THE AESTHETICS OF HAIRLINE DESIGN: Where Technique Meets Artistry Hair transplantation is a true microscopic procedure, where fractions of a millimeter can make subtle but critical

E differences in appearance. These procedures entail the placement of hundreds to thousands of grafts, and in no area is the proper placement, position, and pattern of these grafts more important than the hairline. Attention to aesthetic detail can make the difference between a merely very good result versus one that is excellent and natural appearing.

C The Technique The transplanting of only microscopic follicular unit grafts has many aesthetic advantages which include: less damage to already existing surrounding hairs; greater hair density; faster healing; minimal to no scarring; and the ability to transplant larger numbers of grafts meaning the need for fewer procedures. The typical procedure Before and after a procedure of 2400 grafts Before and after a procedure of 2500 grafts performed by Dr. Epstein now entails the transplanting A of 2200 to 2400 grafts, with procedures of 3000 and more grafts now commonplace.

continued on page 2 F For the patients of

Jeffrey S. Epstein, Close-up Close-up M. D., F.A .C.S.

na al: tur 1. As existing in nature 2. Free from pretension or artificiality WORDS FROM THE DOCTOR THE AESTHETICS OF HAIRLINE DESIGN (cont.)

Since 1993, I have been fortunate to participate in the evolution The Aesthetics of the specialties of surgical hair The transplanted hairlines on this page all restoration and facial plastic demonstrate different aesthetic aspects of a natural a surgery. Few other surgical appearing hairline. b disciplines have undergone such o profound improvements in • Irregularly arranged single hairs creating

u technique and results. While alternating zones of more and less density

t more technically demanding, the natural results of today seem to justify the increased time, • Positioned to look natural with increasing age and any potential future hair loss

E money, and effort expended.

C • Use of the finest single donor hairs along the frontalmost aspect of the hairline

A The most rewarding privilege of doing what I

F do is to have the ability to make a difference in • Individualized for the patient’s goals and facial J

E peopl e’s lives. In doing so, I hopefully make

F shape. For example, some men prefer

F someone’s life a little nicer, boost self-esteem a Transplanted hairlines

R frontotemporal recessions.

E little higher, and maybe help make for a more Y

S fulfilling professional and/or social life. • Optional creation of a subtle widow’s peak . E

P • Maximal forward angulation of the hairs to both S

T I would like to share three special young person’s

E increase the appearance of density as well as I

N heartwarming stories. making the transplant difficult to detect , M . D

. Madeeha ( below ) is a 9 year old who underwent , F

. years of ridicule because she had a scarred scalp Before A

. the result of a burn as a baby. She has traveled C .

S from Oklahoma to undergo two pro bono recon - .

