What you have appears to be an infected hair follicle cyst which we often call a boil. You should see your doctor and he most likely will drain it and relieve your pain.
2017-10-09 07:01:122017-09-15 13:46:33I had FUE 1 month ago and now have a tender hairline
FUE thins out the donor area by its very nature. To avoid this, the grafts should have been taken higher up and distributed more evenly. Your grafts appear to have been taken from the neck hair which is a problem because neck hair is not permanent hair.
So far, we’ve looked at the history of FUE in part 1 and graft quality/survival in part 2…
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FUE Today:
The FUE market may reflect as much as 40% of the total hair transplant market today. I believe that 20% of the doctors offering FUE, are skilled in the process; however, a majority of the doctors who offer FUE today are not skilled in the process. With such a large gap between skilled and unskilled doctors doing FUE, one would ask what the doctors are doing about it, because no doctor wants to be second class. The doctor must get the expertise that they need… somehow.
Some doctors try one of the various instruments that promise great success with the FUE process. Some instrument entrepreneurs try to convince the doctors that if they purchase a particular instrument, great success will befall them and every new doctor purchasing these system, want to believe it. I admire Dr. Jim Harris, who pioneered a special instrument because he offers training on human volunteers to physicians who want to master his unique approach. I have participated in his course and own one of his instruments. There are instruments that:
Drilling is the most popular way of performing the FUE and most doctors seem to favor the drill. Prices for these drills (the doctor’s costs) run as low as $1200 to as high as $220,000 plus $1/graft. Each vendor claims some advantage over the other.
With the discrepancy between $1200 and $220,000, let’s see what value comes with each package.
ARTAS:
The ARTAS system made by Restoration Robotics is the $220,000 unit for FUE harvesting. The sole function of the ARTAS system today is to core grafts from the scalp, leaving them in the scalp until they are manually removed. Their ARTAS system does the coring with a high degree of accuracy. It does this with robotic efficiency using optical siting technology (initially designed and patented by Rassman and Pak — Patent 6,572,625). The ARTAS uses a sharp punch to score the skin and then a dull punch (designed and patented by Dr. Jim Harris) measuring 1.2mm each. The hair shaft lies mostly below the scalp surface and the angle of ‘attack’ by the robotic punching system is calculated by knowing both the angle of the hair stubble above the skin and an estimate of the bend in the hair follicle found below the skin. The hair is left with stubble when the scalp is shaved so the part of the hair shaft that is exposed allows the optical siting system to establish the needed alignment for the extraction. The bend below the skin is consistent in adjacent grafts, but vary in different parts of the head and constant adjustment is needed as the instrument moves from one area to another. The robot can not ‘feel’ the graft, so the extraction is done by science and math, while all of the other instruments on the market allow for the ‘feel’ of the graft as the instrument plunges into the scalp.
A skin stabilizer (invented and patented by Rassman) is used to stabilize the skin for the extraction that follows. The ARTAS leaves the graft in the scalp and moves from one location to another until the entire drilling process is complete (speed of drilling is about 300-400 grafts per hour). About one graft is excised out of every 5 in a single field of view and this variable can be dialed into the ARTAS controls. The robot is very efficient in making the calculations to remove 20% (or 25%….) of the follicular units in any one field of view. The coring is where the automation ends. Once the grafts are cored out, the rest of the process, including the removal of the grafts is a hand process.The ARTAS damage to the follicular units from the drilling part may range in the 5-10% in each patient. The variations by the team or with the patient dictates most of the variables and most damage occurs when the grafts are transected or ripped out after the drilling process.
Restoration Robotics intends to automate the entire hair transplant process some time in the future. They are estimating that the complete automation may be accomplished in 2-4 years. When they complete the automation for implantation, the art of the hairline has to be dealt with and I am interested in seeing how they go about the rest of the automation process. The ARTAS system requires the least training for the mechanical extraction of any instrument available today. In fact, once the diagnosis is complete and the plan is laid out, the surgeon becomes superfluous to the process. As the doctor pays $220,000 for today ARTAS and $1/graft, these costs must be put into the final price for the consumer making the ARTAS FUE possibly the most expensive technology for the consumer today.
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The final part of this series will be posted tomorrow, where we’ll discuss Neograft and manual processes for FUE.
Do FUE procedures form scars?
Yes, there are scars anytime the body is invaded by the surgeon, or any time you cut yourself. The scars come about when the edges attempt to close the gap. The FUE scars are circular, so the size of the scar somewhat reflects the size of the wound. To answer the question appropriately, let’s talk basic math and then convert the math to logic.
