SmartGraft: Not Your Grandpa’s (or Grandma’s) Hair Plugs

Speaker 1:
You're listening to the La Jolla Cosmetic Podcast, with the LJC Chief Community Officer Monique Ramsey.

Monique Ramsey:
Hello, everybody. I'm Monique, your hostess of the La Jolla Cosmetic Podcast. And today I'm joined by Dr. Hector Salazar. And he has been part of our team here at La Jolla Cosmetic for I think going on for years.

Dr. Hector Salazar:
Yeah, we're almost there.

Monique Ramsey:
Yeah, this summer. So, wonderful having you here today.

Dr. Hector Salazar:
It's a pleasure being here. Thank you so much for inviting me to this.

Monique Ramsey:
Yeah. So, let me have you tell us a little bit about yourself.

Dr. Hector Salazar:
I'm Dr. Hector Salazar-Reyes. I'm a board certified plastic surgeon, passionate about cosmetic surgery and all of its aspects. And one of the parts that I'm very interested in is hair restoration. And that's a topic that we're very, very passionate about.

Monique Ramsey:
Talking a little bit about hair transplant technology, so that's changed over time. And I think people might say, "Oh, I don't want to do hair plugs." These aren't your daddy's hair plugs, right? Or your grandpa's hair plugs. Those were very fake looking. So can you tell us a little bit about maybe some of the problems with those older methods?

Dr. Hector Salazar:
It's a great question that you bring up because we face that all the time. And I believe that... Everything in terms of medicine, everything has evolved and continues to evolve. And hair transplantation definitely is a field that has evolved a lot. So in the past, yeah, that's exactly what patients would look like, they would look like they have hair plugs, they would look like dolls having like four or five hairs coming up through a pore in the forehead. And definitely, that is completely different nowadays, we have a new technology. We provide a very, very natural result, we... Let me get a little technical here and tell you that with the technology that we have, the follicular unit extraction device that we have, we extract follicle by follicle. Some follicles, yes, they do contain two, three, even four hairs sometimes, but we take the time to divide those, we take the time and we have the magnification to go in and separate those follicles safely.

So both are viable, or the two or the three are viable. And then we go in, and we graft them, we insert them. We transplant them one by one, and we carefully select the single ones to go in the front of the battle, meaning right in the hairline. And then where we need a little bit more bulk, which is on the back, then we can graft the ones that have two or three. But that's further back. So, when you're in a social interaction, everybody can see that you have a very, very natural hairline.

Monique Ramsey:
Mm-hmm (affirmative). So, talking about that hairline, I think that is something else that really people don't think about when they're thinking about hair transplantation. You as a plastic surgeon are really designing that hairline for them. Is that correct?

Dr. Hector Salazar:
That's absolutely correct. And that's where the artistic part of hair restoration comes in. There's a lot of technical aspects, there's a lot of repetitive work that needs to take place. And definitely for some of those parts, we need the help of hair techs that assist us during the case, but for the hairline, that's something that if it's not done correctly, if it's not done under very, very specific circumstances, you're going to get a very unnatural look. Like for instance, just to tell you, there is a specific area on the sides of your scalp that are called the receding triangles, are those two triangles that you have in the sides of your forehead, just at the level of the hairline, where you start losing some hair. If you make those two receding triangles completely disappear, and you want to bring that hairline and forget about those triangles, you're going to have a very fake result. We have patients that come in and tell us, "Please don't give me a straight line in my forehead."

So that's why having the knowledge about that hairline, knowing the distance of a natural hairline from where it starts to the level of the eyebrows to the level of the ears that's where that knowledge and artistic part comes in.

Monique Ramsey:
And that's the part that you are really... You're designing that for each patient. Is that correct?

Dr. Hector Salazar:
Yeah, that's correct. And then also another thing that we have to take into account is sometimes patients come in and they have an ideal look that they want to achieve. And we always have to adapt the amount of hair that they have, we have to discuss with them what's real, how much advancement of that hairline we can achieve. And that's also a very important part of their evaluation. But yeah, together we sit down, we spend a good amount of time, we discuss with them what's going to be that new level of the hairline, we tell them about another fact that's very important. That hairline has to be slightly irregular. Because if it's perfect, if it's really perfect, then is when you look like a doll again.

Monique Ramsey:
Uh-huh(affirmative).

Dr. Hector Salazar:
So you have to achieve a good amount of symmetry, but at the same time, you have to break that line and make it a little irregular, so you can look very natural.

Monique Ramsey:
And I think that's a great point. And it's something I didn't know. But as a lay person, you know, we don't realize how asymmetrical we are, all of us. Our faces, our bodies, you know. And it's not until you start to think about maybe making a positive change with plastic surgery that you realize, "Oh, well, actually this hip is lower, this eyebrows fuller." Or the left side of your hair is less full than the right side. So that's where really having somebody like you who can help point out what's naturally irregular, to get that natural result.

