Episode 24
Shave-less FUE Challenges

Shave-less FUE Challenges

Episode Synopsis: In this episode, Dr. Danyo breaks down the technique he uses to conduct Shave-less FUE, a unique procedure not offered by many clinics. He explains why the procedure can be challenging and how he and his skilled team have mastered the process so their patients can walk away with little to no noticeability of the donor site.

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Dr. Danyo: I read something recently that, it just, it’ll resonate with me for a long time, probably the rest of my life, in my career, but is to be transformative rather than transactional. And I think, you know, the podcast has been that, and that’s kind of what my interaction and kind of my influence on people in their decision, whether they choose me or other people to do the case, but even during the case, to have, you know, conversations of different topics or businesses, or patient aspirations, whatever, where, you know, you can help in their transformation. That’s what kind of stokes my fire and keeps me going.

Clark: That was 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 breaks down the techniques he uses to conduct a Shave-less FUE. It’s a procedure not offered by many clinics. He explains why the procedure can be challenging, and how he and his skilled team have mastered the process, resulting in their patients walking away with little to no noticeability of the donor site. There’s so much to talk about, so let’s dive right in.

Dr. Danyo, welcome back. How are you?

Dr. Danyo: I’m doing great. How are you, Clark?

Clark: I’m doing well. Welcome, welcome. We are gonna connect here for a few minutes. I always look forward to our sessions, as usual. And today’s topic, I think we just dive right into this. You’ve got some examples and you’ve got some stories about some challenging Shave-less FUE procedures that, even though they were challenging, they ended up being successes. And, you know, this is an attestment to, you know, your approach to the work you do. It’s, you know, if someone is new to the podcast, you know, we often are talking a little about your work in hair transplantation, but also, it’s your work, in a lot of ways, like, as an artist, because, you know, these kinds of procedures, it really is a trained skill that you’ve developed years and years and years, and there’s even doctors out there, I’ve heard from [inaudible 00:02:41] that they’re like wait, it’s, like, a, you know, Shave-less FUE. You know, there’s no way someone could do that many. Or they have hesitations. But you have a different approach than them.

So we’re gonna talk a little bit about that, hear some stories, hear some examples, and just, you know, have a few minutes to connect. So, how does all that sound to you?

Dr. Danyo: Sounds great.

Clark: So, just in a nutshell. Shave-less FUE, can you describe really quickly what that is, and especially how that’s different than years ago, and, you know, the ’80s, and some of the bad images people have in their minds when they think about procedures like this?

Dr. Danyo: Sure. Well, the Shave-less FUE. FUE stands for follicular unit excision, where we take individual follicles. So, we’re not, you know, kind of using a scalpel and cutting out hair-bearing scalp, and then you end up with staples or sutures in the back of your head with a linear scar. We work using a very small punch, and we are extracting hairs. Now, with the Shave-less procedure, which is different than long hair transplant… We’ve talked about that on other podcasts, but the Shave-less procedure, the graft, the hair within the graft is actually short. And my technique of doing it is that I cut and core the hair at the same time.

Clark: Cut and core?

Dr. Danyo: The hair at the same time, so…

Clark: How does that… If I had to visualize this, what’s that kind of like?

Dr. Danyo: So, the cutting devices is a round device. My punch is trumpeted, so there’s kind of a cutting at about 30 degrees away from the graft, which is actually advantageous to cutting hair. So, it’s basically a gentle movement down to cut the hair, and then pushing in to graft the follicle. So, the way I do it, I don’t pre-cut the hair. So, a lot of places, they even have you come in the night before, where they take small scissors, and they basically cut hair, and then leave longer hair to conceal the donor site. So, my technique is I don’t pre-cut with scissors. I do it at the same time, so it’s much faster. If you…let’s say you do 2000 grafts, which is kind of our average graft case for Shave-less, if you’re cutting, you know, individual hairs with a scissor, it’s exhausting. I mean, your thumb gets tired…

Clark: That’s a hair-by-hair?

Dr. Danyo: Yes. And you end up trimming more hairs than you actually take. And so, at the end of the case, the donor site looks thinner than it should. With my technique, where I cut and core at the same time, there are no short hairs left in the donor site. All the grafts have short hairs, but the rest of the hair is kept long. So, when people leave, I mean, their donor site looks very similar to as when they walked in. So, somebody would choose a Shave-less case if they wanted to conceal the donor site.

