FUE (Follicular Unit Extraction)


This insightful information was posted on our hair restoration forum by Dr. Timothy Carman of La Jolla, CA, who is a highly esteemed member of the Coalition of Independent Hair Restoration Physicians.

Has anyone depleted their donor hair supply after 2 or 3 hair transplant surgeries? What options are available if you have done this and need further work? Is FUE an option if strip is not?

One of the issues to be addressed in the initial hair restoration consult, and, in my honest opinion, the most critical concept, is the surgical plan created by the physician in conjunction with the patients’ age, degree of hair loss, donor supply, scalp laxity, and genetic background (familial history); all in an effort to “predict” the future hair loss pattern for that individual. Ideally, then, knowing the limitations given the patients “lifetime supply-demand balance”, as I like to call it, the initial plan will be implemented so as not to ever get to such a distressing or “impossible” situation as described above.

This concept can be difficult to communicate, especially to younger patients, who may want a more aggressive (less receded) hairline than they will have supply for in the future.   In  my opinion, the successful hair transplant is just as much about creating the conservative, less “wow” result as it is the obvious large hair transplant megasession out of the ballpark results; probably even more so. 

The long term picture is a very important concept, thought I should just give it some thoughts here.

Many veteran hair transplant patients are familiar with the term “follicular unit grafting” and have come to know this as the today’s “Gold Standard” in surgical hair restoration.  What many don’t know however, is that a “follicular unit” falls under a particular category of “micrograft” – a term often wrongfully associated with a much less favorable and also misconstrued term “minigraft“.

Believe it or not even some of the leading hair loss doctors in the hair transplant profession today use some “minigrafts” when appropriate for the patient. But what exactly is a “minigraft”? Are they really as bad as some have perceived them to be?

Unfortunately, the terms for the various types of grafts have been misunderstood and misconstrued in our hair loss forum community for a long time.

Recently, Coalition member Dr. Ron Shapiro wrote an article to help hair loss sufferers understand the differences and appropriate use of various types of grafts.

I encourage you to read through Understanding Hair Transplant “Graft” Terminology to learn the various graft types and how they’re appropriately used. You are also encouraged to give your feedback on this hair loss forum topic discussing graft types.

Bill Seemiller – aka Falceros
Associate Publisher/Editor

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Recently, I read a well written summary of the follicular unit extraction (FUE) procedure, its advantages, and it’s disadvantages by Coalition member Dr. Ron Shapiro who recently started to perform FUE at his clinic. A few weeks ago, I published it on our highly popular Hair Loss Q&A Blog. In my opinion, follicular unit extraction has been overhyped online by some hair restoration clinics while underestimated by others. Reading this well balanced article was extremely refreshing. I’d encourage anyone interested in considering FUE to read “The Evolution, Advantages, and Disavantages of Follicular Unit Extraction (FUE) Hair Transplant Surgery“.

Bill Seemiller – aka Falceros
Associate Publisher/Editor

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balding crown hair transplant photosWhile many men would rather not experience hair loss at all; those that do, experience many degrees of baldness. While some hair loss sufferers lose hair only at the front, others lose it in the crown while others lose it all over the top.

While restoring a natural looking hairline and frontal core is standard in surgical hair restoration, the bald or thinning crown is often considered the “black hole” for grafts. Thus, patients need to decide how much hair (if any) they want to designate for the crown as they discuss their hair restoration goals with their physician.

Recently, forum member “Mike the Dane” who’s already had a couple of hair transplants posted a thread with photos asking for input from our community as to whether or not he should start to focus on his balding crown. To offer your advice and/or share your experience, visit “To Crown or Not To Crown”.

Bill Seemiller – aka Falceros
Associate Publisher/Editor

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The goal of hair transplant surgery is to give patients more hair than they had prior to surgery. However, unlike other cosmetic procedures, sometimes patients look worse after surgical hair restoration before they look better.

Some patients are plagued by a temporary hair loss condition known as telogen effluvium or “shock loss” which can occur anytime hair is transplanted in between or around existing hair.  This is true whether the hair is natural or previously transplanted. This often causes great concern for those who don’t expect it, and even those that do; it can be a real brain buster causing mild anxiety.

View this hair loss discussion thread to learn and discuss why shock loss occurs and how to get through the doldrums while waiting for new hair regrowth.

Bill Seemiller – aka Falceros
Associate Publisher/Editor

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Most balding men and women would love to restore their natural full head of hair by waving a magic wand and/or by popping a miracle pill. However, hair restoration involves careful and strategic planning with a skilled and experienced hair loss doctor. While Propecia (finasteride) and Rogaine (minoxidil) are typically good at slowing down or stopping the progression of male pattern baldness, hair transplant surgery is the only method of hair restoration proven to grow hair in completely bald areas.

