Hair Restoration Blog

Often times we at US Hair Restoration receive questions about the difference between the FUT Strip Method and the FUE procedure. Some will make claims that one option is superior, while the other is inferior. Both hair transplant techniques are done in US Hair Restoration and have their own adavntages and disadvantages.  Here is a list of reasons supporting both the strengths and weaknesses of the FUT Strip Method and the FUE:

The FUT Strip Method

• Allows the hair transplant surgeon to transplant a larger number of grafts in one session. Most people who have never had a hair transplant surgery can have maximum results in only one procedure.

• Allows the surgeon(s) to process and harvest the grafts under a microscope minimizing the level of damaged hair follicles.

•  Can be achieved at a more rapid speed than the FUE.

• What can be achieved in one FUT strip procedure can take 2-3 FUE surgeries.

• The number of damaged grafts might be greater for certain patients which undergo the FUE procedure because of their unique hair characteristics. People with wavy or   curly hair may have a higher risk of transection than patients with straight hair. A FOX test may be performed on patients with curly hair or wavy hair to determine whether or not they make good candidates for an FUE procedure. A FOX test is a small FUE procedure which helps to determine the level of damage to follicular graft before proceeding with a complete FUE transplantation procedure.

• The FUE requires more tedious labor and the cost for performing an FUE is usually more than a strip hair transplant.

• FUE procedures require a highly skilled operator and create a technical challenge for less experienced technicians who don’t have good hand-eye coordination.

The majority of the patients which receive a hair transplant with the strip method are going to have a linear scar on their donor area.  This scar can be minimized with certain surgical techniques such as the trichophytic closure, but it can never completely be eliminated. FUE hair transplant procedures offer unique advantages for differing patient circumstances.

FUE Procedure

• The scar visibility is slightly noticeable to completely non-existent with the FUE.  It may leave some miniature spots because of a lack of hair in that particular area or de-pigmentation, like a small dot which is lighter when seen close up.

• Hair can be kept short after the Hair Transplant surgery in front and back.  Any types of spots or de-pigmentation are not easily detectable.

• There is minimal pain for most patients and they don’t need pain killers after their hair transplantation.

• The surgeon can get donor hair from different parts of the body which the strip method has limited areas to take from. Areas such as the temples, beard and other body hair is included in this.

• The surgeon can choose the specific type of grafts to harvest.  When a special type of follicular unit is needed, this option is very good because the surgeon can choose the exact number of specific grafts to transplant. This is great for touch up work on the frontal hairline which needs single hair grafts, or for filling an isolated crown balding spot that does not require any singles.

• The contrast between high hair density and bald areas can be decreased by the FUE. Restoring hair in a scar only needs hair added to the scar, and the FUE would help to minimize the contrast between the scar and the surrounding areas more easily.

Despite of all above advantages and disadvantages about the two methods discussing them with a good hair transplant surgeon is a good starting point to find out what it the best option for you.

Q:

Hello,
I wanted to get more information like FUE transplantation vs. FUSS. I have been doing a lot of reading. How do you know if one is best and using a FOX test? I like the idea of the FUE but hear many claims that it is not good. However, I am not a big fan of getting a piece of my skin taken off. There is so much different information. Also all the normal questions that come with the procedure. I hope to hear from you.

Thank you for taking the time to read this,

A:

Great question! I realize that there is so much conflicting information on the Internet, especially relating to new technology and surgical techniques.

Follicular Unit Extraction (FUE) is a method we use to remove hair follicular units individually rather than taking a strip of the scalp and dissecting it into follicular units.

The truth of the matter is, there are many hair restoration centers which may promote one method vs. the other, strictly because they are capable performing it. They may lean towards recommending one particular one as oppose to another.

If performed correctly, FUE transplantation is a great solution for some hair loss sufferers, especially those with minimum hair loss or those avoiding a scar on their scalp. We also use FUE for people who suffer from significant pain or donor complications with previous strip procedure, and those with violated donor area for which removing more hair through strip is impossible.

