Category: FUE

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Hair Loss InformationCould FUE2 Replace the Strip Method? (Part 1) – Hair Loss Information – Balding Blog

This is a long piece, so I’m breaking it up into 2 separate parts. Here’s part 1, with the 2nd part coming at the same time tomorrow…

Do you believe that the FUE 2 (or standard high yield FUE) process could completely replace the strip method of hair transplantation? Why or why not?

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There are practical problems with the FUE2 method of harvesting. First, the patient must have his hair clipped widely if he wants/needs extensive grafting above 600-800 grafts (the number of grafts which can be taken from a small area is very density dependent). Most people will not allow us to clip their hair that short and certainly people who have had previous strip harvesting will often not want to have their hair clipped that way either. Many patients who come for FUE end up switching to a strip technique, because of the haircut issue alone.

The FUE’s maximum number of grafts, compared to a strip harvest, will produce less hair with FUE. The strip method of harvesting obtains the donor hair from what the surgeon calls the sweet spot. The FUE can not get the number of grafts from the sweet spot as well as the strip, but the FUE may be limited at each surgery. I read a great deal about the reported FUE megasessions and although I am convinced that much of the hype of 3,000 graft FUE sessions are misrepresented and promoted based upon false claims by less than honorable doctors, the public wants to see this happen and they are ready to believe almost anything a slick doctor tries to sell.

So for the patient who is bald and needs a high numbers of grafts, the strip harvesting method is superior because more hair can be moved in a single session, minimizing the number of sessions when compared to FUE harvesting. For those people who want to get the job done quickly and they need graft numbers in the thousands of grafts, the strip method is far more time efficient.

On the other hand, a new dynamic can be created where people take multiple sessions of 500-800 grafts every 6-8 months until they add enough hair to create what they want. A slow approach has many advantages including:

  1. Spreading the costs over a longer time
  2. Developing a changed image very slowly so that nobody will ever recognize the change
  3. Minimal pain and very fast recovery without limitations on any activities from weight lifting to scuba diving, and so on.

There is a place for both choices and for those men who are not very bald, the ability to achieve reasonable results in one or two sessions are a practical approach to the problem.

Check back for part 2 tomorrow…

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Hair Loss InformationScarring and Hair Transplants – Hair Loss Information – Balding Blog

Hi,

I visited two companies that do hair transplant techniques. Basically although I have many questions the key one is this. FUT leaves a scar and means that the individual cannot wear his hair short whereas with FUE you can. The first Doctor I visited left me with the impression that I have at most a level 2 or 3 barber shave. The second person I met, who is not a doctor, but has qualified technicians working for him, said as long as I do not care about shaving my head go with FUT since I have plenty of donor hair on my scalp. This person said I can cut my hair as thin as I want but I just cannot SHAVE all of it off. DOing so would reveal the 1 mm thick scar.

So who is right? The doctor leaves with the impression that I cannot cut the hair as thin as I want whereas the second person seems to tell me thinness is not a problem as long as I do not shave the hair off.

My second qeustions is that if I decide to get FUT, and later on want to shave my head, can I get FUE to cover the scare area?

Thanks!

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All cuts in the skin produce some form of scar. In an FUE the scar is punctate (like a ball point pen) while from a strip excision, it is linear. If a trichophytic closure is used (see here) then most patients will not develop a detectable scar, even with a close hair cut. I wouldn’t recommend shaving your hair. Obviously, once you move hair from the donor area to where it is needed elsewhere, that hair is gone from the donor area. So using techniques to minimize the appearance of missing hair is how you’re going to get a shorter haircut without a detectable scar.

FUEs can be used to transplant into a scar.

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What Kind of Coverage Can be Achieved with FUE2? – Hair Loss Information – Balding Blog

Hi,
Great blog – thank you.

Just wondering if you have any results yet from the FUE2 launch? I’m considering a ht in the near future (i’m 26 and would like my hairline lowered & temples closed etc) and would prefer this to the strip option.

Can you clarify, what the coverage is with FUE2 (i.e hany man hairs per cm2 can be grafted) and how this compares with other methods please? Additionally, what are the levels of risk compared to FUE and strip…

Grateful thanks…

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There is no difference between densities achieved with FUE, FUE2, or strip harvesting. The densities are achieved when the surgeon has the donor supply needed to place in the recipient area.

