Dr. Carlos Wesley

Thank you very much for your confidence. All of us in the office very much appreciate your feedback. Have a happy and healthy 2013!

Hi, Steve0580. I can certainly understand any skepticism and I'm the same way when I hear of any new medical/surgical innovation prior to its publication in a respected peer-reviewed journal. What I can tell you is that we already received our Series A round of funding quite some time ago. The interested parties believed (as I do) in the theoretical benefits of using this approach. Now, the challenge has been turning that theory into actual clinical results. I have to admit that I've been pleasantly surprised thus far with the efficacy of the harvesting method. Lorenzo, our method is different from what you described and I will certainly reveal the details publicly at the ISHRS Conference (if not beforehand). I do, however, appreciate all of the speculation as people are thinking of ways to improve on our field's current methods! Just as you pointed out, challenges such as consistent creation of ideal grafts (just as with FUE and FUT) is something we want to ensure before this ISHRS event. Steve0580's also correct in assuming a few timetable delays. Those are inevitable with medicine and biology in general. I can assure you, however, that all online advocates in support of this harvesting approach are NOT plants. They are all patients who have either come in for a consultation and heard firsthand about the rationale and details of the device or have experienced it themselves as they were involved in the initial clinical trial (the prelim results from which can be ). They've voiced their support because, together, we all believe that this is something that will benefit everyone suffering from hair loss. Thanks and Happy New Year!

We are sharing the preliminary results from our initial clinical trial focused on graft survival. While the scarless approach to harvesting has been the focus of much attention, this alternative method also provides the equally-important benefit of potentially increased transplanted hair follicle growth. By providing a direct comparison between the growth of grafts harvested using traditional follicular unit extraction (FUE) versus those harvested with our alternative method, this investigation highlights both the rate of growth and the ultimate survival of transplanted hair follicles using each method. The results are promising, to say the least. And it is very important to point out that the investigator conducting the hair counts was completely blinded to the type of graft transplanted in the area examined. This eliminated any potential bias in quantifying hair follicle survival.

Our office has posted the preliminary results from our hair follicle survival studies in which this method is compared to current forms of hair follicle harvesting. For more information, please view below...

Patients sometimes wonder if lowering a hairline that never truly receded is possible. Correcting a hairline that has always left a larger-than-desired forehead? This patient demonstrates that…Yes. It is. A 51-year-old man who had a total of 4055 grafts over two sessions. The most recent session took place less than five months ago. Therefore, this patient still has a good 13 months of continued hair growth to look forward to!

Thanks for your kind words. This patient certainly has a newfound confidence. Again, our apologies for flooding this section of the HTN today. This represents the last of our postings for a while... Thanks!

Hi, Spanker. Nope. This was the patient's very first HT. He was quite nervous coming in for the session and concerned about a natural appearance down the road. He's no longer concerned. While there's not a whole lot a patient can do regarding their color contrast (other than not dying their hair as they age), the physician can certainly alter his/her surgical design based on the degree of color contrast between hair and scalp. When the contrast is significant, a softer hairline design provides a more natural appearance. When contrast is minimal, a more aggressive approach to hairline density may be appropriate.

Sorry for bombarding your inbox with so many updates, folks. We're simply trying to consolidate many of my "larger session" surgical patients for Coalition consideration. Thanks for your patience...

Hi, Getsome1. I didn't see if you had FUT or FUE. This can also determine the length of the follicles when transplanted. Grafts from strip harvest are left slightly longer than those harvested via FUE (because you need those short in order to determine the exact exit/direction) in our practice. So, even within the same clinic, you may have variety in immediate post-op hair length. Best of luck!

Increased density (especially in young men) can be effectively achieved by increasing (a) the caliber of hair and (b) number of hairs per follicle in the treated recipient area. It does not necessary require packing in the maximum number of grafts into a concentrated area which may ultimately deplete the "supply" that a young man would have available for the future. These magnified before/after images of this patient's recipient area illustrate this. The greater caliber/higher hair per graft follicles are transplanted grafts. You can also see (based on the pre-existing miniaturized hairs remaining in the recipient area) how thin his hair progression would have really left him at this stage. Crisis averted!

Here is an update from a patient who had a prior session at another practice over 8 years prior to coming to our office. This video illustrates somewhat of a growth timeline, with after video from 8 months and 16 months. His donor area video footage was taken at 8 months and the donor scar image taken 16 months after the 2683-graft session.