With that said, most of hair transplant surgeries are still done through strip for many reasons:

• Strip hair transplantation gives liberty to the surgeon to maximize the quality and viability of the hair follicles. We anticipate some number between 1-5% as the highest for a trans-section of hair follicles in microscopic strip hair transplantation. This is because the grafts are all harvested under 3-D magnifications with stereotactic microscope.
• In FUE cases patients may have a high trans-section rate, meaning that some of the grafts are cut or damaged in the process of graft harvesting and may never grow into healthy hair. The trans-section rate might be very low in most people, with an average of 0 to 10%. However, in some people it might be significantly higher based on their hair’s characteristics. FOX test that should be done in for some people with curly hair, the FOX test can determine the patients who are not good candidates for FUE procedure. It is basically a small FUE transplant that determines the levels of a trans-section.
• In FUE Transplantation, we can harvest –up to 2000 grafts in one session. Sessions larger than that keep hair grafts outside of body for a long period of time that may jeopardize the grafts’ survival.
• These days, we have several methods, such as trichophytic closure, to minimize the visibility of the hair transplant scar.
• The cost of FUE is higher since it is more labor intensive.

I highly recommend having an evaluation by a hair transplant surgeon who is skilled in both FUE transplantation and strip method before you decide which procedure is right for you. A qualified hair transplant surgeon can discuss all your options so you can make an informed decision.

Q:

Are there any constraints on performing a further procedure if required in terms of the time interval and / or the number of grafts that can be harvested within a second procedure which is a) FUT, or b) FUE?

A:

If we need to add density to an already transplanted area we have to wait 6 months following the first hair transplant surgery.  By waiting this minimum of 6 months, we are able to see the complete growth of the recently transplanted hair  from the first hair transplant and thus, we can go in between these hairs to put the new hair.  The number of transplanted grafts in the second procedure is typically a bit less than the first surgery because we remove the scar of the first surgery for the second time.

Using hair from other parts of the body for transplantation into scalp has been used for many years.  Unfortunately though, the change in the life cycle of body hair from different areas of the body has caused the body hair to stay as the last option for scalp hair restoration.  Body hair has long resting phase and short growth phase which means that most of the transplanted hair will stay in resting phase without having visible hair growth.

Comparison of scalp (left) vs. facial (right) hair: Note the difference in density of hair per surface area and the average number of hair in each follicular unit. Scalp hair is denser with more hair per grafts (over 2hair/graft) while beard hair is less dense with fewer hair per grafts (1-2 hair/graft)

Facial hair such as beard and mustache hair on the other hand has a longer growth phase and shorter resting phase.  That is why men can grow their facial hair to become really long.  Facial hair is also thicker than scalp hair in most people.  Thicker hair could be translated as more bulk of hair after hair transplantation.  Both longer growth phase and thicker hair shafts make beard hair a better option for scalp hair restoration in comparison to body hair transplant from other areas.

There are two problems with with beard hair restoration.  One is that they are very sparse and removing hair only needs to be done through a strip procedure.  The other problem with using facial hair for scalp transplant is that the facial follicular units are having fewer number of hair per unit that means less hair per grafts removed with FUE techniques.

Beard transplants are gaining popularity recently with newer techniques for extraction of hair (FUE) and it can be a great alternative to scalp hair for transplanting to the balding area in people who do not have good quality scalp hair.

Q:

I am a 23 year old medical student with about 4 years of hair loss history. I have diffuse thinning with very aggressive frontal hairline loss. I would be looking to do 2-3 procedures at 2000 grafts each FUE style from my beard and chest area. But my body hair and beard hair seem to be just fine. I have had all of my bloodwork done to rule out any systemic problems thats causing this odd pattern diffuse hairloss (autoimmune alopecia is also ruled out by 3 dermatologists).

A:

Before proceeding with a hair restoration surgery, we have to properly determine your type of hair loss and candidacy for a hair transplant based on your history and diffuse hair loss.  Many people who have diffuse hair loss including the hair on the sides and back of their scalp may have a condition called Diffuse Unpatterned Alopecia (DUPA).  This condition can be mistaken with hair loss as a result of other systemic medical conditions like iron deficiency or possibly due to thyroid or other hormonal imbalances.  Body hair transplants through FUE harvesting techniques can be considered for those patients who do not have the option of scalp to scalp hair transplant, but it certainly comes as the last option considering the very short growth phase in hair cycle for body hair as opposed to scalp hair. Beard hair may be a better option in some patients, but all individual options need to be considered after a complete evaluation of patient’s supply and demand of hair.

* More information on body hair transplants and its results in contrast to that of scalp hair transplants, please visit Hair Restoration Blog.

Hair Care Beverly Hills interview with Dr. Parsa Mohebi

Below is the second interview of Hair Care Beverly Hills with Dr. Parsa Mohebi.  Dr. Mohebi is the medical director of US Hair Restoration hair transplant centers in Southern California with offices in Encino, Beverly Hills, Orange County and San Diego.  Dr. Mohebi is the author of Hair Restoration Blog.  He also responds to the questions of many other resources of hair loss and hair restoration.  Her is his recent interview of him by Hair Care Beverly Hills for BuzyMoms.com.