Dr. Hector Salazar:
Yeah, I know. I think you're hitting right on the head of the nail here. Because I would say that if you have an area of alopecia, a large patch of baldness on one side, and that makes it look... It could be due to any circumstance. It could be even because of a prior procedure, a facelift, or it could be because just, you developed a bald patch on one side with age. That... Yeah, we can definitely provide better symmetry. But that symmetry has to have a limit. Because if you make it things like perfectly straight, then is when patients look fake. But yeah, we're here to help them, we're here to orient them and to explain to them how to look more natural and how to achieve their goals.

Monique Ramsey:
So you talked about follicular unit extraction.

Dr. Hector Salazar:
That's correct. Yeah.

Monique Ramsey:
FUE.

Dr. Hector Salazar:
Add the E. Always had that E.

Monique Ramsey:
So, is it sort of like... So the machine that we use, we have SmartGraft. And if you could kind of talk about that technology in particular, and how it might differ from NeoGraft, which people might have also heard of.

Dr. Hector Salazar:
Yes, Monique, you're correct. We have SmartGraft. And we consider that the technology that we have, is the best technology for follicular unit extraction devices. It has many advantages over other devices as the ones you mentioned. And just to give you an example. So, people don't think that a hair transplantation is a true living organ transplantation. You're really transplanting a living organ, which is the hair follicle. We think about it that it's like a little thread or no, it's a living organ. And you have to preserve... You've seen when they... On TV, when they're showing a heart transplant or they're carrying a liver on a plane, they have it in a cooler, right? And the cooler with the perfect temperature, and they have it stored in the perfect humidity level.

So, that's what our technology provides. SmartGraft, when you harvest that follicle, it travels away from the pen that you're using to harvest on a special duct, and it gets stored on the machine at the perfect temperature, on a perfect humidity level embedded in a solution. So, just by doing that, you're going to increase the percentage of survival of the grafts that you have. So, that's why we love the SmartGraft device that we use, because it allows or treats the hair follicle like a living organ. And as a patient, that's what you want. If you're going to be moving hair from one area to another area of your head, you want pretty much 100% survival.

Monique Ramsey:
Right.

Dr. Hector Salazar:
Right? We don't want to lose any soldiers here. So, what we're talking about is up to 98% survival of the follicular grafts that you're moving from one site to another. So, yeah, technology is very important, devices that you have your transplant with are key, and SmartGraft gives us that possibility.

Monique Ramsey:
That's really interesting because I think maybe a lot of patients don't realize there is going to be, depending on the technology that's used, some part that doesn't survive, doesn't live. You take it from one place, you put it in another place. And again, that's why the FUE with SmartGraft is giving us the best chance for-

Dr. Hector Salazar:
Of survival.

Monique Ramsey:
Of that 98%.

Dr. Hector Salazar:
Which is fantastic.

Monique Ramsey:
Yeah. Now, I remember a long time ago, years and years ago, seeing a patient who had a hair transplant surgery and they had a big cut across the bottom of their scalp.

Dr. Hector Salazar:
A bad scar.

Monique Ramsey:
Yeah.

Dr. Hector Salazar:
Mm-hmm (affirmative).

Monique Ramsey:
So, tell me about... Is that the old way? Is that…

Dr. Hector Salazar:
Yeah, you can call it the old way. It's still a valid technique that's called the strip, the strip technique.

Monique Ramsey:
Okay.

Dr. Hector Salazar:
Because what you do is you obtain a large strip of scalp and you excise that, you wedge that out from the back of your head. And then after you excise that strip of scalp with the hairs in it, then you're going to be cutting and dividing those follicles out of that strip. As a result, you end up with a hole in the back of your head that you need to repair. As you're repairing, you bring the scalp together that remains in the back, you're going to develop a scar. Normally, scars that are linear like that, they tend to develop alopecia. So, you tend to lose some hair around that scar. So what happens is, that line can remain visible, not all of the time, but most of the time patients can see it. They can notice it or other people can see it. It's in the back of their head. But when they look in the mirror as they're combing their hair, they can see that. There are some indications, I would say, to still perform this technique, obviously, this technique was developed before follicular unit extraction was available.

So, that's why I told you, yes, you can call it an old technique. It's old, it's still valid. That's not our go-to technique. That's not what we do. But I think it's important. That's why it's important for our patients to understand the risks and benefits and the pros and cons of all different techniques. With our techniques, with the follicular unit extraction devices that we use, patients can be reassured that there's not going to be a line, that there's not going to be a scar, that all the little very, very tiny punch holes that we create in order for us to be able to extract those follicles, those are going to heal without a problem, they're not going to be able to tell that there was a very, very tiny cut right there.

