Maximizing Hair Transplant Donor Hair and Minimizing the Scar with FUT and FUE

Today’s state of the art hair transplants provide many men with the opportunity to restore a full and natural looking head of hair. However, since donor hair is limited, those with larger balding areas may have to settle for lower densities or less coverage. This is why many have considered maximizing their donor area by undergoing follicular unit hair transplantation (FUT) first followed by follicular unit extraction (FUE) to add density and coverage. Additionally, some patients with wider “smiley face” scars left by FUT use FUE to fill-in and minimize the appearance of the scar.

Recently, forum member “nsuede” started a topic to discuss the advantages of using both FUT and FUE to maximize his donor area and minimize the appearance of the scar. You are encouraged to visit “FUT/FUE Combo? Scar Donor Area” to discuss the advantages and disadvantages of both techniques and how they can be used in conjunction with one another to garner the best hair transplant results.

Bill Seemiller
Managing Publisher of the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum
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Tips for Getting a Hair Transplant Overseas

Selecting a quality hair restoration physician is crucial in getting the best hair transplant results. And while we prescreen and recommend quality surgeons who have proven to meet our high standards all over the world, some hair loss sufferers may consider traveling abroad to undergo surgery with their physician of choice.

Forum member “Balding_Male36” is so impressed with recommended hair transplant physician Dr. Pathomvanich that he’s decided to fly to Thailand to have his procedure. Visit and join “Getting Hair Transplant Surgery Abroad” to discuss travel tips for getting your hair replacement procedure done overseas.

Bill Seemiller
Managing Publisher of the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum
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When Is It safe to Scrub Hair after Hair Transplant Surgery?

The following article posted to our hair losssocial community and discussion forums, was written by Coalition hair transplant surgeon Dr. Robert Bernstein:

My hair transplant surgeon asked me to actively scrub away any remaining hair after 2 weeks, as he felt waiting for more than 3 weeks predisposes to folliculitis.

He said that follicles are well and truly safe after day 10. Any thoughts?

Dr_Bernstein_photo_2Around ten years ago I did a study to specifically answer this question (Bernstein RM, Rassman WR: Graft anchoring in hair transplantation. Dermatol Surg 2006; 32: 198-204.).

We found that at ten days post-op grafts were no longer at risk of being dislodged. We therefore tell patients to be very gentle when washing your recipient area within the first 10 days. After that you will be able to wash normally without losing grafts. You can read the study here and watch a video describing the study and its findings here.

Folliculitis, a low-grade inflammation or infection of the hair follicle, is relatively common and may occur up to three months after your hair transplant. It is typically caused by picking or scratching crusts or scabs, or poor hygiene, but may occur even without any precipitating factors. The best way to prevent folliculitis is frequent postoperative showering of the recipient area and, of course, not picking or scratching your recipient area.

Suitable Length of Time Between Hair Transplants

wall clock time hair transplantMany hair loss sufferers will require more than one hair transplant procedure to achieve their desired goals of both coverage and adequate hair density. But how long do patients have to wait between procedures? Are there additional risks involved in undergoing a second procedure after only a few months? What about after a year?

Forum member “Sidat” is preparing for his second hair transplant and wants to know how long he should wait before considering another. To learn and discuss when it’s appropriate to undergo a second hair restoration procedure and what it depends upon, visit “2nd Hair Transplant After How Long?

Bill Seemiller
Managing Publisher of the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum
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Hair Transplant Strip Scars and How to Revise Them

The following response to a question from the Hair Restoration Social Community and Discussion Forums, was written by forum member “MrGio”, Online Representative for Coalition Hair Transplant Surgeon Dr. Patrick Mwamba:

stripscara_zps344439b9Far too many hair transplant patients come to us after being told that they will have a pencil-thin strip scar, if they were told of any chances of linear scarring at all. Many times a scar from follicular unit strip surgery (FUSS) will stretch over time and the patient can never wear their hair shaved short on the back and sides. Sometimes the orientation of the hair in the donor zone can be skewed because the hair above and below the scar can be misangled. This isn’t fair to the patient because they should be given full disclosure of all possible after effects of strip surgery.

Based their specific goals, some patients come to our hair restoration clinic to revise their strip scars and some come to us for treating complications with their strip scars. Even with performing trichophytic closure, we still effectively prefer follicular unit extraction (FUE) method over FUSS (strip).

To treat strip scars, we usually can achieve significant improvement with two small sessions of grafting by FIT. The approach to add lower density over more than one session has allowed us to conclude that the transplanted grafts have a much higher survival rate and better blood supply. Strip scars can usually be treated after six months.

The above image is a view of a strip scar in the donor region that displays hair growing in opposite directions.

How Common Are Poor Quality Hair Transplant Results?

This comment, addressed by Coalition hair restoration surgeon Dr. William Lindsey, was shared by a member of our Hair Loss Social Community and Discussion Forums: 

It’s been 15 months since my hair transplant on both temples, and I’m unfortunately unhappy with my results. One of my temples turned out great, the other one is very thin, with the hair direction off with my normal hair, and, really weird, I still have some thick stubbly hairs there.

I’m interested on what’s everyone else’s take on this?

