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This hair loss article was written by Dr. Ron Shapiro of Bloomington, MN who is a member of the Coalition of Independent Hair Restoration Physicians. 

What is Follicular Unit Extraction (FUE)?

Follicular Unit Extraction (FUE) is a method of obtaining donor hair for Follicular Unit Transplantation (FUT), where individual follicular units are harvested directly from the donor area, without the need for a linear incision. With the FUE technique, a .8mm to 1 mm punch is used to make a small circular incision in the skin around the upper part of the follicular unit, which is then extracted directly from the scalp.

Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE) are sometimes mistakenly viewed as being two totally different hair transplant procedures. FUE, in fact, is a sub-type FUT where the follicular units are extracted directly from the scalp, rather than being microscopically dissected from a strip that has already been removed. To say it another way, in Follicular Unit Transplantation, individual follicular units can be obtained in one of two ways; either through single strip harvesting and stereomicroscopic dissection, or through FUE. Therefore, when comparisons are made between FUT and FUE, what is really being compared is the way the follicular grafts are obtained (i.e. strip harvesting and dissection vs. direct extraction). The process in the recipient area is the same.

The main advantage of FUE is that it does not cause a linear scar. Therefore it is useful in patients who for one reason or another may in the future want to have their donor area very short. (<1cm in length). This advantage was the main reason for the development of the technique.

A hair transplant procedure is usually considered a success if it looks natural and all the transplanted hair grows. But a beautiful head of hair with an obvious scar is not very appealing to patients. Thankfully, with today’s state of the art surgical hair restoration donor closure technique, scars are usually easily concealed by the surrounding natural hair even when cut very short. But are there conditions when the donor scar may be more obvious? What about when your hair is wet coming out of the shower or from swimming?

Forum member “Eman” recently had a hair transplant procedure and claims his donor scar is still visible when he gets out of the shower. View this thread to learn why and to offer your input and experiences.

Bill - aka Falceros
Associate Publisher/Editor

Technorati Tags: hair transplant, transplanted hair, hair restoration, hair transplant procedure

This insightful information was posted on our hair restoration forum by Dr. Timothy Carman of La Jolla, CA, who is recommended on the Hair Transplant Network.

I’ve been doing some research on this, but haven’t been able to find the answer anywhere.  When you have a second hair transplant, do you receive multiple scars or does the hair restoration physician “overlap” the old one, removing it entirely along with the second strip?

If the previous donor hair was taken in a much lower position on the scalp than is the usual case (NOT a common occurrence), it may not be prudent to attempt to remove the first donor scar as the re-occurrence rate and/or development of an even wider scar in that area is a very real possibility.

In general, amongst experienced hair restoration surgeons who are current in their techniques, there should be fairly small variability in the size and location of donor hair chosen, and thus the residual scars, so that the salient points brought up by hair loss forum member “tofueornottofue” should be the rare occasion.

Also, then, as he points out, most hair transplant surgeons will remove the previous donor scar so that at any one time, only one minimal scar is present.

Hope that helps,

Dr. Timothy Carman

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Bill - aka Falceros
Associate Publisher of the Hair Transplant Network and the Hair Loss Learning Center
View my Hair Loss Weblog

In addition to the excitement in receiving a new head of hair, hair loss patients are concerned about scarring.  Sporting a new head of hair is exciting, but bad scarring from a hair transplant can draw unwanted attention to your scalp.  But what do hair restoration physicians do to minimize donor scarring?  What are the risks involved?  Is there anything a patient should be doing to avoid scar stretching?

This hair transplant patient recently had scar repair and wants to know what he can do to minimize scar stretching.  Click here to read other and offer your own input and experiences.

Bill - aka Falceros
Associate Publisher/Editor

Technorati Tags: hair loss, hair transplant, hair restoration

I just wanted to see if anybody had a similar situation like me when I had my hair transplant procedure done.  After I received a handful of shots to the donor area, my heart started racing for about 15 minutes, up to about 230 beats per minute.  I also felt very nervous and felt like my heart was going to pound out of my chest.  This also happens to me at the dentist when I am given novocain). Once the hair transplant surgeon started removing the donor area I was fine for about 15 seconds and then I started to feel really light headed, sick, and my blood pressure dropped. I communicated this to the hair loss doctor and he had me lie on my stomach which got rid of all of those horrible feelings.  I never took any valium that was offered; I just borrowed two Xanax from a buddy.  Has anybody experienced any thing like this?  I am scheduled to go in for a second hair replacement in September and I am really nervous - I do not want to experience those feelings again.  Please let me know your thoughts.

This question was posed by a hair loss sufferer on our hair restoration forum and answered by Dr. Michael Beehner of Saratoga Springs, NY who is one of our recommended hair restoration physicians. His professional answer is below.

If your pulse truly did reach 230 during hair restoration donor removal, that is not directly from the epinephrine, but almost certainly has to be a brief supra-ventricular arthythmia.

This question was posed by a female hair loss sufferer seeking hair loss help on our hair restoration forum and answered by Dr. Michael Beehner of Saratoga Springs, NY who is one of our recommended hair restoration physicians. His professional answer is below.

I’m at 2 months after hair transplant surgery and have noticed shock loss directly above and below the scar line. I’m wondering if this is normal, or could it be a stretched scar?  Also I’ve notice that my hair growth has basically stopped in the donor area. Is this normal?

