Looking To Get a Hair Transplant, But Don’t Want A Scar - Is FUE The Best Way To Go?
Written by Robert J. Reese, DO on March 2, 2010
I am 25 years old and I have been loosing my hair since the age of 17. Currently I’m in a Norwood 3A stage and I am taking Propecia. I used to use Rogaine and when I stopped I noticed a rapid loss. I have been looking to get hair transplants but I do not want a scar in the back of my head.
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
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