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Dr. Carlos Wesley

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  1. Dr. Carlos Wesley
    Thanks again for your comments on this interesting subject. Your crane worker analogy, fisher4man, is certainly an interesting one! It's actually five days until transplanted hair follicles have established their own capillary network. The life of a platelet is 10 days. However, it's not necessarily the platelets, but rather their growth factors and cell recruitment that benefit the follicle during this vulnerable period. Although I agree that PRP/ACell therapy is by no means a guarantee, I have seen it show promise in the appropriate candidate (those with miniaturized hairs that are often surrounded by evidence of dried keratinocytes). And, yes. The OR lighting may not have been exactly the same. We therefore included the magnified timeline images in the video to demonstrate the true progression of hair growth in the male patient. Thanks, ontop, for your comment. The female patient will likely return for a repeat injection at the 7 month mark after her first. Studies on PRP injections have demonstrated that it's roughly at the 7th month when hair caliber and growth peak from an initial injection. After that time period, we'll continue to monitor her. I've been asked to write about PRP in the "Future of HT" section of the upcoming "Hair Transplantation" text book. To illustrate how much uncertainly is surrounding this therapy, at the 2013 ISHRS Meeting, a panel of five hair restoration specialists were asked to describe their PRP injection protocol. All five of them used different methods to isolated the PRP, all five had different concentrations of PRP, all five had different preferred intervals or treatment, and all five reported slightly different patient results. Although it's a procedure with promise, there's a LOT yet to be determined (much like low level light therapy). The one thing I would say with certainty is that you should avoid PRP injections if the doctor tells you it's "guaranteed" and/or if they are suggesting it without first carefully examining the patient with a magnified camera to closely evaluate the scalp.
  2. Dr. Carlos Wesley
    This woman has Hamilton type female pattern hair loss (FPHL). You're correct, fisher4man, in that it looks like traction alopecia. Many people can confuse the two. However, in this case, her Hamilton type AGA demonstrates bitemporal recessions and has a classical distribution of male pattern baldness - thinning evident in the lateral-frontal part of her scalp. These slowly-progessing thinning of recessions is often something we see in peri-menopausal female patients and a few scattered terminal hairs are often viewed within the numerous finer, miniaturized hairs. If you would like to read more about FPHL, here is a great article that describes it in more detail. She is a very good candidate for surgery rather than simply injections because of the health (density and caliber) of her donor area. The PRP/ACell combination used to treat her grafts during her case simply helps ensure a healthy result. We have treated numerous patients as you mentioned - with unilateral injections (one side and not the other). However, (due to its systemic recruitment of cells) the effect of PRP/ACell is not focal, but rather more diffuse. So, unlike transplanting hair into an isolated square to measure its viability, the efficacy of PRP injections cannot simply be measured by adding it only to one portion of the scalp.
  3. Dr. Carlos Wesley
    Thanks for the important (and somewhat controversial) topic. Platelet rich plasma (PRP) is a treatment that has certainly shown promise in our field of hair restoration. Probably the most important criteria in determining its beneficial effect is appropriate patient selection. The main challenge in presenting objective data worldwide is that there is so much variation regarding concentration used and technique of PRP creation and delivery. During last year's ISHRS meeting, five respected surgeons on a PRP panel all revealed that they use completely different techniques and methods of harvesting PRP. Dr. Carlos Uebel in Brazil published quite a thorough study in 2006 in which he demonstrated the benefit of PRP as a storage solution during hair surgical procedures. We have found the same trends to be true: improved survival and hair caliber post transplantation. As far as a stand-alone injection procedure, I will have our office manager post results tomorrow on this site. It can be incredibly effective in the correct patient. Our examination last year revealed that (although PRP's benefit is not gender specific) women often respond best. It is important to have proper evaluation prior to undergoing PRP. What I mean by this is patients with evidence of miniaturized hairs and/or dried perifollicular keratinocytes often respond well. I've been asked to write about PRP in hair restoration in the upcoming Hair Transplantation textbook and will keep you all updated on the trends I find though out the world.
  4. Dr. Carlos Wesley
    Thank you, David. This patient has been very pleased with his early growth and there is still plenty more to come.
  5. Dr. Carlos Wesley
    Hi, KO. This patient had a follow-up procedure in which we covered the entire crown as well as areas of future loss. I'll be sure to have our office update images to demonstrate his complete coverage.
