I am often given questions from patients regarding the Follicular Unit Extraction (FUE) procedure as to how it compares with the other procedures. The FUE is a method where hair is removed in single follicular units which is different than the strip method, which involved a large incision and dissection of strip into follicular units. There is a lot of information on the internet which do not recommend FUE procedures as oppose to many that promote it as the way of the future. In actuality, many surgeons and hair restoration facilities specialize in one method over another and might have bias to or against it. When the FUE is done properly, it has great results for many hair loss sufferers, mainly one’s with a minimum amount of hair loss. Some patients who cannot have the strip FUT (Follicular Unit Transplant) method, will find the FUE procedure to be very beneficial.

Most transplant surgeries today are done through the FUT strip method for different reasons:
The strip method gives greater maximization of quality and viability of the hair follicles. The hair follicle transaction rate (grafts cut during surgery) could be higher with FUE method as oppose to strip technique. Larger surgeries of 4,000+ grafts can be done in one sitting with the strip method, where the FUE cannot get more than 1500 grafts per sitting. Larger FUE sessions also puts the healthy grafts outside of the body for a longer duration, thus making them more susceptible to losing health during the dissection and possibly dying in the process.

Modern technology in strip hair transplant has provided several methods which lower the visibility of scarring due to the FUT strip method. The FUE procedure is rather tedious, thus the cost of the surgery is greater. Ultimately, the best method is to be evaluated by a certified hair transplant surgeon who has knowledge and skill in both FUE and strip method and let him help you decide which method is best for you.

Q:

I am a previous hair transplant patient who has class VI hair loss. I had previous procedures done to get some thin hair in the front and top.  I am keeping my hair very short on the back and my primary goal was to camouflage the scar in the back of my head from previous hair transplants. So far, I have achieved this by simply growing my hair longer, and covered the rest of my scalp with Toppik-like products.

Cosmetically, the hair restoration was successful, but constant usage of this kind of product is a bit messy and annoying. Because of this, I have completely shaved my head and decided to try a different route. With the help of tattooing, I was going to go for a shaved head look. Unfortunately though, the scar is a show-stopper and I need to consider all of my options.

What I would consider to be a successful result is: short hair completely covering my head (even if only relatively light density) combined with tattooing and a self-tanner to reduce contrast. I am not “greedy” about the sides at the front, and will accept a 3 or 3A pattern. Is this possible in my case, though?

A:

It is good to hear that you are not striving for high density and that you are realistic about the final appearance of your hair.  Being a class VI with limited donor hair, should leave options open to create light density in your large balding area, but obtaining more density would be extremely difficult if not impossible due to your insufficient donor hair. You should know your priorities and how many surgeries you are committed to have in order to achieve your desired look.

• If you only need to revise the scar and have trichophytic closure done to minimize the visibility of your scar, one surgery is adequate.  Double edged trichophytic closure is a new technique that can improve the appearance of the scar tremendosly.
• If you are attempting to achieve higher density as well as scar revision, you may need several hair transplant procedures (depending on your donor amount available).

Your donor hair can be easily evaluated and options can be given to you for about what to be expected through attending a consultation with an experienced hair transplant doctor.

Hair Restoration surgery is evolving rapidly and we are consistently refining our approach on a regular basis to improve the quality of transplanted hair while at the same time minimizing the possibility of complications. Double edged trichophytic closure is a new approach to donor wound closure that has been put into practice by Dr. Mohebi and US Hair Restoration.

Double edged or two sided trichotomy can help to minimize complications of trichophytic closure (based on the width of epithelium that is being removed and inability of some the hair follicles or oil glands to find their way out to the skin surface). This practice of double edged closure helps us to minimize the width of the top skin layer (epithelium) that is removed from each edge of the donor wound. By making these changes, double edged trichophytic closure allows hair to grow into the wound from both edges and thus minimize the contrast between a patient’s scar (with no hair) and surrounding scalp (with 100% hair density).

By employing the double edged trichophytic closure in our pratice, we constantly have results of less detectable donor scars. In addition to less detectable scarring, we are also able to minimize the risk of folliculitis or ingrown hairs in the donor area, which are the two of the most common complications of traditional trichotomy.

One more note, I heard about doing scalp exercises prior to and after HT surgeries. What are they?

Sincerely,

-

A:
It’s commonplace to feel tightness on the side in which we took off the strip after hair restoration. The skin takes about two to three weeks to become accustomed to the wound and it gets stretched out to make up for the area that was removed. I strongly urge my patients to do scalp exercises before a hair transplant surgery in which I’ll be performing a strip technique. But I also tell them they ought to make sure to not do scalp exercises after a hair restoration procedure for the first few months.

I’d tell you to avoid any kind of exercise or movements that increase tightness in that donor area, up until you feel there is no more tightness whatsoever. When there is too much tension and stretching in that donor area after a hair restoration surgery, a patient may widen the donor scar, which isn’t desirable.

Thanks for your inquiry.

Q:

To Dr. Mohebi:

17 days have passed since my hair restoration procedure at your office in the San Fernando Valley.  As I remember, I had an FUT procedure with bi-lateral trichophytic closure performed for about 650 grafts to reinforce my front hairline. I want to make sure to say first off that I’m extremely grateful for the time you took to answer the questions I had in a well-informed and honest manner. Also, I’d like to say I had a wonderfully positive experience and was treated kindly by everyone at your office. It was a much different experience than the first time I had a hair transplant with someone else.