Post hair restoration surgery telogen effluvium or “shock loss” above and below the donor scar should be a fairly rare occurrence. It doesn’t happen everyday - or at least shouldn’t.

It is well known that the cause of telogen hair loss around the donor scar is too tight of a closure, which usually is related to taking too wide a strip in that particular section of the head. This is most commonly a problem at the two “corners” behind the mastoid bone. Fortunately, in the great majority of cases, after a few months the hair starts to regrow again, but in severe cases it can be a permanent loss.

Bottom line: it shouldn’t happen.

Mike Beehner, M.D.

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Bill - aka Falceros
Associate Publisher of the Hair Transplant Network and the Hair Loss Learning Center
View my Hair Loss Weblog

Technorati Tags: hair loss, hair loss help, hair transplant, shock loss, hair growth, hair restoration, telogen effluvium, telogen

Those of you who’ve already had follicular unit hair transplant surgery know that your scalp needs time to heal before leaping back in to completely normal activity. But how long do you have to wait before continuing regular intense workouts including weight training, cardio, or contact sports?

Forum member “Eman” recently had a hair transplant with Dr. Rahal and is raring to get back into the gym and continue his weight training. Visit our hair loss forum to read what patient and physician members have to say and learn why proceeding conservatively is prudent. Your input is encouraged.

Bill Seemiller - aka Falceros
Associate Publisher of the Hair Transplant Network and the Hair Loss Learning Center
View my Hair Loss Weblog

Technorati Tags: hair transplant

Do you feel that staples or sutures are better for closing of the donor area after hair transplant surgery.  Which one produces a better scar?

This hair loss question was answered by Dr. William Lindsey of Reston, VA who is one of our recommended hair restoration physicians.

I see this question a lot on the hair loss forum and have put my 2 cents in a few times.  To summarize, I don’t think there is any difference between sutures and staples if placed with the same amount of skill.

I place staples about 25% of the time and it really depends on how the skin comes together for me. The hair restoration patient who is shown in this hair transplant photo album was listening to my assistant and me discussing this very topic. In the last 8 years I conservatively guess that I have placed 300,000 sutures; so I am very comfortable sewing. If there is any tension on the scalp after deep closure I do sutures. On the other hand, I think staples are more comfortable for the patient during that initial 10 days, and if the scalp comes together easily I will use staples for patient comfort. But if I have to trade a bit of comfort for a worse potential scar in my hands, I will suture and explain it to the patient.

Good question.

William Lindsey, M.D.

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Bill - aka Falceros
Associate Publisher of the Hair Transplant Network and the Hair Loss Learning Center
View my Hair Loss Weblog

This hair loss question was answered by Dr. Sharon Keene of AZ, an elite member of the Coalition of Independent Hair Restoration Physicians.

I have hair loss in my frontal hair and at the back. I have noticed that a patch of hair in the back came off (that did not regrow) when I accidentally pulled out some from the braids.  Does this mean that I will not regrow the hair in the donor site if i have a hair transplant?

Your description of frontal and back hair loss sounds like typical androgenic alopecia (androgenetic), though I would have to see it to be certain.  However, your history of traumatic hair loss from a braid being pulled off sounds like traction alopecia.

I assume you had a wound in that area which would have left a scar.  It is typical for hair to not grow in an area of scalp trauma that created scarring, and where the hair follicles were injured or destroyed.  That will not have an effect on the survival of your donor hairs, however, they remain permanent.  The traction alopecia scar, depending on its size, can be excised, with the scar being removed and the hair bearing edges brought together.  Non-surgical hair loss treatments can help prevent further balding from the androgenic alopecia, and in this country the 2 FDA approved medications are topical minoxidil (marketed as Rogaine and found in other treatments such as Xandrox) and oral finasteride (found in Propecia and Proscar).  The medications can stabilize hair loss in 85% of men who use them, but they are not capable of repopulating lost hair follicles.  For that, hair transplant surgery can assist in recontouring your hairline and frontal and back areas where you have already experienced baldness.  If you would like more information specific to your hair loss pattern and [hair characteristics, please send me photos of your hair/hairline from the front, top, sides and back.  I hope this information has been helpful.

This insightful information was posted on our hair restoration forum by Dr. Alan Feller of Great Neck, NY who is a member of the Coalition of Independent Hair Restoration Physicians.

Much of the hair transplant industry has been cleaned up since the advent of hair loss forums and websites like the Hair Transplant Network. However, there are still areas of hair restoration that remain largely unaddressed such as the proper “absolute” position of donor incisions.

This is why I scanned and posted the textbook definition as to how a proper donor incision should be planned and executed. I doubt any doctor will publicly contradict the text, and they shouldn’t since it is one of the few things in medicine that is objectively and demonstrably correct.

On the hair loss forum, a particular physician ignored the basics of “Hair Transplant 101″ by harvesting a donor strip that was obviously too low and led to a needlessly greater chance of large scar formation. Was this just an isolated “once in a while” incident, or was this “less than optimal” approach to donor harvesting a more pervasive problem?

I think it is not only a prevalent problem, but epidemic.

By coincidence I had a patient in my office only a few days before Allan posted his results from a UK hair transplant doctor. What I found in the donor area was appalling. It demonstrated an utter and complete lack of understanding of basic scalp physiology and an almost purposeful desire to disfigure.