Dr Richard Chafoo on Hair Restoration

Another insightful podcast today as Trish chatted with Dr Richard Chafoo – a triple-certified Plastic Surgeon. Dr. Chafoo is from La Jolla Plastic Surgery and Dermatology, based in California.
In this episode, you will discover all you need to know about Hair Restoration, using NeoGraft and their recent technology which is the ARTAS iX. Dr. Chafoo also discusses how long it takes, who are eligible candidates, the process, the recovery period, and the time to see your new hair!
Dr. Chafoo is committed to his ongoing research about hair restoration – so if you want to know more, LINK IN BIO for the full episode.

Transcript- Dr Richard Chafoo on Hair Restoration 

Trish

Hello listeners it’s Trish Hammond from the Aesthetics Uncensored podcast. And today we are coming to you, like, we’re live here at the Non Surgical 2022 Symposium up on the Gold Coast and there’s some amazing speakers here today. But today I am really excited to be talking to Dr. Richard Chafoo. Now Dr. Chafoo is actually based in California in La Jolla, California and he’s a triple certified Plastic Surgeon. He runs La Jolla Plastic Surgery and Dermatology and he is the Guru I guess for one of a better word, he’s probably going to kill me for a designer of hair restoration. So today we’re going to have a talk about hair restoration. So welcome Dr. Chafoo. 

Dr Chafoo

Thank you Trish.

Trish

Thank you so much for joining me. So tell me, obviously hair restoration is something that, it’s a really growing industry. But tell us a little bit about it. Like how long have you been in it for a start? 

Dr Chafoo

Yeah, it is a growing industry. You know, all puns put aside, obviously. But it’s a field that I’ve been involved in for about the past 25 years when I originally, hair restoration was a procedure where we were doing removing a large strip of scalp from the back called an FUT procedure, but that resulted in significant scarring in some patients. So now we’re doing more minimally invasive procedures for patients, something called FUE or Follicular Unit Extraction.

Trish

Okay, and it’s like you’ve been doing it for years. So how long have you been doing it? 

Dr Chafoo

I’ve been doing FUE for about the past 15 years. We started out utilising the NeoGraft system and NeoGraft is a device that was developed by Venus Concept and allows you to individually remove the follicles where hair grows normally in the scalp using a very tiny punch about 0.8 to one millimetre in diameter, we take it over the entire donor region. And then more recently, we’re excited because we actually brought in what’s called the ARTAS iX, which is a robotic means of FUE and so we’ve added that into our practice as well.

Trish

Okay, so is there a particular person that would be after a hair restoration procedure? 

Dr Chafoo

That’s a great question. So Trish that normally, most of what we do hair restoration is in men, because usually men in their late 30s to 50s, occasionally 60s that are just beginning to lose hair or they’re losing hair, maybe in the front region, the crown in between those two areas. And they tried medical therapy but really haven’t done a lot and so this is a process where we restore the hair and we actually replace this hair loss with good hair besides in the back of the head, so that will grow permanently throughout their lifetime.

Trish

So does it just just continue on like normal hair or is there a special way they have to treat hair? It’s just like normal hair just put in a different spot on your head really? 

Dr Chafoo

Exactly. So it’s just put in a different area. So the quality of the hair will remain the same: the colour, the texture of the density, all that it’s amazing. You can place it into an area where they’ve lost hair and put these new follicles in and they’ll grow long term without a hair loss. 

Trish

Yeah, right. It’s so interesting, because, like, I’ve got a relative who actually had hair replacement surgery done years and years ago. But he, like his head, has just gone freaky. Like he’s got all these big plug things sticking out the front of it. And I think he’s got, I don’t know, it’s just it looks like, it looks like he’s been in an accident, actually.

Dr Chafoo

You know that that was one of the problems with the older methods. Because what we used to do many years ago is we would use, as you said, large plugs, and instead of removing an individual was called a flicker unit, which is where our hair naturally grows in the scalp from one to three occasionally for hairs, you would use a larger punch in those situations, and you would get multiples of follicles. And obviously, that’s not the way our hair would naturally grow. And when these were done initially, you would essentially get like a cornrow effect. So it looked like a doll or cornrows, and looked very artificial, very difficult to conceal or cover. So in a sense, you’re better off of losing your hair than looking like that. 

Trish

That’s so true, it’s if he would have waited until the better hair solution came out. So tell me, I know you’ve been doing this for a long time. And you obviously, you do a lot of this in your clinic. And as you were mentioning last night, what makes a Plastic Surgeon do something like hair restoration, because I just imagine Plastic Surgeons do surgery. But last night, you were telling us a bit of a story. Can you share that with us now? 

