Shaving the Donor Area Before Surgery?

/by William Rassman, M.D./0 /,

Can the back of your head around the donor area may not be shaven prior to the hair transplant? As with long hair, it is much harder to hide, and takes much longer time to grow. How much donor hair can be taken from the back of the head? as this is now to be my second attempt!

Thank you, Please Advise

If you are referring to the shaving doctors do before performing follicular unit extraction (FUE), it is not always necessary, but the number of grafts will be less than if you allow a larger area to be clipped. I am not sure what you mean by second attempt, but if you are saying that a first attempt at FUE failed, then be careful in selecting the same doctor who might not have the process mastered.

Tags: shave, clipping, hair transplant, fue, hairloss, hair loss, surgery

Follicular Transfer

/by William Rassman, M.D./0 /

Hi,
I read about a method called Follicular Transfer [FT] carried out by Harley street hair clinic, London [https://www.hshairclinic.co.uk]. If possible can you please give your valuable comments on this technique as well as on the clinic. Thanks

It is just another name they use for follicular unit extraction (FUE). Their site describes this process as two steps — step 1 is extracting the hairs, step 2 is placing the hairs. There is no novelty or new procedure here.

I do not know much about the clinic other than what you can see on their site. I could not even find any physicians mentioned by name on their site… and that seems a bit strange to me.

Tags: follicular transfer, fue, hair transplant, hairtransplant, uk, london, hairloss, hair loss

Any Photos of FUE² Patients Yet?

/by William Rassman, M.D./0 /,

Doctors,

So how soon can we expect to see pictures of patients you’ve performed on using the new FUE procedure?

It takes 6-8 months for people to develop enough hair to see the impact of any transplant procedure, and while this technology has been in development for some time, it was only recently perfected and announced. The FUE2 is just another way to do FUE (which has been around for 6 years), so I would not expect anything but better growth for the process. I’ll post photos in the coming months, though.

Tags: fue, follicular unit extraction, fue2, hairtransplant, hair transplant, hairloss, hair loss

If I Had Minimal Yield from FUE Procedures, Do I Have Alopecia Areata?

/by William Rassman, M.D./0 /,

In the post linked — Hair Cloning and Hair Transplant Failures — you discuss “transplant failure”. Does this mean total failure or just poor yield? I am a male, late twenties that has been mapped for miniaturization and found to have Diffuse Patterned Alopecia.

Would minimal yield from two (2) FUE surgeries suggest to you that the patient is in fact actually suffering from diffuse alopecia areata? Or do you believe FUE is unpredictable? I realize you cannot make a personal diagnosis over the Internet, but I would like your initial thoughts to point me in the right direction because I am running out of donor hair and patience with two failed doctors.

You’re right in that I cannot make a personal diagnosis over the Internet. You report Diffuse Patterned Alopecia which does not define what you have. I am assuming that you do not have the diffuse form of alopecia areata which is an autoimmune disease (very rare in young men) and if you had it, it would certainly kill off hair transplants if they were done. To make a diagnosis of alopecia areata, you would need several skin biopsies and an expert dermatopathologist to read the tissue when it was prepared. Have you gone through this? If not, this might be your next step before jumping to the conclusion that you had FUE failure for technical reasons.

I would love to see your results with a good photo or two, a set of slides from biopsies of your skin and then I can give you an opinion. What I meant in that post you referenced is a total or partial failure. Failures with FUE are often partial failures, where so many of the grafts were transected (having many amputated hairs) that the yield will be less than what has been transplanted.

In regard to follicular unit extraction (FUE), in my opinion, it is a procedure that is quite variable in the hands of doctors with different skill sets. Most of the failures with FUE, are probably related to the skill of the surgeon. I couldn’t tell you if you’re experiencing alopecia areata just based on the failure of FUE by your doctor. I recently wrote a new FUE guide that I hope you’ll read — Introduction to Follicular Unit Extraction Techniques.

Tags: fue, follicular unit extraction, hair transplant, hairtransplant, hairloss, hair loss, failure

Picked Off Scabs 4 Days After FUE

/by William Rassman, M.D./0 /,

I was wondering if after having a FOX procedure if you pick off the scabs from the donor area will this cause more significant scarring. I took off a scab 4 days from my procedure and it looks like it left a dimpled hole. I wonder if this will heal?

It is never a good idea to pick at a wound, as it creates the opportunity for infection. If you have eschar/crusts at the donor site from the FUE procedure (which is usually the case) you can wash them off with a good shampoo and a surgical brush. I don’t know what the dimpled hole is without seeing it, but hopefully it healed up for you.

