The Future of Hair Restoration with Dr. Alan Bauman | Ep. 32

Introduction to Hair Restoration 0:00

Man or woman, we always say the hair follicle is a very emotional organ. If you're having hair loss, a bad hair day can turn into a back hair week, back a hair month, the back of your life. Hair is just one of those things that it often defines us. We're excited to have Dr. Alan J. Bauman, leading expert in hair restoration and the founder of Baumann Medical Group. With over two decades of experience, he helps men and women regain their confidence through innovative treatments. Let's dive in. So back.

What is hair? Hair itself is keratinized protein. You need to have protein to build hair. Is hair actually alive? hair is dead tissue. So how big is the hair restoration business? 20% of men in their 20s, 30% men and their 30s. 40% in men their 40s have visible signs of hair loss. The potential for treatment is out there. When you restore someone's hair, it makes a huge change. in their self-confidence, in self esteem. Time equals follicles. The longer you wait, the worse the hair loss is going to be.

Why are people losing their hair? The main reason for male and female pattern hair-loss is... Welcome to another episode of a healthy point of view podcast. I'm your host, Sam Tejada. And today we have a special guest. This guy here is the GOAT when it comes to hair restoration. You've probably seen him on CBS, CNN, Fox News, all over the place. He speaks internationally. he is guy he's not just the expert, he creates experts. We have Dr. Alan Bauman. How are you, doc? I'm doing great, Sam. Great to be here with you.

Absolutely, man. I am excited about this. You know, I've been hearing about you since I got into the industry of functional medicine. A lot of the guys that participate in these concierge medical therapies, a lot them end up losing their hair and they want to find the best of best. So you start hearing this doctor, Alan Bowman. you know who's all over the news everyone's talking about bottom so. I'm excited to have you here and talk about hair restoration because this is something that people deal with based off of medical conditions they have a hormonal imbalances that they that it might have all kinds of different issues that i want to pick your brain about and.

A lot of our listeners, we have a lot doctors, over 4,000 doctors that tune in to the podcast. You know, obviously they purchase a little bit of products for their practice. And you know I think a of them are always venturing into what else can they do for the patients, right? And when it comes to hair restoration, it's more than just hair transplant. There's a lots of things that go alongside with that. So let's dive deep, man. How did you even get into the whole hair restoration? Was that something that you just wanted to do since a young age?

Well, actually, no, it didn't happen that way. I didn' really know much about hair transplantation growing up, although I was interested in cosmetic surgery really before I could drive a car. And I happened to have been mentored by a very prominent plastic surgeon in New York City around that time. He kind of led me towards the more artistic side of surgery. which was plastic and reconstructive work, essentially. But it really wasn't until much, much later on, obviously, through medical school, internship and residency, did I actually meet a hair transplant recipient and then come to understand just how natural and beautiful it could be.

And then I remember that conversation with him, how it changed his life. both socially and professionally. And I was already into these cosmetic treatments and procedures, you know, through many years of training, but I didn't really know much about hair transplants.

Dr. Baumanu2019s Path Into the Field 3:40

So when I met that patient and his hairline looked amazing and undetectably beautiful, I had to find out more about the technology, more the field. That was back in the mid-1990s, where most things in terms of hair transplant were pretty pluggy looking, like why would you ever want that or do that? and his hairline looked amazing. So I basically interrogated that patient to find out what happened, how did he get it done, who did it go to, and I had a whole conversation. And that was really the fork in the road that changed the direction of my career and my whole life, actually.

Wow, that's back in 90s. So when did the hair transplant really start? Was it in the 90s? So if you look back at old Japanese writings, even in 1940s, there was a Japanese surgeon who was doing eyebrow transplants with single follicle implantation. Now, of course, much of that was lost in war and lost to translation. But really it was Dr. Oren Tryke back in the 1950s and 60s here in U.S. who was doing plug type transplants. Literally using a dermatologic four millimeter punch to move hair from the balding area or from non-balding to the balling zone.

And actually he tried to publish that information in all of the journals and got rejected like six or eight times. Oh really? And it wasn't until after years and years of trying and proving that it could actually work, did they actually believe him. that hair transplant could actually do what it needed to do, which is to grow hair in a bald zone. But fast forward many years later, you've got strip harvesting, strip surgery, and then eventually microscopic dissection of the grafts, then follicular unit extraction.

So fast-forward to today, we don't have to cut a big strip out of your scalp. This is no linear excision anymore. We can literally take the individual graft as small as a single hair follicle, one at a time, from the back of the scalp, leaving no linear scar. And so that's the technology that I'm excited about. That's a technology. I didn't invent it, but I helped pioneer it. Right, right. You know, let's talk about that because I remember growing up, guys would go and get, you know hair transplant surgery and they had this crazy big scar in the background of their head.

A lot of these guys, they ended up losing their the hair plugs that they got from back then and now they're just straight up bald with a bunch of, you know, scars on the back of the head. Now, fast forward to today, the technology is just completely different, right? Totally different. So, look, all of us who were trained around that time in the 1990s and early 2000s, we all underwent training with the linear harvest. Right. That was called FUT, follicular unit transplantation. You would take a big strip of skin containing the follicles and it was microscopically dissected into grafts and then those were implanted.

Wow what a process. Labor intensive for sure but certainly left you with a long linear scar in the back and so those folks who kind of gave up on the process maybe they didn't do medical therapies maybe, they don't have enough hair transplants or have enough hair transplantable hair honestly they're left with that long linear scar and they kind of gave up and that's what you see. The good news by the way we can fix that if you know somebody with an old scar there's lots of ways to camouflage it to put hair back into the scar, to remove the scard, it camouflages the scars.

So, you know, shouldn't lose hope if that's what you're left with. But today, someone starting out with hair loss can feel comfortable that they will never ever have a linear scar to deal with if they do follicular unit extraction, FUE procedure. That's good to know. Talking about someone not having to worry, there is a very strong component with people losing their hair, how that affects them, affects their self-esteem, effects their emotions. Now, as a medical doctor, a surgeon, Sometimes people don't understand that there's almost like a therapist role that you play in this process as well, too, because you're really giving people their life back.

