INTRODUCTION

PROGRAM

DHI CLINIC

ON THE BOAT

CONFERENCE DAY 1

CONFERENCE DAY 2

PHIDIAS AWARDS

PHOTO ALBUM

Thursday, June 5, 2003

On Thursday morning I decided to start enjoying the Greek breakfasts and my diet officially went out the window. As soon as I was finished gorging myself on my five helpings of pancakes, bacon, croissants, oatmeal, and eggs we sailed off for the beautiful islands of Agistri and Aigina.

A half hour later the final day of the scientific program began with a historical and contemporary overview of transplants.

Dr. Sheldon Kabaker: Alternatives to follicular grafting. An historical and contemporary overview

Summary: Dr. Kabaker is a living legend in the field of hair transplantation. He has mentored some of the best hair transplant surgeons in the field today. Having lived through so many decades of hair transplant work he has been able to observe first hand the evolution of hair transplantation techniques. Dr. Kabaker presented a historical slide show taking us through early plug grafts, scalp reductions, scalp lifts, flaps, mini grafts, micro grafts, strip dissected follicular units, and FUE/FIT. He showed us long term results of transplant patients from over 30 years ago. Through careful documentation and observation we've learned what has been most effective and which procedures were unsuccessful and have fallen out of favor in recent years. Even some procedures that have been mostly abandoned have had many successful results with proper technique. Although FUE/FIT are considered a state of the art technique today we must also remember that the best techniques stand the test of time and more time is needed to fully evaluate the pros and cons of all new procedures. In summary, we learned the doctor's surgical skill is the most important factor in any procedure as a revolutionary, state of the art technique can be disastrous in the wrong hands.

Dr P. Cahuzak: Photography--a reliable approach to obtaining high quality images.

Summary: Dr. Cahuzak is a leading French dermatologist who stressed the importance of obtaining high quality images of patients before and after a hair transplant to ensure adequate records are maintained for each patient.

She presented the following tips for taking high quality photographs:

1. White Backscreen color
2. Separate Lighting

• 2 flashes of 200 J each
• 2 white umbrellas
• Tripod mounted cameras
• IR Connection

3. 16 gauge aperture
4. Photo types:

• 1 portrait
• As many close ups as needed.

High quality photographs are a valuable asset as a sales and marketing tool for future patients and to help show current patients how much improvement has been achieved with the transplant.

Dr K. Minotakis: The last year's evolution in the DHI no touch technique

Summary: Dr. Minotakis presented DHI's evolutions in the No-Touch technique using the DHI Choi implanter. One of the advantages of the DHI implanter is the ability to densely pack follicular unit grafts. The DHI implanter has allowed DHI surgeons to achieve excellent density in all patients. Paradoxically, the scientific advancements of dense packing may also cause poor graft growth due to excessive scalp trauma and sub dermal bleeding. Healthy hair follicles, proper graft handling, a rich blood supply, and excellent surgical technique are needed to ensure densely packed grafts are able to thrive after the hair transplant.

P. Straub: Fine donor line all the time

Summary: Dr. Paul Straub is a former president of ISHRS and holds several posts on hair transplant committees. His first speech of the day discussed the pros and cons of donor scars from both FUE/FIT and strip surgeries.

He began by discussing the Woods' Technique, created by Dr. Ray Woods from Australia. The Woods technique is described as donor harvesting without scars and uses a small punch to remove single follicular units. The small holes heal by secondary intention, or the wound edges granulate in on their own instead of being closed by sutures.

The Woods Technique has been very popular with patients and the subject of much discussion on the Internet. However, Dr. Straub feels the Woods Technique has several disadvantages including the following:

• Only small numbers can be done at one session
• Many follicles are possibly transected
• The incisions actually makes hundreds small scars which are hidden between the hairs.

Dr. Straub went on to discuss the benefits of traditional strip scars and how to ensure a fine, pencil line scar results every time in the strip donor area. The tension of closure on the inner suture is paramount as the outer layer must appear no other suture is necessary. Dr. Straub's strip technique is the product of many years of evolution, but even with perfect technique skin quality plays an important role in scarring. Dr. Straub commented that he has been using a harvesting and closing technique which has produced no "known unsatisfactory scars for the past 3 years."

History has taught us that very tight, tough skin causes wide donor scars and very loose, soft skin also causes wide scars. A physician should thoroughly examine scalp laxity to ensure a prospective patient is an ideal candidate for strip surgery. Previous surgery tightens the skin because of the existing excision and because of scarring in the fibrous layer.