T structive hair transplant surgeries. Pictures show

H After repair

E her before and how she looked one year after her F

O first procedure. Her story, covered by FOX’s U

N Geraldo Show, can be viewed on the website D

A www.foundhair.com. Her second procedure

T Hair Loss – It’s Not Just A Guy Thing

I was recently performed. O N

F The Women’s Center for Hair Loss was O

R established to address the unique needs

H of women who experience problems with hair A I

R loss, which can include: diffuse thinning, a R

E receded hairline, absent or insufficient S

T eyebrows or eyelashes, and visible scarring O

R or the loss of sideburns as a result from prior A

T plastic surgery. All of these areas can be I O addressed using state-of-the-art surgical hair N restoration techniques. Mariya ( right ), from the Ukraine, while not yet a teenager has undergone more than Areas of diffuse thinning can be moderately 30 pro-bono reconstructive surgeries to repair to significantly improved upon with hair scarring from facial burns, the majority grafts carefully placed between existing hairs. performed by Dr. John Cassel with the support Successful outcomes are dependent upon of Baptist Health Systems of Miami. Pictures show minimizing the risk of damage to these her before and six months after her eyebrow existing hairs while maximizing the number transplant. of hairs added. Overly high hairlines can be lowered by several techniques, the more common being hair grafting, the other a surgical hairline advancement combined with Serena ( right ) was born with a partial absence of browlift surgery. Eyebrow and eyelash her scalp that always required her to wear restora tion are delicate procedures in which a hairpiece. She spent the summer after high Dr. Epstein has significant experience . To treat school in Miami to have me perform two the scarring and hair loss (especially of the surgeries, the first to insert two surgical sideburns) that are a result of prior plastic balloons under the scalp, the second, two surgery, a variety of hair grafting techniques months later, to remove these two balloons can be utilized. that had been inflated with saline and to allow the expanded scalp to cover the scarred The websites www.womenscenterforhairloss.com areas. Now in college, she no longer needs to and www.eyebrowtransplantation.com contain wear a hairpiece. valuable information on the medical and The photos illustrate the results of different procedures performed surgical treatments for the various types of on women including: the restoration of sideburns lost as a result of prior plastic surgery; the treatment of female pattern hair loss; hair loss in women. and hairline advancement. IN THE NEWS UPDATE ON NONSCALP HAIR TRANSPLANTS Dr. Epstein’s appearances in the media and his contributions to the scientific community: Restoring hair into areas other than the scalp can be grafts (in the case of beard and the popular goatee particularly challenging procedures, involving the transplants), to as many as 3000 grafts (in the case TELEVISION placement of hundreds to thousands of grafts at just the of chest/abdominal hair transplants) can result WABC-TV New York: Reparative Hair Transplants right angle and direction so that natural appearances can in natural appearing restorations. CBS-TV New York: Eyebrow transplants be achieved. Over the past two years, Dr. Epstein has ABC-TV Miami: Body and facial hair transplants a performed over 200 of these procedures. Fox TV Nationwide: Geraldo at Large - Pro bono hair b

transplant procedure on a burn victim o Dr. Epstein has lectured and written extensively to

Fox TV NY: Hair transplantation in men u Eyebrows and Eyelashes the plastic surgery community on his techniques in

ABC Internet News: Hair transplantation in women t Few would doubt the importance of eyebrows and this area, and been published in such outlets as GQ , Univision: Hair transplants to beard and chest eyelashes to help portray naturalness and beauty. New Beauty , Elle , the LA Times, and SELF . WABC-TV New York: Hair Transplants to Eyebrows and Beard The majority of the eyebrow transplant procedures E NBC-TV Miami: Hair transplants to eyebrow Dr. Epstein performs are for eyebrows lacking in C WSVN-TV Miami: Women and hair loss

density or are too thin, usually the result of A FOX-TV Boston: Eyebrow transplants

excessive plucking or electrolysis, but also due F

TV Channels WSVN, WPLG TV Miami : Pro bono reconstructive J

to aging, hormonal changes, trauma, and genetics- E

eyebrow restoration surgery on Ukrainian girl F

especially common in men. An eyebrow transplant F R

typically involves the placement of 150 to as many E PRINT Y

as 375 grafts (or hairs) into each eyebrow, over a S

Health Magazine : Eyebrow transplants .

two to three hour essentially painless procedure. E

Cargo Magazine : Men and hair loss P

By the fourth day, patients are presentable with S GQ Magazine : Hair transplants T E

few if any signs of having had a procedure. While I

New Beauty Magazine : Treatment of hair loss in women N

the hairs usually fall out within three weeks, a few ,

El Diario/La Prensa : New York’s largest Hispanic M

months later they regrow, and are permanent. newspaper- Hair Restoration . D .

Miami Herald : Pro bono reconstructive eyebrow and scalp ,

restoration on burned teen; featured Dr. Epstein on a front F Eyelash transplantation is a newer but rapidly . page story about patients traveling to South Florida to have A . growing in popularity procedure, designed to cosmetic surgery C . restore full and long eyelashes to both the upper El Nuevo Herald : Men and cosmetic surgery S . T

and lower eyelids. This one-hour long procedure Essence Magazine : Women and hair transplants H

Before and after beard transplant E can be repeated several months later if more Elle Magazine : Eyebrow transplants; women and hair loss F density is desired, and results in eyelashes that The Beauty Makers book: One of 24 plastic surgeons profiled. O U

must be trimmed on a once or twice monthly basis Published by Kiamichi House. N D

(j ust like the maintenance required of eyebrow Women’s Wear Daily : Covered the Women’s Center for Hair Loss A T

National Hair Journal : Body hair transplants I transplants) as well as curled to assure the natural O appearance. LA Times : Interviewed Dr. Epstein for a story on the growing N trend of eyebrow transplants F O

