Episode 26: Who Doesn’t Want More Hair???

Dr. Franco: Welcome to “Plastic Surgery Untold.” I’m Dr. Johnny Franco, also known as Austin Plastic Surgeon. I have the great pleasure of having our celebrity cast and a special guest that we’ll get to in just a minute. Today is episode 26, talking all about hair. Who doesn’t want more hair? I know I’ve worked hard to try and keep some of these luscious locks that I’ve grown out over the quarantine time. But let’s get around the room and introduce our celebrity cast here. Across from me is Austin’s most beautiful man, Mr. G-Berto.

G-Berto: Howdy, howdy. How’s everyone doing?

Dr. Franco: And then we got, of course, Celebrity Anesthesia, who has really turned up his Instagram game. So, I hope a couple of you in the audience know who he is.

Travis: Thank you, people.

Dr. Franco: And then our special guest for the day is Dr. Paul Pearce, who is actually a hair expert here in Austin, which never ceases to amaze me how many sub sub specialists…because plastic surgery, for those of you that don’t know, is considered a subspecialty. And then inside of that, so many different specialists. And so, I think, super privileged to have someone like you who does such a unique treatment and something that really affects both men and women. And hopefully, we can jump into how you treat maybe each of them differently. But before we get too carried away, let’s get caught up on what everybody has been doing since our last episode. And then we’ll let Dr. Pearce tell us a little bit about his practice and what’s going on. So, Celebrity, what’s been going on with you?

Travis: Oh, man. What has been new? A lot going on at our house. We’re getting ready and geared up for the move. Today, I was actually supposed to have a guy come out and do some work around our house, get things fixed up. We needed something stained and repainted, and just some odd jobs stuff. The contractor just ghosted us this morning. So…

Dr. Franco: Well, I don’t know anything about that.

Travis: About being ghosted?

Dr. Franco: We’re only four months behind on our building, but don’t worry. You’re catching up fast.

Travis: Oh, yeah. We are.

Dr. Franco: I actually had the privilege of seeing one celebrity’s house. Damn, that’s nice. That’s really nice.

Travis: The new one is finally starting to come along, man, as is your office. I got a sneak peek behind-the-scenes tour, which is pretty cool.

Dr. Franco: I think by January of 2023, we should be in, we should be ready. It should be going full effect by then, no question.

Travis: A boy could dream.

Dr. Franco: G-Berto, what about you? What’s been going on in the most beautiful man’s life?

G-Berto: I mean, not a whole lot in terms of anything new and exciting. Sorry I missed the last recording. I feel really bad about that. But unfortunately, circumstances didn’t allow me to join you guys. So, I really missed out.

Dr. Franco: The Instagram has blown up with people asking if you got Xed. And, you know, it was honestly…I told them we were going to wait to see how the ratings went with and without you. It’s still a bit of toss-up. Fortunately, they’re not all in yet, and we had to film another session.

G-Berto: Those things sometimes take a little time.

Travis: Me and Franco actually talked about bringing back the old survivor days. We’d get around the campfire and have somebody come around and extinguish the flame.

Dr. Franco: Can I tell you what broke my heart? There was a lovely young lady the other day and Austin’s most beautiful man offered to do her Botox and she said no. She said… And I was like, “How? I mean, look at those strong hands.” And she said no. And I was like, “Well, maybe we need to rethink our injectable expert on the podcast here.”

G-Berto: Maybe we should bring her on.

Dr. Franco: Dr. Pearce, tell me a little bit about you. We’ve known each other for probably a year now and…

Dr. Pearce: Yeah. I think it’s been about a year.

Dr. Franco: And I think you…we cover for each other and I think you cover more for me. So, I really, really, really appreciate it. You know, all this vacations I take like Celebrity Anesthesia. But tell us a little bit about your practice and what you do, and why we got you here today.

Dr. Pearce: Yeah. So, I have a practice here in Austin. And it’s a plastic surgery practice. I cover male and female cosmetic and reconstructive issues. But one of the things I kind of dive a little deeper into is hair restoration for both men and women. Because I’ve had a few people in my life, you know, relatives, my brother, all sorts of people in my life that have kind of gone through hair loss. And kind of I’ve seen the effects that it has on them. So, it’s kind of why I got into it. And it’s one of the things that I’ve kind of really…kind of dived really deep into and kind of really…I’ve really gotten to enjoy doing it. So, that’s a little bit about my practice.

Dr. Franco: But I’ve seen you on… Because I follow you on social media as well. What’s your handle, if people are trying to follow you?

Dr. Pearce: Right now, it’s @pearceplasticsurgery.

Dr. Franco: Oh, you’re thinking about changing it?

Dr. Pearce: I’ve been thinking about it. I’m not sure. We’ll see.

Dr. Franco: Well, don’t give away any good names here because we don’t want anybody to take your name and then…

Dr. Pearce: [crosstalk 00:04:33].

Dr. Franco: Yeah. And then charge you, you know, 20 bucks for it or something.

Dr. Pearce: Is that what happened to you?