• If a client has already had a transplant with another hair transplant doctor and is disappointed with the hair restoration results, can the procedure be redone?

Yes, hair transplant repairs are a good portion of our hair transplant surgeries performed in our Southern California offices (located in Beverly Hills, Encino and Orange County). Many people may have unnatural results from previous hair transplants due to the older techniques such as plug surgery, but some may even have problems with recent hair restoration procedures due to technical issues or lack of proper judgment on the part of the hair transplant surgeon. In most situations, the repair is easy and can be done in one or two sessions.

• Is there a minimum age for hair transplant surgery?

It was not unusual that a Hair transplant surgeon discourage a person younger than 24 for a hair restoration surgery.  However, nowadays microscopic techniques being used to evaluate the miniaturization of susceptible hair can assist surgeons in predicting the final pattern of hair loss. By being able to predict each patient’ s final balding stages, we are able to see where the pattern of baldness is heading and based on that recommend hair transplant surgery at an earlier age.

• Won’ t my bare scalp be showing in the back of my head once the donor hair is taken?

If you do not plan on shaving your hair after your hair transplant surgery, your donor wound will never be visible. However, if you plan on shaving your head for any reason, you may choose to have a FUE or Follicular Unit Extraction procedure done rather than the general FUT procedure through removing a strip from the donor area. FUE transplant eliminates the visibility of a linear scar on the back of your head and is the best option for patients who plan on shaving their head or keeping their hair very short in the future.

• Do you provide free consultations?

Yes, the initial consultation with me (Dr. Parsa Mohebi) is always free in any of our Southern California hair transplant offices in Beverly Hills, Encino and Orange County and San Diego.

• What type of information should be brought to the consultation?

Anything related to your hair loss and hair restoration, including family history of hair loss, other medical conditions that may have been attributed to ones hair loss, medical, surgical or even cosmetic changes that you like and may help you have a better result after a hair restoration procedure.

Q:

I have heard of FUE transplants with relatively high-quality hair coming from the neck area, and from the beard. It seems like this could dramatically increase the number of grafts available for patients, at least for the hairline and front.  Then, body-hair (chest, back…), which I think are lower quality (but very abundant on me!), could possibly be used for the crown area. I would like to take as few hair from the back of the head as possible, and as much as possible from other areas.
Doctor, what do you think of this plan? Would it be a good strategy to pull from other sources rather then the scalp for donor hairs? What would be the costs involved?

A:

Follicular Unit Extraction (FUE) can remove hair from anywhere in the body as long as you are tested positive for FOX for those areas.  Neck hair is not the best option for hair transplantation because those hairs may fall out at higher ages of some patients. We can use body hair for hairline, and front or even the crown, but you may need multiple surgeries to obtain adequate density from those areas with body hair.  As we discussed before, body hair has a long resting phase in relation to its growth phase.  So you will have more follicles in resting phase (telogen phase) that do not have any visible hair in comparison to the ones in growth phase (anagen phase) that provide you with actual hair and give you coverage. We do FUE transplants in our California hair transplant centers on a regular basis.  FUE procedures are more labor intense and more time consuming so the cost of them are almost double in comparison to regular strip hair transplant procedures.

(more…)

Q:

We discussed the possibility to close the scar, which I think is a good idea, but again, I had already achieved camouflage with longer hair. While it may only be a 2-hour operation, I admit being very weary of such an operation because my skin is already so tight. I understand that the skin exercises you recommended should help a great deal, but for whatever reasons I am not comfortable with such an operation, especially considering that I would like to cover the whole head with some hair anyway. Perhaps you will convince me on the scar revision, or maybe you will advise me to pursue the FUE plan which would cover the rest of my head. Assuming I have an “average” density in the donor area, how many grafts do you think you could extract from it? How good or bad would be the mini-scars scattered all over the back of the head? I am assuming the surrounding hair will camouflage them?

A:

If you don’t want to pursue scar revision, the only option will be an FUE transplant into the scar from neighboring areas.  I recommend for you to wait until we see you in your follow up visit with a little longer hair before continuing. You also need to schedule for the FOX test to determine your eligibility for a Follicular Unit Extraction procedure.  The answer to your questions about how many grafts could be harvested in one session of your FUE procedure will be answered the day we do FOX test and confirm your eligibility.

