Hello Dr Rassman
Is FUE able to harvest in regions that were considered unaccessible with strips? I think about the temple areas and also the region called the “pigtail”, which in my case seems very dense.Thanks
Yes, harvesting the areas you are talking about can work. It is very difficult to do and the yield will probably be less, because hair densities tend to drop on the sides of the head.
Dr. Rassman,
Thank you for taking your time to read this. I know that hair transplantation has improved greatly in the past decade. Do you think that the improvments have plateaued or can we expect even better results in the hair transplant community in the future.
Thank you for all you do.
I am hoping that the follicular unit extraction (FUE) technology will be improved from an instrument point of view. I personally believe that this technology has great room for improvement. With regard to strip harvesting, I think that we have only improved in our overall efficiency, not in a better technique. We are all waiting for breakthroughs in hair cloning, hair replication or stem cell work for creating new hair.
Good site…I had a strip procedure(5080) Feb./06…Pretty good results…I recently went back for a Fue procedure(1050) to touch up the middle, temple and on a part of the scar from the previous strip…
- How long should I wait before working out and running?
- How long does it take for the newly implanted grafts to settle in their new home?
Thanks and keep up the great work in helping others..
Thank you for the compliment. Where is your doctor? He/she should’ve supplied the answers to your questions as a matter of routine. These are the most basic of questions that should have been explained to you before your surgery.
To answer your questions:
Hello Dr Rassman,
i had a hair transplant surgery,(strip method of 2400grafts approx)from a well reputable doctor about 11 months ago with relatively poor results in the crown area. what can i do in my case, what can i suggest to my doctor? my doctor would make the final assets at the 12th-14th month he told me. (what usaualy happens in cases like mine?)
Thank you
Failure to grow can happen, even if everything is done right. Assuming that your doctor and his/her team did it all right and you did not grow the hair, you should sit down with your doctor for a frank discussion of the problem. His/her experience should produce a good interchange with the risks of failure amongst the possible outcomes. In the hands of an inexperienced team, failure rates might be much higher. On the rare occasions that I have seen failures of the transplants to grow, I have offered to repeat them at my cost. Sometimes it grows just fine the second time, yet sometimes it does not grow even on the second round. I generally wait a year to determine what the results will probably be.
The profession has called the failure of a hair transplant to grow, the “X” (unknown) factor. This distinguishes the cause from the “H” (human) factor, which reflects defects in either the surgeon’s control or the transplant surgeon’s team. Some of the causes of “H” factor include trauma to the grafts caused by drying (leaving the grafts exposed to air for more than 30 seconds at a time), or rough handling, or a switch of the solutions used in error from saline or Ringer’s solution to distilled water (slop in protocols and process of the team).
Failures in follicular unit extraction (FUE), in particular, reflect many elements of damage caused by the extraction process which have been defined by me and some other experts at various medical meetings. Lack of required skills in FUE is the most common cause of graft growth failures. Some of the causes of failure to grow may reflect autoimmune diseases such as diffuse alopecia areata, which has no real physical presentation for an easy diagnosis other than a series of biopsies to look at the scalp under the microscope.
i wonder what size instrument you use and do you do FUE and not FUT as a preference. i am over 50, auburn curly hair, very fine, i think miniaturized; loss on top and front. i read one article which tells me FUE is not reliable and destroys follicles; then i read another which says FUT traumatizes the scalp; i am stuck! which is safest and produces good results? can cortisone injections cure pattern loss in women? thanks
Actually, you are correct about the follicular unit extraction (FUE). Please see the post titled, What Doctors Don’t Want You to Know About FUE. As you see, there are always the pros and cons of any type of surgery, but you must weigh these out before making a decision.
I do not agree that FUT (strip procedure) traumatizes the scalp, though. FUT is considered a minor outpatient surgery.
Cortisone injections are sometimes used by doctors for female hair loss, but in my opinion it generally does little to help hair loss.
Hi Dr. Rassman. This blog you got here is wonderful. Thank you.
I recently had an FUE procedure of about 4000 grafts. It took the whole day for the procedure. The first 5 hours weren’t too bad but the last few were terrible because of the constant need for freezing the donor area for the use of extraction.
Some of the later extractions from the donor area hurt me and no matter what I did I still felt the pain and I couldn’t bear it. But being the man that I am I didn’t complain. Rather, I silently cried and couldn’t stop crying for about 15 minutes. I really couldnt control myself. I am not a man who cries over things like that but my body couldnt control the pain and crying was a form of relief to me at that point.
That’s when they stopped everything and gave me about a 30 minute break. Everything went ok after that.
My question is regarding shock loss. Do you consider what I went through trauma? What are the chances that I would get shock loss? And how would you know whether your natural hairs or the grafted hairs have fallen off due to shock loss?
During these 5 days of post op cleaning, I havent really seen anything fall out. Oh and I am taking proscar daily for 6 months now.
Thank you very much for taking the time to answer my questions. I really appreciate it.
