The following is a transcript of Episode 6 of the Hair Restoration With Dr. Daniel A. Danyo podcast.
Dr. Danyo: It is a huge possibility now for women to lower their hairline, have it done in a very stealth manner. And I’ve seen many consultations and performed many procedures on women who looked at our website, looked at the possibility of doing this in shaveless manner. And that was the key to move forward.
Clark: That’s the voice of Daniel A. Danyo, MD, 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. 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 explains the evolution of hair restoration from the start, to shaveless graft procedures, and everything in between. We’ll also explore the numerous possibilities available to patients today compared to just a decade or two ago. There’s a lot to cover, so, let’s jump right in. Dr. Danyo, how are you doing?
Dr. Danyo: I’m doing great, Clark. How about you?
Clark: I’m doing well. I am looking forward to continuing the conversation. It’s been really encouraging to hear some of the folks who have been listening to the show and giving you feedback. And it’s a helpful way to learn more about something that has a lot of confusion around it. And like I’ve told you, I think always talking to you is so easy and it’s been really informative all across the board. And so, today, I was hoping we could talk a little bit about the possibilities, possibilities of who these treatments can be for. I think there’s probably some misconceptions around that. I think we can also talk a little about the possibilities of the different procedures and how the technology has changed. On this show, we’ve talked a lot, you’ve shared a tremendous amount of misconceptions of how people used to think of hair transplantation and how it used to be addressed, but we’ve definitely learned that this new technology there’s a lot more possibilities. So, when you think about the possibilities with hair transplantation, what comes to your mind? What is your message you want to start off with?
Dr. Danyo: Well, the possibilities are that we can reconstruct hairlines and create a natural look when say 20 years ago when it was just plugs, you couldn’t do that. And the ability to take single hair grafts all the way up to four or even five hair grafts where we can create really eloquent and natural hairlines using single grafts upfront, and then build up density behind to get, you know, a lot of volume behind those single hairs to act as a frame. That’s where you get a really natural look. So, I think for somebody that is looking into hair transplant, I always get asked, will it look natural? And if you do the current principles with using single hairs up front, use guidelines and also extreme clinical judgment when you are constructing a hairline so that it doesn’t look unnatural, it’s not too low or too straight and you have some curve to it, the possibility of having a very natural look is very real.
Clark: Was that always the case?
Dr. Danyo: It wasn’t always the case. Back in the day, people with severe hair loss were generally looked at as the only hair transplant candidates. I’m talking to people that were totally bald and then they were getting plugs upfront and it almost looked like doll’s hair, it look very fake. And some of the hairlines were way too…
Clark: That might be worse getting that kind of treatment, that might be worse than just kind of not maybe, back in the day, right? I don’t know.
Dr. Danyo: Well, yeah, back in the day, so especially people that had severe hair loss, where it was really low on the sides and in the back, if they had really kind of dark, you know, more black hair especially if it was more coarse, not as thin, when you put those plugs in, the contrast between the graft and the skin was just so obvious. Now, there were a lot of people that have undergone plugs. I’m talking like 20, 30 years ago that actually did extremely well, but they had probably no significant or severe hair loss and likely had less coarse hair and more blondish or brownish hair.
Clark: So, you might have mixed-matched hair back in the day?
Dr. Danyo: Yeah. The contrast between this really dense graft and the skin around it, it was too great. It just didn’t look real.
Clark: It just didn’t look good. So, yeah.
Dr. Danyo: But with modern techniques, again, with the single hairs upfront and creating natural hairline patterns, you know, in the past, they were just way too aggressive, too far down in the forehead, trying to make a 20-year-old hairline for somebody who is say in their 50s or 60s, that was just not natural.
Clark: That’s not natural.
Dr. Danyo: So, it’s using good judgment and using the science and the experience of others and yourself to plan something that’s gonna be natural.
Clark: Just so I can see the timeline, what year was that? When I say back in the day, I don’t have quite that frame of context, but what year, you know, timeframe was that? And then let’s fast forward to where we’re at today and look at the possibilities that are available now.