The chart here shows the size of the cutting punch and compares the size of the wound that is created. The scar reflects the size of the wound.
| Diameter | Area | % change from smallest wound size |
| 0.75mm | 0.44mm square | (baseline) |
| 0.9mm | 0.64mm square | 44 % larger than 0.75 |
| 1.0mm | 0.79mm square | 78% larger than 0.75 |
| 1.5mm | 1.77mm square | 300% larger than 0.75 |
The reality of these number are that the 0.75mm leaves almost no scar, because the edges co-apt and there is minimal secondary healing as the scar fills from below as the side skin grows over it. With all of the wounds from strip harvesting, the scars are long and the wound is much larger. Such ‘line’ wounds can be seen when the scalp is shaved.
The 0.75mm wounds are impractical, but the 0.9mm wounds are the standard used in my practice. So in answer to your question; scars are related to the size of each wound. The smaller the wound for FUE (for example), the smaller the instrument used by the surgeon, the smaller and less noticeable will be the wounds in their final healing phase. Please see this previous post, Size of FUE Procedure, for discussion on actual yield rates. If only a needle is used (like the one you get with a flu shot) I sincerly doubt that you will ever find the scar with the naked eye.
FUE review at New Hair Institute
Click on photo for LARGER SIZE
Click on photo for LARGER SIZE
This patient is not going bald. He may be classified as a Norwood 2 or as having a mature hair line. He had the surgery because he did not like his raised corner hair line. He wanted a lower, relatively straight juvenile hair line (he once had). He was old enough (over 30 years old) where chances of him losing more hair or shock hair loss was minimal. He understood this is a cosmetic procedure and was made aware he may need more than one surgery to achieve the density he was looking for.
He chose the FUE method of graft harvesting since he wanted the flexibility to keep his hair buzzed or kept short.
The total number of grafts he received was 1600 grafts. He had two separate FUE procedures of 800 grafts with each surgery spaced out about 1 year apart. The final result you see is after 2 years. If you click on the photos for a close up ZOOM you can see that the density achieved was close to normal (non-balding) hair density. The reason he needed TWO (2) separate surgeries was because you cannot fit 1600 grafts in such a tight space. Each graft can be about the size of a rice grain. After the hairs have grown out, you can fit another graft in between the spaces.
He occasionally attends our monthly Open House events if anyone would like to meet him in person.
You have excessive crusting as a result of poor post-operative washing techniques, or absence of them. An FUE is treated just like a regular hair transplant with regard to the recipient area, but the donor area has open wounds which require daily washing with soap and water. Within 3 days of surgery, you can resume full activities, heavy exercises if you wish. The recipient area requires daily washes as well to keep the recipient area free of crusts. I generally recommend the use of a sponge and supply my patient with a surgical sponge to fill with soapy water and press on the recipient area daily. By repeating this daily, all crusts can be washed off without any fear of losing grafts. IF any crust are present, use a Q tip and dip it into soapy water, and roll it on the crusts and that will lift them off without dislodging them, but never rub them, just roll the Q tip on the recipient crust. I like to see no evidence of any crusting in the recipient area and the crusts from the donor area gone in 7-10 days with daily washing much like the two patients on the right.
I don’t like the idea of anyone removing grafts that have scabs on them because we have published a paper in a formal medical journal, that when a person pulls off a scab (crust) from a recipient area in less than 12 days, the risk of losing the graft is very high. Put a shampoo on your head and let it sit for 10-15 minutes, then gently work the crusts with your fingers. This will take days to get the crust off so that you do not disturb the grafts. See the medical paper we wrote in a major journal below in the web reference that proves my point. Look at the two patients on the right, both one day after FUE sessions and both clean without crusts.
Hi,
I am seriously thinking of having a FUE procedure during the next 2-4 months. I’ll appreciate if you can please help me with the following info.
1. How do i know if i am a suitable candidate for FUE?
2. How long do i have to wait after the test to have the procedure?
3. how long do i have to wait after the surgery, before i can go about my business?
4. I see that you have a special offer going on now, what is the final per graft price after taking into account the travel reinbursement and your offfer?
There are many things to consider before deciding on any hair restoration procedure. I’ll answer your questions on FUE (Follicular Unit Extraction) first…
Some of the other considerations to keep in mind are FUE is a good choice for patients who:
BUT, most importantly, continue to research, make sure all of your questions get answered, insist on seeing patient results in person, and make sure that you choose a doctor who has your best interests in mind.
