FUE hair transplants are the process where individual hair follicles are extracted with a tool and then transplanted into areas of hair loss. In order to extract the follicles the hair needs to be cut down to it’s shortest length above the skin so that the hair doesn’t get tangled in the tool extracting the grafts. This means shaving the scalp in most cases.
For patient’s having procedures which require less than 1500 grafts extracted there is now another option. The patient can grow the hair in the back and sides longer and we can shave either one large strip (smaller than the length of the hair) or multiple smaller strips (also smaller than the length of the hair) which allows the native long hair to hang down and cover up the extracted areas.
This allows the patient to keep the long hair and not shave the entire back and sides of the scalp and still have an FUE hair transplant. This technique is becoming very popular amongst actors (who can’t change their appearance if they have longer hair in the midst of a recurring show) and other individuals that do not want such a dramatic change to their appearance. The results are just as good as the full shaven technique and it is proving to be a very popular alternative to traditional FUE shaving.
I have included some photos of a recent patient I performed this technique on.
All the best,
Marc Dauer, M.D.
This is a photo of the “long hair FUE” process in a patient showing his donor region immediately post procedure with his hair wet and combed down.
This is a patient’s donor region immediately post harvesting approximately 1400 grafts via FUE with the hair raised.
Here is a patient who came to me after having undergone 2 previous trip harvest procedures from another local physician. He decided he was done with the strip harvest procedure and wanted to have an FUE procedure. When I shaved the scalp to perform FUE his precious strip scars were clearly visible and also demonstrated how his previous physician had created “stacked scars” in certain locations instead of including the old strip scar in the new incision.
This is against the 10 commandments of hair transplant surgery.
In every instance of a patient having another strip harvest hair transplant procedure after having one prior, the previous scar should be removed.
If the previous scar is too wide or the scalp too tight FUE should be considered.
NEVER should a physician create a stacked scar, which in reality just creates one huge scar.
This is a prime example of what not to do and is either laziness or ignorance on the part of the hair transplant surgeon who did this.
On this procedure the patient was primarily concerned with creating density in the frontal scalp, but after seeing these photos, the patient has decided in the future to have me place FUE grafts into these scars to help cover them.
Just another example of why it is imperative to do thorough research prior to choosing your hair transplant surgeon.
After an article a few weeks ago that was picked up by multiple press publications about facial hair transplantation there has been a great deal of press focus on this topic. I have been performing facial hair transplantation for many years now. The donor hair to be transplanted on the face can be harvested either from the scalp via FUT or from the neck beard using FUE. I prefer to use the neck beard hair whenever possible as it provides the exact same character hair as opposed to scalp hair which is different from beard hair. This procedure can be very useful for cosmetic purposes to augment ones beard, goatee, or sideburns, or even reconstructive purposes in cases when one has a scar in the beard region and wishes to cover the scar with hair in order to minimize its appearance. When transplanting into scar tissue the growth rate is not the same as with healthy tissue, but there is still good growth, and it just may require more sessions to accomplish the patient’s goals.
I have attached a photo of a patient of mine who I transplanted hair into a mustache scar with excellent results. I have also attached a link to the ABC news article on beard transplantation below.
In a few weeks I will be traveling to attend the (International Society Of Hair Restoration Surgery) ISHRS annual meeting in San Francisco. I always look forward to these meetings to see my old friends and hear from my respected colleagues on the latest and greatest in the field of Hair Restoration Surgery. In addition, I usually present lectures and conduct teaching workshops at these meetings and this year I will be conducting a Board Review course and teaching the FUE (Follicular Unit Extraction) course. I plan on blogging from San Francisco and writing about the new advances I find interesting. I look forward to reporting my findings in a few weeks.
Here is a patient of mine who received 746 grafts to both eyebrows 4 days prior. There is minimal residual swelling present and some minor crusting, but the overall photos give a very nice idea of what the final result of the eyebrow transplant will look like after the new hair is all grown in. Typically most of the transplanted hairs will fall off after 1-4 weeks. The new follicles leave stem cells in the dermis that will sprout the new eyebrow hair follicles after 12 weeks. The final result will be visible after about 9 months, but there will be a marked improvement after 6 months.