Today’s state of the art hair transplants are very natural looking and undetectable by even the harshest critics. This explains its increase in popularity over the last several years. But while advancements in surgical hair restoration are indeed exciting, it’s crucial for men and women considering this procedure to develop realistic expectations. What can realistically be achieved with hair transplantation varies for each patient. Below, we’ve cited a few important tips in helping you learn what to expect from hair replacement surgery.

Supply Verses Demand: What can be realistically achieved depends on the supply of donor hair and the amount of baldness in demand of new hair. Most patients can typically only achieve an illusion of fullness even under the best circumstances. Thankfully, this is usually enough to provide patients with a cosmetically significant improvement. Those with advanced balding may have to make additional sacrifices and leave some balding areas untouched. To see what hair transplants can accomplish on patients of varying degrees of lost hair, view Hair Transplant Photos by Norwood scale.

Balding men and women with hair loss who’ve decided to get a hair transplant are usually excited with dreams of getting their hair back. And though the end result of a hair transplant is a fuller head of hair, the expression, “the devil is in the details” is vital when learning how to fit surgical hair restoration into your life, especially during the first several months of healing and waiting for new hair growth. This includes returning to work, concealing your hair transplant from co-workers, friends and family, how long it takes to heal and look normal, etc.

Visit this discussion thread to discuss how to prepare for the first few awkward months after surgical hair replacement including when it’s ok to return to work. Your experience and input is welcome and encouraged.

Bill Seemiller – aka Falceros
Associate Publisher/Editor

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Do you have any idea as to what the average surface area is for level 5, 6, and 7 on the Norwood scale of hair loss?  I was measuring my scalp and found that even if I progress to a Norwood scale level 7, I will only have about 175 cm2 of bald area. That would only take 7,000 grafts to fill in the entire area with 40cm2, a density that I believe is more than adequate to give an illusion of fullness and hair density. I realize there are variables such as color, hair shaft diameter, texture, etc. that come into play, but shouldn’t any hair restoration physician that transplants 1,000 grafts per Norwood level fill in the entire area with good density?

This hair loss question was answered on our hair restoration forum by Dr. Paul Shapiro of Bloomington, MN who is a member of the Coalition of Independent Hair Restoration Physicians.  His professional answer is below.

Hair Transplant Pysician Dr. Paul ShapiroIn my experience, the average patient’s head can be divided into two areas. 

The frontal 2/3 of the scalp on average measures 100 sq.cm. On average the crown loss is 80 to 100 sq.cm. The area of the crown will vary by how low and wide the crown loss is. On average I would say that to cover the total bald area in most men who are type 6 or 7 on the Norwood scale, I cover an area of 200 sq. cm. But there are men with very large balding scalps in which the area is more like 250 to 300 sq.cm and men with smaller areas. A total area of 170sq.cm.is in the realm of a normal area to cover.

Recently, we sought the advice of our online patient hair loss forum community regarding the potential Coalition membership of two impressive doctors recommended on the Hair Transplant Network for the last year. These physicians are Dr. Timothy Carman of La Jolla, California and Dr. Brandon Ross of La Jolla, California. To learn how we recommend hair transplant surgeons, click here.

View the Potential Coalition Membership for Dr. Timothy Carman

View the Potential Coalition Membership for Dr. Brandon Ross

In addition to garnering feedback from our patient community and highly respected hair restoration physicians, surgeons considered for Coalition membership are often visited and observed in live surgery by Patrick Hennessey, publisher of the Hair Transplant Network. Highlights of each visit along with surgical photos are prominently featured in the “Visits to Leading Hair Transplant Clinics” forum. To view the highlights of Pat’s visit to Dr. Ross’ clinic, click here. To view the highlights of Pat’s visit to Dr. Carman’s clinic, click here.

After extensive research and seeking input from our patient community and other leading surgeons, both Dr. Carman and Dr. Ross have been approved to join the ranks of the elite Coalition. Feel free to congratulate them by clicking on their featured potential Coalition membership threads above.

We encourage those local to these cities considering surgical hair restoration to consult with these excellent physicians to develop a long term hair restoration plan.

Bill Seemiller – aka Falceros
Associate Publisher/Editor

This is probably one of the weirder questions I’ve ever asked.  I had hair transplant surgery about 2 months ago.  But I noticed that my hair has had a very distinct, not so good smell the past few weeks. I take a shower every day, sometimes twice a day and scrub my scalp pretty generously to clean it.   At first, I thought it might be the shampoo I’m using but I’ve used about 3 others as well and it still has that same smell starting up a few hours after my shower. Has anyone else ever experienced this with an hair transplant? Any suggestions?

That’s an unusual issue. Is the smell coming from your hair or your scalp? I know that certain bacterial or fungal infections of the scalp can cause a distinct odor. You may want to check your scalp for signs of discoloration or anything unusual symptoms like itching, bumpiness, or pain.

In the event you suspect an infection, be sure to speak with your hair restoration physician or a dermatologist as soon as possible.

All the Best,

Bill Seemiller – aka Falceros
Associate Publisher/Editor

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