Dr Chafoo

So it’s interesting how you know, I got interested in hair restoration, because I felt that there was a need, there was a need for Plastic Surgeons to be involved because it is a minimally invasive procedure but it’s a permanent procedure. And so the important thing is, I always tell patients, there’s good news and bad news about hair restoration. The good news is it’s permanent, the bad news is it’s permanent. So if it’s not done correctly, it can look as in your relative you just mentioned earlier, it can look quite artificial. So the concept of early creating an in detectable and very natural hairline, I feel like is within the DNA of Plastic Surgeons, right? Because we’re all about aesthetics, we’re all about our looks, we’re whether we’re talking about doing a facelift, our patient or breasts procedure or body procedure is so using that right brain, that artistic experience. And so you bring that to bear, and it has a profound effect on someone’s confidence level. You know, when we create a hairline, we’re essentially framing our face, as we know, the chin frames, the lower part of our face, and the hairline frames the upper part of our face. So if we don’t have a hairline or are quite thin, our eye doesn’t stop at the hairline, but goes to the top of the head and it makes us look a bit older. So simply restoring a hairline restoring aesthetic balance to the face, makes some more youthful. 

Trish

That’s so true. It’s really funny because I’ve always been paranoid about my own hair. Because from the age of 18, I felt that I was really fine around the forehead there. So I went and saw a Trichologist at the age of 18 and you know, there was basically nothing they could do. But years on moving on, now there’s so many women that actually have this problem as well, like, do you? Are you seeing more women? Or is it? Is it still mostly men? Or do you think that’s changing or now that more people, this is a million question now that more people know about it, that it’s becoming more profound for women? 

Dr Chafoo

I think that’s a great point is, you know, we see more women, obviously in our in our practice than we saw many years ago, because there is this newer technology, this FUE method, I would say still the majority of hair restoration candidates, if you will end up being men because they’ve lost the hair completely. The issue for many women that we see in our clinic, is that they have begun to thin out the hair, but it’s not thin enough that they’re really candidates for transplant because you can damage their existing hair. So if they’ve lost a significant amount of hair, yes, there they are good candidates for hair transplantation. But unlike men, about 95% of cases in men is what’s called androgenic alopecia or male pattern baldness. In women, it’s about 40 to 45% so there may be some other cause. So when I see a woman in my clinic for hair loss, I’m thinking well, it could be androgenic alopecia, but it may be you know, drug induced, it may be hormonal, there may be an autoimmune process. And so just like when you want to see the chart trichology just we use a dermoscopy so it’s a little device where it magnifies a scalp when we can really look down at the scalp. And then sometimes we’ll actually do a scalp biopsy and have a dramatic pathologist look at it to tell us a diagnosis because many people if they have an autoimmune disorder, you don’t want those are not necessarily good air restoration candidates. So we’re in men 95% of the time, it is a male pattern hair loss in women it’s less so you essentially have to be more of a detective when you’re looking at evaluating and treating hair loss and when.

Trish

Sorry about that, all that talk got me really like, I wanted to talk so quickly that I almost choked on my own words. So that’s really interesting in the sense that there is a whole lot more. But you know, what if because I looked at some before and after photos last night, and there’s someone who’s like, virtually almost completely bald got a little bit of a what I call a skirt? I don’t know if that’s what they call it. But is that what they call it? When do guys have just that? Yeah, that’s called a skirt? Hey, good. I thought it was just something I made up. But no, it’s okay. So, so guys got a skirt, it’s got a really bald, and, you know, top part. So is that someone that could possibly have a hair transplant? 

Dr Chafoo

So that’s a great question Trish. So, we see patients in our clinic that have got all degrees of hair loss, obviously, if they have a more minimal hair loss, just say just in the front or just in the crown and you can treat that one area, as they lose more hair, the problem is that the donor area is not large enough to be able to treat so the patient you were describing looks like Ben Franklin, you really can’t transplant that entire area. Because if you took all the follicles out from the side in the back, and transplanted them, then they would be thin. So you actually give them a problem to come in for which is not a good thing so in those kinds of situations, again, it’s important to sit and talk to the patient and ask them what their concerns are, most of the time, most men will say, I don’t like how I look. Now, of course, with the COVID stuff in a zoom or a family photograph, that sort of thing and what they point to oftentimes is the frontal hairline. Because if you create a frontal hairline, you create youth for somebody, you know, a famous person I think of is our President Joe Biden. So if you look at him from the front, he’s got a very nice hairline but if you see him from the side or back, he doesn’t really have any significant hair in the in the crown, or the scalp or the crown region, but he looks more youthful, because he has a hairline. So that’s really what you’re trying to achieve in those types of situations. 

