For a long time the only way to perform FUE was to shave the entire back and sides of the scalp as the hair needs to be a few millimeters long in order to extract. That has now changed.
Now we can perform long hair FUE which allows the patient to keep their hair long and completely conceal any evidence that FUE was performed in the donor region.
The patient leaves their hair at least 1.5 inches long and we go through the donor hair individually and randomly cut short the follicles we plan to extract. This allows us to completely conceal the donor region. It also allows up to choose the follicles with the most hairs per follicle which gives the patient the best ultimate result.
Since I have had multiple strip harvest hair transplant procedures in the past, I wanted to have this technique performed on myself to better understand what it felt like, which would in turn give me greater insight into the process. I can wholeheartedly state that this process was so much easier than my previous strip harvest procedures. I had virtually no pain the next day and was back to work a day later.
The photo below shows my donor zone the day after over 2000 follicles were harvested via long hair FUE.
I believe that this process will revolutionize FUE and open it up to so many more people that were hesitant, like myself, because they did not want to shave their head for the procedure.
Here is a patient of mine who had hair loss classified as norwood 6 on the norwood hair loss scale. This essentially means that most of the hair on top of his head had been lost secondary to genetic hair loss.
I performed a follicular unit extraction (FUE) hair transplant using a 0.85mm punch tip. I personally extracted each and every follicle. Many other physicians delegate the extraction component of the procedure to technicians but I prefer to perform the extractions myself.
The patient is thrilled with his results and plans to return for another procedure to create even more cosmetic density.
Here is a male patient of mine who wanted more fullness to his eyebrows. We extracted his donor follicles via FUE. In the video the patient shares his experience undergoing the procedure and his satisfaction with the results.
Here is a very interesting case of a patient who was a frequent break dancer in the day. His continued head spinning cause the hair at the top of his head to fall out in the exact spot where the scalp received repetitive trauma. Anything that causes repetitive trauma to the scalp can cause the hair in those places to fall out.
I harvested approximately 150 grafts via FUE from the back of the scalp and we transplanted these grafts into the area devoid of hair.
The results are show after 1 year. The patient is thrilled.
Marc Dauer, M.D.
FUE grafts transplanted into scalp scar from break dancing
Here is a patient who had a previous hair transplant strip procedure with a large chain Hair Transplant operation by a physician who had been performing hair transplants for over 30 years. The patient came to me requesting more density in the frontal scalp, but also complaining of a wide strip scar that was elevated with severe numbness. He also complained because the Physician who had performed his last procedure created a second strip scar deviating at one point from the first. He wanted me to take out the unsightly scar and consolidate the 2 scars into one.
When I started to dissect out the strip I noticed small blue thread and assumed it was a small retained suture that dipped below and was missed in the suture removed. To my amazement what I then discovered was that almost the entire length of the strip scar was closed below the skin with non absorbable nylon sutures. These are sutures that are only to be used on the skin surface and removed. They were placed into the subcutaneous layer below the skin and created a significant amount of scarring and was also giving the patient numbness. I removed the suture, which was caked in scarring at this point, and consolidated the 2 scars into one. The results are shown in the photos.
This should be a warning and reminder to prospective patients that when choosing your hair transplant surgeon make sure to do tremendous research into the person performing your procedure. Experience and focus on the singular discipline of hair restoration are imperative, but just as important is the fact that your surgeon should not have a cavalier attitude towards hair transplants, no matter how long they have been performing the procedure, and must convey and strong sense of sensitivity and respect for the art and science of the procedure, as well as keeping up to date on the latest developments in the field. The field of Hair Transplant surgery is the wild west and there are more unqualified individuals performing bad procedures than good. You only have one chance to do things right, so take the time to chose the proper physician who will give you the greatest chance of successfully achieving your goals.
Marc Dauer, M.D.
Showing the strip scar before revision.
This shows the nylon suture retained in the tissue below the skin and the scarring.
Here is the strip scar immediately after revision and removal of the scarred tissue and retained suture material.
Today I want to discuss how I as Hair Restoration surgeon manage my patient’s expectations to give them the most realistic idea of what to expect from their hair transplant procedure. Most patient’s today spent time online, from minutes to hundreds of hours, studying hair transplant photo results. This creates varying expectations amongst people.
My role as a Hair Restoration Surgeon is to understand the prospective patient’s expectations and give them feedback as to what they can expect realistically in terms of results from a hair transplant procedure.
The first thing I do is explain the procedure in depth and show them before and after photos of patient’s of mine who have had a similar hair type and balding pattern. This gives an idea of what to expect. I always encourage my prospective patients to spend time on my website looking at the more than 500 before and after patient photos and more than 100 videos of patient’s discussing their experience undergoing the procedure and their results shown on video. I feel that looking at both the photos and the videos give patients a realistic expectation as what to expect and the wide variety of results that are possible. The key factors are hair type, color, skin to hair color contrast, curly versus straight, and most importantly, how much hair will the person eventually lose over time.
Since it takes 6-7 months to see any appreciable results from the hair restoration procedure it is important to stress the growth timeline to the patient so that they understand exactly what to expect and are prepared for the time after the procedure before the new hair grows in. This can be a difficult time for some people and preparing properly is a very important thing to do before undergoing the procedure.
Finally, I tell every prospective patient that they will undergo this procedure more than once. This is for two reasons. Firstly, the transplanted hair will not fall out but the native hair will continue to fall and the person will want to keep up with continuing hair loss by transplanting more follicles. Secondly, almost every patient sees their results and wants to add to them by creating more density. Who wouldn’t want to add more density to their hair if they could?
Today I want to discuss a question I am commonly asked which is “when is the right time to have a hair transplant procedure?” The answer is different for every person. Each time I examine a prospective patient I try and estimate the full extent to which the hair loss will progress over the patient’s lifetime. This is imperative in order to understand how much donor hair the person will have available for the amount of balding area that will present over time. The individual needs to understand and internalize the amount of hair loss they will eventually have and try best as possible to see if they can be happy with a realistic result based on their supply to demand ratio. Young patients may not want to know their eventual hair loss amount or may want to proceed with a treatment plan that does not take this into account. This is not an option, as it is our job as hair restoration surgeons to educate the individual and only do what is right for the patient both in the short term and long term.
In general, I like to wait until the patient is at least 25 before performing the hair restoration procedure unless hair loss is taking a severe toll on the patient’s psychological health and I believe that the eventual loss of hair will not preclude the individual from being a good candidate for the procedure. In addition, that the prospective patient has a good grasp on what is a realistic result both in the short term and long term.
I always tell my patients when they ask me, “do I need to do the hair transplant now?”. No one needs to do this at any point. This is an elective procedure that people undergo in order to make them feel better about themselves. To reclaim a piece of the person that they once had. Something that was once part of their body and their appearance, that was taken away from them. When you get to the point that you don’t like looking in the mirror anymore at what you see on your scalp, then that is the right time to have a hair transplant procedure (assuming you are chosen as a good candidate and you have realistic expectations).
The psychological component of hair restoration surgery is one of the largest factors involved and it is our duty as hair restoration surgeons to educate our patients and allow them to make the best educated decision for themselves both in the short term and long run.