This patient is thrilled with how her eyebrows look now immediately after the eyebrow transplant procedure, and I will follow up this post with 6-9 month post procedure photos in the future.
All the best.
Marc Dauer, M.D.
Here is a patient pre eyebrow transplant and 4 days after the eyebrow transplant procedure.
Today I will discuss a bad hair transplant procedure result that I recently saw in consultation. The patient was on vacation in Pakistan and responded to an advertisement for an inexpensive hair transplant procedure. The patient subsequently was told that he would receive 2000 grafts (which would equate to about 5000 hairs with typical density) for $500. The patient underwent the procedure and stated that he experienced significant pain during and after the hair transplant procedure. I took the photo below approximately 18 months after his hair transplant procedure in Pakistan. What you see in the photo is very sparse growth of grafts. A patient with no hair in the frontal scalp receiving 2000 grafts should have exponentially more hair growth then you see in the photo. You also see an aggressive hairline design, which means that they placed the hairline lower than it should have been placed in a patient with severe hair loss undergoing a first hair transplant procedure. I always tell my patients undergoing their initial procedure that I would prefer to be more conservative with the hairline and create greater density than getting aggressive with the hairline thus having to spread the same number of grafts over a larger area subsequently getting a lower density result. You can always lower the hairline in successive procedures, but once the hairline is placed too low, you have a problem. There are also 2 hair grafts present in the hairline. This should never be. Only single hair grafts should be placed in the hairline to create a completely natural result. Finally, if you look closely it appears that many of the grafts are emerging from a small crater around them. As if they are not flush with the skin, but coming out of a little hole. This is called “pitting” and occurs when the grafts are placed to deep. This also should not occur in a well done hair transplant procedure.
Unfortunately there are many more unqualified physicians performing hair transplants, or delegating the essential functions of the hair transplant procedure to unqualified personnel, then there are qualified Hair Transplant surgeons performing great work. The consumer needs to beware of these unscrupulous practitioners, both in the US and abroad in order to avoid a result like you see here. This patient can have repair work to fix this, but if it had been performed correctly initially, the corrective work would not be necessary. Unfortunately in this case the damage is already done, but hopefully others can learn from this and not make the same mistake.
I decided to commission an animated video which would convey all the basic Hair Transplant Information that anyone interested in Hair Restoration and Hair Transplants should know. It was an enjoyable project for me to create the text copy for the video and I believe it answers many of the basic questions that people interested in Hair Transplants may have. I hope you enjoy this video titled “Hair Restoration and Me”.
Today I will discuss donor density and how it affects the hair transplant procedure. Donor density is the amount of follicles per cm squared in the donor region. A secondary factor relating to density is the hair count, which is the number of hairs in the donor region. This is determined by finding the average follicular density per cm squared and then the average number of hairs per follicle and multiplying the two numbers. The average scalp has between 60-100 follicular units per cm squared and the average hair count is between 2.3-2.7 hairs per follicle. If the majority of the follicles are 2 hair follicles as opposed to 3 hair follicles then the overall hair count will be less. This is why not only the number of follicles is important, but the average number of hairs per follicle as well. The higher the hair count and follicle count, the greater the donor density. The greater the donor density the more hair that can be moved from the donor region to the areas of thinning. The donor region is an unchangeable area whether we do FUE or FUT to harvest the donor hair in the hair transplant procedure. This is why a high donor density and high donor hair count will lead to the ability to move more donor follicles to the areas of thinning.
I hope this helps to clarify donor density and how it impacts a hair transplant procedure.
Today I will discuss how I harvest my donor strip in patients undergoing their second hair transplant procedure. In almost all cases I include the old donor scar in my new strip in successive procedures so as not to leave the patient with multiple train tracks scars in their donor region. The only exception is the patient who has a wide donor scar and when trying to resect it will not give us enough donor hair for the procedure. This is one more reason why it is imperative that the donor area is treated properly on the initial procedure so that the patient has a small donor scar (between 1-3mm), and it can be excised on successive procedures while harvesting donor hair at the same time. I perform many special nuances in order to minimize the donor scar which include; trichophytic closure, using a thin suture to close as opposed to staples, not using cautery, and not taking too wide a donor strip which can lead to wide scars.
I hope this discussion clarifies the harvest of a donor strip in a successive procedure.