You're giving them their mojo back, their self-esteem, and you probably see people The whole personality, the whole persona changes completely. So I wanna dive a little bit deeper into that because there's a mental health component that's involved with getting the hair restoration procedures done. What have you seen? So man or woman, we always say the air follicle is a very emotional organ. And so obviously, if you're having a good hair day, that could color your whole afternoon, so to speak. If you having bad hairday, Whoa, stay away.

Right. And so if you having hair loss, a bad hair day can turn into a Bad Hair Week, A Bad hair a month, the bad her life. Not so good. Just like that first patient that I met who told me about how his professional life changed, his social life, changed. Why did that occur? Well, it became evident to me through that brief conversation that it was a change in his confidence, his self-image, is self esteem. And hair is just one of those things that often defines us, whether you decide to shave it or dye it, or color it.

Evolution of Hair Transplant Techniques 8:40

Or wear some kind of hair wig or whatever, whatever you decided to do, hair as a part of our personality. It's a sign of self expression. So I think as just part the human experience, when we groom ourselves, a hair's apart of it You know, no matter how you wear it. You're talking to me, man. I get a haircut twice a week. Okay, so you know. So that's why I like to have a fresh cut. And I enjoy my hair. Even growing up in high school and stuff, I had curly hair, and it's just part of my persona. Absolutely.

So you're changing lives, not just men, but women too. Backstage we were just talking about how you could do procedures where you don't actually have to take, actually you have shave the back of the head on women. You can actually take the hair follicles out while the hairs long. Correct, so there's some newer technologies available now due to some of instrumentation changes and our techniques that we've perfected where we can literally take those transplantable grafts, remember the graft contain the follacles, without trimming any hair.

you can undergo a procedure and no one would be able to tell obviously immediately after that you've had any kind of change to your hairstyle whatsoever. That's amazing. And that's important for women who are undergoing hair transplantation for sure. Yeah. Um, and this technique also allows us to do eyebrows and eyelashes and things like that. at the same time. But yeah, when you restore someone's hair, it makes a huge change in their self-confidence, in self esteem, and that could mean job openings, that can mean you're doing better on an interview, whether you are on Zoom or in person.

It may mean more confidence in talking to someone about a relationship, for example. And this gentleman, the first patient that I ever met, his life completely changed. My dad was the same. You know, my dad struggled with hair loss for most of his life. He was totally bald and wearing a hairpiece. When I went through medical school, internship residency training, and I had the opportunity to transplant his head of hair back. And putting back, I mean, it was a heroic effort. Over 8,000, 9,00 grafts for my dad really changed his entire outlook.

Not having to deal with the hair piece, but having a full, thick head, of his own healthy, living and growing hair. So you as a physician, would you say that that's probably one of the most rewarding parts of your job, is actually seeing people get their self-esteem back? Oh yeah, the results are, that the payoff, right? So we have patients come back at six months, which is about halfway through the growth phase. And of course at nine months and then 12 months to see the final result. And we want to photo document that we wanna show the before and the afters.

When those patients see their before in the actors, they realize how far they've come. Then they start telling me about how people are noticing that they look different and also how they're acting different. I mean, that's a big payoff for me for sure. It's not instant gratification because hair does take a while. to grow, so to speak. But yeah, just stay patient. That year's gonna go by. And then you'll have it forever. I love that. Doc, how big is the hair restoration business? Hair loss is a huge problem, right?

In America, there's over 100 million Americans with hair loss, and that would include men and women. So they say maybe about 80 million men, about maybe 30 million women, 40 million woman. There's a lot of people out there dealing with it. 20% of men in their 20s 30% and men and their 30s 40% a man in there 40s have visible signs of hair loss so the potential for treatment is out there. You may have heard about this new trend medical tourism people are flying to distant countries for what I would consider low budget hair transplants out their.

And certainly there may be some good surgeons out there, but a lot of times they're running into trouble and they are getting taken advantage of on social media, Instagram and TikTok and what not. And they were being lured to these unregulated locations. This is actually something that I wanted to dig a little bit deeper on. It's part of the things that want to talk about on the podcast. Now that you brought it up, I've seen a lots of that. People going to Turkey, specifically. And there's even on social media, you know, people show like the airplanes coming back from Turkey and everyone's got their head wrapped up.

So, there is a positive side to medical tourism, right? But at the same time, sometimes I question how cheap this is being done. And then also, are they utilizing the most advanced technology? Are they cutting corners? How safe really is it for people here in the United States to save a couple bucks, go all the way to Turkey and get this done? Because at the end of the day, you start having complications and you're back here the US, now someone else has to pick up a different Dr. Slack. What have you seen with this medical tourism?

Yeah, so the industry has seen some pretty bad nightmares coming back from all areas of medical tourism And it's it very well known that you know turkeys a destination for hair transplants also turkey teeth is a thing You know and six people died last year from turkey, teeth So you can go get their teeth and yeah dental restoration, and so you no look There's a real lack of regulation there's You know, maybe there are clinics there that are not run by physicians that Are just run, by folks that, are, not medically trained and so what kind of sterilization protocols are they using you know what what Kind of instrumentation are They using there's a and of certainly a big lack of artistry you Know you've seen the videos people are coming back with a straight line hairline That just does not look is that like a natural yeah and So I mean, there's only a certain percentage of people, a small percentage where that might look good, the rest not so good.

And so medically, like we know here in South Florida, people have traveled to Costa Rica and Mexico for cut rate liposuction and BBLs or whatever it may be in cosmetic surgery. They come back with infections, with problems with scar tissue, and those can be very, very difficult to treat from a cosmetic surgeries standpoint.

