View Dr. True’s Full Video Response:

Dr. Robert True M.D., MPH
Member, International Alliance of Hair Restoration Surgeons
Member, American Hair Loss Association
Diplomate of the American Board of Hair Restoration Surgery
True & Dorin Medical Group, P.C
New York City, USA

Post from: Hair Transplant and Hair Loss Info Center | IAHRS

In general, people who always cut their hair very short would be able to more easily camouflage their donor scars if they did FUE. These are tiny little punctate scars versus a linear incision, however, what a lot of people don’t understand about FUE is that if you have the type of genetic hair loss that your hair loss is going to continue over time and you are going to need more hair transplantation as the years go on and as you age, and you continue to do the FUE type of hair transplants, you can almost get a moth eaten appearance in the donor area versus having a one little linear line that can be very easily covered by hair. [...]

View Dr. Charles’ Full Video Response:

Glenn Charles, DO
Member, International Alliance of Hair Restoration Surgeons
Member, American Hair Loss Association

Post from: Hair Transplant and Hair Loss Info Center | IAHRS

With today’s closure, if the donor hair is taken in the mid of the donor zone and not on the fringes, and with the techniques of the trichophytic closure, it’s highly unlikely that the scar would be so pronounced that it would cause an interference with your daily life or routine. We do need to understand that as time goes on, we all, all types of scalps, men and women, will go on to have what is called senile alopecia. There will be some type of thinning and loss of density throughout the whole scalp. So yes, it is possible when you get into the 70s and 80s, that some of the hair that is transplanted may shed and fall [...]

View Dr. Robert Dorin’s Video Response:

Robert Dorin, MD
Member, International Alliance of Hair Restoration Surgeons
Member, American Hair Loss Association

Post from: Hair Transplant and Hair Loss Info Center | IAHRS

Some physicians in their discussions with patients will relate the size and width of donor scars directly with the width of the strip that has been removed. This is an overly simplistic view of the cause of scaring, and may unfortunately mislead patients on some occasions.

Patients frequently ask how it is that we are able to harvest such relatively large strips from our patient’s donor area. The answer is really quite simple. There are a few surgical techniques that can be easily learned, which make it possible to reduce the overall tension on the wound and still get an excellent donor scar [...]

View Dr. Hasson’s Full Video Response:

Victor Hasson, MD
Member, International Alliance of Hair Restoration Surgeons
Member, American Hair Loss Association

Post from: Hair Transplant and Hair Loss Info Center | IAHRS

The first problem is the cost, it seems that FUE is considerably more expensive than a “regular” hair transplant. The second is what I am reading about the yield of the hair grafts. Is it true that FUE does not grow as consistently well as strip grafts? I would try to find the extra money to have this done using FUE if I was certain that I was making the right choice.

Please give me your honest opinion of what you think is best for my situation. By the way, your websites are the best that I have come across, so I hold your opinion in very high regard. Thank you.

View Dr. John Cole’s Video Response:

Part One

Part Two

John P. Cole, MD
Member, International Alliance of Hair Restoration Surgeons
Member, American Hair Loss Association

Post from: Hair Transplant and Hair Loss Info Center | IAHRS

There are no comprehensive studies yet on any of the technologies that you mentioned, the NeoGraft, FUE2, and the SAFE Scribe System. All of these different technologies have their advantages and disadvantages. For instance, the Neograft uses suction to help the doctor get the graft out of the head. The SAFE Scribe has a dull tip instead of a sharp tip, and really no one really knows what the best way is to help a doctor take those individual follicular units out of your donor area out of the back of your head.

There are a couple things about FUE in general that you should know. View Dr. Wasserbauer’s Full Video Response:

Post from: Hair Transplant and Hair Loss Info Center | IAHRS

My questions are:

Can African Americans transplant hair from one person to the next? And if so, what are the determining factors to gets this done?

Can African Americans have the FUE procedure done from person to person? If so, what are the determining factors? Also, do doctors know of known donors of hair for a fee?

Last question, if I could get some help where would I start? -Craig

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Dear Craig,

I am sorry to learn that your experience with hair restoration surgery has not worked well for you.

