Hair Restoration Through NeoGraft®: Portland, OR, Plastic Surgeon Dr. Kathleen Waldorf Explains

Gone are the days of strip harvesting and hair plugs – follicular unit extraction (FUE) is now considered the gold standard for hair restoration, and many hair transplant surgeons in the United States achieve this through NeoGraft®. Portland, OR, plastic surgeon Kathleen Waldorf, MD, founder of The Waldorf Center, explains how NeoGraft® can provide long-term results without the need for incisions or sutures.

According to the American Academy of Dermatology (AAD), about 50 million men and 30 million women in the United States experience either thinning hair or male and female pattern baldness respectively. Most of these individuals visit physicians to receive treatments to combat hair loss and help restore their confidence, and NeoGraft® provides the opportunity to improve the hair line and density without leaving a linear scar.

NeoGraft® is the first FDA-cleared automated, minimally invasive hair restoration device on the US market. FUE through NeoGraft® minimizes the likelihood of scarring, and allows both male and female patients to wear their hair freely in virtually any length or style in the future.

FUE involves the collection of thousands of individual “follicular units”. These are extracted from carefully chosen donor sites, and then transplanted on to the selected recipient areas. The donor sites chosen are usually at the back of the head, as the hair at this location is more resilient to the effects of fluctuations in testosterone.

While this extraction process may be performed by hand, the sheer number of follicles that need to be removed makes the process long-drawn and tiresome.

The automated NeoGraft®, on the other hand, is a much more efficient extraction process and greatly improves on the manual collection technique. It works based on a system of negative pressure – using a very small rotatory punch, it rapidly and precisely extracts each hair follicle along with the attached shafts and roots from the donor sites. All the grafts extracted by the NeoGraft® device are consistent in length and diameter, making the results of transplantation more even and uniform.

NeoGraft® allows better control of the speed and diameter of the micropunch; custom depth and orientation of each hair follicle; and pre-determined distance between each extracted follicle. As each follicular unit collected can hold between one and four hairs, the process as a whole can extract thousands of hairs in total (typically 1,000 to 2,500 grafts).

During the harvest procedure, the hair transplant technician uses a magnifier to keep a close watch on the scalp as the NeoGraft® micromotor works its magic, creating a small hole as it extracts each follicular unit. The area from which a follicle is plucked is left with a tiny round mark that heals over time to shrink to an inconspicuous spot. As hair grows into the recipient sites, these spots become even more obscured from view.

While the idea of “punching and picking” hair follicles may sound painful, patients under local anesthesia experience little to no discomfort, and often listen to music or read a book while they are being treated.

The precise and controlled approach to harvesting follicular units ensures that every follicle that is collected is completely intact, and results little to no trauma at the surrounding areas of the scalp.

FUE performed using NeoGraft® can also help with hair restoration in other areas, such as eyebrows, near the mouth, and on the cheeks to create beard and mustache transplants.

Dr. Waldorf and her fellow surgeons Dr. Rachel Streu and Dr. Christopher Zarella are board-certified in plastic surgery, and would be happy to answer questions about FUE or NeoGraft® and advise anyone who is looking to learn more about their options to combat hair loss or reduction. To request a consultation with one of them, contact The Waldorf Center for Plastic Surgery online or by phone at 503-646-0101 or 800-310-7901.


Adam Augenstein, MD, Plastic Surgeon in Charlotte, NC, Discusses Popular Male-Focused Procedures

The latest statistics for the past year from the American Society of Plastic Surgeons (ASPS) show that more and more men in the country are dipping their toes into cosmetic procedures, increasing by nearly 30 percent since 2000. Adam C. Augenstein, MD, dual board-certified plastic surgeon in Charlotte, NC, and founder of Aesthetic Surgery of Charlotte, explains how awareness is spreading among men about the benefits of both surgical and minimally invasive aesthetic procedures.

The latest techniques practised by plastic surgeons today tend to be quick and require little to no downtime. This has also led to plastic surgery becoming much more accessible and offering benefits to men from a variety of backgrounds. Men are also taking more interest in their physical appearance, as exhibited by the metrosexual and hipster grooming habits of today.