G-Berto: I accept Venmo.

Dr. Franco: G-Berto will be [inaudible 00:04:42] in the mall as we’re going.

Travis: Oh, yeah.

Dr. Franco: He’s like, “I need a little extra cash on the side. I got to buy some new hair gel.”

G-Berto: Side hustle.

Dr. Franco: But I’ve seen you do a lot of…it looked like teaching some courses and you’ve been to some other courses. Could you do some special techniques and other stuff for hair restoration?

Dr. Pearce: You know what? Kind of one of the things that kind of sets apart my hair restoration practice is that we brought in the ARTAS iX which is a robotic hair restoration system. So, it’s pretty fancy. It has this robotic arm. It’s one of those arms that they use in kind of producing cars and things like that. And what they’ve done is they fine-tuned it to be able to do a lot of the heavy lifting for extracting those hairs through follicular unit excision or that little…just taking each individual graft of hair out of the back of the scalp so that we can move it to the front.

Dr. Franco: And we’re going to get back to this because this is one of the big topics I want to talk about is the old strip method versus this. But before we get too deep into the weeds, you know, I just want everybody to kind of know why we decided to do this as a topic. I’ll tell you personally and anyone who follows us on our Instagram @austinplasticsurgeon…I’ll throw myself a shameless plug before…

Travis: Dude, I haven’t even gotten my wife in here yet.

Dr. Franco: I was going to say, I was trying to beat Travis from, you know, throwing out his wife’s plug on here.

Travis: Which is @yourtrendytherapist. Give her a follow, you guys.

Dr. Franco: But, you know, I personally have… Even though I’ve grown out my hair during this quarantine time, there’s definitely some areas that I’ve already thinned out. I see it in… I think so many people spend so much money, time, effort on these hair restoration…I don’t even want to call them techniques. Maybe gimmicks. And so…

Dr. Pearce: A lot of them are.

Dr. Franco: I think people get lost in the weeds of what really is helpful, what’s not helpful. And so, that’s why I thought that having an expert like yourself would help us through a little bit. You know, one, what kind of things can you do non-surgically leading up to this? What are kind of our surgical options? How this has evolved. Because I feel like it’s evolved a lot since I did this in residency, you know, 10, 15 years ago, and some of the new things that are available, like you’re talking about. And then, you know, how maybe they can find somebody who specializes in this, because I feel like sometimes people get lost endlessly going to different places, and spend a lot of money and maybe don’t see any results.

Dr. Pearce: Yeah.

G-Berto: I know in my practice… Oh, I’m sorry, Dr. Pearce.

Dr. Pearce: No, it’s okay.

G-Berto: I was just saying, I know in my practice, it’s a huge challenge to manage patients with hair loss questions. It’s tough, you know. Men and women, they come in. You know, they want the magic pill. They want, you know, the magic procedure. So, I’m really excited to hear what Dr. Pearce has to say.

Dr. Franco: And some of this is going to be interesting because you see a lot of probably some male pattern baldness and so forth. But you also see some other medical conditions that are a little bit of a different… It’d be interesting to hear the two of you kind of talk about how to sort through some of that because I think that’s its own beast as well.

G-Berto: Yeah. No. I’d love to take away some pearls of wisdom here.

Dr. Franco: Awesome. Well, let’s jump into it before Celebrity starts…while he still has his shirt on and we have… You know, because I’m worried. You know, this is a family show. Got to keep this going. Well, let’s talk a little bit about… Do you mind, Dr. Pearce, if we start from the beginning and kind of what non-surgical things we can do, you know, when you should start? Because, you know… And selfishly, can we use myself as a case example? You know, I personally have a little bit of thinning. I still have good hair, I feel like. And you can tell me if I’m wrong. I don’t think I’m hair transplant candidate yet. But I feel like there’s ways to get on this early to delay the need for some of this stuff.

Dr. Pearce: Yeah. And starting at the beginning is exactly where everyone should start because you have to really lay down a foundation before you even get to even talking about having hair transplant. So, yeah. Starting with all that medical management and kind of understanding the reasons why your hair is falling out is a really good place to start.

Dr. Franco: What do you do or how do you advise people to get started? So, like if I was worried about my hair, I would come in to see you. You’d do an evaluation, do different tests. How do we start the process?

Dr. Pearce: So, essentially, what we do is we sit down, we start, we’re having a conversation. We’re talking about when your hair first started falling out, how it’s been progressing, and really, if you’ve done anything to kind of slow it down. Most guys really haven’t done anything by the time they come to see me in the office. It’s very rare that I have somebody that’s actually gone and gotten Rogaine or some medication over the counter that they can take. But typically, it takes guys about five to seven years before they finally decide, like, “Okay. Enough is enough. I have to talk to somebody.”

Dr. Franco: I’ll tell you… With your experiences and for G-Berto, but for me, with men, it’s interesting because it takes them forever to come into the office. But when they come into the office, they’re ready to do something that day, right now, you can’t do it soon enough. But it’s typically been going on for years and just finally needed something to flip the switch that they wanted to come in.