Trish

Of course, yes, I have seen that we’ve got the little circle at the back. But you’ve got the very good until like, is there like a little bit about the procedure like so from what you’re saying, you get the hair from where there’s lot of hair, like at the back of the head, and that doesn’t leave a bald spot there does it because you like me, here’s what we’ve got in our head, there must be squillions. 

Dr Chafoo

So we have, we’re roughly born with between 100 and 150,000 hairs on our head and we never make more so they don’t regenerate. So unfortunately, so you have to be very careful how much you harvest from the donor area, you never really want to harvest more than 10 to 15% per session and some patients can tolerate two or three sessions. So potentially a patient may have anywhere from 10 to 12 or 14,000, harvesting opportunities, grafts that you could obtain throughout their lifetime, but you never want to, you never want to over harvested in the area. And then when those grafts are removed from the donor region, the hair does not grow back so that’s something that patients need to understand. 

Trish

I was actually going to ask you exactly that question. I was gonna say, does it ever grow back from the donor site? But no. 

Dr Chafoo

So exactly, I’m sorry, it never grows back. Now one of the things that I’m involved in right now that I’m kind of excited about is on the Medical Advisor for a biotech company in La Jolla, and called Simpson therapeutics, and we’ve actually figured out a way to clone the human hair follicle. We’re the only company in the world that has done this. So we’ve been able to take are called potential stem cells, which we all make, we’ve been able to isolate those and we’ve been able to create the two cells that are neat that we need to grow it to grow hair or hair follicle, epithelial and dermal papilla cells, and we put those together in a dish and we could see hair grow and then we transplanted that into a nude mouse. This is a genetic mouse that just can’t make hair. When we grew hair and it was human hair over several cycles so the Holy Grail is, as you say, is getting more hair and the only way to do that is through cloning. So we’re now doing studies on mini pigs, which is pig skin closest to human skin, the broad research that’s been done and so we’re doing that now. And if that’s successful, we may be looking at human clinical trials down the line, but that would be a game changer if we have that technology available someday. 

Trish

That’s amazing. Because like that does sound like a game changer. And I love anything to do with stem cell technology because it’s almost like it’s the next generation kind of thing. 

Dr Chafoo

Yes, very much next generation so it’s really cutting edge. Now the interesting thing Trish is right now, if we’re doing like three to 4000 grafts at a session, that takes several teams to do that. It’s over a number of hours but what if we can clone the hair and what instead of if we’re harvesting 3000, we, like that patient with a skirt that you’re wishing her well that’s like Ben Franklin, what about if now we can clone 20 30 40 50,000 follicles? How is that going to be done, has to be done robotically? And that’s where our company is working now with Venus Concept that makes the ARTAS iX the robot, because you’ll need you’ll have to have robotic technology to do that.

Trish

Wow, that sounds so where we’ve normally got. We’re born with 150,000 hairs, you’re saying that we could possibly increase that by what number? 

Dr Chafoo

So you need to lose about 50% of the hairs in a region before you notice clinical thinning or baldness. So, say in the frontal area, if you have let’s say 20 or 30,000 hairs, you have to lose at least 10,000 of those before you start noticing thinning. Well, if we said earlier on that you only can harvest in a patient’s lifetime 10 to 12 to 14, maybe 15,000 follicles, you can see the maths just doesn’t add up, you can’t get the density that you could get before they lost their hair so that’s the limitations of hair restoration surgery. It is effective, and it’s very natural, and we can definitely get improvements. But the cloning technology that we have will allow us to get the hair back to the density that it was before.

Trish 

Wow, that sounds phenomenal. So it’s going to be one of those to watch this space.

Dr Chafoo

Watch the space. Yeah, we’re alone in this space right now and it’s a few years out. My research team, we are all PhDs that just study the hair follicle are saying that it will be a few years. But the critical part right now is if we can get this to work in the pig model, and the next trials would be human trials, FDA approved human trials. 

Trish 

You’re right. And I know we might have talked about this before. But I was gonna ask you, how long would the procedure take? I know that’s going to depend on the amount of follicles that are taken out. But how long is it like if someone comes to you as a patient, like how long are they going to be there? What’s the what’s the process, right? 

Dr Chafoo

So normally, if we’re doing a smaller area, and maybe we’re doing like 2000 grafts, for example. So normally about a six hour procedure, if we’re doing 3000 grafts, which is sort of a max, roughly the largest number that we’ll do at a time. And this normally is a seven or eight hour procedure. They’re with us most of the day, but the nice thing is, it is done in a local office, people are very comfortable having it done whether we’re doing it robotically or with one of our manual devices. 