  6. Dr. Carlos Wesley
    A common postoperative concern that my patients express is, "when can I safely shampoo my hair?" Our patients always return to our office the morning following their procedure. During this visit, we remove the protective bandage and perform the first hairwash. It also allows for any fine adjustment of follicle placement. The answer to "when" often depends on the characteristics of the follicles during graft placement (i.e. if the grafts are "slippery" or if the placement of a neighboring graft alters the depth of a nearby graft). Perhaps one of the most important characteristics is follicle root depth. The mean depth of a scalp hair follicle is 4.16mm. Our patients are generally able to gently wash their own scalp (including the grafts) on postoperative day 3 or 4. When we note particularly long grafts (as seen below), patients may safely perform a gentle shampoo slightly earlier (days 2 or 3). It is important to realize that these determinations are made by the physician performing the surgery as they are based on intraoperative findings. Fortunately, I believe all of the recommended physicians on this network are involved in all three phases of the procedure (pre-op, intra-op, and post-op). So, be sure to get your advice from them after the procedure. This patient had grafts over 5mm in depth. His pattern is seen day one postoperatively. He was able to perform a gentle hairwash on day 3 as a result of his hair characteristics.
  7. Dr. Carlos Wesley
    Forgive me for indulging, but I can't help but share the "hair tips" offered by my wife, Anna Kaiser, yesterday on Yahoo Beauty's article "How Top Fitness Instructors Maintain Such Great Hair". Proud of her!
  8. Dr. Carlos Wesley
    Fair question, KO. We had numerous discussions regarding FUE or FUT. Essentially, the density (via use of FFs) was most important in the patient's eyes as well as the importance of having more protective tissue around the stem cell-containing portion of each graft. I'll have our office post a video of his donor as it looks great and he can wear his hair at a very short length.
  9. Dr. Carlos Wesley
    Thank you, Voxman. Perhaps now, with his new hairstyle, he'll consider running in 2016!
  10. Dr. Carlos Wesley
    Thanks, Mickey85. The donor was a pretty important element of our pre-op conversations. He wanted to be sure that he could still get wear a short hair style. In his case, I'm not sure that this would have been possible without using a trichophytic closure.
  11. Dr. Carlos Wesley
    A common observation amongst patients during the early phase of hair growth following surgical hair restoration (either FUT or FUE) is ingrown hair follicles. The "pimples" that some (but not all) patients experience generally represent focal inflammation (folliculitis) where a newly-ingrowing hairs are beginning to surface. Patients can often feel reassured knowing that these generally precede more apparent hair growth over the following weeks and months. They can be seen in both the recipient area (where transplanted hairs are coming in) or donor region (especially in FUE where any residual hair fragments may be coming in). They may be more commonly observed in zones where the angle of hair implantation is the sharpest angle (e.g. the vertex or crown as seen in the attached image) In general, a simple cotton ball soaked in rubbing alcohol can be used to rub on each pimple. The microabrasion allows the nearly-ingrowing hair to surface and resume growth. It's relatively rare that an antibiotic is required, but even a one-week course of antibiotic can have a positive impact. The ultimate appearance is not impacted by the presence absence of a few "pimples" and patients should simply be aware that they generally represent an early phase of growth.
  12. Dr. Carlos Wesley
    Thanks, johnboy71 and hairthere. Much appreciated!
  13. Dr. Carlos Wesley
    Thanks, Spanker, for your comment. He's very pleased!
  14. Dr. Carlos Wesley
    Thanks for initiating this tread, crafter. Although not such an uncommon sentiment, syban's "DoomsDay" post might be a little premature. There's some good science out there already. In my opinion, it's a matter of taking those well-structured studies and applying them to our field in the way they'll benefit patients most. I just posted an article on Twitter. That was quite an undertaking! I haven't figured out how to share that link yet, but you're welcome to check it out there or simply type it into your URL.
  15. Dr. Carlos Wesley
    Thanks for your comments, LastcallTx and Future. We perform both FUT and FUE (scalp and beard) on African-American patients. Here is an example of an African-American male patient on whom I performed FUE earlier this year.
  16. Dr. Carlos Wesley
    Appreciate your comments, garethbale. Yes. This patient had been on finasteride 1mg for the past seven (7) years prior to undergoing follicular unit transplantation (FUT). His crown was doing quite well and still has only a few miniaturized hairs as detected during his initial consultation with me using a magnified camera. This detailed imaging is something we perform for all patients coming in for hair loss treatment as it helps to reveal what's really taking place at the scalp level.
  17. Dr. Carlos Wesley
    Thanks, Blake and David. This young man benefitted from a trichophytic closure. While not for all patients, it was certainly something I felt was appropriate in his case due to his preferred hair length, donor density, and scalp elasticity.