Dr. Pearce: Yeah. And typically, their hair loss has been going on longer than when they first tell you because… You know, in order to see thinning in the scalp, you have to lose about 50% of your hair. So, by the time you notice that 50% loss, well, you know, you’ve already been going on it for a few years. So, it’s something that could have been done sooner, but you just don’t really realize it.

Dr. Franco: So, what do you do? How do you get people started? What would be something that you would do to get people started before you get to the hair transplant stage here?

Dr. Pearce: So, typically, what I’m doing is we’re sitting down, we’re having this conversation and then we talk about if they want a hair transplant, well then…the conversation that I have with them is that you need to do something to slow down the hair loss. There’s three really good options that have kind of been vetted out and studied. And the rest all really kind of seem like snake oils and things like that. So, really, what I kind of talk about to them is starting either on Rogaine, Propecia or low-level laser light therapy or laser cap therapy. So, once we get that conversation going, then we’re starting this foundation and they can get…beyond that, for about six to nine months before you can really start talking about a hair transplant because that’s how long it’s going to take to really stabilize that hair loss and kind of slow that down. Because that’s the whole end goal.

Dr. Franco: And I think this is something…you know, in the little bit of hair transplant I did in my training, I think this is what separates people from someone like yourself who does a lot of this to just the part-term or the bottom machine that’s just trying to do something. Because I think people forget there’s still a finite amount of hair. While you can take donor sites from certain things and some of the… I think we’ll jump into it in a little bit, about why the follicular unit and some of these things are a little bit better than the old strip method and so forth. But there’s still only a finite amount of hair you have. If you get overly aggressive about trying to bring people’s hairline all the way down or make them so thick without some plan, you can sabotage yourself down the road.

Dr. Pearce: Yeah. Absolutely. And then you can even just…you could transfer the problem from the front to the very back donor area. And they have this kind of moth-eaten appearance, which doesn’t look all that great.

Dr. Franco: No. We can’t have a moth-eaten appearance. Can’t be… Gilbert’s wincing right now. He can’t be Austin’s most beautiful man with a moth hair appearance.

Travis: Do they make moth balls for the back of the head?

Dr. Franco: So, tell me a little bit. So, your requirement is you get them in, you get them on a medical treatment, probably varies a little bit from person to person, depending on their specific situation.

Dr. Pearce: Yeah, exactly. So, we have to kind of talk about the pros and the cons of all three of those. The one that really gets guys, the ones that…which is probably the most effective at slowing down hair loss, but the one that the minute you mention some of the side effects, guys are out. They’re done. There’s absolutely no way I’m taking that medication. But then you have to have that conversation where, all right, these side effects are very…they’re kind of rare. And some of these other things that you hear on the internet are, you know, maybe not full truths to them. So, that’s a whole conversation in itself.

G-Berto: Would you say that it’s a small percentage of men? That’s what I’ve read is that it’s actually a small percentage of men that experience those side effects with the medication you’re talking about.

Dr. Pearce: Yeah. So, the medication that we’re talking about is finasteride or Propecia. So, Propecia is a really good medication because what it does…some people call it a DHT blocker, but in reality, it doesn’t block DHT. What it blocks is 5-alpha reductase, which is the enzyme that converts testosterone into DHT. And the reason that we use that is because up here in the upper part of the scalp, you know, you have a higher concentration of that 5-alpha reductase enzyme. So, that’s kind of why we get that genetic male pattern baldness, that hair loss there. So, once you start taking that medication, you’re really kind of slowing down that progression in the hair loss. And by doing that, you’re prolonging the amount of time that you can go before you may even need a hair transplant.

But to get to the side effects, you know, sometimes there is…in the studies that they’ve seen, they’ve seen about 2% of men, they have problems with erectile dysfunction or the ejaculate may change, kind of things like that. Some people will develop gynecomastia. But the minute that you mention any effects below the belt, typically, guys are like, “No way. Absolutely not. I’m not taking that medication.”

Dr. Franco: Travis has brought this up so many times. I’m like, “It’s so rare, Travis. It’s so rare. I think you’re okay.” I tell him. I tell him. So, I appreciate you repeating the same things I tell Celebrity Anesthesia.

Travis: Thanks, man. [crosstalk 00:13:34]. I’m over here taking notes, man. I feel like this podcast is built for me.

G-Berto: And correct me if I’m wrong, Dr. Pearce, but don’t those side effects reverse themselves if you stop taking the medication?

Dr. Pearce: They typically do. Now, that’s the other part, too, where on the internet… You know, the great thing about the internet is it gives everyone a voice. The terrible thing about the internet is that it gives everyone a voice. So, you have some people that feel like their sexual dysfunction that started around the time they started taking their Propecia is related to that, and that whatever is permanent afterwards is still related to that Propecia. Now, the studies are not very conclusive in any of that at all. So, we can’t really make a hard line call on that. So, it’s something that we kind of battle a lot when trying to prescribe this medication. I mean, there’s no really great medication out there that has, you know, full effect with zero side effects. So, it’s a conversation that really takes quite a bit of the consult when we’re talking with people starting medical management.