The competitive job market often propels men to opt for facial rejuvenation procedures such as BOTOX® Cosmetic (often dubbed “brotox”), dermal fillers, or facelift surgery, due to a fear of encountering ageism in the workplace and wanting to appear more fresh-faced and energetic. Additionally, cosmetic procedures can provide men with a shot of confidence as they increasingly become single later in life and re-enter the dating pool.

Non-surgical methods, such as Kybella® (to reduce chin fat) and the above-mentioned facial rejuvenation injectables, are very convenient options with minimal treatment and recovery time, and provide subtle but effective improvements without the average person being able to tell they had a procedure performed.

Surgical procedures tend to be performed quite differently for male and female patients. Popular cosmetic surgeries for men include:

  • Liposuction: The most often-treated areas in men include love handles and the “beer belly”. Liposuction for the neck and chin area is also becoming popular as a way to achieve a more chiseled jawline.
  • Chin augmentation: Along with reducing chin fat, an augmentation can strengthen the look of the jawline. In 2016, 55 percent of surgical chin augmentations were performed on men.
  • Rhinoplasty: In men, the overlying skin on the nose is typically thicker, which will affect the extent of change surgery can produce. Men’s noses also tend to have a higher bridge and greater width. Men often prefer a more prominent, angular nose with a less delicate tip. Many are also looking to correct injured noses or a deviated septum to improve both form and function.
  • Gynecomastia (enlarged male breast) reduction and pectoral implants: A sculpted and toned chest is the ideal for most men.
  • Eyelid surgery: Skin, muscle, and fat can be tightened, or skin and fat may be removed from the eyelids if they are in excess and cause drooping (which can also cause obstructions to a clear field of vision). Eyelid contours may also be improved. The result is a more wide-awake, youthful appearance.
  • Facelift: As the gold standard in facial rejuvenation, this procedure can tighten facial tissues, remove excess, sagging skin and fat, and boost volume in deflated areas. Brow lifts and eyelid surgeries are often performed in conjunction with a facelift.

Both surgical and non-surgical cosmetic procedures can carry an element of risk, which is why it is important to conduct your own research on both the procedures you may be interested in, as well as potential doctors you plan to visit (ensure they are board-certified in plastic surgery and experienced in the procedures of your interest).

The consultation is the first step to determining what treatment plan would be most beneficial for you. Be prepared with information about your personal and family medical history, which areas of the face or body you would like to improve, and any questions you may have for the surgeon.

Adam C. Augenstein is one of the few plastic surgeons in the Charlotte, NC, area to be certified by both the American Board of Plastic Surgery and the American Board of Otolaryngology – Head & Neck Surgery. He would be happy to advise anyone looking to learn more about cosmetic and reconstructive surgery or non-surgical cosmetic procedures. To request a consultation with him, contact Aesthetic Surgery of Charlotte online or by phone at (704) 837-1150.

What is NeoGraft®? San Francisco Area Hair Restoration Specialists Drs. David Lieberman & Sachin Parikh Break It Down

Hair transplant surgery has come a long way from “hair plugging” and follicular unit transplants (FUT). Follicular unit extraction (FUE) is the gold standard in today’s hair restoration procedures, and the biggest advancement in this respect has been NeoGraft®. San Francisco area hair restoration specialists Drs. David Lieberman and Sachin Parikh explain how this sophisticated technology has made FUE hair transplanting much more precise, rapid, and natural-looking.

NeoGraft®, which is the first FDA-approved automated and minimally invasive device for hair restoration in the United States, minimizes the likelihood of scarring, as it eliminates the need for any large incisions, staples, sutures, or “plugs”, and allows patients to freely be able to wear their hair long or short in the future.

FUE entails collecting and transplanting thousands of individual “follicular units”, taken from healthy donor sites on the scalp. While the process of follicular unit extraction may be done by hand, the NeoGraft® device offers a much more efficient solution.