Hair Loss, Confidence, and Mental Health 15:00

Very often those folks come, they're literally walking wounded. And I would say the same is true about medical tourism in any cosmetic type of procedure. So yeah, something's gotta give. You can't do what we do at that level that's safe, effective, and artistic at a cut rate shop. So people that are listening now, if they were considering potentially going overseas to get hair transplant done, what's your recommendation on it? My recommendation is to do your homework. Be very, very clear who the surgeon is.

Can you speak the language? And also, do you want to be in a low oxygen environment immediately after your procedure? I mean, that's probably the worst place to with you had skin surgery. And that's what's happening in an airplane. You fly there, fly back the next day. First of all, you're bleeding through your bandages on the plane. For many airlines, it's like a no-go. Yeah, You can't even get on a plane with bleeding bandage anymore, which is the reason why you see those folks on TikTok. They're just bleeding all over the place with no bandaging.

That's crazy. Yeah, and there was someone just recently arrested in Miami bleeding through his bandages. They tried to get him off the plane. He resisted. And he was arrested. Pretty bad situation that made news around the world. So I would just say do your homework. Find a board certified hair restoration physician. American Board of Hair Restoration Surgeons. There's about 200 of us worldwide. Find a fellow of the International Society of Hair Restoration Surgery. That's the ISHRS, and there's a certain number of them.

Do your research on the top clinics in the world. Who are the Top Surgeons in The World Today? You can ask Google that, you'll find a list. But look for credentials, look experience, for expertise. If you're chatting with somebody on Instagram Messenger or whatever, that's probably not a good way To get a detailed evaluation of your hair loss. That's not a consultation that you should be getting for your loss, right? Yeah, I mean, no matter what. I've heard of telemedicine, but not, what is it, Instagram medicine?

Instamedicines, that's gonna work. We're gonna, we just coined the term. Um, That is not good plan. Because also keep in mind that hairloss is a chronic and progressive condition. Now, the transplants taken from the right area are going to be permanent. They're going be immune to male pattern baldness, for example. But your other hair is not. Your other is at risk. So if you don't have a long-term plan, your short- term plan is to get on an airplane, get a hair transplant. That's not a good long term.

And you're gonna end up depleted of donor area, not on the therapeutic regimen to protect the existing hair. You need a professional evaluation. and cloud pharmacies can also run you into trouble as well. Well, it's good that you bring this up, because hair transplant is only one step of the process. And give me the last step, actually. Last step. It should be the solution, right? It's like I was talking about my back, like, I don't want to go under the knife. I want make sure I do everything possible to make that I'm not dealing with the sciatica pain.

But part of it is really kind of figuring out what the root cause is if you're just like randomly starting to lose hair, right? There's a lot of issues of why you losing hair. So that kind leads me to the next question is, why are people losing their hair? So the main reason for male and female pattern hair loss is genetic. And so we are pre-programmed in some way to loose our hair depending on our genetics. It does run in the family. Not just the mom's side, it can be both. Mom's and the dad's sides.

that you're going to inherit the tendency to go bald. Okay. And so for male pattern hair loss, we know specifically what the trigger is. We know it's DHT, dihydrotestosterone, which comes from testosterone, and the follicles are sensitive to it. How do we that that's the main trigger? Maybe not the only one, but a main-trigger. Well, if we lower DHP or inhibit DHD production in the body, We can protect your hair, like pretty good, 90% chance you are going be the same or better in a long run. There's medications that do that, correct?

Correct. So there's medication like finasteride and deutasterides, which inhibit the production of DHT, and they are powerful against the progression of male pattern hair loss. And you don't have to take it orally now, you can do it topically, there is also mesotherapy, deuterosteride. You can also use herbal or non-medical ways to reduce the impact of Dht, things like saw palmetto. There are many other ways also to protect and enhance the existing hair. But just to move beyond that genetic sensitivity, right, which miniaturizes the hair in the common way that you can see hairline starts to recede, the temples move back, you lose density or coverage in a crown and it can progress to total baldness.

There are many other things that can accelerate. your hair loss situation. Like what? So poor sleep, poor nutrition, high stress. All of these things, whole body inflammation, all of things have an impact on the hair follicle. Oh wow. And so if you're like doing night shift, if your overstressed, even professional athletes who are over training can sometimes have difficulty maintaining their hair. Oxidative stress? Absolutely. So now you're really talking about a lot of the stuff that we talk about all the time, the wellness side of it.

This is your wheelhouse, my friend, yeah. Yeah, so which, you know, obviously you've gotten into the longevity space because you now that there's a lotta things that need to be done for your overall health to maintain your health, your hair, right? To not just maintain you health but maintain hair. So, now with hair loss, there are autoimmune issues and stuff, that can also cause it, correct? So there could be scarring alopecias, autoimmune issues, there can be issues with your scalp health. So people's scalp is a very common cause of hair loss.

If your scalps is itchy, flaky, oily, inflamed, is it tender? It's trying to tell you something. And that inflammation right at the level of the scalp, it's not going to be so good for hair. Okay, so this insta-consultation that we're talking about is not gonna figure out the root cause. So so take us through the process of like a new patient who's coming into you male or male, or female, right?

Medical Tourism and Hair Transplant Risks 21:00

How do you put them through? The process to kind of really figure out what's going on, because you talk about DHT levels. So obviously you're doing blood work. You know, you got all kinds of other issues, lifestyle issues. So in my practice, what we do first off is take a very, very detailed medical history. So we wanna know, first of all, is there hair loss in the family? What kind of hair lost are they experiencing? what's going on with your hair situation? Is it something that happened acutely, quickly, you know a sudden shed after, COVID infection or vaccination or something like that.

Is this something has happened chronically, progressively? is it one area or is a large area? Or is that the traditional pattern? And then we look deep into the situation. Are you on any medications? Do you have any medical issues? Are on blood pressure medication, mood modulators, statins? Those are all terrible for hair, by the way. Have you had any autoimmune issues, what's your gut health like? And let's talk about that. A lot of our patients come in and they have skin health issues aside from the scalp, or they got gut issues that are impeding or impairing their nutrition.