Regards
YES!!! I absolutely think your FUE procedure was traumatic!
There is no reason why you had to bear the pain and cry. That is absurd! The surgery is done under local anesthesia and you should not have felt any pain and should have had medications on board to help you deal with the length of the procedure and your emotions. It should be a painless surgery. I am shocked at your story and I am sorry that you were so traumatized.
Shock loss, if it occurs, usually starts weeks after the hair transplant procedure and runs its course over a few months. Previously transplanted hair rarely is effected (I have only seen it less than a dozen times), but your surgeon should be aware of what miniaturized hairs you had and did not have. Shock loss usually occurs in the miniaturized hairs and a good hair transplant surgeon should be able to tell you that. As you are only a few days/weeks following a transplant, I would doubt enough time has gone by to evaluate your concerns. This is something you should speak with your doctor about, as it is his/her job.
With respect to 4000 FUE grafts, I also find that very difficult to believe in sheer numbers, since 2000 grafts would be a very high number for any surgeon. Your wound would also have been massive since a 1mm diameter FUE instrument on 4000 FUEs would leave about 19.5 square inches of punched skin. It would be equivalent to the area of a 4 x 5 inch note card. You must’ve either had a very large wound or a very large head. Privately, I would like to know the name of the doctor who claims to be able to do 4000 FUE grafts in one day and I would love to know what the percentage of grafts that were successfully harvested and not damaged.
Hello,
I apologise if this question has been asked and answered previously, but who would you recommend as the more accomplished surgeons performing FUE in the US. Kind regards
There are a handful of hair transplant surgeons who claim expertise in follicular unit extraction (FUE) in the U.S. You should visit the International Society of Hair Restoration Surgery (ISHRS) for a listing of qualified surgeons and there is a sub-group from this list that do this procedure. Some good hair transplant doctors do not do this procedure, by choice. At NHI, we created the FUE technique and published it in medical journals. There are a few doctors with publication credentials, but many claim expertise. Unfortunately, I have heard about many failures by some of the doctors who claim expertise so you need to do the research yourself and meet with the surgeons on your list (who claim FUE expertise). Ask to meet some of their patients so that you know what the surgeon is capable of doing. I realize this may not be the answer you are looking for, but there is some work required on your part to assure yourself of a good result. Even for me, sorting out the doctors who can perform successful FUE procedures is very difficult as there are so many who claim such expertise and just can’t cut it.
For more, please see:
Most charge by the graft. I was wondering how much hair is a graft? Or is it just one hair? I was also wondering if you can transplant hair in places where it previously didn’t exist and how does that process work. I mean when you put the hair in a certain part, how does it just start growing? Also, is it permanant. And if you have no facial hair, can you transplant hair there? Will it grow like normal facial hair or after the first shave would it not return? Also, what happens to the hair that were taken from the back of the head, does that return to normal?
“Graft” can be defined as: living tissue surgically transplanted from its normal location in one part of the body into another part of the body in the same individual (an autotransplant, like hair or bone marrow transplants) or from one individual to another individual (like a kidney or heart transplant) and is expected to grow and function normally in its new location.
In hair transplantation surgery, a graft refers to a unit of hair or a group of hair follicles which naturally cluster together (a follicular unit) consisting of one, two, three, or sometimes four hairs. Typically, a graft equals or averages to about 2 hairs (see photo at right of average density, from the article Follicular Transplantation: Patient Evaluation and Surgical Planning?), but in individuals with very high densities, it might average as many as three hairs per follicular unit.
Hair (usually from the donor area of the scalp) can be transplanted to any part of the body, including the bald part of the scalp, beard, mustache, or eyebrow. It can even be transplanted to the tip of your nose and it will grow to as long as 6 feet (assuming that the growth phase of the hair lasts as long as 6 years or so)! The donor hair that was taken from the back of the scalp will not regenerate and you will then have either a small linear scar from where the strip of scalp was taken, or a series of small dot scars from where the graft was removed by FUE.
Prior to the 1950s, people incorrectly thought that the balding process was a result of a loss of blood supply, because the skin of the bald scalp was not flush with blood vessels, though that notion was killed by clinical scientists who showed that it was a genetic process, not a blood supply process. It was a relatively simple proof. If there was a blood supply problem, the transplanted hair would have died. Instead, the transplanted hair placed in the bald scalp grew well and the blood supply returned to supply the needs of the new hair at its new location.
Many are concerned about the aspect of small dot scarring after an FUE procedure. Would micropigmentation (permanent cosmetics) be helpful to disguise these tiny scars? If so, what would the methodology be to be most cosmetically effective. I think if this were an option to disguise any scarring, hair transplants would not be as scary to proceed with.
Follicular Unit Extraction (FUE) scars do occur, but they should be minimally detectable with any length of hair (1/4 inch). I do not have experience with permanent cosmetics other than tattoos, which have problems associated with them, including changing color. Actually, a change in hair color over time will impact visibility of permanent cosmetics.
