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The NeoGraft hair transplant machine, touting itself as “state-of-the-art” and “game-changing” has received a lot of press lately with promises to make follicular unit extraction (FUE), a complex and labor intensive procedure requiring a highly skilled surgeon and staff, simpler, faster and more effective. However, NeoGraft has failed to garner the support of many of the world’s expert FUE practitioners (of which there exists only a handful) due to several key concerns.

Consisting of an adjustable, slowly rotating, motorized punch and a pneumatic pressure suction device that allegedly allows each follicular unit to slide in and out smoothly and uniformly, the NeoGraft method of extraction theoretically exerts less force on the grafts than manual extraction. This spinning punch however, while facilitating graft removal, may subject the follicular unit grafts to unnecessary and detrimental torsional forces. In addition, due to the potential for grafts to be wider at one end, there is also a possibility for transection as they are forced through the rotating punch.

Once extracted, the grafts are then sucked through a series of tubes into a collection canister where they are misted to keep them moist while they await implantation. Leading FUE physicians have expressed concerns that the route that the grafts take as they are sucked through the punch and into the collection canister may expose them to further damage. Furthermore, there are concerns that the resulting air flow from the pneumatic pressure may result in rapid desiccation (dehydration) of the extracted follicles. Dehydration of the follicles during surgical hair restoration is one of the primary causes of poor hair growth.

In an ongoing thread on the Hair Restoration Forums, community members are discussing miniaturization analysis and if it should be performed before a hair transplant procedure. Miniaturization analysis is the process where hair restoration physicians carefully inspect a hair loss patient’s donor region (with a magnification device) and determine whether or not miniaturization is occurring in the harvesting zone.

During the balding process, hairs miniaturize or grow thinner at each expansion (or anagen) phase of the follicular growth cycle. Because of this, hair transplant surgeons must ensure they are not harvesting and implanting follicular units that are miniaturizing and susceptible to future loss.  Granted, miniaturization can occur in any scalp hair, but donor hair analysis is extremely important in a successful hair restoration procedure.

In the discussion topic, two hair loss experts (Louise – a hair transplant technician and consultant for Coalition surgeon Dr. Cam Simmons and Coalition surgeon Dr. Glenn Charles) share their opinion of miniaturization analysis and it’s importance before a hair transplant procedure:

When inspecting/assessing your hair’s characteristics, physicians will look for miniaturized hairs in the recipient and donor regions. If the donor hair is miniaturizing, it will not last and should not be transplanted. Some clinics use magnifying loops or a Densitometer or a close-up camera. Dr Simmons inspects everyone’s scalp personally with magnifying loops and/or a Microvid camera. The Microvid camera is a hand-held device that can be moved around one’s scalp and the physician and patient can see the image on a computer monitor. The follicular groups can be easily seen as well as any miniaturization. If the hair is long enough to hide it, tiny patches can be trimmed to get a very close look at the donor hair.

This question comes from a member of the Hair Restoration Discussion Forums and Social Community:

After consulting with several recommended hair transplant surgeons I’ve come to the conclusion that most surgeons implant follicular unit grafts at a density of around 40 – 60 grafts per square centimeter. I’m curious, if I only want to restore my frontal hairline, why can’t the surgeon restore my hairline to the density I had before experiencing hair loss (80 – 100 grafts per square centimeter)?

Although I’m sure each hair restoration physician has specific opinions on implanting grafts at this density (and that final density is unique to each patient’s physiology), there are several reasons why I believe experts do not restore hairlines to an unaffected density:

First, I’m uncertain that the blood supply to the balding areas is sufficient to accept and properly nurture grafts at this density (80 – 100 grafts per square centimeter). Because of this, the graft survival rate and scalp trauma could both be greatly affected. Second, transplanting at this density could negatively affect surrounding native hairs (causing unnecessary damage).

Third, transplanting at this density would require a large strip (in a follicular unit transplantation -FUT case) or various extractions (in a follicular unit extraction -FUE case) for a small transplant area, which could lead to unnecessary scarring. Fourth, transplanting at this density does not take progressive loss into consideration. It seems like a great idea to densely pack or lower a hairline at a young age, but the results can be very unsatisfactory when and if future hair loss occurs. Furthermore, this also depletes precious donor follicular units.