The absorption, if you will, even if they're on a great diet, they are not absorbing it properly. What about micronutrients deficiencies? Does that have an effect as well? Absolutely. So we can look at a lot of different things through the genetic testing that we do to see what metabolic pathways might be influencing your hair and hair loss. That will also, pharmacogenetically, tell us what medications might be helpful for us and also what nutrients to look at that genetically you're susceptible to be low, right?

So we can, you know, are you prone to low zinc? And I had patients that, they're trying to improve their zinc levels and like they are trying, trying and the zinc doesn't budge. Well, in the genetic testing, it tells us, well, they're prone to low zinc. They're going to need more of a higher dose, things like that. A bigger dose. Yeah. So, I mean, A, C, E, D, all of these B vitamins. All these things are really, really important. And that's an epigenetic test that you're doing? So we do, yeah, that genetic test.

That's a genetic tests that elucidates those SNPs or polymorphisms in in genome that tells different metabolic pathways. Are you going be responsive to minoxidil or not? People say to me all the time, oh, I tried Rogaine, it didn't work. Well, maybe you're one of the 35% that doesn't have the pathway to activate minoxidil in the scalp. So 35 percent of people have low sulfo-transferase. You're not gonna get a good response from over-the-counter minuxidils. We need something different. And guys, listen to this.

Listen to Dr. Bauman, what he's saying. Everything he is saying, when he was talking about the metabolic pathways and everything else, this is the science behind it. This is not just come in and get the procedure. We're taking a deep dive here to figure out really what's happening internally. Understanding your body, it's more of, you're takin' a personalized approach with all of your patients. Oh, absolutely. A personalized precision medicine is like, that's really, really we do. And a holistic 360 functional approach to the hair loss situation.

It didn't happen overnight. We didn' just wake up and say, oh yeah, we wanna do this. What we learned is that the digger, the farther we dug into the patient's situation, into their history, and into these biomarkers or genetic testing, the more things we found that were influencing their hair. And that's how I developed an entire department, for example, For Scalp Health. I have a certified trichologist and her team, they can do an exam on your scalp, look at moisture levels, sebum levels pH levels see what the inflammation is.

We can have their signs and symptoms of disruption of microbiome, right on the skin and we want to rectify all of that. before we even consider a hair transplant. Okay, so we get the patient who comes in, deep dive into medical history, lifestyle. You're doing all of these different assessments and diagnostics, you got different diagnostic tools to do it. So, okay. AI-powered microscopes to count hairs. Okay, right to tell that that will we're gonna do photographs microscopic photographs in at least three to five different areas of the scalp We're going to get density readouts, and we are going get the AI To tell us exactly what the hair caliber is in each zone the photograph is going go up to the cloud come back with all that data So we'll have density and hair Caliber measurements in Each area so that'll be the baseline We also do cross-sectional trichometry.

Think of like measuring your ponytail volume in different areas of the scalp. There's an instrument, a caliper if you will, an electronic calipers that can help us measure how much hair is physically being produced. Is that like, you know, with women, especially like postpartum? They go from having this very full, thick hair, sometimes even very beautiful curly hair. And then all of a sudden, they still have a full head of hair but there's like no volume to it. It starts to become thin. That's very common.

As we said, the hair follicle is also a very hormonal organ, right? And so during pregnancy, there are more hairs in the growing phase. So that's gonna make the volume increase. It's going to make hair length increase above normal. And a woman through nine months of pregnancy is gonna have a much, typically, a thicker, fuller, healthier head of hair. Its gonna also appear shinier. I have some other ideas on how that's also, you know, skin health also improves typically during that time. Maybe there's some communication also between the fetus and the mom in terms of exosomes that we don't necessarily know about.

So maybe there is some cellular communication there passing through the placenta. I don't know for sure, but maybe there's some messages for growth as well as those hormonal changes that's happening within the mother.

Causes of Hair Loss and DHT 26:40

But anyway, the point is that as soon as the baby's born, what happens to those hormone levels? They shift. They crash, essentially, back down to normal. And within six weeks, her percentages of hair follicles in the growing phase versus the resting phase go back to normal. And so what happens, you see a massive telogen effluvium, which is basically a technical term for a mass of shed, acute shed. Yeah. So that happens six to 12 weeks out. Sometimes that reveals an underlying tendency towards female pattern hair loss.

which can look very different than male pattern hair loss, obviously not necessarily recession. Well, I can tell you they're not gonna be happy. Oh, they are not going to be. Yeah, woman losing her hair, not a happy thing. There's no socially acceptable model, right? Or someone that you can to look to for female hair-loss, really, out there. Where, you know, men can sometimes shave their head and still look pretty good, just ask the rock and so forth, but for women, You know, there was Will Smith's wife, Jada, right?

she had a whole alopecia hair loss thing going on, right? Yeah, so that's a kind of interesting story because if you look at the photos closely, it looks like her hair is just buzz cut. Like it's not an alopesia areata condition where alopesia ariata would knock out all the hair, would be smooth like a baby's bottom. It's shiny too, yeah. And the skin would thinner in those areas where Alopeci aria occurred. On one of the photo you can see what I would consider a line in the top of her scalp that she points to in one of our Instagram videos that says, oh, this little spot of alopecia or something.

To me, it looks like a scar. Yeah, I don't know if she had a brow lift in that area or had some kind of an injury in area, but a little scar would certainly inhibit hair growth. And we see that in women who have had face lifts, brow lifts. Men and women have injuries, whether it be a car accident or a fire, or some other kind of traumatic injury. Some of our military folks that we take care of have had injuries and burns to their scalp. Those are scarring alopecias. So I don't know exactly what went on there.

I'm certainly not her doctor. Just looking at photos like everybody else online, but it looks like she has a buzz cut. So, you know, that's not really alopecia. That's like self-induced, right? But maybe that little scar is something that she didn't like. I don't know the answer. But a lot of times, if you wear hair, and we should talk about this, especially women who use hair extensions or wigs or weaves and are using hair additions or wearing a certain hairstyle like braids or things like that, they create a lotta tension That can't be good for the follicle, can it?