Your question about transplanting from one person to another is one that prospective patients frequently ask. Unfortunately this cannot be done successfully regardless of ethnicity. The body always will reject foreign organisms, tissue or organs. Kidneys and hearts can be transplanted from one person to another but there has to be a very precise donor match. Even then the person with an organ transplant has to take powerful drugs to prevent rejection of the organ. This is an acceptable necessity when talking about a life saving situation, but would not be acceptable when the situation is cosmetic. Moreover, our skin has the job of acting as a protective envelope for our bodies. It is loaded with antibodies to defend against infection, so perhaps even more than other body organs it will reject any graft from another person even when there has been a donor match. Perhaps someday advances in transplantation pharmacology will allow transplants to come from another person, but now it is not an option.

There may be other measures, however, that may be taken to correct the results of your previous surgery. For example, we have found FUE to be a particularly good technique for African Americans. I suggest that you consult in person with us or another IAHRS surgeon to explore these options.

Thanks again for your excellent question and I hope you are able to find a satisfactory resolution of your problem.

Sincerely,

Dr. Robert True M.D., MPH
Member, International Alliance of Hair Restoration Surgeons
Member, American Hair Loss Association
Diplomate of the American Board of Hair Restoration Surgery
True & Dorin Medical Group, P.C
New York City, USA

Post from: Hair Transplant and Hair Loss Info Center | IAHRS

Robert,

Thank you for taking the time to write! I am not sure I can speak for the majority of hair transplant surgeons, but through my training and experience with many of the top surgeons out there, the short answer to your question is; it is a judgement call.

The chief concern, as you identified, is whether you will do more harm to the existing hair, than good! If the existing hair is close to complete loss, I believe many surgeons would choose to help that patient by restoring a conservative area of hair/hairline.

If the hair in the area seems to be salvageable, some surgeons would feel more comfortable trying medical therapy alone for 6-12 months, while others would simply exercise caution during the transplant. Too many grafts at once with the latter approach can exacerbate shock loss, especially if the patient has fine or miniaturized hair to begin with.

If you believe you are in this latter category, it is always best to go with the hair surgeon who levels with you about the risk of shock loss; you will be replacing the hair with permanent hair, so you will have a net benefit, but the risk of significant shedding with more limited re-growth does exist.

All of the above refers to hair on the top of the scalp no matter where it is thinning. I’d like to mention, however, that the crown is a unique area with its own set of problems. If the only thinning area you want to fill in is the crown, a patient should seriously consider going on Propecia or deferring surgery entirely until it is clear that the frontal area will not need the grafts more than the back!

The reason is that the grafts are in limited supply, and you want to be able to place them in the most cosmetically beneficial area possible - get the most bang for your grafts! - so to speak. The most cosmetically beneficial area is almost always the front, since it is a natural balding pattern to have some crown loss but still have your face framed conservatively. So, whether there is some hair remaining in the crown area or not, many hair physicians would think twice about treating this area aggressively.

I hope that answers your question! Remember that the best surgeons will not treat any area that still has hair in it without having a long discussion with the patient about expectations and alternative medical treatments first. Good luck and I wish you good hair!

Warm Regards,
Dr. Sara Wasserbauer
Member, International Alliance of Hair Restoration Surgeons
Member, American Hair Loss Association

Post from: Hair Transplant and Hair Loss Info Center | IAHRS

My question is: Would you recommend the FUE technique? Or maybe another technique that is know to have better lasting results? Also, how do I find an honest hair transplant doctor that I can trust and that does top notch work? - Shawn
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Shawn:

Thank you for submitting your question.  I will attempt to answer each component of your question individually.

First let me state that the “A”, (or anterior) pattern of hair loss only represents about three percent of patients with genetic hair loss.  “A” patterns are some of my favorite patterns to transplant because with strong mid-scalp and crown hair, the results can be dramatic and therefore very rewarding for the patient.  However with that said, as a young man you must assume that there will be progression in your pattern of genetic hair loss to a 4A, 5A, or even to a Norwood-Hamilton 6 classification.  Especially if you are not firmly committed to stopping ongoing hair loss by properly using either Rogaine, (minoxidil), Propecia, and/or Low Level Laser therapy for the long term.  As a young man experiencing genetic hair loss, your primary concern must be an all out effort to stop ongoing loss.  Stopping ongoing hair loss is the cornerstone of your successful result, not having a hair transplant procedure.  If you are committed to “locking in” your 3A pattern, then hair restoration surgery could lead to you enjoying a full head of hair for the rest of your life.