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.

Are there any negatives to FUE that you don’t have with FUT such as survival rate? I know it takes longer and is more expensive. Anything else people should know?

When it comes to hair transplant surgery, there can be no question that growth from follicular unit extraction (FUE) cases is not as consistent as that of strip procedures. The reason is obvious: the amount of trauma the follicular unit grafts must endure during FUE surgery, even the very best and meticulous FUE surgery, is far greater than the amount of trauma experienced by the equivalent FUT grafts. It’s a simple matter of physics.

That said, hair follicles are pretty hearty. Ask anyone who’s undergone multiple waxings, electrolysis, and laser hair removal. Those little guys will often endure all of that and still come back.

FUE is a great procedure, but it is very exhausting and time consuming even on the best hair restoration surgeons. Smaller cases usually do better because lack of fatigue can make the difference between hurting a graft and not hurting a graft. Also, if 10% of 300 grafts don’t grow, it’s not nearly as obvious compared to 10% of 1,500 grafts. That is, you probably won’t miss 30 grafts out of 300, but you most certainly will miss 150 grafts out of 1,500. The bigger the number of FUE gets, the more the equation works against the final result.

This frequently asked question comes from a member of our Hair Restoration Forum and Social Community:

I recently underwent a follicular unit transplantation (FUT) procedure and was wondering how long I needed to wait before resuming my normal weight lifting routine? Are there certain exercises I need to avoid? Is there anyway to protect the hair transplant scar from stretching while working out?

Although this issue is frequently discussed on the Hair Restoration forums, many people have differing opinions on weight lifting after a hair transplant procedure. Of all the available explanations and suggestions, one of the clearest and informative replies comes from Coalition physician Dr. Robert M. Bernstein of New York:

You may perform normal daily activities for the next three days and moderate exercise for the next 14 days. After two weeks, you may resume your normal daily activities. Avoid direct trauma to the head for two weeks after the hair transplant procedure. Abstain from sexual intercourse and alcohol for THREE days following the procedure.

Exercise

Follicular Unit Transplantation (WOUND CLOSED WITH SUTURES OR STAPLES).

Balding men and woman are often eagerly awaiting the next big hair restoration breakthrough – sometimes spending hours scouring forums and Googling key words in the hopes that a cure or at least a better solution to hair loss is right around the corner. More often than not, the promise of something better gives way to the tried and true.

The NeoGraft FUE hair transplant machine has been promoted as a bright light on the horizon: a device that promised to make Follicular Unit Extraction (FUE) easier, more reliable and more affordable. But has it delivered on this promise? Will this machine change the way hair transplants are performed? How can you separate fact from fiction?

In the thread entitled NeoGraft Chicago?, started by forum member “flashcab”, The Hair Transplant Network’s editorial assistant Blake Bloxham (Future_HT_Doc) debates the pros and cons of the NeoGraft with their  representative Doug Monty.  You are encouraged to read and contribute to this topic.

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David – aka TakingThePlunge
Assistant Publisher and Forum Co-Moderator for the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum
Follow our community on Twitter
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Technorati Tags: Balding, hair restoration, hair loss, NeoGraft, FUE, hair transplant, Follicular Unit Extraction

Much has been written regarding the pros and cons of Follicular Unit Extraction (FUE) compared to Follicular Unit Transplantation (FUT). The allure of the FUE hair transplant is the lack of a linear scar resulting in the possible ability to cut the hair much shorter or perhaps even shave the head in the future if the patient so desires. For some men, this single benefit far outweighs the risk of lower yield and the added costs involved.

So, how much coverage can you get from FUE? What level on the Norwood scale is too high? As with all aspects of surgical hair restoration, there are many factors that come into play.

After his FUE procedure of 1,000 follicular unit grafts to the hairline, forum member “CHB81” started the thread, Complete Coverage with FUE Possible?, in order to learn if the low density he experienced is common and if a second FUE will help him achieve his hair restoration goals. Join the discussion to learn more and add your comments.