Not at all. So that extra tension over time on the follicle which is under the skin, right, producing hair, will cause the folicle to miniaturize and eventually die and scar. And so if you consistently wear heavy extensions or long dreadlocks or tight braids, you will call traction alopecia and that can be permanent hair loss. Okay. It's very, very common. So that's a good thing to bring up because, you know, we work with, especially here in South Florida, a very diverse group of patients, right?

Absolutely. We have Hispanics, blacks, white, everything. So there has to be a significant difference between the type of patience that you work. For sure, so we see all types and many of my patients are international so they're coming in from Europe, from Asia, South America. So let's talk about the difference between some of those because I think that a lot of people want to, you know, everyone's dealing with hair loss so I that's something that we should talk. Absolutely. So, for example, our Asian population, their hair is going to be typically coarse, and the cross-sectional shape is round, it's basically straight.

And they have a lot of bulk to their hairs, but their density is low. So oftentimes when they're experiencing hair loss, they don't need to lose a whole lot of density to really look thin. Okay. African-American patients, patients that have afro-textured hair, They also have low density, but they have a lot a curl. Right. And now in cross-section, each hair looks kind of like a, I would just say a kidney bean. You know, it's got kind a flattened, almost like ribbon effect to it as it curls around the hair fiber.

And of course, they're more prone to those traction alopecia situations because of the mechanisms that they've used to try to style their hair since they were, you know, very young, since there were children, tight braids to kind of manage that afro texture. And also other things that do chemically to tried to straighten the hair. So perms to help manage it can cause significant damage to the scalp and also to follicles over time. What about those keratin treatments that people do? Does that also?

Yeah, so let me talk about chemical processing of the hair, right? There's color, and there's straightening, there is Brazilian blowout, Japanese ceramic straightener, a whole bunch of different things. This just goes to show how many different are out there to manage your hair. But a keratine treatment usually requires some kind of chemical to straighten the air and then high heat to form it into that flat and straight appearance. And the idea down here in South Florida is that there's less frizz.

So, you know, don't tell women you can't have keratin. They can do it, but just maybe they should do something more gentle. And so there are smoothing treatments that are gonna be more gently chemically to the hair fiber. Because think about this for a moment, the follicles under the skin and its job is to produce the fiber, The fiber is dead tissue. It's basically like your fingernail, right? If you cut your hair, your follicle doesn't know. You could shave it off every day. you could let it grow for 10 years.

Follicles don' care. But as that hair fiber grows longer, it will never ever self-repair. And so if you mistreat it, exposed to the elements, to chemicals, the heat, that outer coating of the fiber of hair can degrade. So that as the cuticle degrades, That's the moisture barrier of the hair fiber. It becomes more prone to breakage. And so that's where you can have some problems. The hair will lose its aesthetic value if the cuticle becomes very damaged. Now the easiest way to see this is someone who's bleached their hair for an extended period of time.

They have long, blonde, bleach hair. Their hair looks like straw.

Patient Evaluation and Diagnostic Testing 33:00

Looks like it's been burned in an oven. You know, it frayed at the ends. Okay, I'm painting the picture of most extreme kind of damage. But even, It kind of looks like they got electrocuted. Yeah, so it changes the aesthetic value of the hair. And so what's true across all ethnicities is that hair that is considered valuable is usually shiny and smooth and feels soft. And so if you start losing those properties, you've got to go back to the drawing board because you got a build a new hair from scratch.

You have to grow a better hair because it's very difficult to repair the cuticle. There are some tricks, the smoothing treatments and things like that. Now, in your professional opinion, as a physician, which is the hardest one to treat with transplant? Well, there are inflammatory conditions of the scalp, which actually, hair transplants are contraindicated if there's active inflammation at the level of scalp. So one of things that's happening, we're seeing a lot of today, is a condition called frontal fibrosing alopecia.

And this is where you lose the hair. Literally, there's almost no miniaturization. It's just a complete loss of hair, it's turned into like thin, white, smooth skin around the frame of the face. That happens usually in women between the ages of 50 and 65 years old. Typically women of middle to upper socioeconomic status who have used moisturizers or sunscreens repeatedly. And there's an inflammatory process that's being triggered. And we don't know exactly why, but typically from these nanoparticles, we believe that causes inflammation.

It kills the follicle. You could do a biopsy for testing for that, But there are plenty of good signs and symptoms that we can see on the microscope to identify this active inflammation, which usually also affects the eyebrows. So if you've lost your eyebrows and you're losing your sideburns and your temples and hairline seems to be shifting back a little by little, you could be suffering from this type of inflammatory alopecia. It can be very difficult to treat. There's a couple of medications that seem to work and if we can cool it down, we can test a hair transplant to see in a small area, will it work and will survive.

So the focus would be to bring that inflammation down first. Absolutely. Yeah. And there's a lot of ways to do that. Sometimes topical steroids have been used, PRP has been use, other peptides and things like that, dealing with whole body inflammation, cooling that down a little bit. Low dose naltrexone is another option, but there's a lot of different therapies and treatments for that particular condition. So let's let very difficult to talk about some of these other treatments because some people always want to just take the fast track and go straight to hair transplant.

But I feel like you were giving us this whole patient comes in evaluation, everything else. Do you go straight into transplant or are there certain things that you're doing? We never go into hair transplant. So we're always, even if the patient needs and wants a transplant and they're a great candidate for it, we have to talk to them about protecting the other hair. If you forward with transplantation and you are not on some kind of program to protect the non-transplanted hair, that's a fool's journey.

And actually you're not a great candidate for me, you might as well go to Turkey. But seriously, if you are not going to protect your existing hair, it's not gonna be fun. Because eventually you will not be happy, because you'll lose your hair again. And at the end of the day, as a physician, make sure you have patience. Get the full benefit right that are not going to end up losing their hair again because that doesn't look good for you either. So percent. I mean look if I was a personal trainer and I Was you know teaching somebody how to work out or whatever and then they go and you Know stop off at Burger King for fries and shake or wherever on the way home.