Tags: scabs, hair transplant, hairtransplant, fue, wound, crust

Tinea Capitis / Ringworm Scars (with Photos)

/by William Rassman, M.D./1 /, ,


I had Tinea Capitis as a child and i would pick them off of my scalp leaving these scar spots. I was wondering how much it would cost to fill in most of the “bald spots” also if i get them filled in would it be possible for me to cut my hair and the hair that was transplanted will regrow?

Iam 19years old Male, You have permission to use my pictures if needed.

Ringworm

First, thank you for allowing me to publish your photos. This is an extraordinary case, and one that is ideal for follicular unit extraction (FUE), where we can re-arrange the hairs from one place to another.

What I’m wondering, though, is whether you’re going to experience male pattern baldness. There is a genetic test that will tell you if you carry the balding gene, and it would be worth getting tested. If you do not have genetic MPB, then I would perform FUE all over your head, redistributing the hair from one place next to the balding areas, one at a time. If you are carrying the balding gene, then we would have to rethink the strategy. Cost might become an issue, as there is a great deal of cumulative balding, and although the fees are generally charged per graft (group of hairs), I could work with you on pricing due to the unique nature of the case.

Tags: ringworm, tinea capitis, scarring, scar, hairloss, hair loss, fue

FUE with Longer Hair

/by William Rassman, M.D./0 /,

I am very interested in getting a HT using the latest FUE2 technique. I have a few questions regarding the technique. I know that performing FUE with longer hair takes more time than standard FUE. If I choose not to shave my hair, I wonder if the fee is higher and how many grafts can be transplanted in one session.

Thank you very much for your response.

The price per graft does not depend upon the amount of hair you allow me to shave. If you look at the photos below, you will see that there is a limited amount of hair that I can take. We might be able to get 500-700 grafts without heavily clipping the hair in the head if your densities are good. Much higher numbers of grafts can be extracted with more hair clipping.

FUE
Left: FUE grafts extracted; Right: Hair combed down to completely cover donor area

 

The fee for follicular unit extraction (FUE) is $8/graft for surgeries done by Dr. Pak in our Los Angeles office — and this is a special rate valid until November 30, 2008. This uses our new FUE² technique.

Tags: fue, hair transplant, hairtransplant, hairloss, hair loss

Any Completely Scarless Transplant Techniques?

/by William Rassman, M.D./0 /,

Are there any hair transplant techniques available that allows you to completely shave your head? Or do all of them leave a visible scar of some kind? If they do, how closely cropped does the hair have to be to hide the scar?

The closest thing available is minimal punctate scars that are produced with follicular unit extraction (FUE). The smaller the punch, the less obvious is the scar, but the missing hair follicles become evident if the density is low. In individuals with high density, the use of a 0.7mm – 0.8mm punch will produce an almost scarless appearance, but if you shave your head, you might see it. The hair should be about 1/8th inch long to hide most FUE scars made with small punches.

Tags: hair transplant, hairtransplant, scar, scarring, fue

Follicular Unit Extraction (FUE) Patient Guide

/by William Rassman, M.D./0 /, ,

Dr. William RassmanI wanted to call your attention to yesterday’s announcement relating to follicular unit extraction (FUE). As the ‘inventors’ of the procedure, publishing the first authoritative article in the Journal of Dermatologic Surgery in 2002, I have taken a keen interest in the way this procedure is delivered throughout the world. Much of what I have been observing has been disturbing. Too many doctors with little experience, and skills that have not been refined, have entered the field with heavy marketing programs offering FUE. My experience, however, has shown that some patients are not good candidates for this procedure and damage to the harvested grafts can be substantial in most surgeon’s hands. The key here is graft yield and unfortunately, this is an assessment made either after the procedure is performed with careful surgical monitoring and record keeping (by recording hair damage within each graft), or 8 months after the procedure when the patient can judge the success or failure of the results on his or her head.

I realize there is a delicate balance between what we want and what we buy. Our progress in reinventing the FUE process is discussed here — new FUE breakthrough. I really hope everyone considering having an FUE surgery (or anyone just curious about how it works) will read our new guide to evaluating Follicular Unit Extraction Techniques.

So what prompted me to write a new FUE guide? A while ago, I had the opportunity to view a well known doctor extract approximately 20 FUE grafts under my direct observation. While he boasted that he had mastered the procedure, what I saw reflected far less than such mastery and the doctor obtained a significant transection/amputation rate of the hairs in the graft. That doctor is prominently offering FUE today.