Dr. Danyo: Sure. The plug issue was really, I would say 1995 and before that, and really after 2000, by that time, strip FUT harvesting was well underway and people were doing good work where they were taking out individual hair units from one hair to four hair and the overall science of creating natural hairlines came to be. People started getting much more natural looks from about 1995 forward. And then in 2001, FUE came into its own being. Now, at that time, I was very young, the grafts were hard to get, they were not as good as the FUT grafts. And really after about 2011/2012, when different technologies came out to harvest good FUE grafts and particularly, in the last, I’d say three to four years, where there are now trumpeted punches that allow much cleaner harvesting and better graft take, the evolution has gone from strip harvesting. Now, the most common is FUE or Follicular Unit Excision, where you take individual random grafts instead of taking a strip of hair-bearing skin from the scalp leaving a linear scar.
Clark: Yikes. Yeah. So, we definitely need…We needed more possibilities from those options you’ve been sharing from how it was.
Dr. Danyo: Sure.
Clark: So, now, today, I’m excited to hear about the technologies, hear about the possibilities that you are regularly doing now. You’ve been a true pioneer, as I understand it, with so many of these. And we talked about this on another podcast, the shaveless FUE process and some of these other techniques that you do really well from start to finish. What would you say are some of the possibilities when we contrast how it used to be?
Dr. Danyo: Well, the possibilities need to be broken down into what the patient needs are. And it’s important because I have some patients, they don’t care about concealment. They want to go totally rogue with their social media and tell all their friends that they had hair transplant, and concealment or shaveless technique is not that big of a deal for them. And then you have other people that concealment is vital. They won’t even consider the possibility of getting hair transplant. If other people know that they had it done, or they’d be really limited from work, you know, social activities. And the shaveless technique, and really what I call the art of concealment, we’ve talked about it before, kind of brings out the fact that nobody needs to know that you had this done. And I don’t encourage people to take large time or, you know, a lot of time off from work or social activities because a lot of times, especially if we’re filling in areas where there’s existing hair to cover the place grafts, people can really go stealth. And so that’s a great possibility for people. And in my practice, since I really specialize in shaveless FUE, I see patients over and over again in consultation that say, “I wouldn’t even consider it if I had to shave my head.” So, that raises the possibilities and really includes a huge part of the market of people.
Clark: Yeah. Definitely.
Dr. Danyo: Sure.
Clark: So much of our identity is on top of our heads. And I think it’s probably fair to say you don’t recognize it or realize it until it’s gone or threatened of being gone.
Dr. Danyo: Sure. You know, we kind of seem to focus more on men with hair transplant in male-patterned hair loss, in women, oftentimes don’t consider hair transplant as a possibility. And when I bring it up…
Clark: Why is that? Why?
Dr. Danyo: I think there’s a stigma, they really are very concerned about somebody knowing that they had it done. It’s not like getting a breast augmentation or having some skin work where you might tell people that you had it done. This is extremely private, especially with women. So, one of the possibilities with women is a lot of women have a high hairline or a very long forehead. And it is a great procedure to actually bring that down. Now, a lot of people do do like a scalp reduction where they actually cut scalp and then sew the hair down to the forehead, but the problem is you end up with a linear scar. So, the FUE approach, especially the shaveless approach where women don’t have to shave their head, it is a huge possibility now for women to lower their hairline, have it done in a very stealth manner. And I’ve seen many consultations and performed many procedures on women who looked at our website, looked at the possibility of doing this in a shaveless manner and that was the key to move forward.
Clark: Right. And the possibility does unlock them to be able to get this faster, it’s stealth, and then afterwards, their confidence, their life is going to get better. There’s a lot of benefits that come from that.
Dr. Danyo: Absolutely.
Clark: You were calling out just now how so many people we think, you have men as that example, but because of technology today, how else are the possibilities changing?