We're gonna have a chat about that That's not good. You're detouring our journey here. So how do we know if patients should be on medications or do things like laser light therapy or have regenerative treatments like PRP or exosome therapy? That is a deep discussion. There are some things that work better for different folks and we can figure that out. But you have to have some plan. Get your scalp health and scalp hygiene on point. Get you nutritional regimen on-point. Let's look at those lifestyle factors.

You know, get yourself some sleep, well-nourished. We've got nutritional supplementation and hair care products under the Bauman brand, too. Uh, we've go low-level lasers that you can use at home. So these are things you could do non-surgically, nonmedically. No prescriptions. And we'll measure it. If you come back in, measure and make sure that we're maintaining the existing hair. Do you actually get the data to make you're seeing the progress that's needed? Every patient, every time they come into the practice, they're gonna get measured, we're going to get data.

It's a data-driven practice really, truly. And otherwise, just as a great example, let's say you had this most amazing regenerative treatment, right? A lunch break treatment that you have in the office, there's no surgery involved whatsoever, platelet-rich plasma or exosome therapy, and it works amazing. But how do you know when that treatment reaches its peak? And how to you when it starts to decline? Well, if you didn't take a measurement in the beginning in, the middle and towards the end of the treatment that we would expect it to last, you're never ever going to know when you should repeat it unless all of a sudden you are back to your base lining and now getting worse.

Well we don't want that. We want you to be great and then go from there and maintain or get better. Yeah. So that's where the measurements are key, key component to what we do. Amazing. What is hair? What does hair. Oh, hair. Well, we said is a very emotional part of our body, right? It defines us, our youth and vitality, but hair itself is keratinized protein. And so if you're on, let's say a low protein diet or you are on a diet drug or had diets or weight loss surgery, you aren't going to grow good hair, You need to have protein to build hair Is hair actually alive or is hair something that's just like dead cells coming out of your body?

Hair is dead tissue. So the hair fiber that you see, that cut, it's like your fingernail. And what's alive, however... Because your finger nails are dead cell as well, too. Correct. When you trim your fingertips, doesn't hurt, right? Hopefully. If you didn't catch any skin in there. But the nail bed is what creates the fingernails. Just like the follicle, which everybody's born with about 150,000 hair follicles on their scalp, plus or minus. And about eighty five percent of them are gonna be there very complicated organs they contain almost a hundred thousand cells each there's like twenty different types of cells and they each have some different property and job to do based the hair follicles cycle on and cycle off over time normally think of the pair follicle as a 3d printer.

creating that little strand of hair fiber that we see. So part of that, it's like, I always hear people talk, well I gotta do this treatment, man I have to buy this shampoo and all this stuff because I want my hair to be fuller. And there's a part for me, knowing what I know, right, of how you said your hair dead cells, like your fingernails, that buying all of these chemicals to just put on the hair itself, You're just creating a change chemically, right? It's not actually fixing what the problem is.

So would you say that you have to focus on what's happening in the inside for you to see the actual effects and results in your hair? Yeah, absolutely. Now listen, I don't want to discount what a good haircut can do, because man, a haircut, good hairstyle, and a cut and color and all that for men and for women can be life changing as well. But people spend so much money on these products. Products though it's great products remember are designed to basically make whatever hair fibers You have either more manageable or look better or more voluminous, but it is a cosmetic appearance Those products are really not going to dramatically affect the follicle now should you not have toxins in the shampoos

Hair Biology, Nutrition, and Non-Surgical Treatments 41:00

of course and Should there be some good ingredients that are gonna seep in through the follicle? Absolutely. And that's why we put caffeine, green tea, salt, palmetto, and other ingredients, that're healthy, rosemary, whatever, it's gonna help the hair follicles do its business better. But there's no magical miracle shampoo for hair growth. That's not gonna happen. So yes, you have to build from the inside. every hair follicle is connected to blood supply and that's nutritional support obviously.

There's contributions with the local adipose tissue with fat cells within the scalp and the fibroblasts which are the skin cells and all of that niche, if you will, where the hair, follicles, stem cells live, all those different types of cells contribute to making the follicle do its business as good as it can be. And that's what we wanna try to target. Okay, and how are you stimulating those things? Well, gosh, there's a lot of ways to do that. So, pharmaceutically, you can use products like minoxidil, either orally or topically.

You can low-level laser light therapy, for example. Red light is a great energy producer within the hair follicles, which, by the way, are some of the most highly metabolic cell populations in your entire body. Right. in the correct way, which means the device, the dose, duration, frequency, wavelength, all of that needs to be tied down. A true clinical grade, medical grade device like a turbo laser cap, for example, is a great example. I've seen those, like the little helmet looking things. Yeah, I would gear you away from the helmets and the caps and more towards the more flexible, powerful versions.

Not like the Amazon one that you're probably talking about or Instagram. Yeah. So let's talk about that. There's, you know, in the world of laser light devices, there are devices that are thousands of dollars, and then there other devices are hundreds of dollar. And obviously if you were going to go out and buy a TV, You would certainly know the difference between the two in terms of that price point. More diodes, it's going be a higher price. more pixels on the TV, it's gonna be a higher price point.

So you wanna look for one that's a clinical grade or medical grade device, and that the Bauman Turbo Laser. That's an award-winning device. Nice, I love that. What about nutrition? So nutrition is important. If you are on a special kind of diet that is deficient in protein, you're not gonna grow hair. if you were on some kind weight loss medication, like Ozempic, All the rage right now people are losing massive amounts of weight. Oh wow, they're also losing. Massive amounts. Of hair. They're losing the hair from the set.

Yeah. I didn't hear that. Wow. No, that's it's a big, big problem. We have hundreds and hundreds of patients over the past year or two. that have come in who are on weight loss medications who were having trouble maintaining their hair. Why is that? Do you know what the mechanism is? Absolutely. I mean, we can guess at it. We know that Ozempix slows down the gut motility. It decreases your appetite. Your caloric intake is going to be less. So your body starts to triage whatever nutrients and fuel it has differently.