And this also goes true for the top of the head. A lot of places, the only option is, if you’re male, is to shave your whole head. And, you know, it’s obviously so much easier to extract and place grafts in that setting. But when we’re placing with the implanter pens, the technique that I place, which is the stick-and-place technique, these pens, the grafts are loaded, and I basically almost inject them in between the existing hair. So, it works very well when there’s hair on top of the head, which, actually, most of my patients, they’re not totally bald. They have, you know, hair that we can blend in without damaging the other hair. And it’s much faster, much cleaner, and much safer. But we can do it, you know, with any hair length, from, like, a 1 guard to 18, 20 inches, whatever, long… I’ve done Shave-less techniques even on people with dreadlocks, that have dreadlocks that are two feet long.

Clark: That, I can’t even imagine. It’s just, because there are some folks out there who would say that’s just not possible. But you’ve found a way. [inaudible 00:07:16] you call this the Danyo technique.

Dr. Danyo: Well, I mean, I didn’t come up with Shave-less. And I think there’s a huge need. I mean, 70% of my practice is Shave-less, especially my out-of-town patients. They want concealability, and they want somebody who’s, you know, skilled at actually getting good grafts, and, you know, doing the whole procedure, but doing it in a way that it’s concealable. And it’s hard to do, and not a lot of places do it. But there’s a couple components. I mean, one is just the skill to do it. So, and you need a very skillful team, because when I core a graft, which loosens the graft, or the follicle, my technicians have to go through and find the grafts, and it can be challenging, especially if it’s, like, an African American female with very long, curly hair, that’s not easy. It’s a huge management thing. But we work as a team. We have six hands on your head at one time…

Clark: What?

Dr. Danyo: …and we’re able to do this.

Clark: Whoa. I did not realize it could be that many at one time.

Dr. Danyo: Oh, yeah. But it, you know, I have to be…

Clark: Because that speeds it up.

Dr. Danyo: It does.

Clark: I mean, you’re still doing everything, but, I mean, these are, someone sitting down in a chair, for several hours, hanging out with you and your team, working through this. And, they want to have that concealment so when they go back home, you did mention, a lot of people from out of town, they’re able to go back home and it doesn’t look like anything happened yet, until, you know, you say usually about six months is what you aim for for the growth?

Dr. Danyo: Well, six, I mean, at six months, people have really good growth, you know, from the way we do the procedure, we have great growth at six months. Now, one…

Clark: You come in and you leave looking the same, but…

Dr. Danyo: Yes.

Clark: …give it some time, and it’s, you’re set up for good things.

Dr. Danyo: Yeah, I mean, some other… I look at people that have had previous strip harvest procedures. You know, it’s asking a lot to say, “You know what? We have to shave your head to do an FUE procedure, where that scar is gonna be unearthed, and it might take, you know, two to three weeks to have enough length to actually cover that scar. I mean, that’s asking a lot for somebody to, you know, kind of be reclusive. It might be easier now with COVID and people working from home, but, you know, socially it’s not acceptable for a lot of people. But doing a Shave-less, after people have had strip scars, is just awesome. In fact, Monday, I did a Shave-less procedure on somebody who had three strip scars. I mean, there were three individual scars, and we combined that with beard extraction, to get 1500 grafts. And we just kind of did some fill-in work. He had really good coverage from the crown to the frontal hairline, and we’ve refined a little bit of his hairline with single grafts, and super happy. And he said he’s out and about and nobody knows anything’s going on two days out from his procedure. And I talked to him today.

So, that’s kind of the magic of Shave-less and concealability. Now, one thing I get when I have consults, a lot of people have in their mind that the graft, the actual graft quality, is not as good Shave-less as it is shaved. I’ve had patients say, “Well, I saw a couple people, and they said that ‘I wouldn’t recommend doing Shave-less because you’re not gonna have as good of results.'” And that…

Clark: So, they saw people… It’s, like, other doctors out there, suggesting this? Or anybody?

Dr. Danyo: Yes, and there may be some things on the internet about it, because, I mean, it is hard…

Clark: Lots of things on the internet about…

Dr. Danyo: Yes.

Clark: All sorts of stuff.

Dr. Danyo: But, you know, that hardness is something that we do daily. You know, 70% of the time for men, and 100% of the time for women, I don’t shave any part of the head for, when I do female cases. So, you know, so, we’re in kind of a different world, you know, as far as, you know, getting excellent grafts, and then doing it in a very timely manner. I’m at a point now that I can do a Shave-less case almost at the same speed as doing a shaved case. And a lot of it is dependent on the same variables, whether there’s tethering or, you know, maybe some bleeding, or, you know, different variables can slow things down, but if the variables are, you know, good, I mean, I can literally fly through a Shave-less case and complete it, you know, rapidly.