Dr. Danyo: Well, the possibilities, let’s look at different ethnic groups. Online, a lot of people say that African American patients cannot have FUE, you know, follicular unit excision because of the curl of the hair, that there are too many transected grafts and that the graft take is poor. And that’s just not the case with the new trumpeted punches, we use them…We’ve been using them exclusively for about three years, and using oscillation and different techniques where you can really get deep on the follicles without cutting them. It’s opened up the door for FUE as the hair transplant option for African Americans, but it has to be done with somebody who’s well-versed with African hair who uses trumpeted punches with oscillation. And also has placed a lot of African grafts because they’re different, you know, you’re putting a curved soft structure into kind of a straight line. And there are different nuances to really make it natural and make it sit properly and also take. So, the other option for them was really strip harvesting. And, with African Americans, keloid formation and scar formation, and especially given the fact that a lot of men wear their hair short, that scar can be large and raised, sometimes painful and very visible. So, the strip-harvest for my African American patients, I feel is not a great option given the fact that we can get great grafts doing FUE and using small punches, not large punches, to get the grafts that are required in the take of the vast majority greater than 90%, 95% of those grafts are gonna take if done properly. So, we get great results.
Clark: It’s helpful to look at how the past compares to the present. I’m curious, as we’re thinking about possibilities, it seems like today and now, we have all the tools needed to do this. I wonder what the future might look like. Have you thought about that?
Dr. Danyo: Well, there’s always a hope that there’s gonna be some kind of gene editing where you can literally cancel out hair loss. There may be hair graft cloning. There’s been some work, especially in Japan where that’s a possibility. But it may be 5 years down the road, it might be 20 years down the road. I’ve been in medicine long enough, when you look at different diseases like HIV, cancer, diabetes, when I started medical school, we had an old physician with a lab coat and the white hair standing up and saying, “Your generation is going to see the cure of cancer, AIDS, and diabetes.” And there’s been major improvements, but a cure, no. Not quite yet for all of these diseases. So, I think hair is in the same category and I am hopeful that researchers will continue to expand that possibility and then make it something that is viable. It’s just not there yet.
Clark: Right. And waiting around for the what-if is a big question mark. And with what you’ve seen over your career doing this and specifically this, which is another whole topic we’ve discussed why it needs to be done by…I mean, this is, you know, it takes a doctor to do this. You don’t want to have a sales rep or a technician who’s just going in and performing a procedure like this, but based on what you’ve seen and what you know, sounds like not a reason to just wait to see what else might come along.
Dr. Danyo: Sure. Well, the possibilities we talked about, you know, back in the day, it seemed like people with severe baldness were getting hair transplant, but really there’s a possibility to refine the temporal recession that’s bothering you, or maybe you’re losing hair more on the sides of your hair or your sideburns, even your beard, maybe your eyebrows are thinning out and you’d like to thicken them. Those are all opportunities and possibilities to get hair transplant. And especially if done with a shaveless technique and with concealment, a lot of these people, especially if they just have a natural recession and their forehead is kinda lengthened a little bit and they’ve got some temporal recession and let’s say they’re in their 40s or 50s and it’s really bothering them, it’s a huge possibility to get that done. And it’s actually one of the most common cases that I do. Another great one is people wear beards now. It’s totally in style, but a lot of people have very thin beards or a thin mustache or the mustache doesn’t join up to the beard. And recently, I placed about 60 grafts on each side of the mustache to connect the beard to the mustache and he’s super happy. So, that was very easy to do.
Clark: I know that. That’s another possibility. I had no idea.
Dr. Danyo: Correct. And a lot of people have sideburns that just don’t join with their beard, or they stop, you know, kind of below the ear or in the lower part of the ear and they’re just high. That’s a very easy thing to fix with hair transplantation.
Clark: Anything else that is on your mind about the possibilities of this work and how it aligns with your passion and your experience?
Dr. Danyo: Sure. Right now I’m working on about three or four people with severe hair loss. I’m talking like Norwood 6, 7. That’s kind of at the height at the…
Clark: Yeah. What does that mean? How does the scale work?
