Hair Restoration Blog

Q:

We discussed the possibility to close the scar, which I think is a good idea, but again, I had already achieved camouflage with longer hair. While it may only be a 2-hour operation, I admit being very weary of such an operation because my skin is already so tight. I understand that the skin exercises you recommended should help a great deal, but for whatever reasons I am not comfortable with such an operation, especially considering that I would like to cover the whole head with some hair anyway. Perhaps you will convince me on the scar revision, or maybe you will advise me to pursue the FUE plan which would cover the rest of my head. Assuming I have an “average” density in the donor area, how many grafts do you think you could extract from it? How good or bad would be the mini-scars scattered all over the back of the head? I am assuming the surrounding hair will camouflage them?

A:

If you don’t want to pursue scar revision, the only option will be an FUE transplant into the scar from neighboring areas.  I recommend for you to wait until we see you in your follow up visit with a little longer hair before continuing. You also need to schedule for the FOX test to determine your eligibility for a Follicular Unit Extraction procedure.  The answer to your questions about how many grafts could be harvested in one session of your FUE procedure will be answered the day we do FOX test and confirm your eligibility.

You need to contact US Hair Restoration to schedule the FOX test as soon as you are able.  FOX test’s are done quite easily and assisted by numbing a very small area on the back of your scalp. The small scars of the FUE are going to be scattered throughout a larger area.  That can minimize the visibility of those pinpoint scars.  If you keep your hair not too short it is generally not possible to see them at all, but with a shaved head the tiny scars might be detectable from a close view.

Hair follicles removed from neck to be used for mustache restoration

I have been looking into, the cost, scarring, technique, of the FUE method and am getting the impression that the method permanently removes the hair from the donor area.  If this is true, could the chin/sideburns be used as the donor area?   And instead of placing the hair follicle in my scalp, the extractions be disposed.
My sole objective is to permanently remove my facial hair.  And the FUE method seems to be the least invasive, least time consuming, and most effective (compared to laser and electrolysis).

Lasers works best on dark hair and fair skin, which I have not.  Electrolysis is more effective than Laser and is FDA approved to permanently remove hair. However, Electrolysis is very time consuming, I scar, and over time can be quite costly, as my hair growth is hormonal, where treatment could take years, and at 65.00 per week, get pretty expensive.

If possible I would like to have my hair follicles removed by way of FUE or any similar alternative.  Please let me know, if this is possible with this practice, or any information that would point me in the right direction.

Thank you,
A:

Hi there,

You are correct.  FUE is basically removing and replacing hair follicles permanently from one area to another.  FUE or Follicular Unit Extraction can move hair follicles or follicular units from pretty much everywhere and the extracted hair obviously could be transplanted into any part of body which is covered by skin.

Removing hair for the purpose of getting rid of hair permanently is doable, but you need to be evaluated through a FOX text first.  FOX test is a minor procedure that we perform in the offices of US Hair Restoration to determine the candidacy of the patients for FUE hair transplant procedure.  FOX is a small FUE procedure in which we attempt to remove hair under local anesthesia from the donor area (could be scalp or body).  The reason that we perform a FOX test is to make sure the the hair grafts can be removed from the patient with minimum transection.

If you want to remove body or facial hair through FUE technique instead of laser hair removal, you need to be FOX tested prior.  If we cannot remove hair follicles intact from your donor area, follicles or part of them remain in the skin and can grow into new hair.  Even if you do not want to use harvested hair for transplant purposes, you still need to have a FOX test to make sure that hair follicles can come out completely.

Hi Dr. Mohebi,

A couple of questions for you and the blog perhaps.

Just wondering - I’ve noted that one LA area hair transplant doctor has used Vaseline on patient’s heads after surgery to prevent graft scabbing - what’s your opinion on this?

By the way I’m mentioning this as I feel I may have a greater tendency to scab as despite the twice daily washings my three grafts that you so kindly placed scabbed up and still are scabbed on this 6th day out, Sunday, but seeming to loosen up a bit now (patient had a FOX test with us to check his candidacy for FUE procedure and we implanted the three intact grafts that we biopsied to his crown). I’ve had prolonged scabbing before despite the washings and frequent wetting that I was advised with prior procedures. Also, I don’t necessarily mind the scabs other than I’d prefer not to have to return to work with them if they could be minimized with the Vaseline possibly or something similar.