No matter how perfect the technique there will always be a variation in how patients heal. Some patients always have small scars and some are keloid formers.

In the early days of plug grafts, doctors extracted large "Open donor sites." On rare occasions the scars contracted to make the scars nearly undetectable, but most ended up severely damaging the donor area requiring repair work later. Open donor harvesting has thus been abandoned by most physicians. FUE/FIT has replaced open donor harvesting due to its minimally invasive qualities, rapid healing, and precision of micro-surgical instruments. However, Dr. Straub feels the strip is superior now that pencil line scars can be created with every operation.

Next, he addressed the evolution of donor harvesting and closing such as aligning the punch wounds properly, matching the tongue with the groove, and the preferential use of single or two bladed knives to multi bladed knives to produce strip ellipses. He compared staples versus nylon closures and found similar results of scar quality. The length of time the sutures are left in proved be the most important factor. Leaving the sutures in for 14 days instead of 7 days increases the probability of creating a perfect donor scar by 10-15%. By adding deep absorbable permanent sutures, perfect donor scars are created 99% to 100% of the time.

In conclusion, Dr. Straub commented that his demonstrated techniques produce a fine line scar 99% to 100% of the time. If every scar is a pencil thin fine line, he feels there is no advantage to the Wood’s technique and no need to abandon the current method of strip practice to start using the Woods technique

Paul Straub: Body type and balding

Summary: Dr. Straub's second speech focused on why so many overweight men are balding. Most of us have heard of the stereotype of the "fat, bald guy" like Danny Devito. So why is that so many fat men are also bald? Is it coincidence or is it chemistry? Interestingly, scientific evidence has now shown us that body type does play a significant role in the balding process. Most educated hair loss patients know that the enzyme 5 alpha reductase converts Testosterone into DHT which has been shown to be a major contributing factor towards hair loss. However, recent research has shown that excessive abdominal fat produces 10 times as much DHT as a healthy, lean body.

Furthermore, research shows us that abdominal fat is unique. Low abdominal fat equals low circulating dihydrotestosterone while excessive abdominal fat equals high a level of circulating dihydrotestosterone. No other fat on the body has been shown to do this! We must ask the questions: Can we control hair loss through abdominal fat reduction strategies like weight loss and liposuction? The three key factors we've identified as affecting hair loss are: heredity, aging, and abdominal obesity. Heredity and aging cannot be controlled, but body fat can and each hair loss sufferer must work hard to lose any additional abdominal fat to slow down his hair loss.

Dr. Straub speculated that a possible triad exists between abdominal obesity , crown balding, and coronary heart disease.

My hair loss started five years before my older brothers. I was significantly overweight in my early twenties while he had very little body fat. I began to wonder if the excessive abdominal fat had triggered my hair loss to start earlier than it might normally have. Dr. Straub's presentation allowed me to consider this possibility. I can't turn back time, but I can encourage others to ensure they stay fit and lean to reduce circulating DHT in their bodies.

Truett Bridges: Anesthesia in HT

Summary: Dr. Bridges is an Anesthesiologist who is now performing hair transplants. He helps to train doctors on pain management for patients. He presented a slide show detailing nerve block points and how to effectively anesthetize each patient with minimal discomfort. I was able to watch Dr. Bridges perform his techniques during the live surgery clinic with an excellent bedside manner and compassion towards his patients.

Paco Jimenez: Botox demonstration

Summary: Dr. Jimenez found some willing volunteers and demonstrated Botox injections live on the boat. He demonstrated the ease and safety of Botox injections and how quickly they could be applied.

Following the scientific program we took a break for lunch where I feasted once again on several large portions. I thought my chicken was tasting kind of odd when I realized it was actually fish. In the USA the fish tastes so salty and "fishy" that I can't stand to eat it. In Greece where everything is fresh I didn't even realize I was eating fish until it was halfway gone.

Later we enjoyed swimming on a quiet beach on the island of Agistri. A couple hours later we left for Aigina and had some free time to tour the island. I had extreme difficulty finding anyone who spoke English on this island. Later I learned it was a tourist destination for the Greeks and not for international tourists. We toured Aigina and stayed up reveling late into the night. I really just wanted to sleep, but I felt compelled to honor local customs of all night partying. I learned sleep is a luxury in Greece and not to expect it.