An interview with Dr. Ray Woods and Dr. Angela Campbell on the "Woods Technique " of Micro follicular Hair Transplantation.

Doctors Ray Woods and Angela Campbell are a brother and sister surgical team from Sydney Australia who has developed a new approach to traditional hair transplants. Their procedure, known as "The Woods Technique", allows them to harvest hair from the donor area without surgically removing a strip of skin from the back or side of the head.

I recently had the opportunity to discuss the "Woods Technique" with Dr Ray Woods and Dr Angela Campbell and witness a patient undergoing a "Top Up " procedure at the Woods clinic in Moorebank, Sydney. The doctors operate out of two locations in Sydney, one for local patients in Moorebank, and a beach house clinic south of Sydney used mainly for overseas patients that includes a guest suite, which accommodates them during their stay.

One of the first things I noticed was that there were no surgical assistants. I asked Dr Woods about this and he informed me that each and every hair is removed and placed by himself and Dr Campbell. Because of the unique hands-on nature of their procedure they only treat approximately four patients per week, with each patient usually undergoing anything from one to six procedures. These procedures can be done on consecutive days.

I quizzed Dr Woods, whilst he prepared the patient for a local anesthetic, on a few key questions about his technique that would help explain his passion and belief that his method is the finest and least traumatic hair transplant in the world.

Q: Dr Woods, could you tell us about your background in medicine and how you became involved in hair transplant procedures?

My sister, Angela, and I studied medicine at Sydney University. I graduated in 1983 and Angela shortly afterwards. After spending several years working in various hospitals and private clinics Angela and I opened our own practice in 1986. Although we practiced all forms of general medicine, our practice was orientated towards surgical procedures. Whenever possible, we kept people out of hospitals if we could perform the surgical procedure in our rooms. We also treated skin cancers and gained a reputation for excellent cosmetic results. Many people traveled great distances for cosmetic, surgical and medical treatments.

However I had always wanted to do hair transplantation. This discipline had always fascinated me and I first thought about how it could be done when I was 18 years old. I had a vision that bulbs could be removed from where they were plentiful and placed into thinning areas, one by one. This idea stayed with me for many years. I knew that you did not need to replace the exact number of lost hair in order to achieve an acceptable cosmetic appearance.
In the late 1980s I examined various patients who had undergone hair transplantation by supposedly the best in the business. We were confused, disappointed and perplexed as the advertised results seemed extremely credible and believable but the reality fell far short of this.

I realized it was time to commence work on what I had envisaged so many years before, that is, microsurgical bulb extraction without the removal of large strips of skin.

Q: When and how did you develop the technique?

The technique took many years and countless trials. In fact it evolved over an eleven-year period. Fortunately we had many of our regular patients, who were keen to help us develop our technique and we performed trials on them. It was tough financially, personally and emotionally. Hundreds of times the method and instruments failed, and hundreds of times I gave up. I would fall into bed late at night totally defeated, only to wake up suddenly in the early hours with a new idea. I would then race into work and try again.

Q: How do you remove the hair follicles without cutting?

It is impossible to remove bulbs without cutting. This is a microsurgical procedure. However, the central principle is of trauma minimalization. We endeavored to develop a procedure that was minimally surgically invasive. The first law of medicine is "Do No Harm". At one stage I also worried about hair loss. Hence I tended to adopt that little saying," Do unto others as you would have them do unto you." It was extremely important for us to be able to remove follicles with the minimal amount of cutting. Over many years we perfected the science and the art of removing follicles via 1 mm Micro incisions. The time, effort and sacrifices were incredible, but then again, so are the results, which makes it all worth it.

Q: How does the technique differ from the conventional strip excision method?

Firstly it is true that the results of many strip excisions are very good but the results are critically dependant on the skill of the technician. Placement, selection and angulation of grafts is crucial. However the scar at the back of the head can be very bad even with the best surgeons as it is almost impossible to determine which patients will develop keloid scars or how a particular person will heal under strong tension sutures. This is why we have so much documented and videoed evidence of severe scarring even with the 'best' surgeons with good technique. The results of poor technique can be terribly disfiguring. I believe our method is vastly superior to even the best that's out there. One thing that sets us apart is that each and every hair is methodically and artistically placed by myself or Angela, and that is something that does not happen with other practices as that work is reserved for the assistants and is not done by the doctors themselves.

In the strip excision an expanse of skin is removed. This skin is then dissected, mostly by technicians and assistants. In the best-case scenario, follicular units are dissected out with the assistance of a stereoscope, that is, a magnification device. Usually the patient needs intravenous pain relief and sedation, with drugs such as morphine, pethidine and valium. Due to the sedation, the client cannot interact, and is not aware fully of what is going on.

The grafts are then placed into the balding area. There can be resulting scalp shock, trauma and scarring depending upon the skill and commitment of the technicians and assistants. The ability of the doctor to supervise his assistants is absolutely crucial. Unfortunately, if the technician is having a bad hair day, then you get a bad hair job, but yours lasts a lifetime.
In the Woods Technique, no assistants or technicians are used. There are no intravenous drugs. And certainly there is no strip excision. Follicular units are removed in groupings of 1,2 and 3 via microsurgical 1 mm incisions. The procedure is interactive and the client can observe as we place the hair, one by one, using 21 gauge, and occasionally 19 gauge hypodermic needles. This can only be done with magnification apparatus, and assures no indentation or scarring.

Q: What other benefits does the technique offer?