Dr_Lindsey_photoThree of our frontal cases a year have better hair growth density on one side or the other that I can see from close conversational distance. Why? No idea. Now I can tell you that when we have a staff review that the placer on the good side thinks it’s her skill that allowed for a better result. But the problem with that theory is that half the time it’s on the side of each placer and the other 100 frontal cases aren’t different. So if indeed you were shaved in that area and packed and the follicular unit grafts were handled gently, well you may never figure out why.

As to the orientation. Just like with trees, if I dig a hole in your yard aiming northeast and have your nextdoor neighbor plant the tree, well it’ll aim northeast. So the direction is the doctor’s job. But, in repair cases, I have to match the angle of the newly placed hair to the stuff that is already there, even if it’s too straight up or the multiple directions look even worse.

Reasons Why “Shock Loss” Occurs After Hair Transplant Surgery

I’m experiencing shock loss in the recipient area after my 2nd hair transplant. I’ve been through this before with my first one. IWhy do some people experience shock loss while others do not?    FYI, I’m only 2 months out from my procedure.

This hair loss question was answered by  Dr. Glenn Charles of Florida who is a member of the Coalition of Independent Hair Restoration Physicians. His professional answer is below.

I wish we had an answer to the question of why shock loss occurs in some patients but not others. That would be like having the answer to how the lions could be that bad every year and not get better like most other teams. Unfortunately, I am also from Detroit and actually still watch them every Sunday. Not sure why. Where has Barry gone?

Any previously transplanted hair will come back. If you still had some original hairs that were very weak and ready to fall out they may be lost, but you will be replacing them with permanent hairs. Good luck.

Dr. Glenn Charles

Bill Seemiller
Managing Publisher of the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum
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Separating the Best Hair Transplant Doctors from the Rest

One of the most common questions regularly asked on our hair restoration forum is “Who is the best hair transplant surgeon?” Because selecting a quality hair restoration physician is vital to get the best  result, this question demands an answer.

However, determining “who is the best” is as much subjective as it is objective. Thus, awarding a single hair transplant surgeon the gold medal for being the best isn’t always scientifically possible. However, a small group of leading  physicians regularly demonstrates outstanding work and stand out from the pack. Below we’ll discuss how their skill level, experience, and ethics form the characteristics of an elite hair replacement surgeon and how they continue to revolutionize the hair transplant profession.

An elite hair surgeon continually adapts and refines their technique to achieve the densest and most natural looking results. Reputable surgeons will customize individual hair restoration plans for each patient and always do what’s in the patient’s best interest. This includes standing behind their work and guiding patients through any potential questions, concerns, or problems. Continued education, regularly consulting with other leading surgeons, and dedication to excellence are key ingredients to separating the best doctors from the rest.

The Hair Transplant Network specializes in educating patients on available hair loss treatments and recommending only the best hair restoration surgeons. An elite group of surgeons who perform large, densely packed sessions of ultra refined follicular unit hair transplantation when appropriate for the patient are invited to join the ranks of the Coalition of Independent Hair Restoration Physicians. To see our demanding standards for Coalition membership, click here.

Strip Hair Transplant Surgery before FUE to Maximize Graft Count?

This question, from a member of our Hair Loss Social Community and Discussion Forums, was answered by recommended hair transplant surgeon Dr. Mike Vories:

You read all the time on the hair restoration forum to maximize the number of strip hair transplants and then go follicular unit extraction (FUE), in order to max out one’s available grafts. I often wonder how many patients actually go through with all that though. Or what % of patients is it even necessary for?

Dr_VorriesThis is an excellent point. I have always disagreed with the “FUSS first” concept. A follicular unit is a follicular unit, whether it was harvested by follicular unit strip surgery or FUE. One of the several advantages of FUE is that we can spread the extractions over the entire donor area, and so minimizing the impact on any one area. Also keep in mind that strip excision changes the scalp architecture, and harvesting grafts (especially below the donor scar) with FUE is made more difficult after strip excision.

The only questionable benefit I can see to performing FUE after strip excision is the chance to try to cover up the strip scar with FUE grafts. However, the results of this are variable, and in many cases the strip scar does not have the vascularity to support the grafts. For this reason it is much better to avoid the strip scar than to plan on covering it with FUE grafts.

Dr. Mike Vories
Editorial Assistant and Forum Co-Moderator

Why Non-Surgical Hair Loss Treatments Complement a Hair Transplant

Rogaine PropeciaToday’s revolutionary surgical hair restoration procedures allow a qualified physician to move individual follicular units (hair groupings as they occur naturally) from the sides and back of one’s scalp to balding areas. The end result is a natural looking head of hair, undetectable to even the harshest critics. And while this miracle hair transplant procedure can restore hair to completely bald areas, it does nothing to stop the progression of genetic baldness. What if hair loss continues? Will a second or even third hair transplant be required? Is there enough donor hair to keep up with the progression of baldness? Should proven medical hair loss treatments be used in conjunction with hair transplant surgery? Why or why not?

Forum member “Roy” is about to undergo surgical hair transplantation with Coalition member Dr. Ron Shapiro and wants to know what risks are involved in proceeding into surgery without taking Propecia (finasteride)  to attempt to slow down continued loss. Visit “Going into Hair Transplant Surgery without Medication” to discuss why non-surgical hair loss products complement a hair transplant and the risks included in not taking them.

Bill Seemiller
Managing Publisher of the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum
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