Self Magazine : Hair loss in women R Retrosexual is the new metrosexual H

Before and after eyebrow transplant People en Espanol : Beard hair transplants A

In line with the retrosexual trend towards a hairier I Vanidades : Painless techniques in hair transplantation R more masculine appearance, hair transplants to the R E S

beard and chest have significantly increased in T

SCIENTIFIC ARTICLES/PRESENTATIONS O

popularity. But do not think that men have these R

Guest Editor, Facial Plastic Surgery Clinics of North America - A procedures just to follow trends – rather, they are issue devoted to hair restoration. Authored 2 articles in T I fulfilling self-determined goals of having what they the issue: O N believe is a more attractive or masculine appearance. Hair Transplantation to the Eyebrow, Eyelashes, and Other Parts of the Body For most men, a single procedure of 600 to 1800 Before and after chest hair transplant The Treatment of Female Pattern Hair Loss and Other Applications of Surgical Hair Restoration in Women AAFPRS Annual Meeting, NYC- Workshop on hair transplantation for plastic surgeons Evolution of Techniques in Facial Plastic Surgery textbook- Chapter on surgical hair restoration IMPROVING DONOR SITE SCARS – AAFPRS International Symposium, May 2006, Las Vegas. Workshop on Hair Transplantation AAFPRS Annual Meeting , Sept 2006, Toronto. THE HITS TECHNIQUE Workshop on new techniques in hair transplantation “Grand Rounds ,” University of Miami. Hair Transplantation In most patients, the scar that results from the excised International Society of Hair Restoration Surgery Live Surgery donor strip heals 2 mm in width or less, allowing patients Workshop , March 2006. Attended by over 150 doctors from to continue cutting their hair short. In the quest to around the world, Dr. Epstein performed several surgeries in front of a live audience, and lectured on body and eyebrow perfect the appearance of these scars, a plastic surgery hair transplants and special techniques for donor site closure. technique for closing donor sites called the HITS (Hair Understanding Cosmetic Procedure Textbook, Chapter on Induction Through the Scar) technique is used by Hair Restoration Dr. Epstein. This technique involves the suturing of the Hair Transplant Forum - articles on eyebrow transplants and donor site so that one edge overlaps the other edge, scalp expansion resulting in hair growth through the scar. You can see While not indicated for all some examples of this technique in the photos at right. patients, the HITS technique PRO BONO results in improved donor site Participant- International Society of Hair Restoration scars that have hairs growing Surgery’s Operation Restore. Pro bono program to provide through them. hair restoration surgery to those with hair loss due to trauma or disease who lack the financial resources to pay for procedures . ) y e r e r b f o L y u y b a e ag F t . d e C Plastic n i d , t f i Std iet #3203 l d e c f o o i h y t e C H rt os P t e c f i t r l i l , 3 8 8 A AID P t a d i Soc tary olun V d Boar e d i v rs ami, i a o r p a f d n a t i r d r a d e c o i P s t e a M .S. cial a F r r s m r o f A A n a ermit d . e edicin M ) e t p H U P e e d Boar s u o r e e g f o r r e e r r a t s p f o k r a P f c y r a a b d an l a C c 2 - 0 7 3 - 0 o t d orida Fl a o t e v i l a l n e n o g r erican m o t 0 8 a e h A a l t u b d d h t l h g i h e e v e d T d Boar s u a e th n e t e v e l b t l o h w a g n i e eg Coll . s u erican Am e H e th f o a c an l l e e i , t r o m s u n i t u s , ery g Sur e m a y t s d o t h y s A a c L e f o c i f t i u s l t n a e th f m o n o c n o c . n o t n e i . o c h g y b E e tiv .A.C.S. F i e h t Miami s e e t en id r o t a l t a R or eric Am h v l a c t a p s e c e r e c i f n o a d an d e l a f o r a c e e s i e i g c tru h f o es Pr e d i n e i t F L .D., t a e th s i h r u . h t l u d a t i s a h c o B u b m A ity s e e n i v o k r p c s on M r e omat Dipl f n i e t f o h e r u d o c i o 4 8 4 3 - 9 5 f o e n p OR K o e t f e c as P Y s d n i a s f w e c s e c s f i ec R a e o n s p E t s p , ery g Sur is w s A d e is o r c n a f o c i E . f e n o i e b f Y e a p t o i s er Univ n e N 7 - 2 1 2 i m . , ery g Sur e n e i r D FI h n in H d an p - t n f o e iv a n a a i m r i e , r a r D s i m a a o te g n e c i c i M T h c o e th t a p MI ct u e h t a d tic s o p Epstein, s i d s M h t f o s n i r y l n t l i tr Eps n i i , 4 7 e h s at he A r e m t n s e o , t t o l d n S. 7 s e e s e ation or Plas n ’ n e u b t A F a r u A ( . e e r m c i n a y i e i e s s a or t e r e m t h c o n s t . ogy ol g yn C t f f t e h t s t s ew RO e 1 - 6 6 s a t S u d est R t i r I r a c o s econ R H e s e n i o y e Jeffr s r a u o l u s s p E p E c tru A h cial a F b d i e s c p 6 - 5 h t air t i p . r . r c o r f f n o o e m A s m o o n a h T A A H h T P e Jeffr . 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u PLASTIC SURGERY IN MEN: t FACE

