FUE has become more popular than ever given the fact that in the hands of a skilled surgeon the results can be as good as FUT (The strip harvest method) or even in some cases better (due to the fact that with FUE we can choose which follicles to harvest and therefore choose the follicles with the most amount of hairs per follicle). Up to now one of the downsides of FUE was that it required the entire back and sides (harvest zone) to be shaved in order to harvest the follicles. Now we have a new way to perform FUE cases without shaving the entire donor zone. I call it “No Shave FUE”. What we do is go through the donor zone and cut short individual follicles that we plan to harvest and leave the surrounding hairs at their normal length. This makes the donor zone appear untouched to the naked eye, and is much less visually impactful than a head shave, and gives us the same results as a traditional FUE shaved case. The no shave technique is more time consuming and thus more expensive, but for those people (like myself) who refuse to shave the back and sides of their heads but want the FUE procedure, this is a great option. Below you can see an unshaven FUE patient one day after just over 2000 grafts were extracted via FUE.
All the best,
Marc Dauer, MD
This is a patient’s donor zone one day after FUE was performed.
Typically FUE has been performed by shaving the entire back and sides of the scalp as the hairs harvested via FUE need to be very short. Recently I have been performing no shave FUE or long hair FUE. This technique involves cutting short the hairs to be harvested from the donor region individually while leaving the hair around it long. This allows us to perform FUE without shaving the entire back and sides of the scalp and makes the entire process much less visually invasive. This process requires very specific expertise but for many people that want FUE but don’t want to shave their heads this is a great option. I recently posted a video of the process on my youtube channel which shows the entire process.
In the past we needed to shave the back and sides of the scalp to perform FUE because the follicles can only be extracted as short hairs.
Noe we have a new technique called long hair FUE. With this technique we go through the donor region and individually cut short the follicles we will extract while leaving the hair around it ling. This allows the patient to keep their hair long for the procedure and creates no significant change to the patients visual appearance.
This technique is a but more expensive than short hair FUE but for those that don’t want to shave their head it can be the difference between doing the procedure and not doing it.
The photo below shows a long hair FUE patient of mine’s donor region one week post procedure.
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 has a case of LPP which is a form of scarring alopecia. He has lost small patches of scalp hair in no specific distribution secondary to the disease process and he los all his eyebrow hair as well. He previously had an eyebrow tattoo and was disappointed with the look and presented to me for eyebrow transplants.
I explained to the patient that scarring alopecia is a very unpredictable process and that no guarantees could be made as to the success of the eyebrow transplant. Due to the fact that he had scattered patched affected in the scalp I felt our greatest chance of success was to perform the procedure with an FUE harvest and to find unaffected areas of the scalp to harvest the donor hair from.
I personally harvested every follicle using a 0.8mm motorized punch. We only placed single hair grafts into the eyebrows. We placed approximately 270 hairs per eyebrow.
The results here are shown after only 6 months. The patient should see some increased growth over the next 2-3 months.
The patient is beyond thrilled. The lack of eyebrow hair previously was a constant reminder of his disease process and the new eyebrows have given him a new self confidence.
Here is a eyebrow transplant video showing every step in the process of an eyebrow transplant procedure. My patient in the video is Beverly Hills Plastic Surgeon Dr. Cat Begovic. Dr. Begovic is a world renown surgeon and she was very meticulous in her research before deciding to have me perform her eyebrow transplant procedure. In the video she describes the entire experience in her own words. I hope you enjoy watching.
Here is a patient who came to me after having undergone several previous procedures and scalp reductions with other hair transplant physicians.
He wanted to add hair to his mid scalp and crown (where there was virtually no hair and a scalp reduction scar) and to attempt to conceal a very wide donor scar from his previous strip hair transplant procedures.
I extracted just over 900 grafts from the neck beard and placed them into the scalp and scar. The results are shown after 9 months and they are already impressive.
The patient should see some increased density over the next 3-6 months as the hairs thicken in diameter.
Although the beard hair is a different consistency than scalp hair it works well in cases like this where there is no more scalp hair to donate and when “filler” hair is needed for increased cosmetic density.
The patient is looking forward to another procedure to add more density in the scalp from the beard hair.
A patient with a relatively thick beard can have up to 2000 grafts to donate from the area below the jaw line.
All the best,
Marc Dauer, M.D.
beard hair extracted via FUE transplanted to the scalp
beard hair follicles extracted via FUE and transplanted into strip scar
In the most recent issue of the International Society Of Hair Restoration Surgery journal there is an extensive very interesting debate between those who advocate FUT over FUE and those who advocate FUE over FUT.
Many of the salient points discussed I have previously written about here in my blog. I will briefly review a few of the most important points here.
FUE Advantages- less invasive, diffuse dot scarring versus strip scarring with FUT which in most but not all cases allows the patient with FUE to cut the hair down to a #1 or #2 without showing any evidence of scarring, less discomfort post procedure
FUT Advantages- no need to shave the head to harvest the donor hair, ability to harvest more hair in a single day, more donor hair available to harvest throughout the patient’s life (start with FUT and convert to FUE after FUT is no longer possible thus maximizing the donor zone overall), less expensive than FUE
There are many subtleties to the advantages and disadvantages of both of these procedures.
What is most important is that your hair transplant surgeon is proficient in both procedures and offers both procedures to patients.
I prefer to educate my patients as to the benefits and drawbacks of both FUT and FUE and let them choose the procedure that suits them best. I enjoy performing both FUT and FUE and let patient’s know that if everything goes as planned they should have a great result no matter which method they choose.
Here is a patient of mine who wanted empty patches in his beard and mustache filled in. I used a 0.8mm FUE punch to extract hair follicles from the neck and transplanted these follicles into the beard and mustache. The results are shown after 6 months and the patient is thrilled.