Category: FUE

Hi Dr.
I have a general phobia of surgeries. I am very scared of the whole idea of my skin being cut so when I have my hair transplant I will probably go for FUE. Is this procedure painful?
Thanks.

All anesthesia hurts a bit (like the dentist who prepares your teeth). While the surgery is going on, you feel no pain and after the surgery the pain has been reported as minimal by most people who have had it. Everyone has different thresholds though, so I wouldn’t make bold, sweeping statements like “guaranteed pain free” or similar. Make no mistake — this is a surgery and you need to know what that means for you by meeting with a good, caring doctor who will take the time to go over the process for you.

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Dear Dr.,

I really appreciate your taking the time with this web site and the questions I have sent in that you have answered. I am 29, about to turn 30, and have been on Propecia for about 6 months now, which I started when I saw noticable thinning in the crown/Vertex area. I’ve had good results thus far, some thickening and reversal in the crown area. I have a strong juvenile hairline and in some lighting look like I have a full head of hair – under very bright electric or sunlight my crown looks a bit patchy and there’s a line of thinning/scalp on the top. As I stated in an earlier post, I was turned away from the Aderan’s trial because they said I have too much hair.

My Question is, after I turn 30, what kind of restoration results could I get from an FUE procedure? I’m a bit confused, since you state that extensively bald people should have limited expectations, but that you are reluctant to transplant someone with thinning who wants fill-in work. There is also all the advice I read on the web saying to wait for better treatments down the line if you’re in the early stages of hairloss.

Thank you very much

I don’t know how much or what type of hair you have, so I couldn’t begin to give you any kind of remote guess as to what you can expect from a FUE procedure. You’re getting ahead of yourself.

Every rule has exceptions and to determine what you should do, first get examined by an honest doctor who cares more about you than his wallet, and if he says go for surgery… come to me for a second opinion (you indicated that you’re not too far from my San Jose office).

Hi Dr. Rassman. I’m 25 and have been following your site for a few years now since my hair started thinning at 22. I’ve been taking finasteride though and it’s kept it at bay…

I have a couple of questions for you if you please:

1) Any chance that FUE can become more affordable soon? Am I right in thinking that a FUE procedure of 2000 grafts would cost over $15,000 nowadays? Any chance it could drop to $10,000 soon?

2) This question is sort of related to the one above – Do you have any updates on the Restoration Robotics FUE procedures? All I know is that there are trials being carried out here. You mentioned before you had granted them use of your license… Have you enquired as to whether they’re seeing any success? Any chance the robotic technique will result in cheaper FUE procedures?

That’s all. I really hope you can answer these questions which have been on my mind (and many others I’m sure) for a while now.

Best Regards

Costs for follicular unit extraction (FUE) will follow a supply/demand formula. Although many physicians perform FUE procedures, the failure rate is very high, so buying 2000 FUE grafts may mean that you purchase the delivery of these grafts, but survival may not follow the delivery because of damage done at the time of extraction. There are many groups working on mechanisms to deliver quality FUE grafts that will not be damaged so that they grow. Many groups have devised better tools and have announced them at the various ISHRS conferences and elsewhere (Drs. Feller, Harris, Boudjema, Cole, and myself).

Restoration Robotics will require FDA clearance before their product can be released for commercial application. The other devices are what the FDA calls Class 1 devices, which do not require FDA approval. I’m not sure of their progress at the present time, nor do I know of any costs, though doctors will still likely set their own pricing. My guess (and I am not privy to any info, so this is entirely speculative) is that the equipment start-up costs will be substantial and like any other product or service, costs will come down at some point in the future when it becomes available to a wider market. How near of a future, I couldn’t tell you. One step at a time.

Note: The image is of a violin-playing robot developed by Toyota. It won’t do hair transplants, but it might play you a song.

I can only afford to have my bald patches of my hairline transplanted (FUE) so no other areas of hair will be near. Will the shock loss only affect the donor follicles? or does all of your head hair fall out?

While price/cost is a factor for any cosmetic surgery, it should not dictate the surgery itself. Having cosmetic surgery is not like shopping for the cheapest loaf of bread, laundry detergent, or shoes.

When shock loss occurs, it may be the result of the anesthesia given to numb the head for the transplant and may cover a large area of the scalp, not just the area where the grafts are placed. The mechanical impact of the transplant may not be the cause of shock hair loss. You also have to look at the big picture. We call this the Master Plan. Surgery must be placed along your hair loss timeline and it will be progressive. In other words, you can’t just transplant hair to the small bald patches and expect that to solve your problem, as the balding process is regional. What if you lose more hair around the transplant and behind it as your balding continues? A good doctor should give you insight on your worst case scenario and plan for such consequences. After all, you don’t want to have small patches of transplanted hair scattered around your bald scalp in the years down the line “IF” you were to go bald.

To answer your question in further detail, shock loss is a concern… and while it may not happen, it is a risk. I have addressed your question with the assumption that you have genetic male pattern baldness and not just a patch of bald scalp (which is very rare in genetic balding). Either way, you need a Master Plan created with a doctor (not just me on the Internet) who is willing to look at your hair loss problem as a long term process.

For the follicular unit extraction (FUE), you need to understand it does not work to fill in the scalp balding areas like a patchwork quilt. Do not let the cost of FUE be the primary reason in your decision making process as to what to do and where to put the hair. It is better to be bald than be disfigured with a half-ass surgery.

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