FUT (Follicular Unit Transplant)

This question, from a member of our hair loss social community and discussion forums, was answered by a staff physician from Coalition hair transplant clinic Shapiro Medical:

I had a follicular unit strip surgery (FUSS) hair transplant about 10 years ago, and I was looking into going through a second one soon. I had a consultation with Dr. Rahal in Ottawa who suggested a second strip with 3000 grafts for the front section and the crown area which I think would be a great improvement for me. However he apparently shaves the whole region where new hair will be implanted, which will leave only the mid-section of my head with native hair. Keeping my native hair everywhere would make concealing the recipient areas much more easy.

Looking through the pictures, it looks as though even if I take 4 weeks off work, it will still be quite apparent that I went through surgery after that period, as regrown hair will be very short. I don’t want it to show.

Follicular unit extraction (FUE) is out of question for me as my previous scar will be apparent as shaving the back of the whole head is necessary.

Is shaving the recipient area standard in strip procedures, or should I just keep looking for another hair restoration surgeon who is willing to do it without shaving?

ishrschicagoOverview of the 2015 ISHRS Meeting

The International Society of Hair Restoration Surgery (ISHRS) held its annual scientific meeting in Chicago, Illinois this year. The yearly gathering brings together many of the world’s leading hair transplant surgeons and hair loss  researchers to discuss advancements in medical and surgical hair restoration. Continuing the trend from last year’s meeting, discussion topics focused predominantly on Follicular Unit Extraction (FUE) and future hair loss treatments.

Background on the ISHRS

The International Society of Hair Restoration Surgery (ISHRS) is the most prominent professional organization for hair restoration in the world. Their primary mission is to educate hair surgeons ranging from the novice to the expert. Their website (http://www.ishrs.org/) provides useful information about hair restoration and profiles and contact information for its 700 plus worldwide physician members. This year’s meeting was conducted by the current ISHRS President Coalition hair transplant surgeon Dr. Sharon Keene and program chair Dr. Nilofer Farjo.

At the meeting, Dr. Kuniyoshi Yagyu replaced Dr. Sharon Keene as the acting President of the ISHRS for the coming year.  Congratulations to Dr. Yagyu for receiving this high honor.

Physician Recognition and Awards

Congratulations to the following award recipients:

Coalition hair transplant surgeon Dr. Bernard P. Nusbaum was awarded the Golden Follicle Award for his role in developing innovative hair restoration techniques and furthering the advancement of hair restoration.

Dr. Pierre Bouhanna won the coveted Platinum Follicle Award for his outstanding achievements in basic science and clinically-related research in hair pathophysiology and anatomy.

Today’s hair transplant procedures have done wonders in transforming balding men into hairy men. However, given the progressive nature of male pattern baldness, what happens if hair loss progresses further? Are more hair transplants needed? Will there be enough donor hair available to cover future thinning and bald areas? What will a patient’s transplanted hair look like in 30 years? Do hair transplants stand the test of time?

Anyone considering hair replacement surgery should work with a reputable and skilled hair transplant surgeon on creating not only short term, but long term goals. Planning for future hair loss is an important part of any long term hair restoration plan.

To discuss these concerns and learn why hair transplant surgery with appropriate planning can stand the test of time, visit the discussion topic “Multiple Hair Transplants“.

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 and Social Community
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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:

The aspects of follicular unit extraction FUE hair transplantation that patients should be mindful of is cost, transection rate of the hair transplant surgeon, and experience of the surgeon’s medical assistants. Surgical hair restoration is an investment for the patients that can be for better or worse. A patient shouldn’t pay too much and shouldn’t pay too little for an FUE session. FUE is more labor intensive than follicular unit strip surgery (FUSS), and hence there is a difference in the cost of the procedures.

Transection is the terminal damage of a patient’s precious donor resources. Since donor resources are certainly finite, patients should want to ensure that their surgeon is producing minimal trauma in their donor area. A good FUE surgeon can provide his or her patient with a relatively low rate of transection. Damaging a significant amount of hair will usually provide poor aesthetic results and insurmountable loss to restore future hair loss. There is no better way of describing this atrocity than considering a patient to be a donor of their hair follicles to medical science. Wasting hair to inefficient harvesting methods essentially realizes a patient to be an unsuspecting victim and statistic. Paying twice for a graft is tragic.

I’m 33 years old and I am thinking about hair transplantation, but I am confused in choosing between FUE and strip and also would like to know if there are any serious side effects in the future after hair transplant surgery.

questionFollicular unit extraction and follicular unit strip surgery (FUSS) are both excellent procedures the can produce natural and undetectable results. However, each procedure has its pros and cons. There is not one that is better than the other in all circumstances.

Volumes can and have been written regarding these two techniques. But, in a nutshell, Strip surgery can typically yield more grafts in a single session and offer a higher average success rate in terms of the number of grafts that survive and grow. The downside for some guys is that it results in a linear scar often stretching from ear to ear that requires hair to be a bit longer for concealment purposes.

With FUE, follicular unit grafts are harvested individually using a small punch. This is much more labor intensive. Depending upon the tools used and the expertise of the hair restoration physician and staff, maximum grafts per session may vary from as low as 1,000 grafts to as high as 3,500 with a very high rate of success.

