Interview with Hair Transplant Surgeon Dr. B Limmer

by Kevin Rands | May 15, 2016 5:07 am

Dr. Bobby Limmer speaks to HairlossTalk on Dr. Woods, ISHRS Conference, and Follicular Unit Transplantation

World renowned hair transplant surgeon Dr. Bobby Limmer speaks to HairlossTalk on Dr. Woods, the upcoming ISHRS Conference, Follicular Unit Transplantation, Follicular unit extraction, and physician ethics.

HairlossTalk has recently been in communication with Dr. Bobby Limmer, the inventor of the most popular form of hair transplantation in use today: the Follicular Unit method. He has transplanted hair for thousands of patients and has published numerous articles on hair transplantation. He has received the “Platinum Follicle” award from the International Society of Hair Restoration Surgery, for the most outstanding work worldwide related to the anatomy and physiology of hair. Additionally, he is a Diplomat of the American Board of Dermatology, Dermopathology, and Hair Restoration Surgery. He is also a Clinical Professor of Dermatology at the University of Texas Health Science Center in San Antonio.

He is highly esteemed as one of the most knowledgeable and reputable physicians in the area of hair transplantation anywhere in the world. We are honored to announce that Dr. Limmer will be working exclusively with HairlossTalk in the coming months on several new features intended to bring you helpful and trustworthy information on hair transplantation.

Dr. Limmer is also the president of the International Society of Hair Restoration Surgery (www.ishrs.org), one of the largest associations in the world for reputable physicians involved in hair transplantation.

Since he will be partially heading up this year’s 10th Annual ISHRS Conference, we felt it would be a great time to get his thoughts on everything from the Conference, to the relatively new interest in unique procedures being conducted by Dr. Woods, Dr. Gho, and others.

We hope you enjoy this interview. If you have ever considered hair restoration surgery, this is a must read from one of the most highly esteemed surgeons in the world. We look forward to working with Dr. Limmer in the near future, and bringing you even more unique, informative content.

The ISHRS Conference

HairlossTalk: Dr. Limmer, pleasure speaking with you today. Could you tell a little bit about the ISHRS, and about the upcoming conference in October?

Dr. Limmer: Pleasure speaking with you! This conference is led by the ISHRS and will have a pretty standard program for the meeting. The ISHRS is primarily an educational society. That’s our function. We exist to disseminate information about hair restoration, to encourage research and development, and to keep everyone in the field abreast of what’s going on in the world of hair restoration, both in a surgical sense, as well as restoring hair in a medical sense.

HairlossTalk: Yes we noticed that there will be some announcements at the conference related to new hair loss treatments as well. This is the 10th anniversary of the conference?

Dr. Limmer: This is the 10th anniversary, correct. The first meeting was in 1993, in Dallas, TX. One of the original founders was Dr. O’Tar Norwood, and he will be at this year’s conference as well. What it really did over the course of these 10 years, is that it pulled together sort of a loose network of practitioners around the world into a society where they could talk and exchange information. It has been very stimulating from the standpoint of moving the field forward. What happened at about the same time was the evolution toward progressively larger numbers of progressively smaller grafts. So it all kind of came together at one time, and it was a good time for things to happen.

HairlossTalk: Since this is the 10th anniversary meeting, is there anything unique going on?

Dr. Limmer: (laughs) Everybody wants to have the best program ever, and the best party schedule ever, but in reality, the meeting is still what it always has been, and that is an educational meeting for those who have an interest in the field, and and update meeting for everyone already in the field.

HairlossTalk: Are you familiar with information regarding new treatments or new technologies/discoveries to be presented at the conference?

Dr. Limmer: There are a number of research programs that are funded each year by the ISHRS. The individuals running those projects will be commenting on where they stand with their research, and what their tentative findings are. I can’t say that I am completely familiar with the entire presentation schedule, but there is some new information in regard to whether or not our theories were correct about donor dominance. We’ve always believed that the recipient area where you plant the hair has very little or nothing to do with how the hair grows. There is some new information out of the Oriental research group that indicates more of an influence by the recipient area than we’d first thought.

Follicular Unit Transplantation

HairlossTalk: You are the creator of Follicular Unit Method, the benchmark for what nearly every hair transplant surgeon is doing today. You must have a lot of pride in your accomplishments…

Dr. Limmer: I’ve been in this field of work for quite some time, and it takes a long time to really know this field the way it should be known. When I look at what I know today, versus what I knew when I was in the field for only 5 or 10 years, its very very different. This field has lived on very extensive advertising … to sell a product … and perhaps, sometimes, the product was sold without the customer really needing the product. Sometimes the product was sold even in a way that didn’t exactly fit the customer. I’m glad to say that today’s product, whether you want to call it Total Micrografting or Follicular Unit Transplantation, has made transplantation both consistent and predictable in its results.

A physician still has to understand the pitfalls, and not assume that just because he or she is able to plant a follicular unit, that he’s automatically going to get the intended result… but it has made it so much more foolproof, in terms of not creating things that patients wish they had not done. There is nothing worse than getting 5 or 10 years down the road, and saying “I wish I had never done that”. I honestly can say that since we started Follicular Unit Transplantation in 1988, I have never had a single solitary patient say anything other than “This is the best thing I’ve ever done for myself”.

That makes me feel good about the field. The single most important part of the process is to know what the patient’s goals and expectations are, and secondly
to know whether you can meet those, and if you can’t … then you both need to adjust. Setting realistic expectations.