And we've seen this before. This is not new. we seen it with fad dieting. So weight loss surgery, for example, like something to shrink your stomach or staple the stomach, or put some kind of a balloon in it, whatever, is going to decrease your appetite and decrease caloric intake, right? Right. And so when that happens, you're going lose 50 pounds in six months, something like that. But you'll also lose a boatload of hair. There's not enough nutritional support. Nutritional deficiency and all kinds of stuff.

And a lot of those bariatric patients, there's all kinds of different supplements and stuff for them. Yeah, because that's important. If you're not actually supplementing it, you just never gonna get the nutrition because you are not eating. Correct. That makes sense. So yeah, so you losing those critical micronutrients. But probably more importantly, your just on a caloric deficit. Right. And that is a big problem. There are ways to help maintain your hair if you're on a weight loss program. You just have to supplement maybe with a collagen peptide protein powder, making sure your nutrient intake is good.

It's all about nutrients and fuel. Right. Because when you are on weight-loss regimen, whatever the weight lost regimens is, your body is triaging the available nutrients totally differently. Maybe you're burning fat. That's fine and good, but your body's shunting that energy towards vital organs. And not your hair, by the way. So that can be a big problem. Okay, so we got some treatments. We got supplementation, making sure our nutrition, our lifestyle at some point. Now it's time for the hair transplant.

What do we get? So hair transplant surgery today is not a quick process. It does take a number of hours to accomplish moving these thousands of thousands follicles around. Some patients might need more than one day of a procedure, but it's gonna be a comfortable process, we're really keen on keeping you 100% pain free, comfortable, relaxed in the chair at the time that you're in office. So you come in, you make a plan of action, were gonna do some photography, Your current state of hair loss. We're going to design if it's a hairline.

I'm going design that it is the crown area We map it and then we're off and running so there's different Technologies when it comes to hair transplant and you've been part of it since the beginning You're one of the first or the First with neograft, right? Yes, I was the 1st board certified hair Transplant surgeon to own and operate a neograph tool. And that was really a game changer. Most people today don't even remember NeoGraft. It was back in the mid 2000s when we got that device. That was truly the first mechanical device that we could use to perform FUE efficiently and effectively.

to carefully get those follicles out of the body. And listen, I developed the first manual tool that was commercially available for FUE. I'm not disappointed that it didn't take off. That was called the Bauman Mindex and you can read about it. It was a small device and nobody's retiring on that device. So it is what it, but Neograft was really truly groundbreaking at that time. We were super excited because it was like, we felt like we split the atom when we got the Neographed. You know, it really, really worked well.

And that's, as you say, you know it was on every major morning news show. We did live surgery on the internet from broadcast out of the, today it's the whole big deal. You can go live on Instagram, but at that time live-surgery was like never been done before. We did live surgery with hair transplants in 2010, and that made news around the world. We had over 100,000 viewers watching that hair transplant. More people were watching my hair plant than people watching CNN that day. And that was when CNN was popular.

Wow, that's amazing. So fast forward to today. What are the technologies that make the hair transplant? What am I excited about? Yeah, what are you excited, about what is it that's working? So, of course, we've had a lot of tools since Neograft, many mechanical tools, robotic tools even in the practice, but those all had some limitations. Today, the tools allow us to do this amazing transplant, which we call VIPFUE, and it's a no-shave hair-transplant harvest. So you can actually now harvest the hair follicles from the back and sides of the scalp without trimming any hair whatsoever.

And what technology is that? So it's a motorized mechanical manual tool. Okay. But it doesn't cut the air as it takes the graft. So, it is a combination of a tool itself which, just for lack of better way to explain it, basically finely tunes the rotation of instrument and does not cut hair. And how many doctors have this tool?

Modern Hair Transplant Procedures and Donor Options 48:40

Oh gosh. Is that a lot or? No, this is a very, very specialized technique and there are not many physicians around the world that even do no-shave hair transplants. There's only a handful of us. Really? Yeah. Probably six or eight of around. Are you the creator of this? I am not the inventor, but you know, we certainly do a of it at the practice. It's a fun procedure to do. Now it does take a little bit longer to perform, There's an additional cost to that, obviously, because it does take more time.

And there's also a limit as to how many hairs we can actually transplant in one of those types of procedures as compared to let's just call it a wider shave where we get more access. But for women who don't want to change their hairstyle, guys with longer hair, they don' want shave their head, which is obviously pretty typical when you're going medical tourism. They shave everything. We don''t have to shave anything. Not the recipient area, not the donor area. Nothing. That's amazing. So when we talk about hair transplant and hair restoration, we're always focused on the top of our head.

You've done things like eyebrows, eyelashes, beard. So how do these work and are they the same donor sites that you're using to do something like a beard or eyelash? How does that work? Well, sometimes for beard, let's just say you know you are trying to fill in the areas of the goatee, you want a little stronger there. We can take the beard follicles from under the neck. There are other cases of beard where we're trying to enhance the jowl line, let's say, and we've got to access this hair from the scalp to get those kinds of numbers.

So it really depends. When it comes to eyebrows and eyelashes, yes, we are using the scalped hair and using that no-shave technique because we want to see the curl of the hair. That's really important for the artistry of brow and also for implantation technique of eyelash. What are all the donor sites that you actually utilize for any kind of hair transplant? Oh, man, if you've got hair there, we've been there. You know, to be honest. Yeah. And I'm going to just say it, but you know like people, I've heard people talk about like when they do the beard that they'll actually use pubes for that.

Is that true? So there are physicians that do that, yeah. OK. Howard Stern asked me when I was on his show if I could take the hair off his testicles and put it on this head. But so we have had actually we had done pubic to scalp transplant in the past. Yes. So that is part of what we've done at Bauman Medical. I wouldn't say it's a common procedure. What's the most awkward place you've transplanted hair? Into or from? Both yeah, so below the belt is probably the most awkward place. You know we've had women who have done Let's say laser hair removal and then decided that mmm.