Otherwise I’m wondering if Neutragena shampoo is okay post op vs. baby shampoo? Here’s a Neutragena link for reference.

http://www.drugstore.com/qxp14485_333181_sespider/
neutrogena_shampoo/shampoo_anti_residue_formula.htm

Thanks much,

Patient’s name

A:

Scabbing after hair transplant is very important and if not treated properly may affect the growth of the transplanted hair grafts. We are very meticulous on the care after hair transplant especially hair wash after hair transplant.

Many shampoo s are recommended and used by different hair transplant doctors, but we really don’t have a strong researched based proof for many of those. The only thing that I can tell you is to increase the number of washing in every day to minimize the chance of scabbing. In terms of using shampoos, I prefer using baby shampoo for the first 4 days that skin incisions area still healing, but after that you can use whatever you were using before. We know that there are some solutions and shampoos that can minimize the scabbing and crusting that is seen in the process of wound healing, but since we don’t know how they affect the growth of transplanted grafts we really cannot recommend them in our Los Angeles hair transplant centers. Not until we can have the evidence of their safety on the grafts from a medical study.

Using Vaseline falls in the same category. I prefer not using it in the first two days when the tiny incisions on the recipient area might not be quite sealed.

 

Continue from the question “FUE - Body Hair Transplant“

Question 4: What is your view on “out of body” time for grafts?

Answer: There are articles on out if body time for grafts, what we do is to keep grafts in chilled physiologic solution (0-4 C). If grafts are kept in this condition the survival rate is over 90% in up to 12 hours. That number starts to drop gradually after 12 hours.

Question 5: Do your charges apply for every graft extracted, even if transected, or only charge for each intact graft?

Answer: Only the grafts that are intact and transplanted are counted.

Question 6: How much of the work do you do and how much of the work do your Assistants do? What specific tasks are allocated to Assistants and what do you undertake? To what degree are you present in the room where surgery is being carried out? Do you use needle or blade to make incisions?

Answer: In FUE procedures either body hair transplant, or scalp transplant I am present in the OR the whole time because the majority of the work is done by me. I score the grafts and remove them. Techs generally help me in retracting the grafts from scalp. Trimming under microscope is done by technicians. I constantly observe them for the quality and integrity of the grafts. Every now and then, we may have to change our methods for removing FUE grafts in different areas so the surgical team should be constantly communicating with me in the OR. For incisions I usually use solid core needles to minimize the trauma to tissue and preexisting hair.

Here are a series of very good questions on hair transplant with FUE (follicular unit extraction) and body hair transplant from a patient who did his homework and educated himself on his upcoming surgery.

Question 1: Do you have a pre op protocol for chest to scalp?

Answer: For FUE from chest I want to have a clean wet shave from the whole chest one week before the surgery day so in a week when we do harvest the grafts we only remove growing hairs (the ones that are in anagen phase). Scalp hair on the other hand, I don’t want it shaved at all and I will do my own clipping right before the procedure. We do FOX test for all new patients to determine their candidacy for FUE with a small number FUE harvesting under local anesthesia.

Question 2: How many grafts can you transplant per day and how many hours is a typical working day?

Answer: Just for you to get the idea of how long does a FUE hair transplant may take, the last two FUE that we did in US hair restoration office were 1500 grafts per day each. One of them took 9 and the other one 11 hours. In both surgeries we used scalp hair only.

Question 3: Are grafts that are extracted placed straight into the recipient incisions or are they checked under the microscope first?

Answer: All grafts need to be visualized under microscope to make sure they are intact (not transected). Most of them need to be trimmed too. We usually have to remove some of the upper layers of skin and a little of extra fat around the grafts for them to be in the ideal size for transplant.

I will post the rest of this Q and A series in next few days.

Q:

I am 65 with 2 hair transplant surgery in the past. I ran out of donor hair and I was told I don’t have much more hair for my crown area. Is it possible to use armpit hair and pubic hair for hair transplant on to my crown? Is it going to be a high rate of transection for hair from those areas because of the curly hair there?

A:

The best option is always transplanting hair from scalp to scalp. Scalp hair is the most economical in terms of the number of hair that can stay and grow at any given time. Because of efficiency of hair on the back of the scalp (donor hair), we hardly ever use body hair transplant including armpit (axillary) or pubic hair, but hair from those areas could be used in some conditions such as violated donor areas from old technique surgeries leaving not much donor hair to work with, in presence of large balding area. Body hair transplant, as we discussed before is not a good substitute for scalp hair transplant, because of of the difference in hair growth cycle in those areas as long sleep phase (telogen) and short growth phase (anagen). There are some new studies indicating that body hair may change its trait in favor of recipient area (grow for a longer period of time thus become longer), but it cannot completely become scalp hair.