There is minimal trauma to the donor area. Repeat procedures can be done on consecutive days if required. We can utilize the entire donor area. After a few weeks the client can have a very short haircut without detection. We can achieve coverage in just a few weeks that would take strip excision surgery many years to accomplish. Of course the cosmetic result is superb and it would be done without the scarring, scalp shock and trauma. We take great care with each patient and do not employ any assistants to work on the patient. One definite difference is that we require far fewer grafts to achieve a comparable or better density and result to that proclaimed by strip excision advocates, as almost all of our grafts take and we actually do COUNT all of our grafts and thus we have a measurable achievable result.

Q: How long does the procedure take?

It's difficult to give a general answer as each case differs depending on the type of head we are working with. There are many factors that influence each case such as coarseness of hair, shape of head, skin tone and of course the number of hairs the client wants transplanted. Most take between 2 to 6 sessions, of 10 to 12 hours each, to achieve the result we are happy with. On one end of the spectrum, we do have clients who may only need a small area to be covered ("Top Up") and these can sometimes be completed in a day. On the other end of the spectrum in cases like those with significant baldness, more procedures may be necessary. A total of 6,000 hairs can be transplanted in a 7 to 10 day period. We can do 500 to 700 grafts in a session. Please note that a graft is equal to a follicular unit, and each contains 1 to 3 hair, so the average is 2 hair per graft.
It is not a rushed procedure, and the patient is relaxed and comfortable.

Q: How many patients have been treated since you began your technique?

Approximately 1800.

Q: Why are other doctors not using your technique or a similar one?

Basically, why would they bother? To master our procedure will take many years of intensive commitment and sacrifice. Failure and frustration will be common and financial rewards will be long waited for.

However, with the strip excision method, there are cases of doctors taking a one-week crash-training course and the doctor can set up almost immediately. The market is massive and full of naive balding guys who trust in the 'credibility' of the medical profession. Since the industry is entirely unregulated, an impressive advertising campaign can be employed claiming anything that the doctor is prepared to claim, whether it be true or otherwise. In America people who are not actually medical graduates are allowed to do hair transplantations. How was it ever allowed to get that crazy?

Q: Do you see other doctors adopting your technique?

On masse, no. Strip excision is much easier, several clients can be done in one day, hence, the income is greater, and they can still fit in a game golf.

Q: Do you ever intend teaching your technique if other doctors express interest in learning it?

Yes. If they are really interested I will coach them for a minimum of a 12-month period in the "Woods technique." During that time they would perform our technique on patients who have previous scarring from other procedures and they will learn how we manage to get the hair to grow back over the scarred area. After they have learned the technique they could set up a clinic in their state and practice the technique in the same way that we are doing it right now. The important thing as I said earlier is that the doctor would do the work themselves, and not get an assistant to do the work. In addition I would contractually commit them to a minimum of 12 months of intensive training in Australia and have them pass the equivalent of a clinical examination and a set minimum number of cases in the most difficult of transplant and repair procedures before we would allow them to have use of the name of the 'Woods Technique'.

This would safeguard the public. This totally unregulated industry is responsible for unspeakable atrocities. We are determined to safe guard the public against those who would abuse our technique with mass production profit driven clinics.

We believe it is high time that strict controls and regulations be put into place. And this will start with our technique.

Doctors who are totally committed talented and skilled will be fully trained strictly assessed and accredited according to a strict code of conduct and capability. This will be enforced with legal and contractual obligations.

Q: Could you elaborate on the work performed on clients who have had previous strip excision techniques performed on them?

If the hairline has been badly placed, or if there are thick unsightly plugs, then we can remove those grafts individually. This also involves Micro skin grafting. We also get very satisfactory growth in scar tissue. This means we can place hair into donor site scars and other scars on the head such as post operative and radiation therapy scars where the hair is lost. If the donor hair has been decimated by scarring and loss due to tension suturing and shock fallout we can utilize body hair to infill and repair the scars.

Q: What kinds of results can someone expect from hair placed into scarred tissue and is the density sufficient to cover up the area.

The results can be excellent as is seen clearly in two of the patients on our website and video. One was of a lady who had a cancerous tumor removed and subsequent radiation treatment to the scalp. Her scar was one of the worst that we have seen as the tissue was very atrophic (paper thin) due to the radiation damage. Her procedure and follow up results were filmed for a national television documentary. Another was of a man who had a terrible strip incision scar. His donor site was extremely thin. His scar repair was through the combination use of his chest hair and donor hair. The results were extremely pleasing and are self-evident and the density is limited by the patients themselves when they feel they have enough.

Q: How much does your procedure cost and how do you calculate the cost, is it a per graft fee?

Our costs are not simply a per graft fee. . The costs are based on the perceived difficulty of the procedure, the number of grafts required and the time estimated for the procedure. With many repair procedures we are taking grafts out of unsuitable areas and then reutilizing them and skin grafting where necessary. The client's needs are also taken into account, for example we provide beachside accommodation with surgical facilities onsite and 24 hour access to ourselves for overseas clients. Costing is on an individual basis. Obviously the less complicated, the less costly the procedure, but it ranges from $7,500 to $12,000 (US Dollars) at the present time. Recently we have had clients where even the slightest haircut was not wanted. We then removed the grafts without cutting any hair but then again removing long hair is more difficult and takes longer and as such has a different costing.

We are sensitive to cases of hardship especially where there is scarring and /or an unnatural appearance.

Dr Wood's web site can be found at http://www.4hair.com.au