You need to contact US Hair Restoration to schedule the FOX test as soon as you are able.  FOX test’s are done quite easily and assisted by numbing a very small area on the back of your scalp. The small scars of the FUE are going to be scattered throughout a larger area.  That can minimize the visibility of those pinpoint scars.  If you keep your hair not too short it is generally not possible to see them at all, but with a shaved head the tiny scars might be detectable from a close view.

Q:

hi

I come from china ，I would like to consult your organization a few questions:

In your experience,usually Asians（chinese people) the normal growth of the number of roots Per cm² of hair? Head at the top and post-occipital whether there are different?
using FUE technology，on one operation ，After the occipital Site  get the maxinum number of FU (Asians including 2-3 days operation) at present,how much FU can be planted per square centimeter on Planting area? Between the scope of? and the percentage with normal?

Looking forward to your reply Details!

Thanks for your questions.

A:

Here are the answers in the order they were received:

The number of hair follicles

The number of hair follicles in non-balding areas of scalp like occipital areas have been studied.  A range of 80 – 120 follicular units (FUs) per centimeter were reported. The density of follicular units vary in different locations of the scalp. Also, the number of hairs per follicular unit vary in different areas and with different races. For example, Asians usually have less number of hair follicles per cm², so even with similar number of FUs per cm², the density of their donor area is still less than Caucasians. To calculate the number of hair per cm², you have to average the number of hairs per FU and multiply it by the number of FUs per cm².

Difference of hair on top and back

The shaft of hair may or may not be different in different areas of the scalp. Obviously, if you are balding, you see more miniaturization and less terminal hair, which makes the appearance of the hair less dense on the area. However, without baldness, hair quality would be the same in back and top of the head.

FUE and number of grafts

FUE (Follicular Unit Extraction) is more labor intense and requires more time for harvesting the grafts. For that reason, FUE procedures are generally smaller in terms of the number of grafts per session. What we do at US Hair Restoration is up to 1,500 grafts per day on average, for 8 to 10 hours work in a FUE procedure. The number may occasionally go up to 2,000 grafts, too, but not everyone can expect to get that number with FUE.

Density of transplanted hair

There are many research projects on this topic. The number can be as high as normal density in some circumstances. However, practically we can make up to 35%-40% of the normal density in one session. This is a good number if you consider that the density of hair on frontal areas could be about half of the hair on the donor area in some patients, so 35%-40% is not that far from the normal density in those patients.

Searching for the best Los Angeles hair transplant surgeon may not be an easy task, but Los Angeles has always been a referral center for most cosmetic surgeries, even though hair transplant surgery is one of the newer branches of cosmetic surgery. You can find a wide variety in style and levels of Los Angeles and Beverly Hills hair transplant surgeons. Some of the most updated hair transplant surgeons practice in Los Angeles and San Diego, California, but you can also see lousy surgeries done by some hair transplant surgeons. Overall, hair restoration surgery like any other cosmetic surgery is a buyer‚Äôs beware market, and one must be careful not to fall into the trap of signs such as “Number one Beverly Hills hair transplant surgeon” or “the most experienced Los Angeles hair transplant surgeon”. You can see similar advertisements and a lot more like Extreme make over hair transplant surgeon or doctor 90210.

The good news is that today, most hair transplant surgeons offer free initial consultation. It is importantto take advantage of this situation and shop around. It is your look and your desire to live with it for the rest of your life after all. It is not enough to visit several hair transplant doctors; you also need to educate yourself on hair transplantation process, surgical techniques and hair transplant surgeon’s background before visiting the doctor. This way, you can appreciate a good technique and knowledgeable doctor when you see one while you can find the most affordable hair transplant. US Hair Restoration – a Los Angeles hair transplant surgery center offers free physician consultation for everyone. We offer state-of-the-art hair transplant surgery with exclusive follicular unit transplants (FUT), mega sessions for people with extensive hair loss and follicular unit extractions (FUE) or noninvasive hair transplants that does not leave an scar in the donor area.

Los Angeles is Hollywood and in Hollywood “appearance” is everything. Modern hair transplant surgery with undetectable results has become a demanding field in Southern California in last few years both because of the number of people looking for hair restoration surgery and the ones looking for the best hair transplant surgeon in Los Angeles, Beverly Hills and Southern California over all. Many people travel the world to get their hair transplant surgery done in Los Angeles or Beverly Hills. Los Angeles is and will probably always be the Mecca of hair transplant surgery for people who cannot accept anything but the best.