Monique Ramsey:
Okay. So, when we talk about hair transplant, is it actually surgery? Are they going into the operating room, or what does that look like from the patient's point of view on the day of the procedure?

Dr. Hector Salazar:
I would tell you that, as you're saying, probably the strip technique can be, it's more of surgery, right? Because you're making a cut and then you have to put some sutures and you have to undermine the tissue, so you can actually close and that recovery takes a longer time. We could easily classify this more as a treatment/procedure in which we tell patients to block their morning completely, I mean, have nothing important to do that day obviously. We start our day pretty early, we're talking about meeting here around 6:30. And the first part involves the numbing part. And that's very important. And I know that you want to talk a little bit later about this, but we can probably talk about it now in which we know where the nerves that provide sensation to the scalp live. So we know the location of those nerves, and we would start by numbing those nerves.

How do we do it? We inject local anesthesia in the territory of those nerves. So then the discomfort drops tremendously. At that point in time, what we need to do is we need to finalize numbing the rest of the scalp of the area where we're going to be harvesting those follicles. And just to give you an idea, especially in the part where we're harvesting, there is absolutely no discomfort, no pain to a level that I would say probably most of our patients take a nap.

Monique Ramsey:
Oh!

Dr. Hector Salazar:
They fall asleep. Some patients they just listen to some music. There are some patients that actually are since you can imagine as we're harvesting the hairs from your occipital area from your back, from the back of your head, imagine that you're laying down in a massage table.

Monique Ramsey:
Oh, okay.

Dr. Hector Salazar:
Basically that's how it is. And then one by one, the hair follicles are being harvested, you can have an iPad, you can have your earphones and you can be watching our binging on some Netflix series because that probably will take about two, two and a half hours. And we allow for our patients to take as many breaks as they want. If they want to adjust their body, if they want to just give a stretch to their back or just stand up for a little while, they can do that. They go back into that massage table position and we continue harvesting, harvesting, harvesting. Then once we're done with that part, then we all take a break. But let me tell you what the break is about.

Monique Ramsey:
Okay.

Dr. Hector Salazar:
So, while we continue dividing and selecting the hairs, we are selecting where the soldiers are going to be placed, the threes, the fours, we divide the twos, we line up our soldiers, patients can actually have a break and have lunch. We order some good, nice healthy lunch for them, and then we take that break. And that's a very, very important point in time for patients to chill out to relax. There's no discomfort, there's no pain, they go to the restroom, they come back. And now it's another very important time, we design that hairline that we talked about. So design the hairline, we make our very precise markings. And then what happens is, we numb up now the part of the scalp where we're going to be doing the transplantation. The part that is going to be receiving that. So we do that, and then we're talking about maybe around 2:00, 2:30, 3:00 in the afternoon. We're applying some dressings giving the final instructions and the patients go home.

Monique Ramsey:
And now they go home, do they need pain medicine typically? Maybe Tylenol?

Dr. Hector Salazar:
Absolutely. So, when they go home, patients will pretty much say that they're a little tired. It's rare that patients really complain about pain. They're a little tired, you know, like you've spent your entire day doing something, right? Doing the same thing. So, there may be a little tension in the shoulders, some discomfort there. But that's it. We give them a prescription for antiinflammatory medication. We give them prescriptions to cover if they really, really need an analgesic. But if not, then we always recommend them to take some Tylenol as needed. And that's pretty much it. Then the following day, when we see them to change the dressings, pretty much everybody walks in saying that they had a pretty normal night, and that they feel fine.

Monique Ramsey:
Wow! Now can they... I guess they have dressings on their head, so they can sleep on their back or on their side, or do you have special instructions about what they can do maybe at the beginning or what they can't do?

Dr. Hector Salazar:
Yeah, absolutely. We have a very comprehensive preoperative visit where we explain all that to our patients. And we go step by step, we give them a manual as well. We're always available on the phone for them. And just to give you an example of a recovery afternoon would be don't exercise, don't have any social commitments obviously, you have some dressings just leave those in place. If you normally sleep with a pillow, or two, just add one or two more pillows to your back, so you can elevate your head and decrease the amount of swelling. The other thing is that the gauze that we apply and the dressings that we apply, they'll always suffice. So, they do not need to be reapplying things or there's not oozing or anything like that. It's pretty dry. And then when they come back, we change those dressings for them, and then the day after, they can get rid of them completely, because everything has pretty much already healed.