Follicular Unit Extraction and other new Methods

HairlossTalk: What are your thoughts on the new methods of hair transplantation being discussed today such as FUE (Follicular Unit Extraction), and methods such as those being done by Dr. Woods, and potentially, Dr. Gho?

Dr. Limmer: Follicular Unit Extraction is describing the removal of the follicular units individually, one at a time, and then moving them to the front of the head. The problem with this method is that instead of having a single, very fine incision which can heal in 7 days and ultimately produce a barely noticeable scar, you have a “punch” that is used to extract the unit, which is, in my opinion, not very different the old punch methods which are no longer in use. What you end up with is hundreds, and literally thousands of small, white scars. The equivalent of looking like you were shot in the back of the head with a shotgun.

HairlossTalk: What are some of the Pitfalls of FUE?

Dr. Limmer: The pitfalls are numerous. Follicular Transection is a major issue. That is, injury to the follicle. Additionally, only a limited number of people are going to have follicles that are straight enough for the punch to extract. More importantly is the issue of diffuse depletion of the donor area, especially if you take the same number of grafts that you would in a typical transplant procedure.

Say you take 6,000 grafts with a strip excision. You end up with one linear scar. If you do the same with FUE, you end up with 6,000 separate scars scattered over the entire donor zone. The donor area is diffusely depleted, and you end up with substantial scarring. The linear excision using a 1mm punch is 26 times greater as far as intrusiveness to the donor area, in comparison to the kind of intrusion caused by a single bladed knife. We’re doing a much smaller surgery with the knife. FUE is actually involving a greater amount of surgery with the 1mm punch.

HairlossTalk: There are many adamant folks on some of the forums these days who are very anti-strip incision and pro FUE. Some prefer NHI’s version, and others prefer alternative techniques being done by still other doctors. Each of them has their own preference for who they’d like it performed by, but the general consensus seems to be in favor of FUE or techniques like it. What are your thoughts on this?

Dr. Limmer: Well, some people on the forums are very vocal, but in my opinion, they are the very small minority. Many of them feel that it is a common occurrence with strip incision to have very wide donor scars, when in reality it is only 1 or 2% that actually have a problem with this. As far as I’m concerned, if they have a problem with their scar, they need to go have it repaired. It is easy enough to do. But how are you going to fix someone who has had FUE done and is dealing with a profoundly depleted donor area with extensive scarring? As I mentioned before, a suture wound is typically going to heal in 7 days, whereas a punch wound is going to take 2 to 3 times that amount of time because it has to fill in totally on its own. The rate of healing is far slower with a punch than with incision.

Dr. Woods, Gho,
Disclosure and Ethics

HairlossTalk: So you’re not a supporter of FUE or Dr. Woods Technique?

Dr. Limmer: The whole controversy centers around the donor method. Whether you’re talking about NHI’s Fox Test and FUE, or the Woods method and whatever his instrument is for removing follicular units, or Dr. Gho, who has been theoretically using a needle of some sort. All of this centers around whether or not there is an alternative method to removing the donor. It has nothing to do with the transplantation into the recipient area up front. It relates to donor harvest technique.

Those of us who have been around 30 years will tell you that the smaller the instrument used for the removal, the more potential for follicle damage you get. That has been the history of it. The guys like Woods who are proposing an alternative method of harvest, have to scientifically show the Hair Transplant community that these are not problems for their method. Historically, this information has not been presented publicly at all.

Where is the good hard scientific data on the transection rate (follicle injury) with the Woods or Gho procedure? Conversely, what is the percent survival by these methods? And finally, they ought to also talk about the value to the patient – the cost factor per hair moved from place to place. You can do it with standard follicular unit methods for as low as $1 to $2 per unit. When I look at the prices of these alternative harvest methods, they are from 2 to 4 times more expensive.

All the entire scientific community is asking from these new physicians like Woods and Gho is: “Let’s have some science, not promotion or marketing. How about a little science?” If you’re a potential hair transplant patient, do you want someone who is doing it “fly by night”, or do you want someone who is working in the public’s eye, presenting good solid scientific fact – using reproducible research that is verifiable by multiple peers?

Until you have those things, you don’t have a scientific technique.

HairlossTalk: Our understanding is that Woods has come to the US to begin presenting his technique to the public.

Dr. Limmer: Woods just came to LA to start recruiting. He’s basically offering to sell his technique. I think its unfortunate. With the exception of the guys in the UK who originally developed the OB Forceps and held them as a secret for years before many many women died… every single Physician in this field and on the face of the earth knows: If you have anything that is new or of value to the community, you are to publish it, and present it at the soonest possible moment, so it can be evaluated by peers. If it is valuable, then it should become public knowledge. For someone to hold a technique in secret for ones own financial benefit, is totally unconscionable. It goes against every principle that we stand for as physicians in service to the welfare of the public’s health. It is completely unacceptable.

Final Thoughts…

HairlossTalk: You seem very adamant about this.

Dr. Limmer: I get irritated by people who won’t, in spite of several invitations, stand up and present their findings for peer review and peer education. That’s what it’s all about. That is what the ISHRS is all about. That is what this yearly conference is about. Sharing of scientific ideas so all the patients on earth can have the opportunity to have the most beneficial care delivered to them. Anyone who doesn’t live by those ethical characteristics… in my opinion… stands in violation of their oath as a physician.

Editor’s Note: Dr. Limmer will be presenting awards at the 10th annual ISHRS conference in Chicago, as well as performing an integral role in its execution. Once again, we would like to thank Dr. Limmer for taking the time to speak with us, and provide us with information, and his feelings and concerns.

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