Trish 

Well, you because one of the gentlemen spoke last night, on your talk. He did say that. Yeah, he was really comfortable for him. He watched a bit of TV while he was down there and it was a bit chillax and we’re in because you had numbing cream. Is that what you put on the patient?

Dr Chafoo

Actually, we inject some local anaesthetic and we usually will give them a little oral valley of  pain medication as well so they are comfortable. And obviously we want to anaesthetise that area, you know, a checkup beforehand, it usually is a very overall very comfortable procedure and compare with the older techniques that we talked about the very beginning of the show using a strip method, the FUT, that is not that’s a procedure where there’s a lot of pain, there’s a lot of numbness, there’s a lot of tightness to the scalp and it’s interesting. I’ve had patients that had had a previous strip procedure that came in for us to do, say a robotic FUE and they were anxious beforehand, they were a little concerned. And then after the procedure, they were like wow, this is nothing compared to what I had went through before it’s much less pain because the punch that we’re using Trish doesn’t go that deep into the scalp, you can imagine it goes down about to the level of a tattoo. So you’re not getting into those really deep cutaneous nerves that cause chronic pain and numbness so it’s a minimum is actually a minimally invasive procedure.

Trish 

Okay, so you reckon it might be as painful as a tattoo.

Dr Chafoo

Except you can’t get, you can’t use anaesthesia with tattoos, tattoos or more. And I have patients that have had two tattoos, they’re like, this is easier than a tattoo. I mean, the tattoo hours couldn’t put on anaesthesia and you know, but it’s yeah, it’s really not that uncomfortable for people. 

Trish 

Right. And just just for the final stuff. So if you have a lot, it takes about seven hours, you’re pretty much there for the day. But what about is there anything the patient needs to do before, during and after for care of the hair? 

Dr Chafoo

There is, normally we’ll provide them with certain medications like an antibiotic that we haven’t taken beforehand. The day that they come in, we shave the area down. And then there are some simple post operative instructions for people we tell them that they want, in three days they can wash their hair, about a week or 10 days you can get back to physical exercise and then in about a month, they can get in the pool, they can wear a helmet, we don’t think rubbing against the grafts and there are these little tiny cross that will be formed where we’ve placed the grafts but within about a week or 10 days those are gone. And within two weeks, the hairs grew back into the donor area so really after two weeks is pretty imperceptible and then the end then what happens is the hair follicles that we transplanted, go into a resting phase called telogen effluvium so they don’t grow hair at that point. And you tell the patient that ahead of time, otherwise they’re gonna be looking, sir, well, why isn’t my hair growing right away so it takes about three months, and then the hair begins to grow slowly. After the final result, you’ll see about a year to a year and a half after the procedure. 

Trish 

Wow. So yeah, so for the first two weeks, the hair kind of sits there, but then it disappears. 

Dr Chafoo

Exactly, yeah, for the follicle, it usually will just fall out and you have to alert the patient that because sometimes it’d be concerned, gosh, did my graph fall out, not the graph, it’s just a little hair that was associated with the follicle, the follicles are very quite deep in the scalp, at the time of the procedure. And then in about three months, the actual follicle goes into what we call the antigen or the growth phase, and it’s during that time that the hair, the hair shaft will be created, they’ll begin to feel it and start seeing the hair growing. 

Trish 

Okay, so it’s gonna be three months before there’s anything they can see. So first, I’ll have a panic thinking, Oh, my God, what’s happened? It’s all gone. Okay, great.

Dr Chafoo

So support, it’s like anything in plastic surgery. It’s about you know, setting realistic expectations, explaining to patients, you’re not going to come out of here like a chia, you know, you’re going to have a procedure done, and it’s going to be a few months, and you start seeing the hair grow. But the nice thing about the newer techniques that we have today is that really the way that we make the size and we implant the graphs is FUE method, whether we’re doing a robotically or we’re the NeoGraft, or another device, is it looks imperceptible, it looks so natural, and this is what men worry about, especially, I don’t want somebody you know, most men don’t want to have that plug, like look that you were mentioning earlier on that they’d rather just shave their head, they don’t want that look so now with the technology we have today, literally, they can step out of a pool, a shower, come out of a workout, and their hair is wet, it looks completely natural.

Trish 

That’s so good. It’s so funny because it’s the very first thing people notice, since your hair is your crowning glory and sometimes it’s the last thing really, because a lot of people don’t know that you can do something or they think it’s beyond their reach. But it’s pretty reachable by everyone these days, isn’t it? 