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David – aka TakingThePlunge
Assistant Publisher and Forum Co-Moderator for the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum
Follow our community on Twitter
Watch hair transplant videos on YouTube

Technorati Tags: Follicular Unit Extraction, Follicular Unit Transplantation, FUT, FUE, hair transplant, hair restoration, follicular unit grafts

This question comes from an interesting thread started on the Hair Restoration Discussion Forums:

Which member has received the most follicular unit grafts throughout their series of hair transplant surgeries? How many grafts were available in your donor area? How many hair restoration procedures did it take?

Although this topic is discussed quite frequently, it’s difficult to provide a universal, generalized answer. Since each patient is unique, the maximum number of grafts available in the universal donor area, the number of hair transplant procedures necessary to harvest these units, and the number of follicular units that can be safely harvested vary. Variables, such as donor laxity (the “looseness” of the scalp), hair characteristics, level of baldness, type of procedure (follicular unit transplantation -FUT versus follicular unit extraction – FUE) performed, and density in the donor region all contribute to the number of available grafts, the number of procedures necessary to extract the grafts, and the number of grafts that can be safely transplanted.

Despite these numerous variables, members at the Hair Restoration Discussion Forums are discussing the issue and trying to discover which hair loss patient has received the largest number of grafts, how many procedures it took, and if there are units left in the donor area. Very large numbers, ranging from 10,000 to 13,000 grafts, 4 to 5 procedures, and different methods of extraction are being reviewed. Do you think you’ve received the greatest number of follicular units, or know the maximum number of units available in your donor area? If so, feel free to participate in the ongoing thread – Who has had the most work done?

This question, asked by a member of the Hair Restoration Social Community and Discussion Forums, was answered by Spex – a senior member and consultant to Coalition physician Dr. Alan Feller:

I’m wondering, if a hair loss patient was only going to undergo one type of hair transplant surgery, either follicular unit extraction (FUE) or follicular unit transplantation (FUT), which procedure would yield the greatest number of grafts in the long-term (meaning multiple procedures over the entire duration of a hair restoration journey)? Which procedure (if given the option) should I choose?

Every patient is so very different that the answer to the question varies and there is no definitive solution for every hair transplant patient. Unfortunately, hair transplantation is not an exact science.

For example, I know some patients who have received 3000-4000 follicular unit grafts via FUE over multiple sessions very successfully because they possessed the donor supply, surface area, and the appropriate physiology to enable safe extractions over a large enough area without visible scaring. On the other hand, something like 7000+ grafts (over multiple sessions) via FUE is certainly a very rare and individual case, but has been accomplished many times through FUT operations. Also, this would definitely be the exception and not the rule, and basing hypothetical FUE grafts numbers on this one case along is highly inaccurate and misleading (in my honest opinion).

This question comes from a member of the Hair Restoration Social Community and Discussion Forums:

Years ago, I underwent an antiquated hair transplant surgery where multi-unit, hair plug grafts were implanted in my hairline. After years of turmoil, I’ve decided to have these pluggy grafts removed, or punched-out, and seek a modern, state-of-the-art hair transplant procedure at a later date. However, I’m wondering how long it will take before the redness caused by the hair plug removal procedure fades away?

Because of the size of multi-unit, plug grafts, it’s reasonable to worry about redness and swealling from a removal procedure. Keep in mind that although hair plugs are removed much like follicular unit grafts in a follicular unit extraction (FUE) procedure, the trauma caused by the size of the punch grafts will result in some swelling and redness in the extraction area. For the sake of comparison, a typical follicular unit extraction tool will measure 0.7 – 0.9 mm in diameter, whereas the average plug graft measures (and will require an extraction tool) 3.5 – 4 mm in width.

On average, the redness created by hair plug removal will last anywhere from 2 – 3 weeks. However, keep in mind that the wider the graft, the more trauma caused during extraction, and the longer the area will remain red. For example, a micro or mini-graft (a plug graft dissected into smaller, but still unnecessarily large segments) extraction would remain red for less time than a punch or plug graft removal.