Monthly Archives: June 2011

The WHOLE truth and nothing but the truth


While at Disneyland the other day, I saw a young man wearing a shirt that read, “You must be doing something right if you got haters.” After some reflection, I thought that when it comes to FUE (Follicular Unit Extraction) hair restoration……. I agree with the shirt.

FUE has received a lot of negative words recently from Internet blog sites, and after reading these blogs I am reminded of the Alice in Wonderland ride at Disneyland. That is because I find myself asking the question, “where does all this fantasy come from.”

One blog site dared to call FUE hair restoration “follicular homicide,” while another blogger (who coincidentally worked for a STRIP surgeon)complained that FUE surgery was a fad and would soon fade away in the future. But what generates the most interest and concern is the concerted effort by bloggers that provide inaccurate information about FUE surgery.

The misinformation about automated FUE :

* FUE is the old “plug” technique and will give the “doll head look” results

* FUE leaves a noticeable scar in the donor site

* FUE is follicular homicide

*Grafts from FUE procedures don’t survive.

* FUE costs $50,000-$100,000 per surgery

The TRUTH and some history about automated FUE

There are currently three FDA approved automated FUE devices available to hair restoration surgeons.  The first device is called NeoGraft™, and was created in France.  The second automated device is called Safe System™.  Safe System™ was engineered and invented by renowned hair surgeon, Dr. James Harris of Denver, Colorado.  The third, and most recent, device is a robotic prototype. These devices are being used in the United States with great success….. when used by properly trained and qualified physicians.

Automated FUE devices are now being used in the United States by some of the most respected hair restoration surgeons and former presidents of hair restoration societies. Most importantly, these devices have revolutionized hair restoration surgery in the last few years by making this technique faster, safer, and more reliable to transplant hair follicles with 21st century technology. Compared to the manual FUE technique, using an automated FUE device increases the number of transplanted or harvested hair follicles, with some offices able to routinely harvest and transplant 2000 grafts or more in a day.

Compared to STRIP surgery, FUE hair restoration does not use scalpels, sutures, or staples. By eliminating these surgical instruments and using the FUE technique,  a visible linear scar is no longer an expected by-product of hair restoration surgery. As noted well-respected hair surgeons Dr. Robert M. Bernstein and William R. Rassman noted in a 2002 published study, FUE “produces(s) an imperceptible scar.”

Technically speaking, no one disagrees there are histologic dermal skin changes in the donor site at the microscopic level after FUE surgery. But the level of subdermal scaring and alteration of hair growth direction is significantly reduced with a minimal depth (2-3 mm) FUE technique. Also, from a cosmetic or aesthetic perspective, there is an emerging consensus FUE is a “scarless” hair restoration surgery in the rhetorical sense because a linear hypertrophic scar asscoiated with the STRIP surgery is not present. The sole remaining clinical finding in the donor site after a FUE procedure is a barely noticeable hypopigmented “freckle,” as my good friend Dr. Alan Bauman refers to it.

Allow me to show a typical FUE donor site. In this specific photo, the patient posed for this picture after receiving a “high and tight Marine” hair cut  from his local barber. The hair shafts are  1mm in length and the photograph was taken with both a regular and macroscopic lens at three (3) feet distance. The donor site  is two years post operative with over 4500 grafts harvested in three(3) separate surgeries. Looks pretty scarless to me, what do you think?

The truth about this dilemma or situation is as new surgical technology is available, hair restoration surgery becomes better, faster, safer, and more tolerable.  As a consequence, hair restoration surgeons using older and more traditional surgical techniques are unhappy about loosing business to the  new competition on the block.

But what is the REAL problem with hair restoration surgery?  Truth be told, hair restoration surgery using either an automated FUE  device or  linear strip technique will give patients excellent results. There are pros and cons with either technique, but both surgical techniques have proven results. The final arbitrator for deciding what technique to use requires patient education and proper consent. My own personal choice is FUE but I admit I am biased.

Now I am sure you are thinking…. “then how are there patient’s with bad results?”

Bad results come down to two very important details:

#1: Choosing the right hair restoration surgeon!  I am sad to say this detail is often overlooked because patient’s are searching for “the best deal.”  It is important to have a properly trained physician performing the procedure, NOT A HAIR TECH!!  Unfortunately, private companies promoting automated FUE devices are interested primarily in making a profit and not patient safety.

Some companies market these FUE devices to med-spas and aesthetician skin clinics where untrained physicians depend upon technicians to perform the hair surgery.  These non-traditonal offices recognize the new potential income with the new automated FUE device and buy it….. but they have never attended hair restoration courses or training, possess no concept of basic fundamentals of hair restoration surgery, lack hand-eye skills to harvest grafts, or simply design natural appearing hairlines.

When at their hair surgery consultation, patients should ask if the surgeon is involved in the preoperative, intra-operative, and post operative phases of surgery; or in the very least inquire to the level of activity and membership in  The International Society of Hair Restoration Surgery (ISHRS). Patient’s also need to remember if a hair surgical facility is offering you a semi-expensive procedure at dirt cheap prices there is usually a reason… and it’s not a good one.

#2: Patients MUST be on a daily medical treatment program for hair stabilization!  This includes topical Minoxidil twice daily, a DHT blocker such as Finasteride, and if funds are available using laser light therapy such as the Laser Cap. Why bother having hair restoration surgery if you are not going to make the effort to stop your current and future hair loss. Failure to stop hair loss will put a patient in the position of spending the rest of their life chasing their receding hairline.

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