Your donor area removed is too high on the fringe, and it goes all the way down to the neck area with excision of these hairs as well. This is outside of the safe zone and the areas that doctors believe the hair will last a lifetime. I hope that your doctor discussed this with you because some of this hair may not last a lifetime and some might not even grow.
2018-02-15 06:09:492018-06-22 13:04:21FUE Donor Safe Area Not Respected In This Patient (photo)
You can have a hair cut within 2 weeks of your FUE
2020-11-03 03:48:192020-11-03 08:50:32FUE Donor – Post Recovery Haircut, when can I get one?
I started my research on the fue procedure about six months ago and have come accross an organization known as DHI. My cousin had an fue transplant from them last year and recommended their work, their website is full of info and they have numerous locations. BUT, until I stumbled upon your website, I didnt know half the things I know now, for example the fact that a Doctor is best trained to perform such procedures and that one should look for endorcements from pioneers in the field. While browsing their section on what doctors say about their procedures, I found that your name was listed. PLEASE could you tell me if DHI is a good choice for my procedure, as after studying your credentials I graetly value your opinion. If I dont go with DHI, your organization will be next on my list. I thank you for your time in advance and will greatly appreciate your proffessional advice.
Thank you.
With regard to FUE, the field is still new and most of what I read/hear is through the advertising of particular doctors who promote FUE. From an insider point of view, I suspect some doctors who promote their skills in this area are not able to do a competent job at FUE, but I am not willing to name them because of possible slander issues and my lack of good solid information. This site is not put together to police the profession, but to give good advice to people like you on questions covering the entire range of subjects with regard to hair care. In searching out a doctor, you should always meet patients that they have done to be assured of the skills of that doctor. You would want to get good vibes on that doctor.
A while ago, I got a list of 500 patient references (source was a doctor who I knew was terrible and unethical). I picked up the phone and called the first 20 references that the doctor listed. Every one of the references (all had surgery with that medical group) told me horror story after horror story. I then realized that by publishing such a list, that particular doctor knew that few patients would make the effort to actually call these people and that the list of 500 references was enough to produce the credentials he wanted. This shows that when you do your research, you MUST follow the threads until you have clarity on the inquisition. This is a buyer’s market and as a buyer, please beware.
For information on FUE, please see:
Dr. Kapil Dua, at the ISHRS meeting in October 2018, reported that the transection rate of FUE grafts was more around the ears and on the side of the head than in the back of the head. We have seen similar results as well.
A report published by the Journal of Plastic, Reconstructive & Aesthetic Surgery a couple years back has recently come to my attention. Here’s part of the abstract:
Follicular unit extraction (FUE) has been developed as one type of follicular unit transplantation surgery, a widely accepted hair-restoration technique. FUE has many advantages, including a small donor area scar, less pain and a slender graft without extra surrounding tissue. Complications are uncommon in the literature. We describe a case of donor-site necrosis after hair restoration with FUE, leading to cicatricial alopecia in the left half of the occipital region.
Read the rest of the abstract — Necrosis of the donor site after hair restoration with follicular unit extraction (FUE): a case report.
I have seen the impact of large sessions of grafts using FUE on patients who came to our office over the past 10 years. Most of these necrotic areas were small, so they were easily addressed by good, traditional surgical care. I expect that we will see more of these severe complications as more and more doctors start pushing the number of grafts performed in a single FUE session, just as we saw when doctors who did not know enough about FUT caused similar degrees of necrosis. I believe that those doing FUE procedures and their patients need to be aware of this risk. This complication, however, was a disastrous problem for the patient referenced in the above report, as he lost part of his scalp.
The full article states, “One hundred ï¬fty cubic centilitres (cc) of 1/100 000 adrenaline solution was injected gradually into a 10 by 12 cm area in the left occipital region during surgery over 4 hours. Nine hundred ï¬fty follicles were removed using 0.8-mm punches connected to the end of an electrical driver drill“. So less than 1000 grafts were transplanted with a small punch and yet the complication occurred. This punch size should have minimized the risk. The article does not discuss the density of the punch holes in the donor area. On the surface, nothing was really done wrong.
The article further reports: “digital gangrene and ischaemic necrosis after the use of local anesthetics with adrenaline and chemotherapeutic agent extravasations have been reported.” Our operative consent discusses this risk. We forget that any hair transplant (FUE or FUT) is a surgical procedure and with it, there are risks that must be discussed with the patient. We have previously reported a patient death in a medical office a few miles away from our office, so necrosis is just another one of these rare risks. Clearly, the death that occurred years ago was probably the result of doctor incompetence, so some of the things that the patient must pay attention to when evaluating asurgeon is: their track record, their experience, and their reputation.
I respect the courage of the doctors in this necrosis case, because by reporting it to the doctors performing this in the field, we become aware that the doctors do not control every risk in every patient surgery. As we know very little about this particular patient’s activities after the surgery or his health before the surgery (e.g. was he a smoker?), I can not discuss the article further.
