Episode Synopsis: In this episode, Dr. Danyo answers one of the most common questions he’s asked about hair restoration – do they really work? He also shares his personal experiences with hundreds of patients who have sought out his expertise and explains some of the misconceptions held by those still considering the process
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Dr. Danyo: Really, the goal is if you’re going for four hairs, you’re getting four hairs, and they’re intact. There’s no, the sheath isn’t ripped off. The grafts aren’t transected. And that’s where you get a higher hair counts and you get better results.
Clark: That’s the voice of Daniel A. Danyo, M.D., founder and physician at North Atlanta Hair Restoration, a boutique medical practice solely dedicated to the diagnosis and treatment of male and female hair loss. And you’re listening to “Hair Restoration,” with Dr. Daniel A. Danyo. I’m your host, Clark, and all season long, we’re speaking with Dr. Danyo about how he and his team at North Atlanta Hair Restoration are helping his patients transform their everyday lives for the better. In this episode, Dr. Danyo answers one of the biggest questions: do hair transplants really work? He talks about some of the misconceptions, and shares the experiences he’s learned by working with hundreds and hundreds of patients. There’s so much to talk about. So, let’s dive right in.
Dr. Danyo, it is great to be back. How are you doing?
Dr. Danyo: I’m doing great, as always. I hope you are too.
Clark: I’m doing great. And I just love chatting with you. I love talking through these things. And, you know, each of our conversations, you know, they all are, of course, revolving around hair transplants, and answering the common questions, and unpacking some of the misconceptions. And, you know, we’ve talked about what can go wrong. You know, we’ve talked about a lot of things around this topic, but I always still learn something new. So, the topic we’ve got ahead of us sounds like a simple question. Do hair transplants really work? So, just starting with that, I think I know what you’re gonna say, but with that being asked, what is your response?
Dr. Danyo: Well, have you ever had a one-word podcast? It’s “yes.”
Clark: I love it. Yes. Okay. Okay. So, we’re gonna talk about the yes of, you know, how they can really work? But I also, you know, you do a great job always sharing the flip side, the other perspective, and I’m sure…
Dr. Danyo: And possibly no.
Clark: And possibly no. So, can it work? Can it not work? How about we start on the positive side of can it work?
Dr. Danyo: Yes.
Clark: What are some of the initial things here? What are some of the main reminders and messages that you wanna share?
Dr. Danyo: Well, for a hair transplant to work, and, I mean, to have results that you’re totally satisfied, and it looks natural, and, you know, you’re pretty much done, yeah, with the hair loss, it’s a total possibility if it’s done correctly. And I think it starts right from the start. You know, we’ve talked in many of the podcasts that doctors aren’t that involved, and that it’s very salesy, and you might have a salesperson talking to, and looking at pictures, or doing a video call and saying, “Oh, yeah, you need a certain number of grafts.” And then you come in and you’ll meet the doctor, but then you meet the technician. And the technician actually does most if not all of the case. So, that’s where a lot of the problems begin, that the doctors aren’t involved. And I am very serious that doctors need to be totally involved. And we’ve talked about robots before. I don’t think robots should be extracting. I think the doctor should be extracting. There’s just too many decisions to be made during a case to…
Clark: During the actual procedure.
Dr. Danyo: Oh, absolutely.
Clark: So, you’re saying, because, you know, we live in a world right now where automation, we’re seeing more and more of that. I mean, I’m thinking of Amazon warehouses. I mean, they’re doing some wild things with some pretty smart AI, right?
Dr. Danyo: Yes.
Clark: A lot of machine learning and all that. So, and even in the, like, operation space, in surgery. But it sounds like there’s something different, though, here, and what is that? Why does it need to be a human physician?
Dr. Danyo: Well, because there’s mental feedback. I mean, the computer can get video feedback, but there’s tactile feedback. There’s sound feedback. There’s certain tension that you have to apply to some scalps, and other scalps, you can’t. Like, people that have, like, African American hair, which is curly, I don’t think you should have any tension on the scalp, but when you’re getting the robot, you have a tensioner on your scalp, which is really applying tension throughout, and making it very taut, so that it doesn’t move, so the robot can read. And the problem is, you take a sharp punch, which the robot uses, going through a curve, and you can cut right through it.
So it has a higher transection rate than what it should. And for me, as a physician, being passionate, totally involved, I mean, when I see a transection, which can, is going to happen… It’s just, some of the hairs go at an angle that you didn’t anticipate, or they splay. But keeping it as close to zero as possible, by doing simple adjustments, and it can be changing the torque of the machine, relaxing my hand, allowing the punch to do it, relax, you know, adding tension, relaxing tension, sometimes I have to even crinkle the skin. Sometimes I have to add fluid to lift the skin off the scalp. You only know if you are actually coring the graft, seeing the graft come out real-time, assessing the graft, and going to the next one. So, it literally takes me hundreds of grafts. And so, I’m totally comfortable with the technique that I’m using. And again, they’re very subtle changes, the torque, the speed, all that stuff.