Dr. Franco: How about some other things that you hear about? So, I mean, there’s some of these other treatments like PRP. Some of the new product lines have come out that…and I can’t even name all of them out. But in terms of, like, some of the…I know HydraFacial has added some things. And some other companies have added some hair treatment stuff. Any of these that you incorporate in your practice or have seen? I’ve seen people using PRP ahead of time in conjunction with Rogaine and other things. I’ve seen people using PRP in conjunction with the actual hair transplant itself. And I know PRP, unfortunately, is one of those new frontiers. I think there is a place for it, but I think when something’s new and exciting, unfortunately, it gets used on every wall.

Travis: Everybody gets it.

Dr. Pearce: Everybody gets it. Yes.

Travis: It’s like Oprah handing out new cars.

Dr. Pearce: You get PRP. You get PRP. So, yeah. No. I mean, the PRP, the platelet-rich plasma which is… Essentially, what we do is we draw out… Your blood has growth factors in it. So, we draw your blood. We spin it on a centrifuge and then we can isolate those growth factors. And sometimes we can get them pretty concentrated. So, to really have some good effect, you need some concentration above three times or so to really have some good effect on the scalp. But what you’re doing is you’re injecting those growth factors at a certain kind of level in the scalp, hopefully getting it right around where the root of the hair is, so to speak. And by delivering those growth factors there, you’re hoping to kind of kick start some of that growth again.

Travis: If there is somebody that is good at injecting a scalp, it is Dr. Pearce. I know that firsthand.

Dr. Franco: Was this from your skateboarding injury?

Travis: It was not a skateboard. It was the one wheel.

Dr. Pearce: This was way more advanced than that.

Travis: Way more advanced than a skateboard. I had a fall. Dr. Pearce actually stitched up the back of my head. I didn’t feel a thing partly because I was half-conscious. The other part of it had to do with his local placement. So, I can attest the guy is great at injecting scalps.

Dr. Pearce: Well, thank you.

Dr. Franco: Let’s jump into… Because I don’t want to run out of time here. We’re still…have, I think, scapegoated the elephant in the room. Let’s talk a little bit about surgical management , i.e. hair transplant. And maybe it kind of options down the difference between the big strip method which I knew some people had a big reservation because you had a big scar along the back of your head which was a telltale sign. Because if you ever got to the point where you said, “Forget it. I’m just going to shave my head,” now you have that big scar along the back of your head. And I know that was a turnoff for a lot of people.

Dr. Pearce: Yeah. Yeah. It certainly is. I mean, I have guys that come into my office and they’ve had strip before. They have short hair so you can see the scar. And their wife doesn’t know what they had done. They’ll me like, “Oh, I’d just tell her I had a car accident and that’s what the scar is from.” They just don’t want people to know. So, yeah. There is a little bit of a stigma to that, but there is still a place for strip procedures in the world of hair transplantation.

So, it’s a really good method to get a large amount of hairs in a small surface area and a large amount of grafts that we can transplant. You know, the downside is, yes, you have that scar that you’re left with. If it’s not really closed all that well, it can widen, and then it’s certainly noticeable. And then some people complain about numbness afterwards and it’s painful. You have to take some pain narcotics afterwards. Whereas, you know, you have the other methods and they’re a little bit less invasive, so to speak, but they do spread the scar out over a much wider area. So, the scar is less noticeable.

Dr. Franco: I’ve seen…my practice in Miami. And I didn’t really do it, but one of the other guys did. They used something called NeoGraft which, again, was…I guess the layman’s term is more of like a little punch hole method where they basically try to punch every little hair and spread it out. So, the idea would be that there was no one scar you could take these. But that runs the risk is if you’re…if you’re not highly skilled at it that you could damage a good number of those hairs. And again, someone who has limited amount of hairs, you know, sometimes can be concerning and difficult to deal with.

Dr. Pearce: Yeah. Exactly. Because, yeah, like you said… If you’re trying to go for 2,000 grafts and you don’t have quite the angle on each one of these, you may have to make 2,500 to 3,000 attempts to get those 2,000. So, now you got 500 to 1,000 hairs that you could have used on a future hair transplant, and now you can’t use those at all. So, yeah. It’s a little bit…it’s kind of a trade-off. One, you trade off the strip for a large amount of grafts in one sitting or you can spread out that scar much wider. But the downside is you may lose some of that graft material.

Dr. Franco: And so, how do you guide people about when it’s time to consider hair transplant versus other methods for hair treatment?

Dr. Pearce: It kind of depends on where they are in their hair loss journey because this is… I try to explain to guys. A hair transplant is not a cure for hair loss. If you start losing your hair in your early 20s, 30s…it can happen at any point. I’m waiting for mine to drop because I have hair loss in my family. It’s affected my brother, it’s affected my dad, but somehow…I don’t know. Somewhere in here it’s going to start. But once that journey starts, it goes with you for the rest of your life pretty much. So, where to start and when to start is…you know, if it’s affecting them psychologically, a lot of guys in their 20s… You know, hair loss is not really something that’s associated with being youthful and sexually attractive. So, for guys in their 20s, you know, I have to kind of really…

Dr. Franco: I’m sorry, Celebrity. He doesn’t mean you. He doesn’t mean you.