Due to the method of harvesting, scarring from FUE is in the form of very tiny dots that may be virtually invisible even when the hair is buzzed very short. This appeals to many younger men who like to wear their hair short.

I’m 22 and currently a III or IV on the Norwood Scale for hair loss with deep temporal recession. My dad is a NW 6.5 . For a while I thought I might not go that deep down, but recently, I am seeing the beginning of thinning hair in the deep crown. I am fairly certain I am heading down the path to a NW VII.

I recently went to a respected hair transplant surgeon (recommended on this site), who told me that I have some strong factors in my favor. I have thick, coarse hair. He said he could probably pull 6000 grafts via follicular unit strip surgery (FUSS).

My question is whether 6000 grafts will be enough to fill in my head if I was NW VII. I have a fairly large forehead. I’m not bent up on having a low hairline. I just want to be able to have my face framed and also have full coverage.

One major thing for me is that I never want to take Propecia (finasteride). Even if that means I need multiple hair transplants.

NWVIIThe short answer is yes, sometimes 6000 grafts can be enough to fill your scalp if you were to become a level 7 on the Norwood Scale. However, the long answer to your question isn’t cut and dry.

While your entire head can be covered, the hair may not be very dense and thus, you will most likely have a very thin appearance and may not be happy with the kind of density you can achieve on a level 7 with only 6000 grafts.

I have just done a follicular unit strip surgery (FUSS) hair transplant almost two weeks ago. The surgery seems to be successful in almost every aspect. The only thing that is bothering me now is that I still feel tightness on the donor area.

My hair restoration physician told me he took a strip 7.5 cm long by 1.5 cm wide and got 1200 grafts. Is it considered to be a large area? I feel the tension force from the scar especially when I drive a car and try to turn my neck to clear the blind spot, or when I nod deeply.

My question is that if this discomfort permanent or will disappear shortly?

23072_2_fullGood density in the hair transplant donor region is typically about 100 grafts/cm^2. Multiplying the length and width of your donor strip gives us a total area of 11.25cm^2. Dividing 1200 grafts by the the total area means that your donor strip yielded more than 106 grafts/cm^2.

According to Coalition hair restoration physician Dr. William Lindsey, the average width of a donor strip in his practice is between 1.6 and 1.7 cm or “about the width of a stick of gum”. The length will vary depending upon factors such as scalp laxity and target number of grafts.

For more details from Dr. Lindsey see the following article form our Hair Loss Q&A Blog, “What is the Average Width and Length of a Hair Transplant Donor Strip?

There is a lot to know about state of the art follicular unit hair transplantation. In order to assist hair loss suffers interested in surgical hair restoration to better understand the procedure, Coalition hair transplant surgeon Dr. Alan Feller has created the following short video primer.

If you are a male or female with thinning hair who is considering hair transplant surgery, we encourage you to view this informative presentation.

To discuss the content of this video join the conversation at, “Dr. Alan Feller- Hair Transplant Primer for Newbies

To learn more about hair transplant surgery, consult with one of the pre-screened, quality hair transplant surgeons recommended by the Hair Transplant Network.

Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.

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The below question was asked by a member of our Hair Loss Social Community and Discussion Forums and answered by Janna, the lead medical technician for Coalition hair restoration surgeons Dr. Ron Shapiro and Dr. Paul Shapiro.

I’ve had 3 strip procedures totaling 3,000 grafts with poor results. My goals are to add density in front and revise the scar. If I got another follicular unit strip surgery (FUSS) by a much better hair transplant surgeon this time, would that doctor be able to take the strip from the same area, remove the scar and then close up the area nice and tight? Seems that I could accomplish both goals that way.

scarThis would depend much on the size of your current scar and how much donor you need to thicken the frontal area you want addressed. Remember that the size of the donor strip+scar can only be a certain width or else there is great risk of the scar stretching.

There are different approaches to achieving your hair restoration goals and I’d consider you a repair case. Sometimes the repair cases aren’t done over just one procedure so it’s important that the clinic is able to work with you and get you to where you want to be.

Lead Medical Tech and Surgical Manager
Shapiro Medical Group

David (TakingThePlunge)
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.

One of the most common questions patients ask after hair transplant surgery is: “did I lose a graft?” Patients are extra cautious after surgery, and any slight bump of the head or funny-looking graft causes anxiety. This is because the grafts are fragile during the first few days after surgery, and it is possible to “lose” one. Excessive pulling, rubbing, or bumping can dislodge grafts. These few grafts are truly “lost” and won’t grow. But how do you know if you’ve actually lost a graft?

When a graft truly dislodges, you’ll see two things: 1) bleeding, and 2) an intact follicular unit graft — usually laying flat on the scalp near the hole where it was originally placed. I’ve said this on the forums many times in the past, but it’s still a very frequently asked question. Well, they say a “picture is worth a thousand words,” so here is an image showing several truly “lost” grafts. If a patient sees something like this, they probably did lose a graft. If not, they’re probably okay:

lost graft

Blake Bloxham – formerly “Future_HT_Doc”

Editorial Assistant 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

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Watch hair transplant videos on YouTube

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