Follicular Unit Extraction and Scalp Micropigmentation

 Most men will suffer hair loss to some degree in their life. This is because of DHT a male hormone that negatively affects the hair follicles of the scalp; most aggressively at the temples, crown and top of the head. So men bear this change or maturation of male pattern baldness (MPB) well; but many experience the well documented ‘psychological effects’ which culminate in low self image, esteem and confidence.

It is no wonder that hair restoration through hair transplant surgery is  one of the leading medical cosmetic concerns among men.  Today’s follicular unit transplant (FUT) surgery is providing the undetectable and natural solution that patients’ seek.

Nevertheless, some people with advanced hair loss and limited donor hair for the surgery have fewer choices. Follicular Unit Extraction (FUE) surgery combined with scalp micropigmentation (SMP) offers and innovative approach for men with advanced male pattern baldness (MPB).

A combination of these less invasive procedures can provide excellent results under the skills of today’s leading hair transplant surgeons.  A combined FUE and SMP procedure means:

• Individual follicular units (FUs) will be transplanted for balanced and even coverage
• Individual FUs will be transplanted to created an attractive age appropriate hairline

• will include selection of dermal pigment to match your hair color
• micro injections of dermal pigment to simulate ‘stubble hair’

• to support the development of transplanted hair a short term prescription of Propecia may be prescribed

 These two advanced hair restoration procedures can provide a patient with the option of having a shaved or ‘military type hair style that is attractive and a safe medical solution to their hair loss. s where the entire scalp and hairline frames the face with closely cropped ‘stubble’ hair. A person with limited donor hair can be a prime candidate for this safe and less invasive hair transplant procedure.

Skilled hair restoration surgeons can take individual follicular units (FUs) and create the maximum balanced coverage over the scalp. They can then create further ‘look of density’ by simulating hair stubble with scalp micro-pigmentation (SMP). Los Angeles hair transplant centers are innovative leaders in hair restoration procedures.

SMP is a procedure where special surgical needles are used to inject dermal pigments into the scalp or other areas such as eyebrows into the skin.  The color of pigment selected is close to that of the patient’s hair resulting in a cosmetic hair shadow.  SMP is a safe and very non invasive procedure.

Combining FUE and SMP to resolve the challenge of hair loss for people with little alternatives and represents an advancement in modern hair restoration.  This solution is not for everyone but is a welcome choice for some people who previously had limited alternatives to resolve their hair loss problem.

Follicular Unit Extraction (FUE) for Scar Revision

FUE hair transplant procedure is used for completely restoring hair to balding areas of scalp. The nature of this surgery makes it more time consuming because each follicular unit (FU) is extracted singularly. The FUs can have one, two, three or even four hair shafts. This type of procedure on like ‘Strip Method’ hair transplant procedures allows for a limited number of grafts to be extracted.

Since the extraction of individual follicular units (FUs) is done individually it is perfect for the small procedure of revisioning a hair transplant scar from a previous hair transplant. The surgeon can extract a small number of grafts from the permanent zone and artistically and strategically place them in the scar. This process of using FUE uses hair to obscure and blend the margins of the scar to the surrounding scalp.

Follicular Unit Transplants (FUT) has come of age. This advanced type of modern hair restoration provides patients with a natural, proven and permanent hair loss solution.  Many people do not understand that FUT hair restoration is available in two distinct forms of hair transplant surgeries. They are

1. the ‘Strip Method’ and
2. ‘Follicular Unit Extraction’ method

Both these procedures consist of transplanting hair from the permanent zone. This is the area of the scalp where hair loss does not occur.  The harvesting method in each procedure is different. This blog is particularly devoted to the ‘Strip Method.”