Travis: Oh, god. Chest pain. Oh.

Dr. Pearce: But the guys in their 20s, you know, I really try to start them on medical management. We try to do everything we can to prolong that holding off of getting a hair transplant until maybe their early 30s, mid-30s. Because that’s really a good time right there. You’ve already had hair loss going on for about a decade or so. And if you’ve done something about it to hold on to that hair, well, maybe that’s less grafts that you need to get back to that goal, that appearance that you want to have or that fullness in the front or in the crown area. So, 30s and, you know, mid-30s or so is a good range to start.

Now, I have done some guys in their 20s. They’ve proven to me that they’ve stuck with a program. You know, they’ve taken the medication and they’ve actually seen some improvement through their medical therapy. So, it’s hard for me to get guys in their 20s into the chair because I’m pretty hard on them to kind of keep them…make sure that they’re sticking with the program.

Dr. Franco: And what about… Since we…I know we’re picking on Celebrity here today, but what about anesthesia? Is this something that most people go to sleep for? Is this something you do…conscious sedation in your office? Is this something they don’t even need…need anything? Where are we at with that?

Dr. Pearce: So, it’s a procedure that’s definitely done under local anesthetic. And that’s probably the worst part of the procedure. Pretty much every guy that sat in the chair, they always say the worst part is just the numbing part. But typically, it’s a couple of regional blocks. We do, you know, the supraorbital nerve here. And then we kind of have to do a ring block kind of going all the way around. So, that way, the whole thing is numb. And we also have to kind of come across the back of the neck so that way we can harvest this in a pretty comfortable manner.

You know, I had some guys that do it without some of that conscious sedation. We give a little Versed shot in the arm and it just kind of helps them go to sleep during the harvesting procedure. But I’ve had some guys that do without it, and they do just fine. I’ve had other guys refuse it and then right when I hit their goal of getting 2,000 grafts, they throw up in the corner. So, it’s like, “I’ve been offering you Versed to relax you, but you haven’t taken it.” So, you know, it’s a combination of those things.

Dr. Franco: Okay.

G-Berto: Dr. Pearce, is this a one-and-done kind of treatment or is it done over a series of, like, treatments, the procedure itself?

Dr. Pearce: The procedure for the hair transplant itself, it depends on the goal and how much hair loss these guys have. So, if it’s just a little bit, just right here in the temples, that’s pretty fairly easily filled in on one treatment. But if they want from the front back, yeah, we can do larger volume cases. But typically, you know, I like to stick around the 2,000 to 3,000 mark, not really go over any higher than that only because the length of time that the grafts are out of the scalp now we’re increasing the time that they’re, you know…the risk that they’re not going to survive the transplant. So, I try to keep that, you know, 3,000 below per session. So, sometimes they need two or three treatments.

Dr. Franco: I also think, just like any surgery, breaking up the amount of time because I mean just for you and I and even Celebrity and anyone who does procedures, it’s…you know, you’re really intensely focused over that time. And so, trying to make sure that it’s focused…also for the patient, it’s a long time to be in a chair especially if they’re not completely asleep. And so, I think there’s some benefit to that, too. And you don’t want to overuse your gold mine here, right? Because you overharvest your gold mine and then, you know, 10 years from now, they lose more hair and you’re scrounging.

Dr. Pearce: Yeah, exactly. You definitely want to save some for later because eventually, everybody…if you get one hair transplant, you know, in your 20s, you may need another by 45, 40, if everything goes well, you’ve taken all your medication that’s kind of slowed down the whole process.

Dr. Franco: Before we jump to women, a few places I used to see in my residency and it’s only…honestly become a little bit hotter and I asked this question before. But what about for, like, eyebrows and eyelashes? And even for men, I’ve heard some people trying to kind of fill in their beards, trying to do some other kind of exotic areas and stuff. And I think those got forgotten about, but I feel like they’ve become more popular.

Dr. Pearce: Yeah. Yeah. No. Certainly, because… I mean, you know, anywhere that you want hair, you can get a hair transplant. You can take the hair back here and move it anywhere you want. So, yeah. I mean, we are…you know, we’re doing eyebrow transplants. We’ve been doing beard transplants. The only one I really haven’t gotten into is the eyelash transplants. That one’s pretty intense. It’s a pretty, pretty finite procedure. So, I haven’t quite gotten into that one. But yeah. I mean, just about all of them you could do. You can move hair just about anywhere on the body.

Dr. Franco: Because we did more eyebrows and some other things for traumas, a lot of reconstructive. You know, someone either had a bad gash where they lost skin or from a burn in those. And it tends to be a little bit more challenging, obviously, than healthy, good skin. But kind of interesting how you can basically reconstruct these areas in a very unique way.