There is going to be some restrictions though. And that is, we don't want the hair transplants to be bombarded by the shower. That's really important. You don't want those drops hitting those new hair grafts that you placed. So we tell them how to shower, it's basically collecting the water in a cup, in a separate cup and then just using that to gently pour it and then we tell them how to shampoo. Apply the shampoo inside that cup of water and then mix it gently and then pour it in a very nice way over those follicles. That has to be done that way for two weeks. After two weeks, they can shower regularly. No hats, we don't want any friction. As a matter of fact, it's funny because we had one of our patients, he was a construction worker. And he said, "But look, let me show you my hat." And a construction workers hat you can absolutely use because it has a halo. And that halo adapts pretty well to the parts that we do not do the transplant and everything else floats. So, those are the only hats that are allowed.

Monique Ramsey:
So, let's talk about getting back into life with our new hair. When can you go on a really fast boat ride without a hat on? How much is too much wind?

Dr. Hector Salazar:
That's a great question. And what I normally tell them is it really depends on the patient, when do you want to go back to your regular life. I would say for the first two weeks that we don't let you shower in a normal way, especially in the parts that we have grafted. You may develop a little crusting. And that crusting obviously can call attention, social attention. People see it, you can... "Oh, you had something done?" So if really, if you don't care of people noticing that you had a procedure done, if it's something that it doesn't bother you for people to ask you about it, or if you tell everybody at work, "Hey, guess what, guys? I'm going to go and get some hair." You can really come back in two days, I would say.

I mean, you do it on a Thursday, and then you come back on Monday morning and yeah, people are going to ask you about it and you can tell them and hopefully they're all going to be very supportive about it, and celebrate together with you. If you don't want people to know about it, you just tell people, you're going to go to Cabo for a couple of weeks, and then just come back a little refreshed and with some more hair.

Monique Ramsey:
And with those tan towels that you can just wipe on like you'd been at the beach.

Dr. Hector Salazar:
Exactly. Exactly. 100%. But yeah, I would say that that's the time frame. I would say two weeks for it, since you are going to be able to shower in a normal way. Remember this, we have to cut your hair very, very short in the areas that we're going to be harvesting. So practically, it's a shave in the back. What we do is we coordinate for our patients, a haircut at a specific beauty salon that we work together with, and we do that one or two days prior to their transplantation. So what they do for us, is they do a very, very nice fade of the rest of your hair that we're not going to treat. So for your hair in a week to 10 days when it grows back, that it grows back with better harmony, right, to have a nice length, so you don't have a mismatch in your lower back, you don't look like you went to the military that morning. So, definitely I would say that you get your haircut, then we shave the area where we're going to be harvesting. A question that could be raised here is what about women?

Monique Ramsey:
It's in the back of my mind. I was just about to ask you.

Dr. Hector Salazar:
Right? Because guys, they look like they have a nice short haircut, and then in two weeks, they're going to go back practically to normal.

Monique Ramsey:
Right. And nobody's going to be the wiser.

Dr. Hector Salazar:
Nobody, yeah. I mean, you'd have nice short hair, that's it. So for women, what we do is we... Yes, we do have to shave, but what we do is we shave a very specific area and we leave and respect the hair above and below. So I know that our patients can be a little skeptical or afraid of, how am I going to... How's the back of my head is going to look? It looks normal, it looks like you have long good coverage of, like, long hair. We do it in a more concentrated strip area, than with a gentleman that where we can harvest from pretty much everywhere. But yeah, it's a matter of time, and then in two, three months, you're going to have much longer hair, and then at some point that hair is going to catch up. And that's it.

Monique Ramsey:
Now for women, what is sort of the main reason that women might need hair transplants, or is it a certain age? And then where are they losing their hair?

Dr. Hector Salazar:
Yeah. I mean, the pattern of hair loss is different between men and women. Women somehow, they're very protected, not only about hair loss, but also heart attacks and other different situations in life, they're protected by estrogens. So as you age and your estrogen level and life starts decreasing, then you start developing some hair loss as well and some other changes, right? So yeah, hair is an issue at that point. And normally, what happens is, instead of getting those... Remember when we were talking about those triangles, those receding triangles on the sides of the forehead? Women tend to start losing hair more on the, right in the middle, right in the middle aspect of the scalp. And it can run like a small channel, all the way from the hairline, all the way to the back. And little by little, they start noticing that, "Oh, my hair is a little... I don't know. It looks or feels a little lighter, looks and feels a little more scarce over here." And always they put their hand right in the middle as they move it up and down, right? Our audience probably can't see me with my gestures.

Monique Ramsey:
Like you're brushing away your bangs.

Dr. Hector Salazar:
Exactly. So, that's, I feel, where women start losing a little bit more hair. And it's at a different rhythm. It's at a different pace than man. Sometimes when we have alternative treatments other than hair transplantation, we probably are going to touch base on this later. But we have other types of treatment for a very incipient or a very... At the very beginning of that process. But then when women really, really lose some hair, that could be an issue right on that mid strip line and then we do hair transplantation there. Another area or situation for women is also facelifts. Facelift, even though we do it in men or women, we cannot deny that it happens more on female patients. And sometimes where the cuts were made on a facelift, you develop a small area of baldness, and then we can help in those areas with hair transplantation as well.

