Hair Restoration Blog

Q: Hello Dr. Mohebi, I had a strip procedure a month back for 1500 FUs on the front/middle section of head. While I wait for this results, I was thinking if I can have a FUE procedure for crown and hairline enhancement, so that my recovery will be well utilized. I may be wrong. Could you provide your recommendation/suggestion? Thanks. A: In short the answer to your question is yes.  However, there are some qualifying factors and conditions for this consideration. When performing a ‘Strip Method’ FUT surgery it is possible to also perform and ‘FUE’ follicular unit transplant immediately following the first surgery. Actually the two types of procedures can be performed in the same session; as long as the FUE grafts are being placed in different recipient areas.. If you need to restore hair in the same recipient area as a previous hair transplants procedure, then I recommend a minimum wait of 5-6 month from the first hair transplant procedure. The reason for this is that we need to see outgrowth of hair from the first procedure. The visibility of the new hairs allows us to be able to place new hair in between them and to avoid placing a new hair graft on top of the old ones.

Follicular Unit Extraction (FUE) and Slap Micro Pigmentation (SMP) could be both used to minimize the visibility of the scalp scars after a strip hair transplant procedure.  At US Hair Restoration, we offer both these techniques.  However, there are pros and cons to each that the patients need to know before proceeding with the procedure.

FUE for Scar Revision

FUE transplantation into the donor scar: Left side - Intact scar, Right side - FUE grafts transplanted into the scalp scar

Since the extraction of individual follicular units (FUs) is done individually it is perfect for the small procedure of revisioning a hair transplant scar from a previous hair transplant. The surgeon can extract a small number of grafts from the permanent zone and artistically and strategically place them in the scar. This process of using FUE uses hair to obscure and blend the margins of the scar to the surrounding scalp.

SMP for Scar Revision

SMP to minimize donor scar visibility after hair transplantation - Picture is taken immediately after the SMP procedure

Scalp Micro-Pigmentation is the process of using special pigments and fine needles to create the shade of stubble or shaved hairs on the scalp. SMP utilizes dermal pigments that match the patient’s hair color. Used in scars like FUE it can artistically applied revises the margins of the scars. This revision results in the obscuring or blending of the scars margins to the surrounding scalp.

SMP vs. FUE for Scalp Scar Revision

choosing FUE rather SMP for revising the scalp scar has to do with the type, location and size of the scar.  It also has to do with the patient preferences.  If patients are willing to keep it very short or they want to completely shave it.  It is good for the patients to educate themselves with pros and cons of each technique in order to make a more informed decision.

FUE and SMP

FUE and SMP are two methods that can also be used in conjunction with one another to revise a hair transplant scar. Recommendations and the preference of the surgeon most often provide the best results. These modern advances in scalp scar revision are performed in Los Angeles leading hair transplant centers like US Hair Restoration.

Q:

Who makes a good candidate for FUE? Are the cost’s higher than with other techniques you use?

A:

An FUE transplant is best suitable for those who have not experienced a tremendous amount of hair loss and are not expected to advance any further to a higher stage of hair loss. The ideal candidate for an FUE would be someone who falls under the category of a class III on the Norwood scale. A class III patient is one who has not experienced miniaturization on a large area of scalp and has no prior family history of advanced balding. Also, an FUE patient may require several procedures in order to restore their hair, as opposed to just one.

You also asked about the price of a FUE hair transplant.  The cost of FUE transplant is twice as much of the cost of a hair transplant with the strip method per each graft.

Q:

Dr. Mohebi

There seems to be a lot of talk on the internet about FUE and ARTAS procedures. Can you explain to me what the pros and cons are of these types of procedure vs the strip technique?

A:

We perform both ‘Strip Method’ and FUE transplants in our practice. Both of these procedures are the most modern forms of Follicular Unit Transplantation (FUT) for hair restoration. FUE procedure could be done through different techniques such as manual and automated.

ARTAS is a FUE machine that harvests Follicular units by a robotic arm. Since the robot removes the hair grafts, the procedure is easier on the surgeon, but it is not flexible as of using different punches that might be necessary in different individual. Besides the harvesting the rest of the procedures are the same in two techniques of Strip FUT and FUE.

Strip gives us better quality grafts and preserve your donor hair better. It is also more affordable. This is especially important for someone like you with possibility of further hair loss in the future (based on your microscopic evaluation). Strip hair transplant leaves a linear scar on the back that might be visible if you shave your head in the future or keep it very short. I think the main question is whether you need to keep the option to shave your head in the future or not. Here is more on the differences of FUE and strip hair transplants in our blog.

Report of ISHRS 20th Annual Scientific Meeting

OCT 17-20 2012– Atlantic City, Bahamas

The annual meeting of International Society of Hair Restoration Surgery is the most significant hair restoration meeting worldwide.  This year’s meeting was one of the best in terms of the content of the information discussed.  The meeting was held in Atlantic City, Bahamas.