Dr. Pearce: Yeah, and it’s a lot of fun. I mean, it’s just…to see that result… You know, the whole downside of hair transplantation is that it takes a while to see the results. So, you may do your procedure on a Monday and you really don’t see the full results until — you know, depending on how much hair you transfer — up to a year later.

Dr. Franco: Can you go over this? Because there’s a pretty unique phase with hair transplant that tends to freak people out.

Dr. Pearce: Oh, yeah.

Dr. Franco: And if you can just kind of maybe tell people so that they know what to expect. Because it’s like the fool’s gold and then the “Oh, shit” and then “Okay, now, I’m starting to see it.”

Dr. Pearce: Yeah. So, after hair transplant, you know, for the first couple weeks, you got all the red crusties and scabs and stuff like that that’s kind of falling off. But somewhere between that two and four-week mark, you’re like, “Wow. This looks great. Yeah. I’ve got shorter hair here. Things are looking good.” And then around that three to four-week mark, that’s when all the hair that you just transplanted, pretty much about 80% of it are still kind of shit. And it all falls out. And I get phone call from time to time. I have this conversation all the time, but I get these phone calls like, “It’s all falling out. What’s going on?”

Dr. Franco: It didn’t work. They all fell out.

Dr. Pearce: “This failed. What’s happening?” It’s like, hold on. Hair grows in three different cycles. It’s going to go to sleep for about three to four months. And then around the four-month mark after the procedure, that’s when it starts to grow back in. That’s when the fun starts.

Dr. Franco: Because I think people have to understand is the actual hair bud, the follicle way down under the skin that you can’t see, that’s still there. And it’s just the actual shaft that falls out. And so, they haven’t lost…they lost the hair shaft, but they haven’t lost the actual source of the hair.

Dr. Pearce: Yeah, exactly. And that’s the same thing when people start on Rogaine, you know. A couple months into using Rogaine, they’ll start seeing a lot of shedding. And that’s when a lot of guys will freak out and just stop using it because they’re like, “Oh, my gosh. It’s making my hair fall out. It’s making it worse,” when in reality, it’s just starting to work because it’s starting that growth cycle over again and kicking out that old hair. So, if you use it beyond that stage, then you start getting really good results from there.

Dr. Franco: Can we jump a little bit into women? I know G-Berto sees a lot of medical hair issues. And so, I don’t want to skip that, but maybe before we run out of time, at least give a little love to women and then we’ll jump into some medical stuff.

Dr. Pearce: Absolutely.

Dr. Franco: How do you treat women? Because we get some of the same hair thinning questions from women and just kinda…typically a little bit older, but… And then it’s not the true, like, male pattern baldness but they just feel like overall their hairs start to thin out a little bit. How do you approach that? Do you do some of the same hair treatment medical management? Are they hair transplant candidates? What do you do with those?

Dr. Pearce: So, for women when they come through the office, it’s a little bit more of a different conversation. So, you know, we talk about when it started falling out, how much she’s been losing. Because we also have to talk about, well, it’s normal to lose about 100 to 150 hairs a day. But then you start talking about more hair than that falling out and kind of not coming back. So, then we have to really look into, well, one, genetics.

So, a lot of female hair loss can be related to genetics. They may have it in their family. And women lose their hair a little differently than men. So, they may kind of thin out all over, but they still… Look at that, me knocking this thing around. They still will keep their front hairline. So, that’s a little different. They just kind of thin out all over.

And then, you know, we kind of have to talk about hormone levels or even their thyroids. So, we have to cover a lot more different topics and really kind of dive deeper into what maybe causing their hair loss because for men, you know, 95%, 99% of the time, it’s genetics. It’s male pattern baldness. Whereas women, there is a whole slew of things that could be causing their hair to fall out.

Dr. Franco: That’s interesting because it’s funny how it affects everybody, and everybody gets, you know… I still feel like it causes anxiety for everybody no matter what the cause is.

Dr. Pearce: Yeah, definitely.

Dr. Franco: If you don’t mind, can we… I know G-Berto had a few medical questions. Do you mind if we do a few rapid-fire medical stuff and just kind of…where to direct this. And then I’d love for you to kind of help guide some of us. Like, if we see patients who come in, you know, who we think may be a hair transplant candidate, while we’re referring them and they’re trying to get into to see you, because I know you’re a busy guy, is this people that we should get started on medical management? Should they just wait till they see you? What would you recommend for people listening and trying to get… Help us. You know, if we’re trying to get them to you in the three months or whatever it might take to get in to see you, you know, what should we be doing to help the process?

Dr. Pearce: Yeah. If somebody’s talking about hair loss and thinning, you know, one of the conversations to have is starting some sort of medical management. So, for both men and women, the easiest thing to obtain is the minoxidil or the Rogaine because you can get it over the counter. It comes in a 5% form. Typically, for people, I tell them to get the foam concentration because it absorbs a little bit faster.

Dr. Franco: That’s what I use.

Dr. Pearce: Good. There you go.