Here are some FUE articles you may find interesting:

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Sensitivity in Donor Area a Week After FUE Procedure – Hair Loss Information – Balding Blog

I recently had a FUE procedure-just one week ago. I am experiencing heightened sensitivity and slight pain located above the donor strip where the occipital area is and up to near to the top my head. This is particularly noticeable when I rest my head or touch it slightly. Is this normal after one week of surgery or is it a possible symptom of occipital nerve damage? If this is the case, how can this be diagnosed and treated? Or are these symptoms normal or all much to early to tell and I should wait it out? I understand numbness can take months to heal but it’s the sensitivity and pain that concerns me. Thank you.

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There are two major nerves that feed sensation to the back of the head (greater and lesser occipital nerves). There is also a large major nerve above the temples. These nerves branch are like a tree and any punch that is placed in the path of a small nerve could transect (cut) it. It could also bruise the nerve. If you look at the image here, you will see that these small nerves are all over the scalp so it is inevitable that one or more can be damaged. As long as it is not the major nerves, bruising or transection should not be a problem, as the other nerves that cross over the same skin area will substitute for any damaged ones. But there is always some damage and few complaints that last more than a month or two. If a major nerve is cut, then there will be anesthesia (numbness) over the distribution of that nerve. Be patient and wait this out.

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Hair Loss InformationIs FUE the Best Choice for Someone That Has Had a Lot of Transplant Work Already? – Hair Loss Information – Balding Blog

I have followed this site for a few years now and I am so impressed. First off, your integrity seems to be apparent in how you run this site. There is none of the cheap salsmanship common to some of the hair replacement surgeons with whom I have spoken. You provide so much disclosure that it is obvious that you truly want educated patients. It seems to me that the medical hair replacement industry was crying for someone like you.

With that, I am happy to share with you my story and ask you my questions. I am a 45 yr old male who began losing his hair at 19. I was told early on by a few surgeons that I was an excellent candidate for hair transplantation because my donor hair was so good (it was rated a 9 out of a possible 10). I believe that I am a Norwood 6 but I know that I have long lost all the hair that I was to lose. I have had 13 hair transplant procedures with Dr. X [editor’s note: name removed] and 2 scalp reductions with another doctor. The procedures were performed between 1989 and 2001. In total, I had 1679 “large” grafts, 379 “medium” grafts, and 321 “single” grafts. My hair provides decent coverage for someone who by this time would have been left with only what I call “clown fringe” (I am sure the visual will resonate with you) but I do use a concealer (Fullmore) to hide some small patches of my crown which show, and some of the scarring. My goal is to surgically get more coverage – or at least more uniformity in my existing coverage – so that I can stop using the concealer. I would like a good evaluation on what surgical options may be open to me, as I have already had so much work already performed and donor hair is not so plentiful. These are my questions:

  1. Do you ever do any work in NYC/LI?
  2. If the answer to #1 is no, can you recommend any good and caring surgeons in the NY/LI area?
  3. It seems like FUE2 would be a natural choice for someone who has had so much work performed already and where so much donor hair might not be harvestable in one strip. Is this a correct assumption?
  4. Is it possible to do many smaller strips so as to increase yield for someone who has had so much work performed already? Does it matter from where the strips are taken? I think that I may have some donor hair on the high sides.
  5. I have not heard of too many people having as much work as I have had. Does the work I describe sound like it is so much? Are you aware of many people who have had more work?
  6. I have been using a concealer for 15 years – just during the week and just during the day. Are there any health affects of such prolonged use?
  7. How does the cost of the FUE2 compare with the normal strip method?

Any of these questions which you can answer would be appreciated.

Keep up the site.

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  1. At the moment, I only have offices in California and do not plan on going to New York.
  2. Dr. Robert Bernstein is a caring and competent doctor with a Manhattan location.
  3. Follicular unit extraction (FUE) is less productive when donor densities are down from multiple surgeries and when there is lots of scarring.
  4. With regard to taking high strips, it is generally not a good idea as high strip scars tend to show and they may not be in the permanent zone, so the hair may not last your lifetime.
  5. I have seen many patients that have had more than a dozen surgeries plus scalp reductions. One patient I met had 27 procedures, of which I believe most were sham surgeries. Without seeing you, I can not comment on what you did and did not get.
  6. Your approach with the use of concealers is well defined in my new book, Hair Loss and Replacement For Dummies, for the readers who do not know much about them.
  7. FUE costs are high compared to the strip method, but more important, they may not be very productive. FUE costs roughly 2x the amount of strip procedures, per graft.