Dr. Danyo: Well, the scale goes from 1 to 7. Seven is somebody who has total hair loss and almost has just the saddle in the back, which is really low in the back and on the sides. A 6 is bald on top from the hairline up into the middle scalp and into the crown, but there’s not as much hair loss on the side, so maybe not as low in the back. All the way up to a 1 or 2 where there’s just some temporal recession or thinning. So, the patients that have severe hair loss, I’m talking like a Norwood 6 or possibly 7. And it all depends as well on how big the head is and how much area is involved. But I am doing a multi-stage procedure on about three or four patients right now, a couple of them are about 7,000 grafts into the goal of getting 9,000 grafts. And we’ve done this by extracting hair from the back of the head and then extracting hair from the beard and also the chest and doing that in each session so that, it takes about three different sessions separated by about six months. And I take all of that hair and spread it out evenly except in the hairline where I put mainly, or pretty much all hair from the back of the head. But the beard and the chest hair, which have different coarseness issues, they get spread evenly around the top of the head and you can create a very good look and very consistent look and also get incredible coverage. Because, you know, the donor site, for a lot of people, they may have a limit of 3000 grafts. Typically, you can get about 5,000 grafts over multiple procedures to get coverage, but to get full coverage from front to back takes about 9,000 grafts.
Clark: Wow. And something that I’m always surprised about is how each of these grafts are done by hand. You do these by hand?
Dr. Danyo: Yes.
Clark: Man, that is impressive. And why, as we are wrapping up, as we are thinking about the possibilities, I think one thing that will remain unchanged is how there needs to be that intentional delicate work from start to finish by a physician, that’s not gonna change.
Dr. Danyo: No, and it has to be done in a way that the possibilities are not done in a sales manner, that they’re done in a true possibility manner because I’ve had many patients that have severe hair loss, and when I go through all that needs to be done and then look at the density in the back of the head, the beard and the chest, I’ve had many patients where I say, “Listen, you’re just not a candidate to get full coverage. I can get some coverage upfront and maybe round off the edges of the crown to bring it in a little bit, but to get full coverage, it’s just not a possibility for you.” Now, some other options are to include scalp micropigmentation, either shave the head and then do scalp micropigmentation so it looks like a shaved head, and we’ve had incredible results with that, or combined the scalp micropigmentation with the hair transplantation and that is a slam dunk, especially if the goal is to get coverage of the scalp in people that have really dark hair, where that contrast between white scalp and dark hair is prevalent. It really blanks out the scalp. And we’ve had incredible results combining scalp micropigmentation with hair transplantation.
Clark: Good deal. I always enjoy connecting with you, Dr. Danyo, on this, hearing about your work, it really does matter. It’s changed countless lives and I’m looking forward to continuing the conversation in the future.
Dr. Danyo: That sounds great.
Clark: Dr. Danyo, enjoyed another conversation with you today. I always love hearing the passion, the expertise. We’ve heard countless stories offline of just how this is resonating with folks and the work you’ve done over the last decade, it has made a difference. So, final question for you is simply, what do you want to leave us with as it relates to the possibilities, what are your final thoughts?
Dr. Danyo: The possibilities are there for anyone that is unhappy with something in their hair, whether it’s their hairline, crown, full hair loss, thinning in their eyebrows, beard, etc. And you need to see a physician who is well-qualified to explain these possibilities and do it in a very tempered manner and outline everything with both immediate and then long-term goals so that the possibilities become realities.
Clark: Well, thank you again. And I look forward to talking with you soon.
Dr. Danyo: Sounds great. All right. Well, stay healthy.
Clark: Thanks for listening to “Hair Restoration with Dr. Daniel A. Danyo.” You can book your consultation today with Dr. Danyo by simply calling 678-845-7521 or online at nahairrestoration.com. And be sure to subscribe, rate, and review this podcast wherever you listen to your audio content.