Hair Restoration Blog

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:

Hi Doctor,

I am a class VI hair loss patient and have had one hair transplant in the past to get some thin hair on the front and top.  I am keeping my hair very short on the back and my primary goal was to camouflage the scar in the back of my head from previous hair transplants. So far, I have achieved this simply with longer hair, and the rest of my scalp was covered with Toppik-like products.

Cosmetically, it was successful, but usage of this kind of product is a bit messy and cumbersome. Thus I have shaved my head completely to try a different route. With the help of tattooing, I was going to go for a shaved head. Of course, the scar is a show-stopper and I need to consider my options. What I would consider successful is this: short hair covering my head completely, even with relatively light density. Combined with tattooing and a self-tanner to reduce contrast, that would be a success to me. I am not “greedy” about the sides at the front, and will accept a 3 or 3A pattern.

Is it possible in my case?

A:

It is good that you are not after high density and that you are realistic about the final appearance of your hair.  Being a class VI with limited donor hair, it should be possible to create some light density in the large balding area, but obtaining more density would be impossible or difficult due to your insufficient donor.  You need to know what your priorities are and how many surgeries you are committed to have.

• If you only need to revise the scar and get trichophytic closure to minimize the visibility of the scar, one surgery is adequate.  Double edged trichophytic closure is a new technique that can improve the appearance of the scar tremendosly.
• If you are after achieving higher densities and scar revision, you may need several hair transplant procedures if you have enough donor for them.

Through a consultation with an experienced hair transplant doctor, your donor hair can be easily evaluated and that can give you a good idea about what could be expected (in your case).

Double edged trichophytic closure is a new approach to donor wound closure.  Double edged or two sided trichotomy can help to minimize the complications of trichophytic closure based on the width of epithelium that is being removed and inability of some the hair follicles or oil glands to find their way out to the skin surface.

Hair Restoration Surgery is evolving rapidly and we are consistantly refining our approach on a regular basis to improve the quality of transplanted hair while at the same time minimize the possibility complications.

Double edged trichophytic closure helps us to minimize the width of the top skin layer (epithelium) that is being removed from each edge of the donor wound.  This approach allows hair to grow into the wound from both edges and thus minimize the contrast between scar (with no hair) and surrounding scalp (with 100% hair density).

By employing double edged trichophytic closure we constantly have results of less detectable donor scars and are able to minimize the risk of folliculitis or ingrown hairs in the donor area, which are the two common complications of trichotomy with the traditional methods.

Q:

Hello Dr Mohebi. I am about 16 days post op and had my trichophytic sutures removed about 5 days ago. The wound has healed nicely with no scabs left -but I still experience sensations in the donor area during my sleep which eventually causes me to sleep sideways or my stomach. Are these sensations unusual this many days post operation? Thanks for reading and responding.

A:

Having slight pain or tenderness following the first 2 days from hair transplant surgery is not unusual.  However, if the pain is to the point that it is affecting your life style or to the point that you have to continue to take pain medications after the first few weeks, I recommend that you go back to your hair transplant surgeon and let him/her re-evaluate you.  Development of folliculitis, especially if you had trichophytic closure, may cause pain.  Minor pain or unusual sensations (paresthesia) after any wound closure could be due to the irritation of small nerves that are in the vicinity of the healing wound and may last to a few weeks after surgery, but will eventually go away.  Having said that, it is not a bad idea for you to be evaluated by a specialist in-person to be on the safe side.