Hair Restoration Blog

Q:

Dear Dr. Mohebi,

What follicular unit trimming technique does USHR employ? Is there a survival rate difference between the different trimming techniques (chubby vs skeletonized)?

Are there any distinguishing characteristics of the follicular units, once they are grown out, between the chubby trimmed versus the skeletonized trimmed follicular unit grafts?

Dr. Mohebi, is there a size difference between a a follicular unit containg one hair and a multi-hair follicular unit?

Thank you for sharing your expertise and opinions.

Sincerely,
–

A:

These are great questions and we will use them for blog posts too. Here are the answers to your questions:

We are committed to the gold standards of hair restoration in our hair transplant procedures. We perform exclusive follicular unit transplants to maximize the natural appearance of the hair while increasing the survival of hair follicles. We only skeleton single hair follicular units that are needed to be used for frontal hairline to minimize the chance of growing anything but single hairs which mimics a normal hairline.  For anything else 2s, 3s and 4s we use chubby grafts to maximize their viability.

Chubby grafts can result 100+% result because of the growth of hidden hair follicles in telogen phase.  They also have more supportive tissue to support the follicles.  It has been studied and documented that chubby grafts have a higher survival rate than skeletonized ones (proven in two different studies done by Dr. Beehner 2010 and Dr. Seager 1997).

Even transplanting two single hair follicular units in one site have higher survival rate in comparison to two individual single hair that are transplanted separately.  That is why we combine the single hairs with other singles in one site to increase the final density and also enhance survival of hair grafts.  The only exception is for the single ones that we have to use the way they are on hairline area to minimize the chance of growing more than one hair on the hairline.

• So here is my recommendation for hair transplant surgeons: Make the hairline single hair grafts skeletonized and the rest keep them chubby for the best result.

For more on that please read the Skinny Vs. Chubby follicular unit transplants article on our website.

Folliculitis is a pimple -like skin lesion that is seen when hair follicles become inflamed for any reason.  Folliculitis could be seen anywhere in the skin.  Follicle and their surrounding tissues may become infected with different bacteria often Streptococcus aureus.

Certain variations of folliculitis are also known as hot tub folliculitis and barber’s itch. Sever cases of infected folliculitis can cause permanent damage to the hair follicles and lead to local hair loss on the area of infection.

Folliculitis After Hair Transplantation

Folliculitis is one of the common complications of a hair transplant surgery due to blockage of hair or its sebaceous gland when a newly transplanted hair is growing.  Folliculitis after hair transplantation usually appears as small, red or white-headed pimples around one of more follicular units.  Folliculitis may present with itching, mild pain and discharge. Most cases of folliculitis (especially the ones occurring after hair restoration surgery) clear spontaneously in a few days, however more extensive types may need medical or surgical treatment.

Folliculitis may be seen a few days or even months after a hair transplant surgery. They are generally difficult to be differentiated from common pimples or acne. Presence of simple folliculitis usually does not affect the growth of transplanted hair.

Treatment

Simple folliculitis generally does not need any treatment and the lesions tend to clear up on their own within a few days.  Occasionally, they may become infected and that is seen with the spread of redness and inflammation of skin around the original inflamed follicles.  A physicians evaluation can best determine whether or not you need antibiotics for the treatment of your folliculitis.  Occasionally, as a way to avoid use of medication or continuing infection, your doctor may decide to drain them.  Draining the folliculitis collections is a simple procedure and can be easily done in your doctors’ office.

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.

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