Hair Restoration Surgery is evolving rapidly with newer technologies that enhance our understanding of hair growth and the tools that help us expect better growth. This year’s conference hot topics had five areas of focus. These topics are reviewed below:

Robotic hair restoration

ARTIS or Robotic Hair Transplantation was actively promoting its robotic arm that helps the surgeon to extract the FUE Grafts for hair transplantation.  The Robotic hair transplant update for 2012 was not as significant as many attending physicians anticipated.  Considering that the robotic hair transplant is being promoted and used in several offices actively for over a year, most surgeons expected to learn more about the scientific evaluations that can differentiate robotic procedures with other techniques of hair restoration.

The doctors who used robot in their offices in the last year discussed their personal experience with robotic hair restoration.  Some discussed that the numbers of grafts have been improved, but there was not a significant evaluation on the quality of grafts to other methods of FUE hair harvesting or to compare the robotic grafts with grafts from strip hair transplants.

Stem Cell and hair multiplication

We have had a few discussions about new advancements in Stem Cell research in 2012.  Some of the familiar faces gave lectures about the status of hair stem cell research and where we are standing on hair multiplication.  At present it appears  that no one has started the phase III level of research.  In practicality this means we are unlikely to be able to have a way to multiply hair in the next 8 or 10 years. Until we hear the phase III level of hair multiplication studies are successfully completed our patience and our practices will be reliant on our present hair restoration methods.

FUE transplantation

Many doctors discussed the increased rate of FUE hair transplantations worldwide.  However, comparing different countries, it is apparent presently FUE is being used mostly in Asia and Europe in comparison to the United States.  I (Parsa Mohebi, MD) presented result of the study of the effects of delay in extracting follicular units on viability of FUE grafts.  I have discussed the conclusion of our study on 3 patients in which FUE grafts were initially punched and then removed in 5, 30, 60 minutes and 4 hours.

This study was the only study conducted  to compare the in-situ viability of the follicular unit grafts.  The study showed that keeping the punched grafts in scalp longer than a few minutes may decrease the survival of the grafts. The results of this study may help the design of the next generation of FUE devices and robotic surgery to try to be more efficient with the time that grafts are punched and before they could be removed from the scalp.

Methods for improving the aesthetics of hair restorations

I had another presentation on the advantages and disadvantages of extracting hair from temporal areas.  I have brought up the “Mad Scientist Phenomenon” which refers to the situations that hair transplant surgeons harvest maximum number of grafts from the donor area on the back and not take any hair from temporal areas in patients who have a high density of hair on the temporal areas. The thickness of hair on the temporal areas may undermine the drastic changes that a hair transplant may have on restoration on the front and top areas.

Finasteride Controversies

Dr. Washenik from Bosley discussed the controversies around finasteride (Propecia).  He discussed the persistent sexual dysfunction controversy and a Canadian lawsuit that could not link the side effects to the medication.   Dr. Sharon Keen discussed that the studies that reviewed the permanent side effects of finasteride did not have adequate objective evaluation of health status in those patients.  There were also some discussions about other side effects of finasteride such as the DHT blocking effects on increased production of testosterone and estrogen that may lead to gynecomastia (enlargement of breast tissue in men).

 Why have an FUE Transplant Procedure for Hair Restoration?

Mohebi Medical, US Hair Restoration centers are leading clinics in hair transplants. Their southern California offices receive questions daily via phone or online regarding the latest advancements and technologies in hair restoration. Parsa Mohebi, MD an internationally recognized leading surgeon and researcher in hair restoration leads the medical team at the clinic. We receive calls almost daily regarding hair restoration through hair transplantation.  We are often queried regarding Follicular Unit Extraction [FUE] hair restoration surgery.

FUE Hair Transplant

There is a lack of clarity for some people regarding FUE and FUT hair transplant surgeries. Mohebi Medical, US Hair Restoration centers specialize in performing both types of surgery for hair restoration. Though Strip Method, a form of FUT hair transplants is by far the most common surgery performed; FUE procedures offer certain advantages.

FUE hair transplant surgery is a form of hair restoration. This medical procedure should absolutely be performed by a Board Certified medical doctor. FUE stands for Follicular Unit Extraction (FUE.)  FUE is a method to remove hair follicular units individually. The other method used in modern hair restoration involves taking a strip of the scalp and dissecting it into follicular units. FUE is a particular type of FUT hair restoration surgery.

Based on a patient’s consultation and microscopic scalp evaluation, and FUE hair transplant may be deemed the best choice. At our Los Angeles based centers we do not have a preference for a type of hair transplant surgery. Mohebi Medical maintains a patient centered practise Doing what is best for the patient.  FUE transplants are great solution for some people.

FUE transplantation is a viable solution for many hair loss sufferers, especially those with minimum hair loss or people who really want to avoid having a scar on their scalp. FUE is also a good choice for people who suffer from significant pain or have low pain tolerance. There may be other specific medical reasons base on a person’s medical history that makes FUE transplant the best choice for them. At times we choose FUE to correct issues arising from poor surgeries done elsewhere.

Below are some more facts regarding FUE hair transplant surgery:

FUE transplantation, we may harvest up to 1500 in one session.