Body hair transplant with pubic and armpit hair in particular has its own problems. Body hairs have different characteristics from scalp hair. They are limited in numbers and should be reserved for the cases that no other alternatives are available. As we mentioned before, in cases of severely diminished donor hair, body hair could be an alternative to scalp hair. Body hair could be conveniently obtained with FUE techniques. Patient needs to be tested before the procedures with FOX test. If patient is FOX positive, it means that the hair could be harvested for the actual procedure with no trouble.

It is about 8:00 Pm and we just finished performing a big FUE procedure and I thought I write this post on “who is a candidate for FUE procedure” before going home.

Recipient and donor area right after a FUE (Follicular Unit Extraction) procedure.

Follicular Unit Extraction or FUE hair transplants is one of the methods of hair transplantation with Follicular Unit Transplant (FUT) technique. The biggest advantage of FUE is that, the linear scar in the donor area on the back is eliminated.

FUE has been around for a few years now. Many people ask about the advantages and disadvantages of FUE when they are considering doing a hair transplant surgery. People always ask; whether or not FUE hair transplant is the right procedure for them. There are many articles on hair transplant techniques including FUE and its different methods that compared FUE with regular techniques of strip hair transplant. Hair transplant surgeon has to consider patient‚Äôs needs when planning for a hair restoration procedure. Many surgeons don‚Äôt do FUE on a regular basis. This needs to be explained to the patient. Unfortunately some doctors talk patients out of this procedure simply due to their inability to perform one. That is the same for mega session surgeries that many people are told that grafts won’t survive if place too densely only because they can not perform one. This might be due to not having enough skilled personnel or any other limitations.

Donor area with small wounds of FUE punches right after FUE procedure

The most important factor that people consider when they consider doing a FUE is elimination of linear scar on the back with FUE hair transplant surgery. It might be because they want to wear their hair short on the back or shave it at some point. FUE by far is the only method that can completely eliminate the linear scar on the donor area. Have more comfortable post-op period is the other reason for choosing FUE.

All patients need to be tested before performing an FUE procedure for their candidacy. At the Los Angeles office of US Hair Restoration, Dr. Mohebi tests all patients who are considering this method for their hair restoration. FUE test (FOX) is easily done in the office with to extra charge to the patients. We perform a mini FUE procedure under local ansthesia to test feasibility of removing intact follicular unit grafts with different FUE technique and see which method is the right one for each patient. If patients are FOX negative then other options should be discussed with them. Even if patient’s are FOX positive, they have to understand that they may have a much better yield and superior final outcome with regular strip technique. For some patients, not having scar on the donor area is more important than having higher density in recipient area and they can live with thinner hair in the recipient area, but they don’t want any line of scar at all. These patients are the best candidates for FUE if they are tested positive for that.

Follicular Unit Extraction (FUE) - Advantages or disadvantages

My patients always ask about advantages and disadvantages of Follicular Unit Extraction so I thought this topic makes a good post for the blog. Before going over these points I have to say, although we at US Hair Restoration offer the most advanced techniques of FUE nationwide, most of our patients are still being transplanted by strip technique and I don’t recommend FUE to everyone and select my FUE patients very meticulously. Here are the main reasons why we do recommend FUE to some people and not to everyone.

Advantages

• FUE does not leave a linear scar, which is great for those who want to wear their hair very short on the back or the ones who may need to shave their head in the future (like actors).
• FUE has a more comfortable healing process with decreased healing time.
• No restrictions in physical activities for those who want to do strenuous exercise right after FUE procedure.
• FUE is a viable alternative for those who have tight scalp that makes strip surgery risky or impossible.
• Follicular unit extraction makes it possible to harvest hair from body, beard or almost everywhere else.
• FUE is very useful when we need limited number of grafts like for restoration of eyebrow hair.

Disadvantages

• The biggest disadvantage of follicular unit extraction is that the maximum follicular unit graft yield is lower than when it is done with strip technique due to higher rate of follicular transection compared to the strip technique.
• Although linear scar is not present after FUE, small punctuate scars will be there that may make future FUE hair transplant surgeries more difficult or impossible.
• Not everyone is a candidate for FUE and patients need to be tested with FOX before proceeding with the surgery.
• FUE procedure takes much longer to perform compared with strip FUT procedure.
• FUE is more laborious thus it cost more compared with strip technique hair transplants.
• In FUE, we have more chance of burying grafts that increases the risk of having folliculitis (tiny inflamed cysts under the skin) on the donor area.