The problem with your situation is donor scarring and your donor area must be a mess. It’s difficult to make any real advisable points without first seeing what I’m dealing with, but you might be able to excise the highly scarred donor area (probably using a balloon expander) if that is bothersome to you. Good luck.

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FUE Scarring? – Hair Loss Information – Balding Blog

Hi Doctor,

If one were to get a FUE or FUE2, and in the future decide to shave it all, will there be left over dotted scars in the back from the donoring?

What kind of scarring can one expect from FUE or FUE2?

Thanks

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PencilYes, any incision made to the scalp will result in a scar of some kind. It is not an entirely scarless procedure and any doctor that tells you there are no scars is feeding you a load of bull. Scarring for FUE will be a small pinhole… like a pencil mark. If your density is low, scarring can be a problem with the follicular unit extraction (FUE) procedure, because the amount of hair to cover the donor excisions will be less. If the density is high, it hides well. Shaving your head like your facial hair, will leave ‘dots’ of white circles measuring between 0.7 – 1mm wide, or if your surgeon used a wider instrument, it will be even wider.

I just saw a patient who had 3300 grafts with a FUE technique by another doctor and the back of the head looked like he was shot with 3300 holes from a pellet gun; few of the grafts grew after a year. Your skin and other factors will determine how visible these scars are with your head completely shaved to skin level — but why would you bother getting a transplant if you’re just going to shave your head anyway?

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The Story of a 3,000 Graft FUE Procedure Failure – Hair Loss Information – Balding Blog

Story time! Although I can’t provide photos (by patient request), I’ll do my best to paint the picture…

A man in his early 20’s flew to Los Angeles from Alaska to see me last month. He already had two hair transplant procedures using the follicular unit extraction (FUE) technique — one surgery of 1,000 grafts, and another of 3,000 grafts — by two different doctors (that I won’t name) who each claim expertise in this process. The 1,000 FUE case by the patient’s estimate was about 50% successful, while the 3,000 FUE case had, according to the patient, no growth after a year. The donor area was heavily scarred from the FUE extractions and were easily seen by lifting up the hair. A strip procedure would have produced less scarring than this patient showed now. To compound the problem, those hairs that did grow from the first surgery were placed in a radial direction (like the spokes of a bicycle wheel) and the hair pointed to the sides, not the normal frontal position. So not only was he dealing with a huge failure of growth, but now he had to deal with poor placement for those grafts that did grow! Imagine a person with hair growing out of his head like the spokes of a bike?

This patient most certainly had a low donor density to start. I recommended a strip surgery to harvest the most grafts he can get and with the reduced donor density, I recommended about 1,300 grafts, which is possibly the most I can harvest. Fortunately, his hair loss was only in the first 1 1/2 inches of the hairline and by taking Propecia he might hold the rest of his hair in place, although there is miniaturization behind the frontal 2 inches, suggesting that he might bald further over time. He wanted to look normal, but I could only suggest that I would try to make him look better.

FUE is not a panacea for scars. As I have said here before, the follicular holocaust that is seen in FUE is substantial, even in the hands of those who claim success. This is a buyer beware market. You should always ask to see a number of patients who had the procedure and look carefully at the donor area. Another FUE procedure on this patient will be disastrous (even in my hands), as scarring is clearly a problem.

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Large FUE Case? – Hair Loss Information by Dr. William Rassman

Dr. Rassman

What is the largest number of grafts you recommend to be transplanted in one session using FUE? What is the maximum number you guys at NHI have done in one shot using this technique?

Thank you and Happy Holidays to you and your staff.

The largest case we did was 2,800 grafts. The large follicular unit extraction (FUE) cases require high densities of the hair in the donor area. Those individuals who have lower densities generally have from 20-40% less hairs per square inch, so one could expect that yields may be as low as 700 – 1,000 grafts for most — and that is generally people from Asia (like Indians), many from the middle east, and those with African hair. In a Caucasian with an average density, we have done 1300-1500 FUE grafts.

I think that many of you have seen comments made by me — comments of disbelief about the number of FUE grafts claimed to be performed by some dishonest doctors. I’d like to see some more honesty in the industry, but the almighty dollar is more important to some.

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Hair Loss InformationFUE Aftercare Question Because My Doctor Is Unavailable – Hair Loss Information – Balding Blog

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!

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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.