This technology improves on the manual collection technique, as it works based on a system of negative pressure (using a small rotatory punch) to rapidly, yet precisely, extract each hair follicle (including the attached shafts and roots) from the donor site. Patients under local anesthesia experience little to no discomfort as the NeoGraft® device works its magic.

During the actual harvest procedure, a magnifier is typically used to closely observe the scalp, while the NeoGraft® device’s micromotor that creates a tiny hole as it extracts each follicular unit. The area is left with a very small, round mark, which will heal over time and ultimately shrink to a tiny dot. And as the hair grows back in the donor area, these already small dots will be obscured from view.

By using NeoGraft®, a doctor is able to control:

  • The speed and diameter of the micropunch
  • The depth and orientation of each hair follicle
  • The distance between each extracted hair follicle

NeoGraft® balances being precise and meticulous with being extremely efficient – as each follicular unit extracted can hold between one to four hairs, the process as a whole can involve the extraction of thousands of hairs in total (typically between 2,500 to 3,000 grafts).

The hair follicles that are removed are completely intact, and the NeoGraft® results in little to no trauma to the surrounding areas of the scalp.

The donor area is typically at the back of the head, as this hair is more resilient to the effects of testosterone fluctuations. Each graft extracted by NeoGraft® has the same consistency in length and diameter, so the results of transplantation is more even and uniform-looking.

While FUE – generally via NeoGraft® – has become the norm in most cases of hair restoration, it may be more appropriate to utilize the strip-harvesting method or try non-surgical methods of for some patients. This can depend on a number of factors, and the most suitable form of harvesting will be best determined in a consultation with an experienced, board-certified physician.

In a few cases, NeoGraft® can even facilitate a type of scar revision without the actual hair transplant. If a white scar, for example, shows through dark hair, NeoGraft® can be used to make tiny holes in the scar, which will revascularize during the healing process and make the scar flesh-colored instead, thus making it much less stark or noticeable.

Drs. Lieberman and Parikh, who are both board-certified head and neck surgeons themselves, would be happy to consult anyone who is looking to learn more about their options for hair restoration and/or determine whether NeoGraft® is right for them. To request an appointment with them, contact the Lieberman & Parikh Center for Hair Restoration online or by phone at (650) 327-3232.

Statistics on Facial Plastic Surgery: The Bay Area’s Dr. Stanley Jacobs Notes Increases

The face has been an object of attention for as long as humanity has been around: It graces ancient pottery, fills museums of antiquities, and now is presented virtually on countless smartphones and social media platforms each day. In addition to driving technology’s ability to capture and preserve someone’s looks for posterity, the world’s collective fascination with the face has also given rise to a growing desire to adjust individual features, an endeavor possible now like never before via facial plastic surgery. Bay Area facial cosmetic surgeon Dr. Stanley Jacobs has studied the long and fascinating history of facial aesthetics, which is why he noted with interest the recently released statistics from the American Society of Plastic Surgeons.

According to the published numbers, plastic surgeons in the United States performed about 17.1 million total cosmetic procedures in the United States in 2016, an increase of three percent over the year before.

While the most commonly performed surgery was breast augmentation, three other surgeries in the top five—rhinoplasty, blepharoplasty, and facelift—are focused solely on the face, and the other—liposuction—is frequently used to shape specific regions of the face. Given that the numbers for each procedure were higher in 2016 than 2015, it’s safe to say that facial plastic surgery is on the rise.

Liposuction—a surgical fat-removal technique that can be used on the neck, cheeks, and elsewhere—is in the second slot, with 235,237 procedures reported. That’s an increase of six percent in one year.

The next three most commonly performed procedures ranked as:

  • Nose reshaping, up two percent to 223,018
  • Eyelid surgery, up two percent to 209,020
  • Facelift surgery, up four percent to 131,106

Breast augmentation was the most commonly chosen cosmetic surgery procedure among women. Not surprisingly, this didn’t register at all on the list of male-chosen surgeries. For men, facial plastic surgery ruled the year, with nose reshaping and eyelid surgery taking the top two spots. Liposuction and facelift were at places four and five, respectively, with male breast reduction sitting at No. 3.

