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Surgical Treatment

Irvine Institute of Medicine and Cosmetic Surgery (IIMCS) Surgical Treatment for Hair Loss.

At the IIMCS, we perform hair surgical restoration using traditional FUT (STRIP) and FUE.  Dr. Williams is our primary surgeon and he intimately participates in all surgical phases (pre-operative, intra-operative, and post-operative) with our patient's hair transplantation experience.  Dr. Williams performs the entire procedure and is assisted by his clinical staff who possess over forty years of hair transplant surgery.

Traditional Strip surgery

The Follicular Unit Transplantation (FUT) or Strip technique is currently the major surgical treatment procedure used by hair restoration surgeons according to a 2011 survey by the International Society of Hair Restoration Surgery (ISHRS). At our surgical facility located in the beautiful city of Irvine, Orange County, we perform this surgery technique using the Trichophytic closure technique and PRP therapy for our patients who do not meet the criteria for FUE or who desire a less expensive procedure.

Actual Patient- The initial incision
Actual Patient-After the Donor strip is removed

Actual Patient-Suturing the skin edges together
Actual patient-Slivering of the donor strip into individual follicles

Automated FUE

At the IIMCS, Dr Williams is well known in the surgical hair community for his aesthetic sense, hand-eye-skills and performing the FUE technique. In 2009, he was one of the first surgeons in the United States to begin using the automated FUE device, NeoGraft. Since then, he has added two (2) other FUE devices to his medical and surgical hair practice to harvest follicular units from the donor site.

Currently, Dr. Williams is using Dr. John Coles FUE device, the PCID, because of its superior sharp punches and advance computer programming options. Automated FUE with the PCID device increases the total number of grafts harvested in one surgical session, and more importantly this advance computer device decreases the transected number of grafts.

In comparing the FUT (Strip) with FUE, Dr. Williams feels FUE is the least invasive method of hair restoration surgery, and is generally a better tolerated surgical experience. He performs FUT (Strip) using the Tricophytic closure technique, but more patients are demanding FUE because there is no excision of a donor linear strip from the scalp. Thus there are no sutures, staples, or linear donor scar. Automated FUE compared to the manual FUE technique, reduces the surgical time and increase the harvested hair grafts. There is nominal bleeding and decrease risk of complications.

A known outcome of FUE surgery is the potential of hypopigmented lesions where the follicular units are removed from the donor site. FUE has been called "scarless" in the past, but this term refers to the lack of a linear donor scar and not tissue changes in the donor site. In fact, in some patient's donor site there are areas resembling hypopigmented "freckles." But in many patients these hypopigmented lesions don't exist or are barely visible in the donor site even when the hair is cut to less than 1mm. The rate of hypopigmented lesions in the donor site varies from one patient to another and there no tests available that predicts this hypopigmentation. Genetics, cell and tissue health play an important role in this phenomenon.

Using the automated FUE device, hair follicles are individually removed with a 0.8mm or 1.0mm diameter punch. At IIMCS, the follicles from the back of the head are safely stored in Hypothermasol and PRP before the are subsequently reinserted in balding areas of the scalp. Our office uses the traditional hand placement technique by experienced technicians.

The placement of the follicles in the recipient site are based on the cosmetic priorities of the patient after a thorough and complete consultation with Dr. Williams. The hair follicles from the posterior or back portion of the scalp are chosen because it is considered the "safe or stable" area. Generally, the follicles at this site are genetically programmed to remain healthy and thick for a person's entire lifetime. These follicles do not miniaturize or fall out unlike the hair follicles on the top of the head.

Our patients have the option during the procedure to watch television, listen to music, or have a casual conversation with the surgeon and surgical team. The surgical procedure is virtually a painless procedure aside from the initial injection of local anesthesia. If desired by the patient, the surgical procedure is typically performed with oral sedation to help the patient relax.

Automated FUE leaves no visible linear donor scar and eliminates the fear of people seeing a scar at the back of the scalp if the hair is worn short. As early as four (4) days postoperatively there is minimal perception that a surgical procedure has been performed. There are no staples of sutures to remove and the donor site heals naturally.

Recipient Ste three (3) days Post-Op

A complication sometimes seen with the STRIP surgery is a feeling the scalp is too tight from the suturing together of the scalp. Compared to FUE nerve pain or damage to major blood vessels has not been reported in the medical literature. The post operative care after FUE is much easier.

Donor site three (3) days post op

Well healed donor site six (6) days post op

Donor site twenty-one (21) days post op


Few Hair Surgeons Perform Automated FUE

Very few doctors offer a manual or automated FUE for hair restoration because of the long learning curve to acquire the skill sets to perform the surgery, longer length of surgical time to complete the procedure, and other technical concerns. While any new surgical technique takes time to gain acceptance, excellent surgical outcomes are common with the FUE technique. In promoting FUE, we view our efforts as advancing a new and better surgical technique that patients demand. We do not in any way disparage our professional colleagues and friends.

Many hair restoration surgeons discourage their patients from FUE hair transplantation by speaking of the transection rate of an FUE transplant but fail to point out that with a STRIP surgery hundreds of follicles are transected when a piece of scalp is cut out. Furthermore, follicles may be damaged when suturing the scalp together. In addition, the scalp has to be cut into small units to be given to several technicians who will then separate the follicles to prepare them for transplantation.

Ideally, the transection rate should be between 3-5 percent of hair restoration surgery. Our rates our very comparable and in some procedures the transection rate is much better. All hair restoration procedures may damage the follicles depending on the skill of the surgeons and technicians, as well as the technical surgical tools used.

Antagonists of FUE point out in FUE hair transplant the hair follicles have to be pulled, twisted or traumatized in order to remove them from the scalp. With the Cole PCID computer technology used at our office, though,these concerns are eliminated because the punches are the sharpest in the hair surgical industry. Thus the trauma and forces induced by the FUE technique on the hair follicle and dermis is significantly reduced by the Cole PCID FUE device.

Sample FUE Case

Norton Grade 5 patient received 2380 grafts by means of automated FUE

Pre-Op Photo

Recipient Site Three (3) Day

Recipient site three (3) days post-op

Three (3) Months Weeks post-op

Three (3) Months Weeks post-op