Today FUE hair transplant procedures have made hair transplants less invasive and much more comfortable for the patient than ever before. Unfortunately one of the drawbacks of FUE is that there is a lower overall yield of the number of grafts from the donor zone as compared with FUT plus subsequent FUE procedures afterward. What this means is that it is very important to accurately estimate the end point of hair loss as well as the total available donor graft count so that a proper plan for hair restoration can be formulated at the beginning rather than running out of grafts later on and have to leave large areas of bald scalp without transplants.
There is a push to create very low, non balding hairlines, in young patients using large number of grafts. Unfortunately many of these patients will end up with a severe form of hair loss and won’t have enough donor hair to cover the eventual bald zones. In these cases it will actually look even worse with a low rounded hairline and larges areas of bald scalp behind.
Here is a case showing how I used a relatively conservative number of grafts to augment the hair in the frontal scalp. Even though it wasn’t a huge number of grafts it created a huge visual impact. The after photos are only 9 months post procedure so the patient will continue to see thickening of the hairs and cosmetic improvement up to 18 months post procedure. The patient his already thrilled with his results and it show how a relatively moderate number of grafts can still have a significant impact while still leaving a good amount of donor grafts available in the future for continuing loss.
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.
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.
This is a patient who previously underwent an FUE procedure performed by another physician with unnatural results secondary to the placement of large grafts in the hairline. I created more density and placed single hair grafts into the hairline to create a more natural look. The grafts were harvested via FUE using a 0.8mm motorized punch tip. Approximately 400 single hair grafts were placed into the hairline to create a much more natural look.
Unfortunately there are many physicians offering hair transplants that are not properly trained. It is imperative that you do your research before deciding on your surgeon and always chose someone who specializes exclusively in hair restoration.
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