Monique Ramsey:
Interesting. So, you touched on, you know, maybe some nonsurgical ways to address hair loss or hair thinning. And what would those be?

Dr. Hector Salazar:
So, this is a very important area that when we opened the branch of La Jolla Cosmetic into the hair restoration, when we brought the program, what we immediately thought was, "You know what? Let's have a holistic approach to this. We cannot or we should not be only addressing the hair loss problem with a hair transplantation." So definitely, those other interventions are very important, starting by having good nutrition, having optimal supplements that contain all the different elements that your hair needs to thrive and to be healthy. So, we also cover that area. Then in addition to that, there are other treatments such as topical minoxidil, shampoos, conditioners that have good ingredients that actually promote having healthy hair, that all the elements are natural, they're not harmful for your scalp, because that's the last thing we want. Right?

Monique Ramsey:
Mm-hmm (affirmative).

Dr. Hector Salazar:
We want to promote a healthy scalp. In addition to that, techniques such as plasma rich and platelet injections, PRP injections. But definitely stimulating your hair to grow at a better pace and to have more vitality is important. So, that's a different type of treatment that we can also offer to our patients.

Monique Ramsey:
So the PRP for the people in the audience who don't know, you draw a little vial of blood from the patient. So, it's from you, super natural.

Dr. Hector Salazar:
Yeah. Solution is in your body. You have the solution. Yeah.

Monique Ramsey:
And then you put it in the little spinner, which I'm sure that that's not the right-
Dr. Hector Salazar:
Centrifuge.

Monique Ramsey:
Centrifuge, yeah. And then you put it in there for 10 minutes. And what that does is it separates out the-

Dr. Hector Salazar:
The different elements of the blood.

Monique Ramsey:
... different elements. So, then you're using part of that to then re-inject or put into the scalp.

Dr. Hector Salazar:
Right. The way I like to explain this to my patients is, if you get a small cut in your hand, you get a small cut, and then the first thing you do is you notice a little drop of blood, and then you hold it with your other hand, and then it stops bleeding. So, the reason why it stopped bleeding, it's because of the platelets, right? The platelets are the cells that are circulating all the time in your bloodstream and they're ready to patch that wound, that little injury. And then it stops bleeding, you get a little crust there that you naturally formed, and then as time goes by, let's say two, three hours later, you look at that little cut, and it looks a little red. It does not mean that it's infected, but it looks a little red around. So there's, somehow you notice that there's more blood flow, that there's more circulation to that area. And the reason for that is because now you need to heal that cut.

So you need to have all the right blocks, all the elements, all the little healing substances to eliminate that injury, to erase it completely. So, when you think about it, that healing process, every single element is in your blood. So, what we do with PRP is we separate the different elements of blood and we get the plasma that is rich in platelets, meaning that plasma that has all the properties that your body has for you to heal an injury. So we hyper concentrate that plasma, and what we do, is we actually re-inject that into your scalp. And by doing that, we're going to promote two different things. One is going to be to get, remember when I said that a little bit of redness, so better blood flow to the scalp will bring better nutrients. Better nutrients will promote healthier hair, thicker hair, so the hair that you have, it's going to have more vitality.

And in addition to that, since that plasma has all the different substances that give the signal for your body to heal, what's going to happen, it’s going to stimulate some hair follicles that you have that are alive but are not shooting hair. So those are hibernating, those are in a phase of hibernation. It doesn't mean that they're... They're not dead, they're alive, but they need to wake up. So, the PRP helps us with that part as well. Not only giving you healthier hair, but also waking up some of those follicles that are asleep. And those can account from anywhere to 10 to 15% of your follicles that are viable, that are dormant. So we bring them back. So, we have several examples and our patients can look at those pictures in our different platforms as well as when they come and visit us over here of patients that we have done PRP injections on. And this is important for patients.

It's not that you're going to generate a bush of hair, or like it's going to get out of control. No. In reality, you look at the pictures and you see a much thicker hair, you see a much healthier scalp, and you see a more dense hair overall. So, I mean, for some patients, that's the only thing they need.

Monique Ramsey:
Interesting. And so, I'm assuming it works equally well with men and women.

Dr. Hector Salazar:
Yeah, absolutely.

Monique Ramsey:
And sort of any age, or is there sort of a time? I mean, you know, we hear this term all the time now, pre-juvenation. You've got rejuvenation when you need to rejuvenate something, but there's actually people who are doing things sort of preventative maintenance. So, is PRP for the scalp something you could do pre-juvenation, or is it really more once you start to see that maybe you have some changes?