As facial plastic surgery is proving increasingly popular, so, too, are minimally invasive procedures that focus on temporarily rejuvenating and refreshing the skin. The uncontested top procedure overall—dominating over all other options, nonsurgical and surgical alike—is an injectable form of botulinum toxin type A. The 7,056,255 injection sessions in 2016 are up four percent from 2015’s 6,757,198.

There are several brand names available in this category (Dysport® and Xeomin® among them), but the most prominent is BOTOX®. Injections reduce muscle contractions. If properly applied with precision by a trained and experienced injector, BOTOX® can slow activity in the specific muscles that cause noticeable frown lines on the forehead, as well as crinkly crow’s feet.

Second to botulinum toxins, but still far surpassing surgical choices are soft-tissue fillers, tallying 2.6 million applications in 2016. This is followed by chemical peels with 1.3 million

Often, patients can combine the effects of facial plastic surgery and nonsurgical options to get a benefit unattainable from a single procedure or treatment. Dr. Jacobs, for instance, combines a surgical facelift with a the carefully controlled application of chemical peels to address both the skin and its underlying architecture in what he’s called a SynergyLift™.

The American Society of Plastic Surgeons compiles its statistics annually by sending out a survey to member surgeons, combing a dedicated database, and extrapolating the resulting aggregated information. The results are considered by many to be the most comprehensive statistics exploring cosmetic and reconstructive plastic surgery in the United States each year.

Dr. Stanley Jacobs is a triple board certified doctor specializing in facial plastic surgery. Bay Area residents may recognize him from his segments on KRON4, as well as his frequent appearances at events in the greater community. For more information, call his office in Healdsburg at (707) 473-0220 or in San Francisco at (415) 433-0303. He also has an online contact form.

Fat Grafting: St. Louis Doctors Explain an Advanced Cosmetic Surgery Technique

In St. Louis, the cosmetic surgery specialists at West County Plastic Surgeons of Washington University see a variety of patients with a variety of needs. In this Missouri city, women and men seeking a new look are the same as those throughout the country: They want that area to be smaller, while this area could use some more volume. An increasingly popular solution to both problems is fat grafting.

While dermal fillers and even implants have taken an ever-larger share of the spotlight—and certainly have their own benefits—fat grafting is a cosmetic surgery procedure with multiple established uses, as well as a body of researchers continuing to explore new and innovative applications.

But first: What is fat grafting? The procedure is used to take fat from a donor area somewhere it’s plentiful on a patient’s body, after which it is processed and injected elsewhere into the same patient.

The process is, of course, more involved than that. Specifically, the procedure starts with a consultation with a professional cosmetic surgery specialist to determine whether fat grafting is the best options for delivering a patient’s desired results. With fat grafting is identified as the right course, the patient can expect a procedure in two parts: removing the fat and re-introducing the fat.

For removal, the doctor will administer a solution into the donor area to make the tissue firmer (known as “tumescent”), a technique that reduces both pain and blood loss, leading to less bruising and faster recovery. Using a cannula, the doctor will then loosen and suction out the necessary fat cells, collecting them in a special container.

Note that though fat cells are being removed, liposuction is not intended as a strategy for weight loss.

The harvested fat cells will be spun in a centrifuge to separate them from other materials removed along with them during the liposuction procedure. Once isolated, the cells intended for fat grafting are moved into small syringes, ready for injection where desired.

Because these cells are a patient’s own fat, the body is more receptive to them than other foreign substances. The “familiarity” lowers risks of rejection and related complications and extends the life of aesthetic results, often by years.

Patients should know that the volume of fat to be injected at this point is significant, but not large. As a cosmetic surgery procedure, fat transferddd is best used for contouring and detail work. West County Plastic Surgeons of Washington University uses the technique to correct post-mastectomy contour deformities in breast cancer patients, other contour problems around the body due to trauma or surgery, and hollow or sunken areas on the face due to volume loss and shifting fat.

For instance, fat grafting can be used to fill in a divot left behind after the removal of a benign leg tumor. It can also restore a youthful roundness to the apple of the cheeks, which also tends to pull up the sagging tissue that causes jowls.