We use a standard double accounting system when we perform an FUE. We count the number of attempts at FUE, then we count the number of grafts that come out. By subtracting the difference, this tells us how good we are at the process. Then, we recount them when they are examined, trimmed and placed into the recipient area. All of this activity is recorded on the patient’s surgical report which is available to any of our patients who want to see it.
I’m thinking about getting a strip method hair transplant and then just filling in the scar with FUE. Is that an option thats worth pursuing? I don’t want the line scar but I want every graft transplanted. I understand FUE has problems with transection or something.
I get this question quite a bit from patients who have already had the hair transplant strip surgery and then inquire about having a follicular unit extraction (FUE) procedure to follow it up. It makes little sense for the person that already has a strip scar (no matter how wide it is) to have an FUE into the donor harvest. If it’s just about treating the linear scar, better solutions would be a scar revision or Scalp MicroPigmentation (SMP). FUE grafts used in linear scars are generally wasteful and an expensive way to treat the scar with less than ideal results.
My complaints about the way the FUE technique is used are:
As the first to publish a paper on FUE (introducing it to the medical community), I can speak with authority on these issues. The ARTAS FUE robot has not really changed the process, except for leveling the playing field for those doctors not skilled in the extraction technique. The FUE technique, as done in most doctor’s hands without the robot, is not as good as the grafts produced by a strip surgery. If there was a formal study, I would expect that each doctor would show variable comparative results when comparing their FUE results with this strip results, making such a comparison between FUE and strip surgery essentially worthless.
The presence of a fine line scar will not be seen in most patients who had a strip procedure, because they generally leave their hair just long enough to cover a strip scar. If they were to cut the donor area hair very close to the scar, at some point (depending upon hair length) the scar will show. I had two hair transplants and although I have a scar, few people can see it even when I show it to patients who visit me in the office. The public does not understand that there is scarring in FUE procedures, even though some doctors and clinics promote it as “scar-less” surgery. In some patients we have had to treat these FUE scars with SMP to allow for a close haircut or shave. The SMP process is the only one that treats FUE scars today and we are seeing more and more patients with this problem as time goes on. I suspect that the strip scar issue is more of a problem with a person who has dark hair and white skin, than the person who has medium brown hair and an olive skin. Nevertheless, both techniques do have consequences.
Here is an example of scarring from a large FUE procedure with the hair cut short. While there is no linear scar, you can clearly see the white pinpoint dot scars all over the back of the scalp. We’ve treated this with SMP (photos to come in a follow-up post later). Click the photo to enlarge.
With all that being said, I am not denigrating FUE. It is an important technique and in certain situations it may be superior to a strip surgery. Examples of superior candidates include those without large balding areas, and athletes who want to be able to resume full exercises and swimming within a week of the surgery; however, in patients with large balding patterns, taking the required number of grafts through FUE is not efficient and is relatively more expensive. There is massive experience with strip harvesting (some good and some bad). I have seen in some patients that visit me, that many doctors are harvesting grafts with FUE from the non-permanent areas to reflect a large need for grafts in a single session. Grafts that are taken from the non-permanent zone, may not last.
Hey Dr. Rassman, I have a question regarding a recent curiosity about FUE post op care. Would it damage the grafts if i buzzed my head down to a 2 in about a month from now? I had a 3500 FUE procedure for zones 1 and 2 in Canada about a month ago. I just want to be sure and have been trying to contact my doctor but he is currently unavailable. If you could answer this question that would be great!
Shaving the head or clipping it after FUE procedure is OK after a month.
Considering that you must have paid a pretty penny for 3,500 FUE grafts, I am distressed that your doctor can not be reached by you. I would like it if you take good photographs of your head now and then more photos again in 8 months. I have been seeing a number of patients with FUE grafts in the 3000+ range that have had very poor results in terms of growth. So don’t forget to keep me in the loop — if for any reason you don’t get good growth, I might be able to help you.
You have a terrible complication that caused you to lose a lot of your donor hair. Maybe with time, it will come back. Go back and speak with your doctor since your donor area is in trouble. You may have been donor area may have been over-harvested, or this could be shock loss since it is in the first month. If your hair comes back, you will see it return around the same time as the recipient area grafts start to grow. If the donor hair does not return, then Scalp Micropigmentation is the only solution available to you or to anyone in your situation (see: https://scalpmicropigmentation.com/).
2018-03-08 06:39:592018-06-22 09:46:41I Had an FUE of 3500 Grafts Less Than a Month Ago (Photo)
Question for you. I am 41 years old. Been on Finasteride for four months. From the tip of my hairline to about 3 inches back has miniaturized slightly. I have noticed that it no longer grows in length. Is this common? I have to buzz cut the rest of my head to match that front part every few weeks. What could be the reason for this? Why don’t those follicles grow anymore…it is like they have paused the growth cycle at the front?!
Great question. When hairs are going to die, sometimes they just stop growing or the growing slows down almost to a crawl. These hairs will eventually fall out and contribute to patterned balding. Drugs like minoxidil (topically) or finasteride can reverse this process.