Included are five photographs (recently taken) of my grafts about fourteen days after the surgery. I got rid of the scabs on the grafts and donor area. I noticed the hair grafts are now growing, and a few have fell off the scalp. I have a few inquiries.

• One snapshot reveals, at the pinnacle of the front hairline, a red circle and the particular area looks bald and bare. Do you remember planting any grafts in this part of my head. I expected this part to have hair growing on it because the front tip sticks out.
• The donor area feels sensitive and it’s still painful but also numb in other parts. I’m wondering if this is what usually happens after a fortnight.
• The back of my head (donor area) feels stretched and makes it hard for me to look at my shoes or look down when urinating. It’s a bit painful. I don’t think I had this issue after my first hair transplant. Or maybe the pain wasn’t as prolonged as it is now. Maybe it’s because the bi-lateral trichophytic closure is on another scarline? When do you think the pain in my donor site will go away?

Thanks again for the well-done procedure. I look forward to hearing back from you.

A:

It warms my heart that you enjoyed your visit with us when getting your hair transplant. You underwent a donor scar revision procedure to enhance the look of your donor linear scar on the back of your head with a two sided tricophytic closure to ensure hair growth into the scar for the highest invisibility. About your questions, I’ve written below my responses to them in chronological order.

• Intentionally, we made the frontal area irregular so it wouldn’t appear to look linear and reconstructed. After the hair transplant, you ought to have lost a good number of grafts. The way your hair looks now and is not the way it will look eventually. I’d advise you to wait at least another six or seven months so all your hair will have grown out. It will look much better.
• As part of the healing process, a bit of inflammation is normal and will appear about two weeks after a hair transplant procedure. But, if the inflammation doesn’t eventually go away or if it becomes more inflamed, come to my office immediately.
• You may feel more pain and stretching on the back of your head because you’ve had previous surgeries. There wouldn’t be as much pain in the donor site if you hadn’t ever had a hair transplant. Try not to look down too much or in a herky-jerk manner for the following eight weeks after surgery because there’s a risk of stretching out the donor scar. On the second month, if there’s still pain, visit me and we’ll take a look at it. In the meantime, if there are other questions you may have about hair growth or other inquiries regarding your hair transplant, call and make an appointment to see me.
  I’m eager to meet with you again in later visits.

For previous hair transplant patients, scar revision is the process of correcting or minimizing the scar appearance left after a hair transplant procedure. In the case of a patient email we received, his scar seems to be a bit wider on one side compared to the other. His transplant was performed in a different clinic and the result of the wide scar was of natural effect. He asks, “Is it better to do only half and not touch the good side so to speak?”

There are a couple of techniques that can be used to correct this issue. The most common is a simple excision and closure of the scar which may reduce the scar’s width. Considering the scar is behind the neck area, BOTOX can be applied to prevent future stretching. Some patients may require what is known as trichophytic closure which allows hair to grow into the scar further minimizing the appearance of the scar. Finally, the most effective way of eliminating scar visibility is by means of an FUE (follicular unit extraction) procedure to fill in the scar left behind by the strip procedure.

The maturation or completely healing of a scar is a timely occurrence. Scars can sometimes take as long as 6 months to fully develop and can continue to evolve even after that time but at a slower rate. Because of how long scars can take to fully develop, we avoid during any type of scar revision surgery until at least 6 months after wound closure. We offer free donor scar revision consultation at our Orange County hair restoration office.

Hair restoration surgery through follicular unit transplantation is the golden standard for hair transplants to date.  This procedure is designed to fully recreate a natural looking hairline and add density or restore lost hair caused by male or female pattern baldness.  The only concerning factor of this technique is the scar that remains after the procedure is complete.  Men especially whom have had hair restoration surgery have wondered and asked how short can their hair really be to avoid seeing or even noticing the scar and if there is a way to avoid such a scar?

The linear scar that is left after a hair restoration procedure through strip technique is really inevitable but can be made less visible depending on your hair transplant surgeon.  Most facilities that do hair transplant practice a technique known as trichophytic closure for their patients.  Trichophytic closure is a technique used where hair follicles will penetrate through the donor scar which, in turn, minimizes its visibility and detect ability.  This can be compromised if the scar ends up stretching or widening.  Another study conducted has shown that BOTOX can be used to prevent further stretching or widening of the donor scar and must be applied by a professional physician for best results.

The length of a person’s hair is really up to the patient or their stylist’s best disclosure. Most donor scars are minimal and undetectable but in most cases anything shorter than a #2 clipper (1/4″ buzz cut) may make the scar visible.

The only other option available to minimize scarring is through a different hair transplant technique called follicular unit extraction (FUE). This technique is done by selectively extracting follicular units and refining them for hair transplantation.  The result is undetectable and the downtime is even less than that of follicular unit transplantation through strip technique. This procedure can also be used to fill in existing scars where hair use to grow or the donor scar area. Findings on this type of procedure were originally published when conducted on patients with neurological scar revision.