Travis: Same here. We’re all on the Rogaine.

G-Berto: That’s what I recommend to my patients.

Dr. Franco: The foam is a little user than the liquid drop things because I feel like that one doesn’t go anywhere. Gilbert got a little excited here, almost lost his desk. Thank you, G-Berto.

G-Berto: Yeah, I’m excited that we’re all on the same page.

Dr. Pearce: Yeah. Because I mean, like, the Rogaine, the topical, it takes about 30 to 60 minutes for that to absorb. So, when you’re talking to a guy for 30, 60 minutes for them to wait for something to absorb before they wash it out, they’re not going to stick with it. They’re done with it. Whereas 15 minutes, it’s a little bit more reasonable. And typically, I tell them to use it about once a day. The box will tell you twice, but some studies have kind of shown that it lasts in the tissue around 21 hours. So, typically, I tell guys to put it in at night. You can go to sleep with it [inaudible 00:29:36] wake up in the morning. Take a shower and then you’re done with it. You can just style your hair however you want. And the same thing for women.

Dr. Franco: That’s super helpful. And then G-Berto, what about some medical questions you had?

G-Berto: So, I see a lot of what I consider to be challenging cases. There are different types of hair loss. Maybe you could shed some light on these, Dr. Pearce. One of the most challenging ones that I come across is CCCA or central centrifugal cicatricial alopecia. And that’s just so hard to treat especially because most of the time it’s women that are coming in, you know, to see me for this. And, you know, I have my treatment regimen that I recommend to them which involves usually like a low-dose oral antibiotic for anti-inflammatory properties, intralesional Kenalog injections. But is there anything else that you can suggest or recommend that, you know, might help me out in my practice?

Dr. Pearce: You know, I mean, you’re right. Those are difficult because it’s just…it’s…you know, you want to do something, but you can’t quite talk about transplant with that because if you do, it’s just…you’re kind of just wasting your time. You’re spinning your wheels. So, I mean…yeah. The same thing is the Kenalog injections, the antibiotics, I really kind of…you know, I’ll work with patients on those, but I usually want to involve somebody in dermatology to kind of help work with us together because that’s more of a team effort when it comes to those things.

G-Berto: Right.

Dr. Franco: No. I love making the dermatologist do all the hard work. We just come in. We do the treatments. Boom, boom, boom. You know, follow up with one G-Berto. I love that. That’s what I do. I’m so glad that we’re on the same page about this. What other big take homes would you like us to talk about? I don’t want to miss any big take homes for hair treatment, hair loss, those type of things.

Dr. Pearce: Kind of some take home kind of points is, you know, for men especially this is a lifelong thing. This is not a one-and-done treatment. You have to do… You know, if you… As long as you care about having hair, you have to be one some sort of treatment to keep your hair. And then a hair transplant is probably a good idea. But even then, you’re still… Whatever hair you have up here at the time of your hair transplant, that’s still at risk for falling out years down the road. So, you have to do something to help keep that hair.

Dr. Franco: Okay. I like it. I think this is just an ongoing thing. And hopefully, we’ll get you back again to talk about this and give us some more updates in the future and maybe talk about some other plastic surgery procedures because I don’t want people to get the wrong idea. I know hair is your passion, but you do a broad array of plastic surgery as well.

Dr. Pearce: Yeah, I do the full gamut. In fact, after this, I think I’m going to go see somebody about a broken eye socket.

Dr. Franco: What about… Celebrity, I feel like we’ve ignored you other than making hair jokes. Paul, any role… Do we ever have patients that ask for anesthesia? Like, if you had someone like myself who’s just anxious as shit, I mean, would…is that even an option for them or is that something you’re like, “Hey, just man up.”

Dr. Pearce: For general anesthesia, I mean…you know, if they’re super anxious, you know, typically, I’ll work with them more on the oral side and things like that, you know. If I’m going to have general anesthesia or anything like that or I’m going to have somebody, you know, [inaudible 00:32:45] anesthesia in the room or, you know, we’re going to do this at a surgical center where I have all the tools that I need to keep it as safe as a procedure as possible. I mean, even when I give them the Versed, they’re going on the pulse ox and put them on the EKG, I’m keeping track of everything as best I can. And, yeah, if you’re super anxious and you want general anesthesia, maybe, you know, that type of procedure is not really quite the right thing for you at that time.

Dr. Franco: So, you say that that’s pretty rare that you have to do something…

Dr. Pearce: Yeah, extremely rare.

Travis: And with the… You know, Dr. Franco, I’m just beating a dead horse with this. But you can get the scalp really, really numb. That is not a difficult place to get completely, completely numb. So, it doesn’t surprise me that once you get past that first series of injections, after that, you’re kind of on cruise control. You can just reduce anxiety with either some type of benzodiazepine or other medications just to make them feel a little sleepy or reduce that anxiety probably a chip shot.

Dr. Pearce: Yeah, exactly.

