This hair loss question was answered by Dr. Paul Shapiro who is a member of the Coalition of Independent Hair Restoration Physicians.
Dr. Shapiro, are your graft survival rates for follicular unit extraction (FUE) hair transplants coming close to your strip results?
Your question about graft survival is a good one but the answer is complex. When we talk about the survival of our surgeries we are honestly going by gut feeling and what we know should look like 95% survival.
To truly know the survival of a transplanted area, the area needs to be tattooed and photographed prior to surgery. The pre-surgery photo gives us a count of the hairs present before surgery. Then the incisions made need to be photographed and counted. Lastly, the grafts need to be planted and can be re-photographed. Most studies done this way are done using 1 sq cm tattooed boxes. In a year we can then take a photo of the tattooed area and count the number of hairs. And, even using this method is not accurate because about 10 to 15 of a person’s hair is in the catagen stage and cannot be seen.The only way to really measure survival is to transplant onto a completely bald head and mark out sq cm areas with a tattoo.
Some studies have been done using this technique but they are done with very few grafts. If one studies 5 areas and plants at a density of 40 FU/sq cm in each box, then that is only 200 hairs. That is a lot less the planting 2,000 hairs and it takes a lot less time. The studies that have been done show that even under the best conditions we do not get 100% survival but can achieve 95% survival.
At SMG we have a good feel for what 95% survival should look like since we have done so many surgeries. But we do not accurately measure the survival and I am not aware of any hair restoration clinic that does. One of the main reasons is that not many hair transplant patients want 1cm square boxes tattooed on their scalp.
The survival of our FUE cases using special holding solutions, ACell and ATP spray are getting better and are approaching our strip survival. But I do think overall the survival is best in our strip cases. But since we are not doing exact measurement and comparisons, this is just our observation.
Dr. Paul Shapiro
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