy to sliver and trim the follicular units has greatly improved our donor yields, on average increasing donor yields by about 25%. Optimal donor harvesting delivers higher yields while conserving this limited resource. Hence, today we are able to offer properly selected patients the option of maximizing their hair restoration outcomes with cases that have surged to the five to six thousand levels. Indeed Rome was not build in a day, but it is nice to have the option to minimize the need for multiple procedures, while maximizing our patient’s hair restoration outcomes.

18-Dec-06 12:00 PM

Tricophytic Closure

Bernardino Arocha — Mon, 06 Nov 2006 19:00:00 GMT

State of the art donor closure, employing tricophytic closure delivers nearly invisible donor scars. Strip harvesting employing two layer closure, using vicryl or other absorbable suture for the first layer takes the tension out of the superficial layer, hence yielding a faint scar usually only 1mm wide or less. The addition of a third step employs the beveling of the wound’s lower edge to abut the superficial epidermis and hair, so as to cause the hair to grow through the scar. This final step makes an already minimally detectable scar almost completely invisible.

6-Nov-06 1:00 PM

Meet the Experts Hair Transplant Surgeon, Dr Bernardino Arocha Is Raising Eyebrows

Annisa Chan — Mon, 06 Nov 2006 17:00:00 GMT

*As printed in the Fall 2006 issue of The National Hair Journal.

NHL: Dr. Arocha, how did you first become interested in art?