Dr. Franco: Well, this has been fun. We could talk about hair endlessly, but we got to get to my favorite part: fact or fiction. So, we’ll pepper you with just a couple few little questions here, Paul, if you don’t mind. So, question number one, fact or fiction, you were a professional wakeboarder.

Dr. Pearce: That would be fact, actually, yes. Back in the mid to late 90s. Yeah. I rode for a number of wakeboard companies: Quiksilver clothing, Spy Optics. I rode on the tours. I actually judged for the tour for a while. And then…yeah. So, I still wakeboard to this day.

Travis: I can attest to this. He’s much better than I am.

Dr. Franco: Brings me to question number two. Fact or fiction. You’ve tried to teach Celebrity Anesthesia how to wakeboard, but has been an impossible task.

Dr. Pearce: Well, he rides a board that’s meant for the cable parts so it’s got no fins on it. I mean, yeah. Like…

Dr. Franco: Oh. So, it was like…it’s a small female child’s board? Is that what you’re saying? The only one that [inaudible 00:34:36] his feet.

Dr. Pearce: I mean, to his defense, he does ride it very well for the size that it is. So, yeah.

Dr. Franco: I mean, I thought the pink was because Mary wanted one. But that’s cool, man. I didn’t realize you each had your own.

Travis: No, no, no. When you’re the same size as a 12-year-old girl, the board’s the same. So, it is what it is.

Dr. Franco: Paul, then we do another section here that we like to call “behind the bovey [SP].” And this is basically something that we want people to know that they would never think about when they’re doing this. So, maybe something about hair restoration, hair treatment that nobody ever thinks about but you think is a pretty cool golden nugget, you know. Just something behind the scenes that people don’t know. You know, I’ll tell you while you’re thinking. One that I didn’t realize, you know, when we were doing hair transplant as a resident and one of the private groups would do the old strip method, you know, in 2,000, 3,000. At first, I didn’t realize why they wanted so many resident volunteers. But then I realized that you’re just a little steady hand supporting hair follicles for six hours.

G-Berto: A little scut monkey.

Dr. Pearce: Yeah. Just trimming all those grafts. Right?

Dr. Franco: That was my behind the bovey from my hair transplant days. I’m sure the system’s gotten a lot better now.

Dr. Pearce: Yeah. It has gotten better. That’s for sure. So, something that nobody would kind of really think about as far as hair transplants go?

Dr. Franco: Yeah.

Dr. Pearce: You know, I think part of that is that when you go to get your hair transplant, consider this that everybody is like, “I want a complete…I want to lower my hairline. I want to bring it down to when I was 18.” You don’t want to do that if you’re, like, 45 or 50. Like, no. I really have to fight with guys on that a lot. Because they’re like, “Just bring it down like when I was 19.” No, because then you’re going to be 70 years old and you’re going to have this, like, Harry Styles hairline that’s, like, halfway up your forehead. It’s just not going to look right at all.

Dr. Franco: I feel like that’s a good golden nugget. That’s a good nugget there.

Dr. Pearce: Something to consider.

Dr. Franco: G-Berto, can we get a little quote of the day, a little something to take us home?

G-Berto: Yeah, yeah. I was looking one up right now and…

Dr. Franco: Oh, thanks for doing your homework ahead of time. I appreciate it. Between you and Celebrity, you guys are working hard. Good. Thank you.

G-Berto: I’ve got one from UCLA coach John Wooden. I think this kind of really hits home for me because, you know, I feel like I’m picking up pearls from Dr. Pearce. Just when you think you know a lot of, you know, medicine and you think you’ve kind of got it all covered, you can always learn something new. But John Wooden said, “It’s what you learn after you know it that counts.”

Dr. Franco: It’s what you know after you know it?

G-Berto: It’s what you learn after you know it that counts. So, like, you know, Dr. Pearce just dropped bombs of knowledge on us today with, you know, hair transplant and hair loss, hair restoration. I just feel like I’m picking up all kinds of little nuggets.

Travis: I’ll get us a quote.

Dr. Franco: Did G-Berto just lose his quote privileges?

G-Berto: What? That was a good one. It’s John Wooden.

Dr. Franco: Yeah. So, explain to me something you just learned after you knew it?

G-Berto: Huh? No, no. It’s…

Travis: Oh, man. When quote of the day goes awry. You guys seeing it first live, ladies and gentlemen.

G-Berto: Is my face red right now?

Dr. Franco: Well, Dr. Pearce, I truly, truly appreciate you taking time out to come and join this infamous cast here and be on our podcast. We truly appreciate.

Dr. Pearce: This was a lot of fun. Thank you for having me.

Dr. Franco: Well, hopefully, you’ll be back in the future. And for everybody, don’t forget to download us “Plastic Surgery Untold.” You can download on iTunes or anywhere you get your favorite podcast. It’s the greatest podcast in the world as voted by us. Thank you, guys. See you later. Bye.

Travis: See you.

About The Author

Dr. Johnny Franco
Episode 24: Where Should I Have My Surgery? Does the Surgery Center matter?Episode 27: Local Lipo – Fact or Hype?


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