• FUE procedures for patients needing more grafts than 1500 should be done in another session.
• FUE allows for donor hair to come from other areas of the body; this is helpful when scalp donor hair cannot yield the number of grafts needed.
• FUE is a great choice for other cosmetic options such as restoring eyebrows and hairlines
• FUE transplant are an optimum choice for scar revision in the scalp when most often only a limited number of grafts are needed.
• The cost of FUE is higher since it is more labor intensive and requires more specialized artistic skill.

In properly considering and FUE transplant, it is recommended to 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. Our firm provides online video consult for our patients globally.

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 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 manny claims that it is not good..However, I am not a big fan of getting a piece of my sking taken off. There is so much differnet 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:

Thank you for your question. It is a very good one.

Follicular Unit Extraction (FUE) is a method by which we remove hair follicular units individually as opposed to taking a strip of scalp and dissecting it, extracting the follicular units.

You are absolutely right in the fact that there is a lot of different information online, for and against FUE procedures. The truth is that many hair restoration surgeons and facilities promote one method versus another due to their specific surgical capabilities. FUE, if done right, might be a great solution for some hair loss sufferers – primarily those with minimal hair loss, those who (for any reason) cannot have any type of scarring on their scalp, those who have had problems associated with previous strip procedures, and those with a compromised donor area wherein a strip procedure just isn’t possible.

Having said that, most hair transplant surgeries are still performed utilizing the strip method, for a number of reasons:

Strip hair transplantation allows the surgeon to maximize the quality and viability of the hair follicles. We anticipate a maximum hair follicle transection rate (“transaction rate” referring to hair follicle ‘grafts’ that are cut during surgery, resulting in follicles no longer capable of growing healthy hair) of 1-5%, since the grafts are harvested under 3-D magnification with stereotactic microscopes.

In FUE cases, patients may experience significantly higher hair follicle transection rates of up to 10% or more. A FOX test is performed, primarily, on patients with curly hair to determine whether or not they are candidates for an FUE procedure. (It is basically a small FUE procedure.)

Although mega and giga session hair transplant procedures of 4,000 grafts or more can be performed using the strip method, individual FUE procedures cannot harvest more than 1500 to 2000 grafts. Sessions larger than this will keep hair grafts outside of the body for an extended period of time, potentially jeopardizing their survival.

Today, we have several methods to minimize the visibility of any scarring resulting from a strip procedure.

An FUE procedure is labor intensive, and as such the cost for performing an FUE procedure is significantly greater.

I think it’s best that you be evaluated by a hair transplant surgeon, skilled in both FUE and strip techniques before deciding which procedure is right for you.

Please don’t hesitate contacting us if you have any additional questions.

Thanks,

Q:

My hair loss is ruining both my life and my family’s lives. I go to the XXX school of medicine in XXX and would be flying over to get the procedure done. I wanted to see if we could discuss a large FUE treatment from my body and beard area for transplantation into the balding areas of the scalp to end my hair loss for good.

I look forward to hearing from you,

Cheers

A:

As I have previously stated before here in my blog, body hair can be considered as an alternative method for hair restoration as long as you, the patient, understands that the end result is not going to be comparable with a scalp hair transplant due to smaller final length of hair and short growth phase (Anagen) as opposed to long resting phase (Telogen) that are characteristics of body hair.  In other words, you may only see a portion of transplanted hair follicles in growth phase while the remainder stay in resting phase without maintaining a visible hair shaft.

Beard hair transplantation could also be another option, which is typically closer to scalp hair in many patients and has a longer growth phase (which is why it grows to become longer in comparison to body hair).  However, any of these options have their own pros and cons and patients should be evaluated for each treatment plan based on their needs and only after a complete evaluation by a hair transplant surgeon is performed.

Discount for FUE Transplant – Limited Only for Study Participants

As a leader in hair restoration, US Hair Restoration is now conducting a study on different methods of FUE (Follicular Unit Extraction) hair transplantation in its Southern California offices.  Our main goal of this study is to compare the quality of grafts harvested by the most advanced hair restoration techniques.  Study patients will be entitled to a discount from our standard rates of FUE hair restoration. The study will be going on until the end of July 2010 and the results will be submitted for publication in world-wide medical journals.

Who is a good candidate?

Hair loss patients who does not want to have linear scar on the back of their head might consider this option most probable for their needs.  Also, any candidate should know that the number of grafts available to be harvested in one FUE session might be significantly less than what could be done through a traditional strip method.  Thus, in addition to those who want to avoid scarring, patients who does not need a large number of grafts for their hair restoration may also be relatively better candidates.  FUE could be used for treatment of male patterned hair loss with class III and IV, eyebrow hair transplants, or to restore the linear scar from a previous strip procedure. Applicants can call the US Hair Restoration office at 1 (800) 302-8747 to schedule a consultation with Dr. Mohebi.  If you are still unsure whether or not FUE is the right procedure for you, please read our website and in particular the page on Follicular Unit Extraction.