Strip Method Hair Transplants

In this form of FUT hair restoration surgery a donor strip is taken from the back of the patients scalp. The size of the donor strip is determined in the patient’s pre-op consult and microscopic evaluation.  The donor strip is removed by your hair transplant surgeon and separated into naturally occurring follicular grafts of 1, 2, 3 and 4 hairs. These grafts are meticulously and artistically placed in recipient incisions made by your doctor in the balding areas.  Below are some of the advantages that patients who elect the FUT strip method enjoy.

Advantages of FUT Strip Hair Transplant

1. Maximization of the number of grafts that can be harvested in a single hair transplant session.   This advance technique allows for the transplanting of over 3500 grafts. Many patients who have never had a hair transplant can complete their hair restoration in a single surgery.
2. Damaged to hair grafts is minimized. The strip procedure allows the surgical team to harvest and process the grafts under microscope effectively reducing transection (damaging hair follicles).
3. The surgery is less labor intensive then its FUE counterpart and can be elected at a more affordable cost.

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.

Here is a question from a previous patient of US Hair Restoration:

I was wondering if there is any limitations on performing a second hair transplant surgery for me who have one surgery with you before.  I am experiencing more hair loss on the top and I also want to make it even denser in the front. I need to know when is the best time of doing a second procedure and what will be the cost of hair transplant for my second procedure.

A:

The best time for your second hair transplant is around six months from the first hair transpalant is you want to add density to an already transplanted area.  If the transplantation is to be done on any other areas it could be done as early as 2 months as long as the donor is healed properly adn allows a second round of removal of strip.  In FUE cases anytime after the first 2 weeks when the inflammation is over the second procedure could be done.  We have done 2 FUE procedures as back to back but occasionally in some patients the swelling of tissue minimize our success in the first few days after surgery.

The cost of a second procedure in US Hair Restoration is based on the number of grafts and the current cost of hair transplant.  However, we have 10% discount on our rates for our previous patients so your future hair transplant procedure will always be discounted with USHR.

In regards to the question of whether or not there is a minimum age requirement for hair restoration, Dr. Mohebi stated: It is not unusual for a hair transplant surgeon to discourage a person younger than 24 from pursuing a hair restoration surgery.  However, nowadays microscopic techniques being used to evaluate the miniaturization of susceptible hair can assist surgeons in predicting the final pattern of hair loss. By being able to predict each patient’s final balding stages, we are able to see where the pattern of baldness is heading and based on that, we can now recommend hair transplant surgery at an earlier age.

When asked about the donor scar following a hair transplant and whether or not it will be visible, Dr. Mohebi responded: If you do not plan on shaving your hair after your hair transplant surgery, your donor wound will never be visible. However, if you plan on shaving your head for any reason, you may choose to have a FUE or Follicular Unit Extraction procedure done rather than the general FUT procedure through removing a strip from the donor area. FUE transplant eliminates the visibility of a linear scar on the back of your head and is the best option for patients who plan on shaving their head or keeping their hair very short in the future.

To determine recommended options or graft numbers for your personal case, Dr. Mohebi suggests attending an in person consultation in any of his five California regional offices. In addition, he stated: Yes, the initial consultation with me (Dr. Parsa Mohebi) is complimentary in any of our California hair transplant offices in Beverly Hills, Encino, Orange County, San Diego, and San Francisco.

Lastly, the interviewer inquired as to what clients should bring with them to their free consultations and the doctor replied: Anything related to your hair loss and hair restoration, including family history of hair loss, other medical conditions that may have been attributed to ones hair loss, medical, surgical or even cosmetic changes that you like and may help you have a better result after a hair restoration procedure.

New FUE Transplant

FUE (Follicular Unit Extraction) Transplant devices have been improved in the last few years.  Among the new methods are different devices for making the procedure more automated. US Hair Restoration is a leader in hair restoration and is launching a new research to compare different methods of hair restoration with FUE method. The study will be goin on between May and July of 2010. There are only a few spots available for the participants of the study and candidacy of the patients should be determined by US Hair Restoraiton first.

Who is a candidate for our FUE Study?