Fat grafting can also be used in augmentation for patients who want to change the size and contours of their buttocks.

Because the nature of a treatment depends on its scope, the amount of time a fat grafting cosmetic surgery procedure may take typically ranges anywhere from one to five hours. Similarly, recovery may be expected to take anywhere from two days to two weeks.

As for future applications, the West County Plastic Surgeons of Washington University team is working with the American Society of Plastic Surgeons to study and evaluate other cosmetic surgery-related uses for fat grafting, including breast augmentation, the reconstruction of an entire breast, and healing aids enriched by stem cells.

Note that liposuction can be performed as a standalone procedure, without the doctor harvesting the fat for later use. Any patient considering combining fat removal with fat grafting should be sure to discuss the idea during the consultation.

Contact the West County Plastic Surgeons of Washington University team to learn more about fat grafting and related cosmetic surgery options, including facelift. Call (314) 996-8800 or reach out online.

Considering a Tummy Tuck? Harrisburg, PA, Surgeon Dr. John Stratis Outlines Your Options

Whether you have recently experienced weight changes, given birth, or simply developed a beer belly or “spare tire” over time, the contour of the abdominal area can be corrected with a tummy tuck. Harrisburg, PA, body and breast focused plastic surgeon Dr. John P. Stratis – one of the cofounders of the comprehensive cosmetic surgical practice at Stratis Gayner Plastic Surgery – explains how a tummy tuck or abdominoplasty is performed and the procedural options that are available to you.

A tummy tuck is a surgical procedure in which excess fat and skin are removed and the underlying muscles tightened to improve the look of the abdomen. While the operation can achieve dramatic results, it requires skilled and experienced hands to be safe and effective.

According to the latest statistics collected by the American Society of Plastic Surgeons (ASPS), the number of tummy tuck operations performed by member surgeons each year in the United States has increased by 104 percent since 2000. Individuals of all genders can receive tummy tucks. New mothers often have the procedure performed as part of a mommy makeover, while men often develop noticeable bellies as they age due to weakening and permanently stretched out muscles and skin tissue.

There are several types of tummy tuck surgery available to patients. Your surgeon will help you decide which procedure is most appropriate for you depending on your unique abdominal profile and the type and extent of results you are looking to achieve.

A traditional or standard tummy tuck is performed under general anesthesia and is performed on an outpatient basis. One or two incisions are made during surgery. One is made in the lower abdomen below the line of most kinds of underwear and swimsuits just above the pubic bone. A second may be made around the navel or belly button to allow the surgeon address the upper abdomen. Excess skin and fat will be removed, and the lower and upper abdominal muscles will be tightened. A new hole will be made in the repositioned tissue to allow the belly button to show through.

For some patients who have experienced extensive weight loss—whether with the assistance of bariatric surgery or otherwise—a fleur-de-lis tummy tuck may be ideal. In order to be effective long-term the patient must be committed to the healthy eating and exercise habits that enabled the weight loss.

A fleur-de-lis tummy tuck involves two incisions. While the first is made in the lower abdomen, the second is created vertically down the midsection to more comprehensively address the lax abdominal tissue. The length of this second incision depends on the amount of abdominal correction required, but it typically will not extend above the breastbone. The belly button may also be positioned at a level that looks more proportionate and aesthetically pleasing. Once the tummy tuck is complete, the surgeon will close the incisions with dissolvable sutures to heal properly. The procedure is performed under general anesthesia on an outpatient basis.

Your surgeon may recommend a mini tummy tuck if the cosmetic correction desired is minor. While a mini tummy tuck is less extensive than a traditional one, many patients find that the procedure gives them the results they were looking for with less recovery time required. A mini tummy tuck addresses only the lower abdomen, removing excess skin below the navel and repairing the muscles there. Some surgeons also perform liposuction along with the mini tummy tuck to better contour the remaining tissue

After any sort of tummy tuck is performed patients usually notice an immediate difference. Bruising and swelling in the operated areas are common and resolve in the weeks after. A special garment may be worn after surgery to keep these side effects to a minimum and allow the incisions the freedom to heal. A drain may also be used to reduce any buildup of blood and other fluid.