If Rogaine, (minoxidil) did not provide you with an acceptable result, for whatever reason, then it is not the right option for you.  Don’t look back, simply move ahead with one of the other two FDA approved options.  And you note that you have now chosen to use Propecia.  All things being equal, I believe that Propecia provides men with the most convenient option to stop the progression of genetic hair loss.  And convenience is critically important.  If you make something easy enough for someone to incorporate into their daily lives, their compliance is much greater over the long term.  And this coorelates directly with maintaining scalp hair counts over the long term.  Consider taking monthly pictures of your scalp to more objectively monitor your result on Propecia.  Remember that a “GOOD” result is NO CHANGE in the photos.  This represents a stabilization in the progression of your pattern.  Not every patient will improve the quality of their hair by using any or all of the three FDA approved options.  But that is OK.  If “regrowth”, (slight thickening of the shaft diameter of the genetically susceptible hair) occurs, so much the better.  But the goal is to stop your current pattern of hair loss from progressing.  And virtually all men will achieve this goal by using Propecia for the long term.

Regarding your concerns about donor scarring with a transplant procedure, I will state the following.  Every surgical procedure has potential advantages and disadvantages.  With the advent of the “trichophytic” closure technique, scarring in the donor zone with “strip” harvesting has
greatly improved.  It has improved to the point that I find that my patients can wear very short hairstyles without any concern.  In my practice I find that I am limiting performing the follicular unit extraction, (FUE) technique to patients who require very small transplant procedures, (less than 1,000 follicles), or to transplant into wide donor scars initially created by another physician.

My biggest concerns with the FUE technique are as follows;

1) With the FUE technique the follicles are harvested from a much greater area of the donor zone, therefore, the harvested follicles may not be truly “permanent”.  Remember, what appears to be strong “permanent” hair today, may not appear this way in twenty or thirty years.  You would then have invested in a procedure that was to provide you with “permanent” hair, only to experience loss of that hair if it is susceptible to your genetics at a later timeframe of your life.  This is an example of why it is so critical for you to commit to stopping ongoing hair loss.

2) There are many reports of slightly “kinky” hair growth and unacceptably high follicle transection rates obtained with the FUE technique.  I can only surmise that the extracted follicles are somehow “manhandled” by those who may not be experienced in the technique.

3) At the International Society of Hair Restoration Surgery meetings there have been case study reports of long term donor zone anagen effluvium, (noticeable long term thinning in the donor zone where hair is shed by the follicles in the near vicinity of the extracted follicles) associated with the FUE technique.  If you saw what the donor zone looked like in these case studies, you might not be so interested in the FUE technique.

The bottom line is that there is no “one size fit’s all” procedure.  Each surgical technique, and every patient has potential advantages and disadvantages that need to be considered in creating the most appropriate surgical plan.  If a hair transplant surgeon only performs a single technique, I would seek a second opinion.

The Physician members of the International Alliance of Hair Restoration Surgeons, (IAHRS) have been carefully screened for ethics, and consistent quality results.  These physicians are considered among the “best of class” in the hair restoration profession.  I recommend that you consider scheduling a consultation with one or more of the members of the IAHRS.  You won’t be disappointed.

With Best Regards,

Robert J. Reese, DO
Member, International Alliance of Hair Restoration Surgeons
Member, American Hair Loss Association

Post from: Hair Transplant and Hair Loss Info Center | IAHRS

Thank you for your help in this matter.
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Thank you for your question regarding your dilemma of whether to have hair restoration utilizing strip surgery or FUE to obtain the grafts. Unfortunately, you may have heard conflicting information on this topic from either patients or physicians, due to either a lack of knowledge about either procedure, or due to a commercial bias. I am going to try and give you some information that may help you sort the facts and make a decision that is right for you.

You are not alone in your fear about ending up as one of those people you have read about with bad strip scars. But, lets take a step back, ignore the hype and look at the two procedures. First, I would like to tell you that about 60% of my patients opt for strip surgery and the remainder opt for FUE. I am hopeful that the reason my patients select one procedure over another is because they understood the risks, benefits and costs and then made a decision based on the merits of each procedure.

Strip surgery, if performed by a competent physician, rarely results in a a scar that is wide or disfiguring unless there was a gross error in estimating the skin laxity or mobility, or the patient had an abnormal tendency to heal with a wide scar. Both are pretty rare. The average scar width is probably between 1 and 3 millimeters. Pretty much undetectable unless someone is combing through the hair looking for it, however, if you cut your hair short maybe less than a 1/2inch or 1/4inch it may be somewhat visible. [...]

View Dr. James Harris’ Full Response:

James A. Harris, MD, FACS
Member, International Alliance of Hair Restoration Surgeons
Member, American Hair Loss Association

Post from: Hair Transplant and Hair Loss Info Center | IAHRS