So, the key is, if you’re thinking of Shave-less, the grafts can absolutely be done in a pristine manner, and be done effectively so that the results are not impaired. I wouldn’t be doing Shave-less if that was the case.

Clark: Wow, so, someone might be doing searches on the internet, they might be talking to other doctors, other people, and they say, you know, it’s, you’re not gonna get the same results, but you’ve found a better path through that. It’s really innovative.

Dr. Danyo: Yeah, but it’s a mentality thing, and, you know, I’ve just been persistent, and I know that there’s a need. I’ve always kind of been empathetic to people’s needs my whole life. It’s something my parents really instilled in me. And so, for me, my practice, my patients are up at the top, and everything funnels down from it. You know, my success, or, you know, the growth of the practice. And so, putting the patients first means that I need to really work hard. You know, I’ve been doing this for, you know, Shave-less procedure, since about 2013, that, you know, I’ve just become, you know, adept at doing these things effectively, you know, quickly, and doing it in a way where when people leave, the whole experience is, can be, you know, shocking, you know, in a good way. Especially when the spouse comes in. They can’t believe that we just did all that, and there’s really not that much noticeability.

Clark: Wow. That is… Yeah, you would almost kind of think you… You know, you go in for a haircut or something like that, you instantly look different. That’s gotta feel kind of weird for the people leaving, and then they just gotta trust the process, and, you know, let the time go by, and you start to see that growth, and you do the check-ins…

Dr. Danyo: Yep.

Clark: …to, you know, as that’s going along, and it is. You said the word “magic,” and that’s the word I’m thinking about too.

Dr. Danyo: Yeah. Yeah, so, the other day, we were gonna talk about some instances with Shave-less. Actually, I’d say it was about two or three weeks ago, I had an African American male that came in, and he was scheduled to actually have a shaved case, 2000 grafts, and he came in with pretty long hair. I mean, his hair was probably an inch and a half, two inches long. And he said, “You know, I’ve decided to do a Shave-less procedure.” Now, we had actually had another smaller case scheduled at about 2:30 or 3:00, so…and he was actually running a little behind, so we didn’t really technically get going till about maybe a little bit before 8:00. So we just kind of had to lay the hammer down, and we were able to do, you know, 2000 Shave-less on an African American male, and in a very quick manner. The whole case was done prior to the patient coming in at 2:30, the second one, so…

Clark: Whoa. That’s like a, what is it? The NASCAR pit crew, almost, of, like, moving quickly but efficiently.

Dr. Danyo: Yes. Yeah. And, you know, I can’t give enough praise to my staff. They just, you know, really have such a great kind of tireless attitude. They take on challenges, and, you know, they have such great hands and a coordination. We, you know, we don’t really even have to talk to each other during the case much, because we just kind of move around each other, and we’re able to, like I said, have six hands on the head, and the grafting and pulling in the [inaudible 00:16:18] of having a full head of hair. And so, it’s fun to be kind of on the back end of doing this. Initially, I mean, 250 grafts was, like, torture, you know, trying to do a Shave-less procedure, but I’ve done, in one day, I’ve done 3100 grafts in one day, Shave-less. That’s kind of my record.

Clark: Man. That’s gotta be. Yeah, that’s definitely a personal record, and it’s kind of like a, hey, those people who don’t believe, you know, take a look at this.

Dr. Danyo: Yeah. But, you know, I think, you know, just kind of, my message to people is that if concealability is really important to you, it’s something that we can, you know, come up with a game plan to make this so that nobody knows you had it done until, you know, the results come in and people are saying, “Man, you look great.” You know, that’s what I want. I don’t want them to say, “Did you have hair transplant?”

Clark: Uh, no. Yeah, definitely. That’s… Yeah, it’s kind of…you know, hair takes a while to grow, but it’s almost kind of a, that gradual, slow increase, and that slow improvement. You almost wouldn’t want something to look different overnight even if you could.

Dr. Danyo: Exactly.

Clark: That’s like, “Wait what happened? That’s kind of unusual.”