And I only use trumpeted oscillating punches, which are the best. But that’s another discussion. But I think, on the extraction side, it takes a physician to do it. The other aspect is pain control. I don’t want my patients to feel any pain during the procedure. And you have to take into effect how much medicine you’re injecting, what the concentration is. Because you can overdose people easily. It’s a big area to numb, and you’ve got the back to numb, then you got the top of the head. And a physician needs to do this, not a technician.
Clark: Wow. I love hearing every little aspect of this. And it’s also kind of poetic, like, a craft. And, like, when you know something so well, you know… You and I have talked before about documentaries that we love, and it’s always really interesting to, like, kind of get super zoomed in on a particular area. And there’s so much complexity here that goes into it.
Dr. Danyo: There’s a lot. And that’s why, to get the best results, you have to have somebody with experience. And I think it needs to be a physician doing it to be able to tweak all these little variables that are happening throughout the entire case. They have the knowledge and the wisdom to manage all this stuff effectively. So, you’re not hurt, it’s done in a safe manner, and they are the most invested, not a technician, but it’s the doctor who’s the most invested. They took the Hippocratic Oath, do no harm, that they’re going to make the right choices. I’ve had, on a very rare occasion, patients that we planned on doing 2000 grafts, where the grafts are tethered, they’re extremely hard to get out, there’s a lot of splay and curl, and I limit the amount that I’m gonna do that day, because it’s going to be a very long day. And the longer we’re in, that means the grafts are out longer, which potentially means the graft take might not be as good.
So, you have to, as the captain, make these decisions, and have a practical discussion with patients to say, “You know what? I think it’s in your best interest if we just half the number today. And we’ll come back at a later date in the near future and finish it.” All the patients that has happened to totally appreciate it. But again, it can only be made by the captain. That’s the doctor.
Clark: Wow. That makes a lot of sense. And we’ve talked before about how, you know, “what could possibly go wrong?” And, well, the answer is, “a lot.” Not to try to scare anybody, but there’s a lot of things. Now, you just mentioned something I’ve not really thought about. You were talking about overdosing someone with a pain medicine? What do you mean by that?
Dr. Danyo: Well, you know, anesthesia, lidocaine, novocaine, although nobody uses novocaine, but novocaine is kind of the, like Xeroxing, you know, photocopying a paper. But, I mean, there are different anesthetics. And when you throw in other medicines that they’re on, when you’re throwing in…you know, we have people that have high blood pressure, they’ve got some cardiac arrhythmias, you know, different medical conditions, you need to combine that with the medicines that you’re using. So, the combination that I use gets a long-term block. I dilute portions of it so that we can inject safely, and I do it in stages, because when you do a huge area all at once, for one, people can, you know, have more reactions from the anesthetic, which can be like a weird taste in the mouth, all the way up to seizures, or feeling dizzy.
Or, the other thing is we do add some adrenaline, which is called epinephrine, to kind of block, it kind of binds the anesthetic to the nerve much more, and that way, you don’t have to add as much anesthesia. But if you add too much epinephrine at one time, it’s like going to the dentist, where you get the racy heart and the dread feeling. And, you know, patients remember that. If you put somebody through that, when they come back at 12 months, they’ll say, “Doc, man, my heart was racing so much.” And so, over the years, I’ve really adjusted things that that doesn’t happen. And it comes with knowledge and experience to do that safely, but then get effective long-term blocks, where you’re not reapplying, you move to the next area, and do the same thing. So, when you minimize medication, you’re actually gonna minimize swelling, because your head has to absorb all that stuff. And you’re minimizing complications, side effects, greatly. So, again, this all needs to be done by a physician, not an unlicensed, you know, technician.
Clark: That’s a good point about the technician part, because when I hear…and again, I am on the outside here. When I hear the word technician, that sounds like a legit person. But from a medical perspective, I just heard you use the word “unlicensed.” So, what…can you [crosstalk 00:12:11]
Dr. Danyo: I’m not trying to disparage technicians, because I literally, I could not do what I do without my technicians.
Clark: What is a technician?
Dr. Danyo: So, technicians would be like a medical assistant. They’re assisting with the case. Now, in my practice, anything that I stick somebody with, whether it’s anesthesia, you know, using the device to core out the grafts, or place the grafts, because we use pen implanters, and I place all the grafts. But my technicians, after I core, or create, like, a circular incision around the graft, my technicians then go behind me and pull the grafts. And they have to be done in the right way. And especially when you’re doing a shaveless case, they have to find the grafts within all that hair. And that can actually be, probably the most time-consuming portion of the procedure.