E While women are the fastest growing segment of the hair transplant field, sedative, addresses that

C men are the fastest growing segment in the plastic surgery field. In fact, the area of greatest concern

A American Academy of Facial Plastic and Reconstructive Surgery reported last to most men- the hang -

F year an over 50% increase in the incidence of men undergoing facial plastic ing and/or full neck. J E surgery procedures. Able to be combined F F

R with liposuction, the E

Y While many of the procedures men undergo are the same as that of their procedure allows for the

S direct removal of the

. female counterparts, there are some definite differences in the goals between

E excess neck skin and Before and 3 months after direct midline neck lift P the sexes. In general, men seek to be more private than women about the S

T work they have performed, therefore quick healing and particularly natural fat under the chin, and E

I heals as a single 2 to 3 inch long midline scar that typically is hardly if at all visible. If N non-surgical appearances are important. Current techniques of the commonly

, performed procedures of blepharoplasty (cosmetic eyelid surgery), browlifting ever detected, it in no way looks like the typical facelift or necklift scar. M .

D (usually performed endoscopically through several small incisions in the . , scalp), and rhinoplasty all provide for a three to eight day recovery and Dr. Epstein has been performing the direct neck lift for the past eight years, almost all on F .

A undetectable appearances, as performed on both men and women. It is in men (with a few female exceptions), with excellent results. Patients have experienced as . C the treatment of the aging neck that particular differences in techniques much as an 85% reduction in the excess neck skin. No bandages are required, and patients . S

. exist between the sexes. are typically presentable at 3 to 5 days, the time at which sutures are removed. F A C I A L

P The Executive Aesthetic Physical L A S

T Most women present to the plastic surgeon with a pretty good idea of what procedure(s) I C they desire, having been educated through the shared experiences of friends and family S U members, as well as what they read in magazines. Men, on the other hand, are usually not R G

E as knowledgeable as women – they know that they want to look better (often meaning R

Y look younger) but do not know from what procedure(s) they would benefit nor what feature(s) creates an older or less aesthetic appearance. Furthermore, they want to have this work done as efficiently as possible, preferably all in a single sitting or procedure.

It is for these men, and some women, that the executive aesthetic physical was designed. Similar to how a patient undergoes a thorough medical evaluation and treatment recommen - dation in an executive health physical, with the executive aesthetic physical a complete evaluation of all the aesthetic elements from the neck on up is provided. Dr. Epstein is then able to recommend to patients a plan for treatment, which may include any of the following procedures: blepharoplasty to remove excess eyelid skin or puffy bags under the eyes; browlifts for low hanging brows and/or extensive forehead wrinkling; facelifts versus necklifts; rhinoplasty to elevate hanging nasal tips and address other aesthetic concerns; and hair restoration to frame the face and provide a fuller head of hair. Sometimes smaller procedures, such as Botox® or Radiesse® or Restylane® filler injections are recommended.