Dr. Hector Salazar:
I would say that, could you do it? Yeah. Could you wear a belt and suspenders? Yeah. So, if someone is really interested, yes, they can do it. Definitely since it's a treatment of maintenance, and that's something that I also want to touch base on, I would definitely reserve this treatment for patients that really need it. What we do is, we always recommend to get the first and second treatment, always. We take pictures, we get the first treatment, take another set of pictures, and then bring back patients provide for a second treatment, and then take another set of pictures. At that point in time what we do is, we follow them up in three more months. And then what we do is we sit down, spend time with them and look very carefully at the different pictures at the beginning, in the middle, at the end, and within the interventions. And what we do is we come up with a good plan for them.

Yes, absolutely. As I said, PRP is a treatment that you need to maintain. How often? That's what we need to find out. Because patients respond differently. It's a matter of doing it once a year, it's a matter of doing it twice a year, or even three times a year. So we have to see where they fall, and how frequently they need to be treated.

Monique Ramsey:
Now, going back to the SmartGraft, and let's say you've had your hair transplants done. And for men and women who might color their hair or have keratin process on their hair, or, you know, are there any specific no, nos? Or once everything's healed you can treat that hair the same as the hair, oh well, it is your hair, just in a new spot?

Dr. Hector Salazar:
Exactly.

Monique Ramsey:
So you can still do all the things you might have done before with your hair?

Dr. Hector Salazar:
Absolutely. It's your hair. And one thing is that if you are developing some white hair, and that applies for men and women, if you color your hair, we highly encourage for you to continue coloring it, because in a way it facilitates things, harvesting colored hair versus white hair.

Monique Ramsey:
Oh! It's easier to see?

Dr. Hector Salazar:
It is easier to see. But I'm just giving you some of the inside information. But yeah, we encourage them to continue doing it. After you, or while you're recovering, we ask you not to do it for those first two weeks because we really want to pamper those grafts and treat them in the best way possible. After that, yes, you can continue with your traditional regimen. And yeah, the other point that you were bringing up, it's your hair. And most of the time, with regular alopecia, I'm not talking about certain pathologies, but with just regular alopecia as we age, it's a matter of a problem of the hair follicles in that area, not of the real estate in that area. Meaning if you grab a follicle from the back of your head, that follicle is very healthy, the one that we lost at the frontal aspect, it was a non healthy one.

It was one that was going to age soon, and you were going to lose that poor follicle anyway. Once you implant that hair follicle with good genetics from the back of your head, that hair follicle is yours and it's going to stay there, and it's going to continue having a happy life with longevity.

Monique Ramsey:
In its new home.

Dr. Hector Salazar:
In its new home. Right? Because the problem is not the real estate. The problem is actually who was living there.

Monique Ramsey:
That's interesting. I like that. I like that analogy, that does help. It's still fertile ground.

Dr. Hector Salazar:
Exactly, exactly. Mm-hmm (affirmative).

Monique Ramsey:
So, tell me how did you get interested in this and who were sort of some of your mentors in learning about really, how to make hair revitalized for somebody?

Dr. Hector Salazar:
As I was going through my plastic surgery training, I was fortunate enough to work with Dr. Alfonso Barrera in Houston, and spend some good amount of time with him, and actually absorb a lot of his knowledge. And he's one of the world's authorities in hair transplantation. And definitely absorbing all that knowledge, when I moved to La Jolla, I said, "You know what? Definitely, we have to be able to provide this part of, as I said, a holistic treatment for hair restoration for La Jolla Cosmetic patients”. I think it's important.

Monique Ramsey:
And I think it's also not only having within the hair restoration division of the practice, having a lot of choices and a holistic approach. Really, within, you know, what we do is a lot of antiaging. And so whether you're having a little Botox, or you're having a facelift, or having your eyelids done, or whatever it is, a lot of times the main driver is you want to look younger. So, to not have hair as part of that, it's sort of like a missing link. And clearly, you can look younger, but it's going to stop at a point if you don't address the hair side of it.

Dr. Hector Salazar:
Now, one huge advantage that our practice has, La Jolla Cosmetic, it's a practice where patients number one are treated as individuals. And we create a plan for every single patient that truly fits their needs. We have the whole gamut of options and treatments, surgical, nonsurgical, a little bit more invasive, minimally invasive. But the most important thing is for patients not to feel that we do everything, or I don't want to go there because they have it all. And I want to go to the place where they do only left temple hair transplantation. Right? And that's very important, because within our group, within the whole spectrum of people that we have, we have a great team. We have several board certified plastic surgeons, you're not going to find a much stronger group of board certified plastic surgeons, we all have different niches, we all have different parts that we specialize in. So we have a very, very nice practice. They're going to feel that they're in a truly boutique practice where we treat them as the most important patient in the world and we provide them with the best service in the world.

