Is Graft Survival Lower with Follicular Unit Extraction (FUE) Hair Transplants?

Thu 15 Nov 2012

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

In a recent forum post about a follicular unit extraction (FUE) hair transplant he did, Dr. Lindsey stated, “… I personally did 3000 FUE punches in order to get 2600 grafts…” Three thousand FUE punches to get 2600 grafts? Is that right? Four hundred grafts sounds like a big number to lose.

Good question! It depends on how you count “lost”. When doing a FUE, you are placing a cylindrical punch around a cluster of hairs, incising the epidermis and dermis, and then lifting out the cluster gently, so that the fatty attachments to the bottom of the root bulb avulse without; A: damaging the fragile root itself or, B: the fatty tissue actually holds the roots in the scalp and all you extract is rootless hair shafts. It’s harder than it sounds. Hence, FUE costs more and is more variable in results than strip (FUT).

On one hand, you could certainly say that you “lost” 400 grafts because you pull out 400 or so rootless hair shafts that won’t grow and need to be discarded and you also made a 0.9mm hole in the scalp that will take only 5 days or so to heal with virtually no visible scar. But, in fact, you didn’t lose anything except an opportunity to make fewer punch sites on the head. Because the root remained and was not extracted, those hairs will grow back with the next cycle of hair growth.

I take care to explain FUE in just those terms prior to starting. Sometimes I’ll make 100 holes and get 95 grafts: Fantastic! Other times, getting 50% is tough, particularly in patients with scar tissue in the donor area or really curly hair. For example, I’ve now done maybe 20 FUEs on black guys. ALL heard me recommend strip and chose FUE due to their plans for short hair or scar potential in spite of my fairly blunt discussion that FUE may result in weaker results than they or I want. Unlike in straight-haired guys, where that cylindrical punch fits around the hair cluster reasonably well, with black guys’ hair, it’s a bit like trying to remove a corkscrew. The cylindrical punch does indeed cut through the roots at a higher rate simply because the location of the root is so difficult to predict.

I hope this helps explain the numbers.

Dr. William Lindsey – McLean, VA


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.
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One Comment so far:

  1. Dr Pradeep Sethi says:

    The hair roots are at different stages of hair cycle, like Anagen, Catagen and Telogen. So, the length of the grafts also vary according to the stage. During FUE, we uniformly insert the cylindrical punch to a particular length: 2.5-3 mm long. The main purpose of the punch is to cut the attachments of the hair root from the surrounding structures as well as from below the root. Some of the Anagen roots must be deeper than 4 mm. These roots may not come out as easily as other roots with the same amount of traction. So, even though we punch 3000, we may miss 400! But with vigilance and extra effort in extracting, using both hands during extraction we can extract them. The most experienced person in the team should be asked to extract those grafts with higher magnification

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