Great! Thanks, David. And, Rob, I'm not 100% sure, but I don't recall the patient using concealer. I can follow up with him and find out. His donor hair did certainly grow back and was quite thick. If he did use it, it wouldn't have been throughout his entire scalp. Only in the donor. But I generally discourage patients from applying anything like TOPPIK until about two weeks out from surgery.

Thanks! We also excised about 20 or so of the most "offensive" pluggy grafts within his original hairline while performing this revision. This was done using a 0.8mm punch.

The advice you've received from Janna and Dr. Charles has been very sound: contact your surgeon, Dr. Feller, first before taking additional steps. That said, you're right, LondonHTseeker, about the benefit of steroid injections as an adjunct to scar reduction to camouflage facial scars. You mentioned noses. I know of a couple plastic surgeons who published on the benefit of steroid (triamcinolone acetonide) injection used along with surgical scar reduction and have attached their before/after pic. Because corticosteroids reduce the main culprits in scar formation (fibroblasts and collagen), a number of surgeons use steroid injections to treat hypertrophic (thick) scars either alone or along with surgical scar reduction. It's important to reassess the scar every 4-6 weeks if you're doing this until the scar tissue stabilizes. In our office, we do occasionally incorporate intralesional injection of steroids with surgical donor scar reduction. Our patients are asked to return to the office about 5 weeks postoperatively to determine if any steroid injections are merited. Good topic!

Thanks for your continued interest in this topic (a patience!). Yes. We had initially projected a 2012 completion date, but instrumentation involves a fairly intricate development process. I can tell you that things have continued to progress very well on the development front. After a conference call with our team of engineers last week, it appears that we are on target for a follow-up clinical trial using the completed instrument by February of 2013. There was a reference to another doctor's method. I'm very excited that others are looking into eliminating the stigma of visible scarring in our field. However, what's equally (if not more) important is the associated hair growth of the transplanted hairs once transplanted. Therefore, I have been gathering data from our initial trial (using a more basic iteration of the instrument) that was initiated late last year. I plan to have some comparative growth analysis between: 1) this new method, 2) traditional FUE, 3) and strip harvest grafts by December of this year. P.S. I'm surprised to hear that an information request to our office did not receive a response. We are generally quite responsive. Please email: drwesley.office@gmail.com if you'd like to learn more.

It's cases like this that make all of us in the field really enjoy our work. Helping patients to not have to worry about something that bothers them (whether it's a unnatural appearing hairline from an old transplant, or the natural progression of hair loss) is one of the most common motivations and benefits that hair restoration surgery provides.

Thanks for your continued interest (a patience!). I can tell you that things have continued to progress very well on the development front. After a conference call with our team of engineers earlier today, it appears that we are on target for a follow-up clinical trial using the completed instrument by February of 2013. In addition, I have been gathering data from our initial trial (using a more basic iteration of the instrument) that was initiated late last year. I plan to have some comparative growth analysis between: 1) this new method, 2) traditional FUE, 3) and strip harvest grafts by December of this year.

Gillenator does make some very valid points. However, I'd have to say that, as a general rule, it's not so much the length of the incision that matters as much as the regions through which the blade (whether it be a scalpel or FUE punch) passes. I've attached an image of the nerve distribution in the back of a scalp. Any cut along the pathway of the greater/lesser occipital or post-auricular nerves (seen as green in the image) may lead to a change in sensitivity. Even a very small percentage of patients who have elected for FUE after having undergone a strip harvest previously may experience this hypersensitivity in the donor area. It's clear when I'm performing the harvest that they have aberrant nerves (nerves that, after having previously been severed, grow back in a path that is not anatomically "normal"). What is normally numbed by a traditional nerve block that addresses these pathways (in green), does not work when a patient has developed an aberrant nerve. So, to answer the question as to whether "a follow-up FUE or strip session is better?": While FUE is traditionally more comfortable, it's still not a 100% guarantee.

Thanks! He's a very relieved gentleman. Interestingly, because of his concern from his prior surgeries, we took this case with a "stepwise" approach. On the first session, the left donor was harvested for the right hairline. On the second, the right donor for the left hairline. The donor received a double-layered closure, then reinforcement sutures once the initial set was removed at 14 days, as well as frequent follow-up direct corticosteriod administration into the donor scar to ensure that the scar would not spread once the sutures were removed. Needless to say, we got to know each other very well during this process!