Some surgeons employ a long-acting local anesthetic, Exparel, during the procedure for sustained post-operative pain relief. They may also prescribe patients pain relief medications for their comfort during the recovery period and allow patients to do whatever they feel comfortable doing after the procedure. This “self-limiting” leads to a faster recovery. It typically takes about six weeks after a tummy tuck for patients to be able to safely and comfortably return to all their normal activity, but most patients can drive and return to work after a week.

Dr. Stratis is board-certified by the American Board of Plastic Surgery and specializes in performing tummy tuck procedures. To learn more about the surgery and which method may be most suitable for you, request a consultation with him online or call the practice at (717) 728-1700.

Four Ways to Rejuvenate an Aging Neck, from Surgery to Kybella®

While a wrinkled and sagging face bears most of the blame for giving away a person’s age—or even making someone look older than their years—the reality is that the neck also significantly contributes to the problem. Considering the 2015 introduction of Kybella®, Boston-area board-certified plastic surgeon Christopher Davidson, MD, has appreciated the increasing availability and popularity of neck-focused procedures and treatments. Here are four to consider:

• Kybella®

A primary aesthetic complaint from both men and women is a double chin, caused by a pocket of fat that can stubbornly refuse to change no matter how consistently someone diets or exercises. This fat is a problem for anyone who wants facial definition, as it softens what would otherwise be angular lines and creates the impression of multiple chins—especially when looking down. Since fat-reducing lifestyle alterations are not always successful, the most effective treatment often involves the physical destruction of the unwanted fat cells. Kybella® accomplishes this by rupturing them with deoxycholic acid, a chemical the body uses to break down fat during digestion. The form used in Kybella® destroys fat cells it encounters in the submental area, and these cells are then eliminated from the body.

Kybella® is an injectable, and a single treatment session can involve up to 40 or 50 injections, all carefully placed in the targeted area. The FDA has cleared Kybella® for use in reducing double chins, and since its powerful active ingredient can damage any cells it encounters, application is limited to specially trained medical professionals who can minimize risk and maximize results, which appear over the course of weeks and months as fat is gradually removed.

• Liposuction

Another option for eliminating unwanted neck fat is liposuction, which involves removing fat cells by suctioning out the unwanted material with a thin tube known as a cannula. This takes the fat cells in question out of the equation and can give the chin-to-neck transition area more definition. With the fat gone, results are immediately noticeable—and will become increasingly apparent as post-procedure swelling subsides. Patients who choose this method are often those searching for a double chin treatment with fast-acting results.

• Neck lift/facelift

Not all aesthetic neck issues are due to excess fat. In fact, the loss of fat can, in some cases, leave loose skin behind. Young, healthy skin readily conforms to body contours, but after years of being stretched out by underlying fat, some skin—especially skin that has lost collagen, hyaluronic acid, and elastin due to aging and environmental factors—simply won’t shrink back down.

Sagging skin on the neck creates a turkey wattle effect, and drooping skin on the face, due to volume loss higher on the cheeks, can form jowls that appear at the jawline. A facelift is a surgical procedure that lifts away those jowls, while a neck lift focuses on tightening the skin below the chin. Together, these two options can significantly revitalize a patient’s profile, so they are frequently performed in combination.

These procedures may also involve some amount of fat removal via liposuction.

• Juvéderm Voluma®

As noted above, volume loss in the cheeks leads to problems farther down, as the natural structures holding tissues in a firm, youthful position give way to laxity. By reintroducing volume with the hyaluronic-acid-based injectable Juvéderm Voluma®, support can be temporarily rebuilt, rounding out what is known as the “apple” of the cheek and effectively pulling up the sagging tissue that forms jowls.

Any of these options can be performed as a standalone procedure, but they may also be combined to produce a desired youthful effect over time.

Learn more about any of the neck treatments and procedures mentioned here, including Kybella®, from Boston-area plastic surgeon Christopher Davidson, MD, who has more than a decade of experience in the field. Call his office at (781) 237-7700 or visit his contact page.