The surgeon’s technical skills take years to acquire and perfect, and although there are now some very fine doctors who I believe have truly mastered the technique and can deliver a quality service, I believe that they are in the minority of those offering it. There is a substantial worldwide demand for this minimally invasive hair transplant (virtually painless during the post-operative period, the patient can return to full activities in a week including all types of exercises, and there is no linear scarring). The problem for the patient, however, is in selecting a doctor where the FUE technique does not produce a “follicular holocaust” causing a substantial loss of donor hair and a failure of the procedure. This insight seems to be hidden from most buyers, because prospective patients want to believe in the marketing hype that is prevalent on the Internet and they are sold the technique by professional marketing pitches. There is no way to determine in advance, the skills of the doctors offering to perform the surgery.

In our new FUE guide, we have defined a way for patients to examine the various doctors offering this procedure, giving them an idea of what questions to ask and what things to look for. There is no site to offer guidance in the doctor selection process so the consumer must arm himself with the knowledge and skills to make the proper judgments themselves. Hopefully, our writings will appropriately arm the readers interested in this technique.

Tags: follicular unit extraction, fue, hair transplant, hairtransplant, hairloss, hair loss

Announcing Follicular Unit Extraction Enhanced!

/by William Rassman, M.D./2 /,
FUE Enhanced

 

We have made a significant breakthrough in the way to perform Follicular Unit Extraction (FUE) and we have put a substantial effort into giving our readership some practical basis to understand how to evaluate the significance of our breakthrough technology and the FUE process in general. There have been recent claims about FUE that I frankly can’t believe which are now appearing on various websites around the world. Considering that I literally pioneered the FUE field, I believe that I am an authority worth listening to. I have not spoken up about this before, but there is no time like the present to address my concerns publicly.

Please see our latest FUE writings at newhair.com/fue.

Also, we just announced a huge fee discount on our FUE breakthrough, which we’re calling FUE2 — or Follicular Unit Extraction Enhanced. See newhair.com/fue2 for more on that.

 

Tags: new hair, nhi, rassman, pak, fue, follicular unit extraction, fue2, enhanced, breakthrough, hairtransplant, hair transplant

Is What They Say About FUE Real or Marketing Hype?

/by William Rassman, M.D./1 /

Hi! Need your comments on the “No Touch Technique”. Is it similar to FUE. The medical group claim it to be better than the strip method. The FAQ section on their website mentions the difference between their technique versus FUE. But I am confused. Only you seem to be the qualified person to clear the doubts. Ultimately, which one is the safest and more result oriented method, which any average hair transplant patient can go through.

Thanks

There is a lot of marketing hype in the industry, because there is big money at stake. Many doctors claim what they think you want to hear. From the time you pay for the procedure until you get the results, the time-span runs 8 months, so you see that if a doctor is not honest and sells hype, then your check clears his bank account before you ever see what you bought.

In this case, it seems that this medical group has a tool that they use that removes the grafts via the FUE technique (no strip) — but at what accuracy? How successful are the grafts to grow out? They don’t state any statistics, so I don’t have any idea how to answer your question. I do not know enough about this group to make any qualitative statement about their work.

Many times tools are used by clinics that seemingly don’t care about growth rates and just want to be able to collect your money and say, “Well, the graft is in your head. — even if it doesn’t grow due to damage from when it was extracted, I did my job.” The consumer can tell how good the doctor is by asking them to discuss the amount of damage to the hairs in the grafts when they are extracted. At our clinic, we count damage per hair in the graft and can not only tell you what we got for hair yield, but show you our records of yield per hair and per graft. In a very recent article published by a Japanese group in the Hair Transplant Forum (a print newsletter), they discuss damage per hair in each graft with FUE. Their paper mirrors our formal publication back in 2002 that says there is considerable damage to the hairs in the graft in a substantial number of patients.

Watch this site over the next week and you will see ways to tell the scam artists from the good guys. You should not believe everything you read. Just because there is a doctor selling you the service, be very careful in your decision to go the FUE route without some proof that the clinic or doctor offering the procedure actually gets good results.

Tags: hairtransplant, hair transplant, fue, hairloss, hair loss, no touch technique

Doctor Offers 4000+ FUEs in One Session

/by William Rassman, M.D./0 /, ,

Hi there… I am a female who has had a 1600 graft transplant using the strip method and am considering a second procedure of 1,000 grafts with a different surgeon. I am very concerned about shock loss, which I did have after the first transplant. Below is an extract from a doctor’s website. I would be grateful to hear your opinions on this.