  18. Dr. Carlos Wesley
    While a month is certainly a safe bet for anyone who is advancing a hairline and a lot of work is being performed in non-hair-bearing areas (e.g. bald crown, bare recessions, etc.), there are plenty of healthy-sized procedures that can also go unnoticed after 10 days. In addition to the examples that I presented above, a considerable number of female patients in whom increasing frontotemporal (recessions) density is a goal can have all of their grafts well camouflaged by day 10 when they return back to "the real world" (I just saw another example of that today before composing this). 2000+ graft sessions to the patient's mid scalp or filling in their frontal scalp without advancing the hairline recently allowed a few patients of mine who were attending a wedding 10 days after their procedure to make the occasion without any noticeable evidence of a recent procedure. While I agree with 'Cant decide' in that not every patient should expect to be back to looking exactly the same prior to one month postoperatively, there are plenty of examples of patients who certainly can comfortably get back to their routine much earlier. I've included below an old video of FUT and FUE patients as seen one week to one month after their sessions with me.
  19. Dr. Carlos Wesley
    Thanks for your comments on this patient's progress. Now, regarding Pilofocus, there was a recent expose in TheVerge that shed some light on our endeavor. At long last, Pilofocus is just jumping on Twitter as this (rather than trying to respond to the various patient requests in different threads) may be the best media for updates in 2014.
  20. Dr. Carlos Wesley
    To those requesting an update on Pilofocus, here is an article recently published in "The Verge". While both informative and somewhat provocative, the story contains a few points that require clarification: 1) The patient quoted with a large, red donor scar is not actually a surgical patient of mine, but rather a patient with whom I had a consultation as he sought treatment for his cosmetically-unacceptable surgical scar that he received after having undergone surgery with a different surgeon at a different location. 2) Amongst the many interviews I granted to the journalist, one took place immediately following a very in-depth consultation during which I counseled a severely-depressed teenager. Although his hair loss was his stated source of depression, I also worked to find him a psychiatrist that has helped him through his clinical depression. This is a rare instance and certainly does not reflect the majority of the healthy and confident patients with whom I meet. I was, therefore, disappointed in the otherwise well-written article when I felt that this unique psychiatric referral was presented as my preferred treatment for many. It falsely portrays our medical issue of hair loss as frivolous when, in reality, I feel so strongly about its importance that I have dedicated my professional career to treating it.
  21. Dr. Carlos Wesley
    That is great to hear, scooter. In general, patients should be able to return to work or social activities in 7 - 10 days without evidence of the procedure being noticeable. Another trick that a few patients use is to temporarily grow out facial hair. That way, when they return to work, people are initially a bit distracted by their temporary new look (beard or mustache). By the time patients then shave it cleanly a few days later, their friends/colleagues have grown accustomed to their overall appearance!
  22. Dr. Carlos Wesley
    Rootz is correct. A study illustrated that newly ingrown transplanted hairs can grow in for the first time even 18 months after the procedure. We have also observed that the use of platelet-rich plasma (PRP) and ACell as a graft storage solution appears to result in slightly earlier growth of transplanted hair."
  23. Dr. Carlos Wesley
    Thanks, David. Here is a close-up view of the patient's donor scar at 15 months postoperatively. Generally, any residual redness along the donor scar has resolved within 3-4 months after the procedure.
  24. Dr. Carlos Wesley
    Here are various examples of our patients whose pre-existing hair helped camouflage the redness and the stubble for the short-term postoperative period after surgical sessions with me. I have included four (4) patients with various hair lengths including a female patient. The first patient has a video with an intraoperative segment to demonstrate the surgical pattern. I have attached their intraoperative pattern pictures as well. PATIENT #1: His intraoperative appearance can be seen in the video below: PATIENT #2: PATIENT #3: PATIENT #4:
  25. Dr. Carlos Wesley
    Realizing that this section is rather sacred territory for patients and viewers who are considering the HT procedure (i.e. No Docs!), I still wanted to update the community on fakeplstctrees simply because a number of my patients have inquired about his progress. Firstly, he is very well and since his procedure with me has become a friend and someone who has subsequently referred others to my office for surgical treatment of their hair loss. For reasons of his choosing, he is no longer very active in the Internet community (as far as I am aware). So, to allay any concerns or questions people may have about his progress, I am posting images of his progress at the 19th month postoperatively. Comparisons are made between before the procedure, on the day the surgical pattern was designed, and 9 days after the procedure.
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