Thanks for your kinds words and I'm glad you enjoyed the video. I think that, based on the progress we've made in our field over the last few years and what's currently in the pipeline, the full coverage, short hairstyle scenario may certainly be possible for more and more men and women in the future!

Here's another approach that also works, you can have your doctor directly administer an anti-inflammatory to calm the nerve irritation a bit more rapidly. We recently published an article specifically about this thread: post-op nerve sensitivity. Studying 552 patients of all shapes, sizes, genders, and numbers of sessions they'd had, we found that the only statistically significant factor that led to a higher instance of what jawful is describing was having a follow-up session with a different surgeon than the one who performed your initial session. Here's the study: Factors influencing postoperative hyperesthesia in hair restoration surgery - Wesley - 2011 - Journal of Cosmetic Dermatology - Wiley Online Library There are a number of theories as to why this may be and, if you guys are interested, we can go over them.

I'm glad you are enjoying these informative videos. Hopefully, they are providing some pretty objective info without terrifying anyone due to the actual surgical footage! Our office will try to put the chest/abdomen-to-scalp FUE video out next week once the recent data and footage are sorted through. Leg FUE? Hmmm. We'll get to that in time...

Good question! It wasn't that his donor was depleted as much as there was a limit to the amount of donor hair that could be clipped and still effectively conceal any linear scars from previous sessions at another clinic. In general, you can harvest FUE from sections about 75% as wide as the donor hair is long and still effectively conceal the FUE donor harvest in the short term (first week or so). In this patient's case, we were challenged by not only keeping the donor hair that camouflages the linear scar intact, but also leaving enough hair to cover up the patch from which the grafts were harvested. The beard hair FUE harvest, therefore, was to simply obtain more grafts and get slightly better density.

Great topic. As a patient, it's also important to know what to look for when viewing your very own follicular grafts. There's a big difference between "healthy" versus "denuded grafts". Ideally, each graft should possess a healthy amount of subcutaneous and dermal tissue that protects the stem cell-containing portions of the follicle: the bulb and bulge, respectively (as seen on the right side of the first image as well as the second image). Denuded grafts do not have that tissue and are more susceptible to dehydration and traumatic handling (both of these hazards decrease hair survival when transplanted). Another way to be gain more confidence in the actual number of grafts may be to be charged a flat fee rather than being charged by the graft. This way, there is really no incentive to "fudge" on the numbers or to take a naturally-occuring 3 or 4-hair graft and split it into 3 or 4 single-haired grafts (that, as a result, do not possess much protective tissue around them). Finally, in addition to being able to see the grafts, as a patient, you should also be free to view the physician as he/she is making the recipient sites. This is really where the artistry comes into play and the time and attention the physician is taking to follow the exact angle and direction of the pre-existing hair is critical for natural-appearing results.

Firstly, I've received consent from the patient who initiated this thread to post his pre-operative images... Now, regarding the posts by Formertrackstar: I can understand your frustration from the consultation charge that you described years ago and I will try and help you straighten things out as best I can. I can assure you that, whatever amount you may have been charged for your consultation that was scheduled with Dr. Unger, I did not receive a penny of the consultation fee. During that time period that you described having your consultation I would often provide general information to patients who were waiting to see Dr. Walter Unger rather than having them wait in the lobby. It was simply to streamline their consultation experience, give them more information, and prevent them from being either bored or unnecessarily exposed in a common waiting area. I did this without any payment in return. Checks would be made out to Dr. Unger. In trying to think of reasons why any patient would ever be charged more than the standard $250 consultation fee that Dr. Unger has charged for at least six years now I can only think of a few possibilities: Did you have any additional procedure performed (e.g. cortisone injections, a diagnostic biopsy)? Did you, by chance, make two separate $250 payments (perhaps a $250 prepayment that was overlooked)? I received word that you called our office last week and that our secretary was unable to locate your chart. That is very unusual and makes rectifying everything more challenging. Fortunately, you mentioned in your public blog that you had paid Dr. Unger by check. It would help if you can track down a signed copy of that check so that we can best address this frustrating event. Sincerely, Carlos K. Wesley, M.D.