Dr Chafoo

It is. And the most important thing is if you’re considering hair restoration, do your research, you know, look for a qualified Physician, go and look at their photo gallery, see what the results are go in for a consultation. We allow patients to give patients names of patients that have had a procedure done so they can talk a little bit more detail about it. But you want to feel comfortable as a patient where you go ask a lot of questions, you know, get a lot of information. The other important part of this whole process of hair loss, especially in men is how do we keep the hair we still have. So I think sometimes men think, you know, Doc, I’m just going to have a transplant procedure, because I never want to have to think about this again. And I tell them, well, for the transplants, yes, but what about the rest of your hair because we know that hair loss is a lifetime problem, and they’ll continue to lose more hair. So there are medications that are very effective today, that can help to significantly reduce the chance of further hair loss and then further transplants because at some point, if you don’t address that problem they’re going to run out of donor area.

Trish 

That’s true, I guess that’s probably would have been the last question, what about if you run out of hair like is it going to, I mean, I guess it depends where you place it the first time, if you do use that hairline, it’s still going to stay the highest?

Dr Chafoo

And the thing is, and that’s a great point is you really want to make sure the hairline looks very age appropriate and very, very natural. And that’s why most of us that are involved in hair restoration, don’t like doing hair restoration on someone who’s too young, because some of this very young, and I’m talking to somebody that is in their early 20s, what their expectations are not really realistic. They want their hairline down low and flat like it was when they were a teenager and you don’t want to do that because as they continue to lose more hair, it will look quite unnatural so it’s about designing the hairline. I spent a lot of time in the clinic, theatre designing, marking out the hairline, looking at old photographs, we’ve all got our phones, we can kind of like scroll through and find pictures of how our hairline look, a lot of the guys will come in and bring their significant other because women have a very good aesthetic eye. And then we decide on the hairline so the key is to make it look natural looking so it looks good for a long term.

Trish 

And my last question, because I know that you’ve got a lot to do while you’re here. I wanted to ask you, can you lose your hair from your hair that has been transplanted? Can you lose that as well? Or once it’s there, it’s there forever? 

Dr Chafoo 

So that’s a great question. You can lose that hair, but it depends where the hair is taken from. So there’s what we call a safe donor area, an area where it’s much less likely to be lost and that’s something you know, I always give people the analogy again, Ben Franklin, you know, we’re just despite the fact that he lost all the hair, there was always that fringe that remains there even into advanced age and so you really want to plan that out. You really want to make sure the follicles that you take are taken from an area that are much less likely to be lost. The problem is that some clinics will recommend these what we call mega sessions where they’re doing, you know, 5 6 7000 grafts at one time. In that situation, you’re right, they’re probably harvesting grafts are not going to survive, they’re just going to, you’re going to lose at some point.

Trish 

Got it. So where it comes from is going to be relevant as to whether you lose it again. So you take it from there, back, put it at the front, and if it was going to lose it, if you’re going to lose at the back anyway, you will lose it with it, wherever it is. So it’s the whole thing gone. 

Dr Chafoo 

Yes. And it’s especially when we’re harvesting in the back area, we don’t want to harvest up too high to where the crown says because obviously a lot of guys lose hair in the crown region. So if you harvest up too high, you’re gonna be taking grafts that are destined to undergo miniaturisation ultimately not create hair. So it’s a waste of time for a patient and a waste of money too.

Trish 

And I think that was so interesting. I’ve learned so much about restoration day. That’s great. I haven’t learned more than I learned last night. Oh, that’s awesome. Look, thank you so much for joining us today. 

Dr Chafoo 

My pleasure. Thank you for having me. 

Trish 

Lovely. So guys, if you’re in the US, you can go and see Dr Chafpo at La Jolla in California. Otherwise, if you want to find out where there’s any practitioners who do this hair transplantation here in Australia, just drop us an email to [email protected] and we’ll put you in touch. Thank you so much for joining us today. 

Dr Chafoo

It’s been a pleasure, Trish. I appreciate your time.

You can find out more about Dr Chafoo here https://www.lajollaskin.com/ 

Check out for any practitioners who do this hair restoration here in Australia https://anybodi.com.au/members/ 

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Well, like all good quickies it's time to dust off and get back to our day jobs! If you liked the podcast please rate us because we need the validation for our fragile hearts. If you have a story to share or have a burning question you would like us to cover please slide into our DM’s on Instagram at @transformingbodiespodcast. Stay positive, keep your boobs and chins high until we chat again xoxo Trish