Monique Ramsey:
And really lots of options. And I love the fact that you're all so technically competent in all the things you do. But then you also have these little interests. And I think all of us as students of the world, we all tend to do really well at what we enjoy. And so, I love to see that sort of enthusiasm from you about this part of the anti aging process and having a way to address it in a really natural way that people, they're just happy. We've now restored something for them and they can go about their life without having it be a sort of something that bothers them.

Dr. Hector Salazar:
Yeah, exactly.

Monique Ramsey:
And one of our patient coordinators, her boyfriend just had hair transplants. And she told me last week, she said, which I wouldn't have never thought of. But she said, "He's so excited because he can wear all kinds of clothes, and like work attire." And I thought, "What does she mean?" Well, he used to wear a baseball cap with everything. And, you know, you don't think of that, but for that person to think, "Oh, gosh, how am I going to go to this wedding and also cover up my head? Because I'm embarrassed." So, you know, I think that once you are able to address these things and fix them, it opens up a, really a whole new world, wouldn't you agree?

Dr. Hector Salazar:
100%. I would say that once you have that much of a youthful look, immediately you will see that potential that this treatment has. You would realize that, oh my God, even the style of clothing that you were using, maybe you were little by little adapting into a more mature style of clothing and then all of a sudden you realize, "Oh, I can wear lighter clothes, or I can be a little bit more contempo." So I would say that it touches your self-esteem in a good way. You look in the mirror every day and it's something that you'll see that you try to avoid looking in the mirror to a body part that you don't like. You look at it, but you kind of want to deviate your attention from that body part as fast as you can, including your scalp. So, definitely going into and having this procedure done, you'll see that even your hairstyle, the way you feel about yourself, all that's going to change in a positive way.

Monique Ramsey:
Absolutely. Now, one last question. Most people, they're having hair transplants on their head, but what about eyebrows?

Dr. Hector Salazar:
Well, you can also restore eyebrows with hair transplantation. The same technology that we have, follicular unit extraction, as you can imagine, the hair of the eyebrows grows at a different pace than hair in your scalp, right? So the hair in your scalp is going to grow more, more rapidly. But definitely it is an option, we would do the follicular unit extraction from the scalp, and then we go in and we transplant that hair follicle into the eyebrows. We previously designed very carefully the eyebrow and, because, believe it or not, it's something that it's very, very critical. And it's crucial. And the other thing is you really, really need lots of skills because the angle of the hair, it's important, you don't want to look like an owl. It's really important that you follow the natural growth of that eyebrow. But if you want to have a thicker eyebrow, or if you feel that you've lost some of your volume, this is an answer. Yeah.

Monique Ramsey:
Interesting. So one of the things that I think most patients would maybe ask is, how do I get started? You Know? So what's the first step?

Dr. Hector Salazar:
I would say that probably our audience has noticed that already, we're very approachable. And maybe sometimes you think about all these barriers that are between you and having that first consultation, not with us. Definitely, for patients to go ahead, pick up the phone, give us a phone call, send an email, text, whatever way you want to touch base with us, even through social media, Instagram, Facebook. And then what will happen is that we will establish an appointment, then what we will do, we'll ask them to fill up some forms, we'll see them on that first evaluation. Again, as I was telling you, we approach this in a very holistic way. Our environment is very down to Earth, friendly, we like our patients to understand every single aspect of the treatments.

Dr. Hector Salazar:
And that way with the power that knowledge gives them and that's actually what we give them, they can make an educated decision in a non pressure environment.

Monique Ramsey:
Mm-hmm (affirmative).

Dr. Hector Salazar:
Our patient coordinators are truly patient advocates, and they work with patients together to guide them through this journey. So, they're going to be the first contact in our clinic, and then they're going to walk them through the process. And after that, we schedule the procedure, and then we take it from there. We are with them throughout the process, the recovery, we have, like, several visits and we're available to our patients at all times through the phone, through emails, FaceTime even, or Zoom, whatever is needed.

Monique Ramsey:
That's wonderful. And one of the things that we do and it's probably the hardest maybe for hair transplants, we do have all our pricing on our websites, our ranges of pricing. And so I think with hair transplants, is it sort of by the area? Like, "Oh, I want my temples done, or the top of my head is really bald." Or is it the number of grafts?

Dr. Hector Salazar:
It's the number of grafts. Also, it depends on the number of areas because that's going to be directly correlated to the number of grafts, but definitely we make it as clean and clear as possible for patients. And that is the number of grafts. On their evaluation, we would estimate the number of grafts that they need to achieve their goal and they would exactly know how many grafts and we would draw for them how much we can advance or the number of areas that we can address. And again, if it's something that's beyond our possibilities, we'll let them know. We'll say, "Well, you know what? We need this many, we don't think that you're a candidate." And I think that's one thing that they can be 100% confident that they're going to find in us honesty.