So, they’re vital. And they’re under my direct supervision, but they do a fantastic job. And they’ve got great stamina and great passion for doing this. And then, they help me on the implant side by loading implanter pens. And then just helping with the overall workflow and comfort for the patient throughout the day. And they help with a lot of administrative stuff. So, again, they’re vital in that capacity. But when they’re just left to do a procedure, without medical supervision, I have a real problem with it. Our society has a real problem with it. It’s an epidemic in this country. And it’s a problem that needs to be addressed at the state board level, for all states, because, you know, that’s who kind of governs medicine within each state. And some states are starting to do it, because there have been issues. And, again, they’re not licensed to do a medical procedure. And hair transplant is a medical procedure.
Clark: All right. There’s a lot more that goes into it than people realize.
Dr. Danyo: Yeah. But kind of back to the main premise, you know, that the hair follicle, I mean, it’s incredibly hardy. Like, you can take it out of the body, and it can stay out of the body for hours. And then you can put it back in and it has a very high success rate. I mean, if you do everything right, studies show that it can be greater than a 95% survival rate at the grafts. And because there are dormant hairs within the graft when they do hair count analysis, a lot of the studies show that it’s a higher hair count than what’s in the graft that you can actually see, because there are dormant follicles that are, you know, really small, that you can’t see, above the skin. But, you know, it is hardy, but it’s actually extremely fragile. So, you can injure the graft by coring, you know, creating a circular incision around the graft. You can transect it. You can disrupt the sheath. A lot of the follicles are in twos, threes, and fours, you know, grouped together. You could have one follicle with one transection, or one follicle with two, or, you know, any combination. And really, the goal is, if you’re going for four hairs, you’re getting four hairs, and they’re intact. There’s no… The sheath isn’t ripped off. The grafts aren’t transected. And that’s where you get a higher hair count, and you get better results.
The next is pulling the graft. If you don’t go deep enough, because you’re scared that you might transect it, then it’s like pulling a dandelion out. You pull, and then the top of it comes off. Well, that graft’s not gonna work. So, the pulling part is crucial. And it’s great. Sometimes they pop out like a Whac-A-Mole, and you can take one forcep and pull them right out. Other times, you have to double and triple pull them, meaning you have to use one forcep, go under it, and then go under it again to pull it out. And it’s case-by-case, but that, doing the double and triple, doesn’t hurt them. But it’s the safest way to actually pull the grafts.
The next is drying. A graft, if left to the air, can dry in about two to three minutes. And once it dries, it really affects growth, and could literally kill it. So you constantly have to keep the grafts wet. You cannot be keeping them out. They have to be in the proper solutions. And the next is just overall handling of the grafts. You have to be very light with your hands. You have to touch certain portions of the follicle, meaning the top, not the bottom or the mid-portion, with forceps. And then the last is implantation. I’d really… We talked about direct hair implantation before. But there’s no question that that is the least traumatic of the modern ways of putting in hairs into the balding area, because the grafts are loaded, protected within the needle. And then you can…you basically stick in place, or inject them right into the scalp, and we get perfect depth control, angulation, curl control. And we don’t have to add extra medicine to lift the scalp off, skin off the scalp, or lots of epinephrine to stop bleeding, which stresses the scalp, and the grafts out. So, I think hair implantation with implanters is superior for graft take. And recent studies have shown that, versus doing it where you put all these surgical slits, and then hours later, come back and stuff the grafts into the slits.
Clark: Very cool.
Dr. Danyo: Yeah.
Clark: A lot goes into it. And, you know, it all…all of our conversations… Someone can listen to just one of these and kind of get a pretty clear picture of why you do what you do and the passion behind it. But all of these episodes have a similarity of how it kind of builds on itself. I mean, there’s a lot here. So, I know at the end of the day, what it’s all about is that, that big high five, that big hug that you get to see, you know, and your follow-up meetings and appointments, to see how they’re feeling, and it is often like they’re a different person.
Dr. Danyo: You know, we’ve had a lot of great feedback about the podcast. And, you know, the biggest thing, you know, when we first started this, and talking with Mark, who does my marketing and works with you, you know, I said I don’t want this to be a marketing ploy. I want this to be, you know, educational. And I wanna give material to people to get educated. Because when you go on the web, I mean, it’s the Wild Wild West out there. You just don’t know what to believe. And the feedback that I’ve been getting has been really positive that people feel educated about the process and about what’s going on in the industry. And that makes me very happy.
Clark: I love that. Well, thank you for sharing that. Very cool. Well, Dr. Danyo, I think this answers all my questions. I think you’ve shared [inaudible 00:19:47] but also kind of some of the things that could go, you know, not necessarily go wrong. In this case, we’ve had a whole episode about that. But, you know, how could they not work? So, lots of important things that you shared today, and as always, hey, thank you so much.
Dr. Danyo: Thank you, Clark.
Clark: Hey, thanks so much for listening to “Hair Restoration,” with Dr. Daniel A. Danyo. Book your consultation today with Dr. Danyo by calling (678) 845-7521, or online, at nahairrestoration.com. And be sure to follow, rate, and review this podcast wherever you listen to your audio content.