Dr. Danyo: Exactly. So, that’s where the long hair can come in. You know, we do that from time to time. I would say most of the long-haired cases I’ve done have been more on the crown. And I’ve done, you know, people that have more, like, natural recession in their forehead, we can do, you know, bring it down, like, a centimeter, or, you know, a half inch or something with long hair, and be really stealth. But, you know, the Shave-less, like I said, it’s a short hair that’s moved. We just cut and core each hair as we go, so we eliminate all that time of trimming, and then you don’t have a donor site that has a lot of trimmed, small hairs in the donor site. The rest of the hair is not touched, so the donor site’s concealed.

Clark: That makes sense. And you were mentioning just a moment ago about your team. So, what can someone expect when, you know, they’re doing their research, they’re thinking about their options, they end up scheduling a time to come visit? You know, you just were bragging on your team. How do they fit into all of this, and what, you know, how does all this work? How does the magic happen?

Dr. Danyo: Yeah, so, let’s say you call the office. Typically, you’ll speak with either Kelly or Becky up front, and they have a lot of knowledge on the overall process, and they kind of give options as far as what kind of consultation you want. We can do online consults, either by phone, where people send in pictures or videos, and then we can discuss. That’s generally what I do. We can do video conferencing that’s HIPAA-compliant, and we have a nice texting app that does video, again, that’s compliant, and we can do it that way. Or people can come in. But generally, we, Becky and Kelly kind of go through the process to kind of determine where people are. I mean, a lot of people do call, and they’re more curious, but they haven’t really made up their mind. They don’t even know what hair transplant is a lot of times. So, oftentimes, there’s a conversation, and there’s a foundation that’s laid, to help them, but not necessarily, you know, a relationship with us that’s kind of being fostered.

When it gets to more of the consultation point, then that’s when I get involved. I do all the consultations. And I’m involved right from the start. And then, prior to the case, we’ve got videos that we send. We have, you know, paperwork. We’ve got so much on our website. Somebody from my clinical team will call, and we kind of get people prepared for the procedure. There’s really not much to prepare. And then, you know, we do the procedure. I’m totally involved in the case. I work with my technicians. We get before and after pictures that day, set up follow-up visits. We have a great texting app called Klara, K-L-A-R-A. And it’s not like a regular portal. It’s really a texting app, and you can text pictures. We do all of our follow-ups, you know, as far as communications, if people, especially for people out of town, sometimes they’ll do video conferencing for the follow-ups, or just pictures. Or people come in.

So, you know, I think our success has always been communication from the start. I think the podcast…we talked about this off-air, that the podcast has been great to kind of educate patients, and really kind of get them to know us before they actually even meet us, or even give us a phone call. And that’s, I think that’s vital, to have kind of a relationship that’s communicative and informative and empowering. You know, I read something recently that, it just, it’ll resonate with me for a long time, probably the rest of my life, in my career, but is to be transformative rather than transactional. And I think, you know, the podcast has been that, and that’s kind of what my interaction and kind of my influence on people in their decision, whether they choose me or other people to do the case, but even during the case, to have, you know, conversations of different topics or businesses or patient aspirations, whatever, where, you know, you can help in their transformation. That’s what kind of stokes my fire and keeps me going.

Clark: I love that. And so, yes, during the procedure, it can be several hours, and they’re, you know, you’re, it’s you and them, and some of your technicians, also, so you definitely have that opportunity to have a lot of conversations. Now, you know in the back of an Uber or a Lyft, sometimes, it’s like, yeah, you wanna talk to the driver, and sometimes you’re like, “You know what? I just wanna kind of chill out and relax,” and maybe they’re gonna listen to an audiobook or something. So, that is an option, too, right? Like…

Dr. Danyo: That’s absolutely an option.

Clark: [inaudible 00:23:05] I mean, they’re already…I’m sure there’s some anxiety.

Dr. Danyo: And some people want oral sedation, where they’re literally sleeping most of the day. So, you know, kind of, the day kind of develops, and… But the key is that the majority of my folks say that the experience was awesome, and that’s… It takes a lot of work from everyone in the office, from start to finish, and afterwards, to have people say that the experience was awesome. And it’s not just the procedure. I mean, it’s everything. And we work hard on that. We’re kind of, we’re constantly building on that, having meetings, trying to do, you know, more information, with blogging, and YouTube videos, and the podcasting. And so, it’s fun for us, and I think it’s educational and empowering for the patients.

Clark: That’s great. Well, Dr. Danyo, as always, thank you for taking the time, and just kind of walking us through the common questions, the common things, and taking, you know, those challenging cases, but still finding success. I always appreciate your time, and I’m looking forward to our next conversation.

Dr. Danyo: I am too. Well, have a great night.

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.