Thanks

“[FUE] allows for the extraction of 4000+ follicular units in a single day session. Removing individual follicles with a microscopic instrument allows the skin to heal quickly and naturally. Patients receive greater freedom regarding hair styling choices and a diminished healing time, allowing them to return to the normal activities of life sooner.” [note: quote edited]

Firstly, 4000 FUE grafts in one session without damage to the grafts during extraction is something that I simply don’t believe. I would have to see it and judge the transection rate under this surgeon’s hands. As for this doctor discontinuing the use of the strip harvesting method “due to its highly invasive nature” as his site states, well, this is more a marketing ploy than anything else. If the doctor could successfully do the amount of grafts using FUE that he claims, that’s great — but as I said, I highly doubt 4,000 FUEs can be done in one session with minimal transection rates. Plus, if you were to have this done, you would have to shave your head. I don’t know that most people would be prepared to do that. You’d have good reason to be skeptical.

In your case, shock loss will probably happen again. Shock loss in women often happens on the second and third procedure, but it usually grows back. Even the anesthesia can cause it in some women.

Tags: fue, hairtransplant, hair transplant, hairloss, hair loss, shock loss, female, women, woman

7 Months After FUE Procedure, I Think My Surgery Was a Failure

/by William Rassman, M.D./0 /,

Dr. Rassman,
I had a 3000 graft FUE procedure performed at the beginning of the year. To date, after 7 months post-surgery, I estimated based on a family member’s meticulous calculations with a magnifying glass that I have only 20-25 grafts/cm2 in my previously bare hairline area, when I supposedly grafted in my hairline area at a density of 70 to 80 grafts per square centimeter.

Should I expect further improvement in the coming months or has my surgery failed to achieve the grafted density? Of course, my doctor believes I can expect improvement in the next 5 months, but I have seen little to no improvement since the 4th month post-surgery. Should I expect my final surgery outcome to be a failure?

Thanks in advance.

Honestly, I don’t know. It can take as long as a year before all the hair grows in, although that long is unlikely. Furthermore, nothing is a 100% in life (except death and taxes). In my opinion, failure from follicular unit extraction (FUE) is common, even with doctors who promote them. The procedure is very difficult to do and 3000 grafts tells me that I might think that it was never done at those numbers, at least successfully.

I would discuss and follow up with your doctor in the next 5 months as your doctor recommends and hope that you get what you and he expect. Generally, it takes 8 months for 80% of the hair to grow and 90% in 10-12 months. I could go into this at length, but stay tuned to this site as I am going to address the subject of FUE failures in the very near future.

Tags: fue, follicular unit extraction, failure, hairtransplant, hair transplant, hair loss, hairloss

Revising a Donor Scar with a Tight Scalp?

/by William Rassman, M.D./0 /, ,

I have hair transplant done 2 years ago about 2000 grafts, however I have a donor scar that runs from ear to ear and wider than 1 cm since the skin got constantly pulled. My head skin is very tight,so i am wondering what can I do to fix this ? I want to cut my hair short in the back. Should I transplant hair from other part back to the donor area or any other solutions?

thanks.

You should start doing scalp exercises (see video) and then try to get a surgeon to perform a scar revision surgery with new techniques that are available today. These do not always work, because your body has a new baseline after you have a surgery. You can also try transplanting hair to the scar using the FUE technique, which will work if a revision of the scar does not work. None of these methods are perfect, but they can minimize the look of the scarring. You need to see a doctor to discuss these options for your specific needs and expectations.

Tags: scalp, donor scar, revision, scarring, hair loss, hair transplant, hairtransplant

Removing Small Plugs with FUE

/by William Rassman, M.D./0 /, ,

Dues FUE removal of small plugs with a 1mm punch leave “rolling” athrophic scars or just a tiny white scar?

A 1mm FUE (follicular unit extraction) punch has the potential to leave atrophic or tiny white scars, however it is rare. We routinely use a 1mm FUE punch to remove unsightly “plugs” from patients who have had old style hair transplants. Keep in mind that almost all patients with these type of repairs will additionally require a normal, modern hair transplant to fill in the area between the “plugs” to soften the pluggy look.

Tags: fue, repair, plugs, hair plugs, hairtransplant, hair transplant, hair loss, hairloss