A patient came to see me last week asking about multiple, short Follicular Unit Extraction (FUE) procedures for his frontal hairline, eventually totaling 1400 grafts. He is a busy attorney and wants to have his hairline restored, but did not have the time to get it done. He went to a doctor who told him that he could come in after court every 2-3 weeks, and get 200 FUE grafts placed into the frontal hairline. As an attorney who does not trust anyone at first glance, he came to me for a second opinion. Money was not an issue, but the charge would be $2,000 for each procedure.
I told him that this did not seem like a good idea to me. If he had 1400 grafts total over 7 sessions just two-three weeks apart, the hair would fall out between the surgeries and the surgeon could not see where the previous transplants were placed, therefore possibly causing damage. I also believe that 7 surgeries are not as good as one, but if he insisted on multiple surgeries, he must wait 7-8 months between the surgeries so that the previous grafts would not be damaged. It is possible that two surgeries spaced 2-3 weeks apart (one on the right side and one on the left side) might be able to harvest 500-700 grafts through an FUE surgery, but he would have to keep his hair long.
For more on FUE / FOX Procedure, please see:
Dr. Rassman,
It has been a little over six (6) months since I have had FUE surgery. I had approximately 900 grafts done. My surgery was with a well respected doctor in the industry.
However, I have experienced poor growth thus far. My updated pictures that were recently sent to my physician showed lingering redness in the recipient and poor growth. My doctor responded that he was concerned about the lack of growth, and suggested that I have biopsy peformed if there is no improvement in the coming months.
Is this necessary and what can I expect a scalp biopsy to show as far as poor growth is concerned? It seems to me that not enough grafts were placed to begin with and that I may have experienced poor growth due possible transection of some of the grafts. Some areas are growing in better than others. What do you think?
Thanks
I really cannot tell you what is to be expected and what is poor or good growth without examining you. Not being your doctor puts me at a great disadvantage. It seems you are in good communication with your physician and I would recommend that you follow up with that doctor. Sometimes the full growth may take as long at 12 months.
I believe that follicular unit extraction (FUE) has problems, even in the hands of good doctors experienced in that form of art. Notice that I said the “form of art”. I believe that FUE is a form of art in the way it is done. I have received many reports of failed FUEs and have spoken to doctors who are skilled in this ‘art form’ and they report hearing of many failures amongst the doctors procaiming to be experts in it. For example, I know of one doctor who is well known for FUE (he heavily promotes the practice expertise) and states that the speed for doing them exceeds an extraction rate of over 1000 grafts per hour. I would say, off hand, that this doctor’s failure rate must be huge. Not knowing your physician’s experience, I can not comment on your doctor, but you should be able to meet many of his/her patients to determine his/her success rate.
For more on FUE / FOX Procedure, please see:
Where can I (as a private man) order tools for FUE. I´ll do it by myself.
give me a adress, please.
Thank you
This is a most strange request. The tools for Follicular Unit Extraction (FUE) are varied. Some of them are not for sale. There are advertisements for some of the instruments in the Hair Transplant Forum International (the official medical publication of the International Society of Hair Restoration Surgery — ISHRS). You can contact the ISHRS for subscription or advertiser information.
I certainly don’t recommend doing surgery on yourself or others, though.
Hello-
I am 26, and I am curious if it is possible to get implants for a shaved head. I like to keep my head shaved very tight ( just above bald ) and am starting to notice my hairline receding at the temples. I was curious if it is possible to get implants to reform my natural hairline, but still keep my head shaved. Thank you for your help
Follicular Unit Extraction (FUE) sounds like a good solution, if you qualify. As you are in California, you should consider visiting me (offices in San Jose and Los Angeles) for a free consultation.
For more on FUE / FOX Procedure, please see:
I am wondering if there is a fix for spare beard growth. I cant grow a french beard because I dont have hair under my lower lip connecting to my chin. What can I do about it without invasive surgery?
Although you do not want to have surgery, a small Follicular Unit Extractation (FUE) procedure may be worthwhile. The hair that exists under the lower lip usually reflects very small quantities of hair. The entire procedure can be done in an hour with no significant pain and certainly no visible scars. The transplanted hair will grow like the rest of your beard and you can shave it if you get tired of it.
hello doctor,
my skin has a tendency to form keloids. i’m considering of having FUE on my frontal hairline. I know that keloid will probably grow on the donating area, but is there any possibility at all that it will form on the recepient area? Your answer is very important to whether I’ll have the procedure or not.Thank you.
Keloids in the frontal area are extremely rare. In fact, I do not recall ever seeing a case or even hearing from the medical community about this complication. Although an unscientific study, hundreds of doctors were polled some years ago in an audience setting and the results were that not one hand was raised asking about keloids in the frontal hairline. With that said, I would do a few test grafts and wait 6 months or so before undergoing a hair transplant. Better to be safe than sorry.