While not necessary or indicated for many patients, the executive aesthetic physical Before and 8 months after facelift and hair transplants has an invaluable role in Dr. Epstein’s practice. With his specialization in surgical hair restoration and his extensive background in facial plastic surgery, he is uniquely experienced in understanding the aesthetic goals and needs of men, and able to recognize The Direct Midline Necklift versus Facelift the importance, when In women, a full facelift or necklift is the procedure of choice to address the indicated, of primary areas with which women are usually concerned: tightening the neck; restoring at least a smoothing the jowls; and returning the midface fat to a more youthful elevated minimum amount of position. Requiring 3 hours to perform, a week to ten days is required for hair to create a more sufficient healing to allow concealment of the incisions that are made around youthful appearance and behind each ear. in conjunction with

other indicated plastic Before and 2 months after lower lid blepharoplasty In men, the direct midline neck lift is an excellent and practical alternative to a surgery procedures. facelift. This one hour long procedure, performed under usually just a mild oral a b o u t E

LONG-LASTING FILLER NATURAL RESULTS C A F

SUBSTANCE RADIESSE® IN RHINOPLASTY J E F F R

JOINS THE RANKS OF FDA- E

One of the most popular plastic surgery procedures for both men and women is Y

rhinoplasty- the cosmetic sculpting of the nose. This procedure is most common - S .

APPROVED “QUICK FIXES” E

ly performed to repair the results of inheritance or trauma- features such as a P S

bump, a hanging or bulbous tip, or a wide bridge. The technique almost always T E

Filler substances like Restylane®, and relaxing agents like Botox®, are quick I

used by Dr. Epstein is the external rhinoplasty approach, whereby a small inci - N yet highly effective modalities that can provide a more youthful, relaxed sion is made along the bottom of the nose, allowing for full visualization of the , M

appearance. Each of these products have unique indications, and can .

entire tip and bridge, permitting meticulous sculpting and rasping to allow for D . be used individually or in conjunction with others. What they all have in the most natural appearing result. , F common is the advantage of not requiring any surgery. . A . This external approach is particularly useful for revision procedures. In patients C . S

Restylane® is a filler substance that minimizes superficial to medium depth who have already had a rhinoplasty but are looking for an improved cosmetic . F wrinkles. It is also an excellent product for lip augmentation. Highly tolerat - result, there are some definite challenges. Some of these challenges include A C ed and natural feeling, Restylane® has few if any side effects, is safe to use, I asymmetric remnants of tip cartilage due to overesection, insufficient removal A and lasts for 6 to 8 months in most individuals. No skin test is required, and of cartilage or bone along the profile, and improperly fractured bones. L P L

patients are completely presentable immediately- similar to the other prod - A S ucts described here. Perlane® , which recently received FDA approval, is for The goal of rhinoplasty, whether as a first time or reparative procedure, is the T I deeper wrinkles, and is excellent for longer lasting lip augmentation. enhancement of the appearance of the entire face by addressing those features C S U

of the nose that are viewed as out of place or unattractive, and as a result, R Not a filler substance, smoothes wrinkles by temporarily weakening G

Botox® draw attention away from other facial features. By restoring the nose so it is in E R or paralyzing the muscles that cause them. When properly injected into the harmony with the rest of the face, the results should then be seen in the eyes. Y muscles around the eyes, Botox® can elevate the brows, providing a more youthful appearance to the eyes and/or forehead region. Frown lines above the nose, crow’s feet, and even muscle bands in the neck can all be effective - ly treated with Botox®. The results typically last 3 to 4 months.

Radiesse®, like Restylane®, is a filler substance, but used more commonly and effectively for deeper applications, such as reducing deep smile lines, filling in defects of the nose, sculpting the cheeks, and minimizing jowls. While Radiesse® has been used by Dr. Epstein along with many other plastic surgeons for over 5 years, it has just received FDA-approval for cosmetic purposes (it had previously been approved for injection into such areas as the gums). Popular among both men and women, one of the main advantages of Before and after primary rhinoplasty Before and after revision rhinoplasty Radiesse® is that it lasts for as long as 1 to 2 years, and is the most effective product for filling in the nasolabial folds (smile lines).

Unlike other fillers used for wrinkles and lip augmentation, Sculptra® is useful for restoring overall volume to the face. Typically administered as a series of three treatments, Sculptra® restores a more youthful, fuller appearance. Computer imaging is especially useful in providing patients with realistic goals. Pictured are before and after photos with the computer rendering. WHY OFFICE-BASED SURGERY?

For most patients, the comfort and privacy of a doctor’s private office over the hospital or ambulatory center makes it a preferable place for having a plastic surgery procedure. The office of Dr. Epstein has achieved accreditation by AAAHC (American Association of Ambulatory Health Care), thus assuring the highest levels of safety and confidentiality.

Want to learn more about Dr. Epstein’s work in Before Computer Imaging Actual Results facial plastic surgery? Visit: www.plasticsurgeryoftheface.com