And once we establish the number of grafts, what they'll see is that the quote correlates to the number of grafts. And obviously, as you can imagine Monique, which one is the most expensive graft, it's the first one. But after that. After that, you'll see how as the number of grafts go up, the price goes down, and we are at a very low market price for follicular unit extraction.

Monique Ramsey:
You make it affordable, which I think is really nice. Because I think from the patient point of view, it's like, you don't want to be at the point where, "Well, I really want this, but I can't afford all of it." So, only do this little bit. Because if you only do a little bit, you're not going to be quite as satisfied because you didn't get to that goal.

Dr. Hector Salazar:
Exactly.

Monique Ramsey:
And Meredith talked about this the other day. One of our patient coordinators, we did a whole podcast on financing options. And I think that is another thing that people don't realize is... Yeah, you can pay with a credit card and earn the miles and go to Cabo for real.

Dr. Hector Salazar:
Exactly. For real. After two weeks. Exactly,

Monique Ramsey:
Or, you know, you can finance part of it and have a monthly payment, just like you do with your car. And like you said, the honesty, I think that's so true. And I think that the team is advocating for you as the patient and really will help. And you've turned away patients, I know you have. You know, if the health isn't quite right, or if we're not going to get to their goal, we're not there to take your money. We've been in business now almost 34 years. And that's because we have integrity. And I think that's something that you as a physician, it's wonderful when a patient can go in and say, "Okay, I trust you."

Dr. Hector Salazar:
Yeah. No, no. My main interest. Number one is the patient's health. Number two is their satisfaction. And then the rest of our different goals can come and go, but number one, if they're not satisfied, or if it's not a safe procedure for them, or if we're going to do it, but it's going to fail, or some situation like that, that's the reason why I'm here to protect them first. So, listen to their goals, see what the status is. And if it's a procedure for them, perfect, fantastic, we're here for that. If it's not, then let's look for other alternatives. And we have them, that's our main advantage. We have multiple ways of treating the same problem. So, that's great.

Monique Ramsey:
Yeah. The other thing is having all the patient reviews. You can get a really good idea about a doctor and about an office from the real patients who've been there, who've come before you. And so we've got thousands of reviews on our website, and you can filter by doctor and you can filter by procedure. So, take a look at what other people say. And I mentioned this the other day on a podcast, you know, we have a lot of patients who are happy to talk to other patients.

Dr. Hector Salazar:
Our reviews are 100% real, right? Our reviews are from real patients that come here to our office that undergo a treatment and all of our reviews are up and available for our patients to see. We're very transparent with this. And we feel very proud of our stars and all of our achievements. And not everybody can claim that.

Monique Ramsey:
Well, and I think when we are talking about real reviews, well, of course, all the reviews are real, aren't they? Well not necessarily. If it's on Yelp, it very well could be from a patient who went to that practice, but it also could be a really mad ex girlfriend or boyfriend who's trying to get back at that practice. You don't know, you don't know that it's really a patient. And so we have a third party who sends questionnaires or surveys to all our patients after and validates them. So we know that that response coming back is somebody who really had an interaction with the practice, which I think it's a big distinguishing factor. And not all of us would necessarily think about that. So we're going to put in the notes, we're going to put links to how to learn more about SmartGraft, you'll see some before and after pictures, meet Dr. Salazar, and see all his credentials on his page. And we'll also have ways to contact us, how to text and call and all that.

So, just look in the show notes. And if you subscribe, all you have to do is bring that to us and we'll give you $25 off a purchase of 50 or more. And in this case, I highly recommend one of the supplements that you brought into the practice Dr. Salazar, which is Nutrafol. And there's even a Nutrafol, I can't remember if it's plus or... It used to be called menopause, but now they've changed-

Dr. Hector Salazar:
Women's Plus.

Monique Ramsey:
Women's Plus. Okay. So, yeah. For those of us in that age range, but it's really great. So it's a nice way to sleep better and your hair gets fuller as well. So, be sure and subscribe. And we thank you Dr. Salazar for your time.

Dr. Hector Salazar:
Thank you so much.

Monique Ramsey:
It was fabulously informative, and I'm ready to sign out. So…

Dr. Hector Salazar:
There you go.

Monique Ramsey:
You put me on your schedule.

Dr. Hector Salazar:
Very good, anytime. Thanks so much, Monique.

Monique Ramsey:
Thank you.

Speaker 1:
Take a screenshot of this podcast episode with your phone and show it at your consultation or appointment or mention the promo code podcast to receive $25 off any service or product of $50 or more at La Jolla Cosmetics. La Jolla Cosmetic is located just off the I-5 San Diego Freeway in the XIMED building on the Scripps Memorial Hospital campus. To learn more, go to ljcsc.com, or follow the team on Instagram at ljcsc. The La Jolla Cosmetic podcast is a production of The Axis.