They want some hair back in that area Okay, you know We have transplanted hair to that and as I mentioned I've a patient where we harvested not only chest hair, but arm hair body hair Underarm hair and pubic hair put on a scalp and beard That's amazing. So there's so many options for people that are losing their hair. But again, those are pretty rare. Those are some rare situations. Even like the eyebrows, though. You see a lot of women go and get these tattoos done and everything else because their eyebrows are very thin or they're losing them.

There's an option for them that doesn't require getting your face tattooed. Right, and the tattoo, honestly, the micropigmentation is very flat looking, in my opinion. It's very two-dimensional. Even if you have microblading done, it still doesn't look like a real eyebrow. So adding to that with hair transplants from the scalp is a really nice way to kind of rebuild the eyebrows. And we've been through a lot of different phases here over the years. We went through like the 1980s, where it was like this wavy, thin brow, I think hopefully maybe we're getting out of the Kardashian era.

where it was much thicker, but certainly the eyebrow styles have changed. And so if you over plucked in the 80s, and now you want the Kardashian one, you're gonna have to transplant it to make it happen. But maybe you've tried to style your brows, or maybe even just with age, they've gotten weaker. Look, eyebrow transplantation for men is increasing in popularity. Men are realizing that a strong frame of the face includes robust eyebrows. And if you just have a little tuft of eyebrow in the middle and you don't have the tail, really it starts to look weird.

Adding that back in is super simple and easy. It's a one day bit of business. I like that. So Doc, you speak publicly. You teach a lot of doctors all around the world, internationally. For the doctors that are listening, that're considering to get into the hair restoration business, what's your advice? Where do they start? Well, first of all, it's an amazing field. But it is not simple and it not easy. And I think that's one of the things that, you know, sometimes in the world of hair transplant and hair restorations, the information that we get online is that oh, this is a simple, easy thing and here you go, sign up and go.

But to perform a hair transplant, first of all, is a labor of love. I mean, it's a 20 man hour job between the hours of 7 a.m. and 5 p. m. to get the job completed. So you need a robust team. You need to have a good plan. And that's just the procedure itself. That has nothing to do with the evaluation that we talked about. We spent a lot of time talking about how to evaluate what the algorithm is and so forth. So I would say that if you think that you have some dexterity, you should first come and observe a hair transplant.

My office is open to observers. Oh, we have an open door policy. You can come in any time and observed what we do and how we it. We also have more robust training programs. So through the Bauman Institute, which includes programs for non-medical folks as well as licensed medical practitioners, we have a hair coach program, where you can come in and learn about hair loss and see how regenerative treatments like PRP, PDO and other technology, or even TED, transepidermal delivery, how these treatments are done, and how the evaluations are How do we use the microscopes to see what's going on?

You can come in and do a short-term fellowship, meaning a preceptorship where you're just observing for maybe a day or two at a time, or maybe you want to come for a week or a month or longer. So we have all of those programs through the Bauman Institute, but I would say connect with us through our website at Baumann Medical. and send us a note if you're interested. I would say go and observe hair transplants. Come to the meetings, the International Society of Hair Restoration Surgery, and there are many other meetings as well, but that's really the main one where people gather.

Last year was in Denver, next year is in Berlin. So come to conferences and learn the right way to do things. And look into things like board certification and look up what it takes to become a board certified hair restoration physician.

Advice for Patients and Doctors 55:20

because what you're gonna find out as you start to dig into it is that there's a lot of mistakes, and I'm here to help you avoid those errors as go through. Let's help some people, but if you are passionate about hair restoration, you know, look me up. You can find me on all social channels, just drop me a message. You guys always hear me say it's like every great athlete has a coach and Dr. Bauman can be the coach to get you through that Process so you can offer some of these procedures to your patient at whatever stage you're at in learning about hair restoration I don't care if you are a medical student and you want to come in you know, or you're in your undergrad, you can come in and observe with us.

We have high school students, undergraduates, we have medical students we, have interns, residents, and people who have been doing hair transplants for a long time, they want to sharpen up their skills, look at an eyelash transplant, Learn how to do FUE faster, better, whatever. You know, that's what we do. There's a solution there for all of us to learn. Absolutely. So I love that. And Doc, before we wrap up here, for that one person who's struggling with their hair, right, what is that message that you can leave them with?

Yeah, probably the most important thing, Sam, is if someone's out there with thinning hair and they've got some hair loss, they know maybe they're at risk for hair lost. They're seeing some hairline recession or some other sign or symptom. First of all, I wanna say time equals follicles. And that means that the longer you wait, the worse the hair loss is gonna be. So take some action. We're available. You can visit baumanmedical.com for information. There's over thousands of pages of information, hundreds and hundreds of hours of video.

If you have just a simple question, you go to baumannmedicall. com slash ask, and you can type in a quick question. I promise my team and I'll get back to you with the answer. if we know it, if don't know, we'll find out. But if you want to start a hair restoration journey, you know you need treatment or maybe you've been doing a Rogaine over the counter or you got something from some cloud pharmacy, online pharmacy but never talked to a doctor about your situation. That's where you an evaluation.

So we can start that either in the office, certainly it's great, we've got all the technology there, or we could talk about it online. Send in a couple of photos, set up a Zoom call, figure out what's going on, take the first step. But there's a lot of hope out there. We can fix it, we can address it. You can keep the hair that you have and restore the air you lost. Amazing. And we're gonna put all these links right down below. People are gonna be able to follow, check it out. So Doc, I appreciate you coming on the podcast, sharing all of this very helpful information for both the doctors and the consumers.

Your doing some amazing stuff, you're making people feel well, getting their self-esteem back, appreciate it! Thanks Sam, it's really a pleasure to be here with you. Awesome. Guys, thank you for listening to another episode of a healthy point of view podcast. Make sure you click, subscribe, follow, do all that fun stuff, leave comments, share this with all your friends until the next one. We'll see you.