Please make an appoitment to be evaluated by Dr. Mohebi before planning for your surgery. You will be spending one hour with the doctor and at the end you will have a master plan for your hair loss treatment. The discounted rate of the FUE does not apply to any of our other hair transplant procedures being offered at our offices.

How Can I start?

Applicants can call  1 (800) 302-8747  to schedule their free consultation with Dr. Mohebi.  We will be comparing manual techniques with Neograft and Harris’ Safe System that are amoung the leading companies in automated FUE industry.  We hope that by performing this study, we will be able to make more clear the advantages and disadvantages of each method and eventually adopt one of them for our regular use in the office of US Hair Restoration.  The results of this study will be released on our website and in future medical literature.

Q:

Not too long ago, I had a hair transplant (using FUE). Things were OK until several months after the transplant. I spent some time having fun in the sun, and it was maybe close to triple digit degrees outdoors. As soon as I got back to my house, I noticed my scalp in the transplanted area had turned white. It looked like the skin on my head had been scorched. But I didn’t think it was a big deal and I kept on using the Minoxidil with Betaderm spray, which my doctor highly recommended.

A few weeks later, the top of my head (which had been grafted) began to peel and the skin fell off (like a sun burn). And there were a few transplanted hairs which fell off as well, with the skin. This really alarmed me. After about eight weeks, the scalp seems to have healed, although there is some redness in places; but, overall, it seems to be OK. But, I’m a bit worried about the condition of my after-playing-in-the-sun scalp. I know it was probably a sun burn, but I just hope my grafts weren’t damaged beyond repair. I’ve done some research on skin consequences of sun burn, but I wonder if the grafts can ever fully recover from the exposure to the ultra-violet rays. I know if my skin becomes more tan, it’s OK. But about my grafts, I’m really concerned about them.

I need answers, doc.

Yours truly,

A beach bum with a hair transplant

A:

Hey beach bum,

Skin and scalp which has been exposed to the sun’s rays for long periods of time damage both native hairs and transplanted hair. The consequences can be especially harmful if a person who has had a hair transplanted is not under an umbrella or is not wearing a hat of some sort. The scalp skin could be damaged that way. It is best to stay out of the sun after a few minutes, at most. For the first six months, hair transplant patients may want to use sunscreen or wear a hat to prevent hair loss and to guard against permanent damage to hair follicles.

For those who don’t like to wear hats or other types of protective head wear ought to guard their hair as if their financial stability depended on it. Make sure your hair density increases to the point in which your hair follicles cover your entire scalp and so the scalp skin is not exposed to the sun’s scorching rays (especially during summer).

I can’t give you a verdict on whether your newly transplanted hair is permanently damaged. I’m sure I don’t have to tell you this, but I’ll say it anyway in case there are people reading this blog who are in a similar situation: from now on, be very careful about your scalp’s sun exposure. And just kick-back and wait a while to see if the damaged hair grows back.

Remember, after hair transplant care is very important, if not crucial to the longevity of your hair restoration results.

Hair removal has been practiced in different ways and can be achieved with either temporary or permanent relief. From regular razor trimming, waxing, electrolysis, and advanced laser hair removal these procedures do the job and do them well. As of recent, we had a patient ask us of a different method of hair removal. He was considering using follicular unit extraction (FUE) procedure to achieve this.
“Instead of placing the hair follicle in my scalp, can the extractions be disposed?” His goal was to remove unwanted facial hair quickly and permanently. This is actually a possibility for almost any person who does not want to have a hair transplant procedure, per say. We recommended that the patient at least be evaluated through FOX test to see if the hair grafts can be removed entirely through FUE. This means the grafts have to come out whole after making the FUE incision.
If the hair graft units cannot be extracted whole through FOX test, then the procedure will not be effective. The reason why the hair graft must come out whole is to prevent leaving the bulb in its place. If the bulb remains then the hair shaft may continue to grow normally. A fully extracted graft unit can then be replaced (or disposed).

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.