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Hi,
I was wondering if you could tell me if it would be better for me to get strip or fue? I have already had 1 strip procedure 5 years ago (3300) and feel I need more hairs to fill my thinning frontal area. I am worried about fue because I heard the back of your head may appear as if moth eatin. Also, I exercise so I want to recover as quickly as possible. I used [name removed] before and that’s who I plan to use for my next procedure. Any recommendations? Thanks.

The things that make a follicular unit extraction (FUE) surgery produce a “moth eaten” donor area include:

1. the use of larger punches
2. low density donor hair

If you already had a strip procedure, another strip may be a better choice for you, but if you are a hair transplant ‘virgin’ (not your case) then FUE is a much more clear decision process. Going the FUE route will make for a very fast recovery with full activity, including swimming, scuba, and professional level exercise. I do not generally make recommendations for doctors here.

hello doctor Rassman,

I have two questions about FUE.

1. would it be possible to do a mega-mega session?.. for example 2000 graphs on one side of the head and then within a week 2000 graphs on the other side?
2. is it possible to use the entire “horseshoe” for FUE?

thank you.

Yes, it would be possible to have the above schedule. First however, I would want to biopsy your hair to satisfy myself that you are FOX positive (a good candidate). Then if you are a candidate, the answer is yes to both questions.

I have been losing hair for a long time now. I am 42 and want to start taking propecia. I am also considering FUE. I keep my hair really short (Setting 1 on clippers). My question is do I need to be on propecia before i get my fue procedure done. Will the doctor prescribe me propecia after my procedure. Can I avoid propecia if i get a FUE procedure.

You do not need to be on Propecia before any hair transplant surgery, but in most young men I recommend it and suggest that it is started as early before the surgery as reasonable (minimum 2 weeks). Generally though, it is always a good idea to minimize shock loss and also to minimize further natural hair loss with Propecia. The decision to go on a medication or even surgery is highly individualized to your particular situation, and you need to discuss all these pros and cons with your doctor.

Results from FUE are variable while the strip procedure is predictable nearly 100% of the time-Does this mean the strip method is the better option as its more certain. And if this is true why would you tell people and/or use this method rather than the strip method at NHI.

I test everyone to determine how good their follicular units will come out with follicular unit extraction (FUE). I call this test a FOX Biopsy and I insist on doing this so that I am comfortable that wastage is not a problem. It is hard to match the quality grafts that a strip-method hair transplant can produce. With an FUE procedure, the bottoms of the follicular units can be stripped of their fat and supportive structures; in a strip procedure, the follicular units are all perfect. If you saw two follicular units side-by-side (one from a strip harvest and the other from an FUE), you would see a significant difference. I believe that when this problem occurs, the growth from an FUE with stripped infrastructure should not, in theory, grow as well or as thick as a strip graft. The benefit of the FUE technique, of course, is the lack of the linear scar in the back of the head, allowing for a very closely cropped haircut without noticeable scarring. We perform both techniques at NHI.

Hi Dr. Rassman
Is there any risk of shedding phenomenon after FUE procedure at donor site(most of which is occipital area)?

You will likely not shed from the donor area, but I suppose there is a small risk with any surgery done on the scalp. The mechanism will be the same that causes a telogen effluvium from almost any stressful event. I am curious as to what is driving the question. Has something happened to you as a result of an FUE?

I have a hypothetical question:

I know, that in general you don’t transplant more than a certain ratio of hairs available in the donor area to the transplanted area. What i was wondering is if i wear my hair in a certain style (in this case a bald fade) it would’t be as important for me to have thicker hair in the back, but of course, i would want good density on the top and front. under these circumstances, would you transfer more than usual to the top and front?

I generally develop a Master Plan with each patient, unique to that patient. What I feel my job is, is to do what is in your best interests and that includes combining what you want and what I feel is ethical. Many patients have different priorities, so my job would be to come to some conclusion about your hair supply and then lay out a plan that is worst and best case possibilities to address your desires at this time.

Since your question is hypothetical, I will say that hypothetically what you’re asking for is possible under the right conditions. Also, if you were to want to do a fade hairstyle in the back (donor area), a linear scar could be visible with a strip procedure, but you’ll probably be alright with follicular unit extraction (FUE).

Hello, I am turning 26 in a few months, I would like to know what transplant procedure would best suit my current hair loss pattern. I have researched the strip method, also the individual extraction method, I like the individual method better, it seems to be less evasive and less surgical, however, the cost appears to be higher, why is that? Would I qualify for the single extraction? What degree of a transplant do I require to restore my hairline to a even more full appearance? Any estimates in cost? Thank you for viewing my questions and looking over my pictures, you have my permission to use them on your site if they help in any way. If you require photos from any other angles please let me know. I am not on Propecia, I have been reading about Provilus, is that a good alternative? I am more interested in the natural ingredients if they have similar results.

Thank you again, I hope to hear back from you with some positive ideas!

First, thank you for permission to post your photos! If I was able to map out your scalp for miniaturization, I’d be able to tell if the top and crown of your head, which appears normal now, has any early signs of balding there. The pattern you present with is between and Norwood 3A and 4A pattern and I suspect that there is miniaturization in the 4A pattern area where part of the forelock still persists. If you took Propecia (necessary to prevent further loss and the possibility of shock loss after transplantation), then transplanting the frontal area with about 2000 grafts would suffice in most men with your pattern. I would have to know more about your hair characteristics (straight vs curly, coarse vs fine) as this will tell me the value of your hair, part of the essential formula for estimating hair replacement.

Provillus will not give you the same protection against shock hair loss that Propecia (finasteride 1mg) would, so if you get a hair transplant, you need to be aware of this. For your information, the main ingredient in Provillus that does work is saw palmetto, which as I’ve stated many times before, is a weak DHT blocker at best.

The follicular unit extraction (FUE) technique is very labor intensive and the time it takes to do it is much more than a standard strip procedure. That is why the cost is higher. Also, the results from FUE are variable while the strip procedure is predictable nearly 100% of the time. For more info on FUE, please see:

• Follicular Unit Extraction: Minimally Invasive Surgery for Hair Transplantation
• Follicular Unit Extraction: The FOX Procedure

From the article:

A robot that can pluck and move individual hair follicles on a person’s head makes hair transplants look more natural than those performed by humans, a US company claims.

The robot can also perform the procedure twice as fast as human clinicians, with less pain and scarring for the patient, says Restoration Robotics of Mountain View, California.

Read the full text at NewScientist.com - Surgical robot gives hair transplants a natural look

I am well aware of Restoration Robotics. They approached me a year or so ago to obtain rights to use our U.S. Patent to perform such surgery. Dr. Pak was the engineer back in 1998 when he helped me design the first prototype. I am eager to finally see this project get on its way.

I must disclose that if they succeed, I have a financial interest in their success from the license grant.

Hi Dr. Rassman. Thank you for this website. I visit every single day and gain some comfort in the support here.

I am a 38 yo male with stong family history on both sides of my family. I started to thin in the front/hairline of my scalp at 22 years old, and started minoxidil immediately. After adding Propecia when it came on the market, I feel have done a good job at slowing down the blading process. My father and only brother were both almost totally bald at my age. I am probably a Norwood 3 - my mid-scalp and crown are still quite thick. My hairline has suffered and is loosing ground slowly every year. Temples are receeding and “widow’s peak” is now almost gone. Watching this happen, as everyone here knows, is devastating. I am contemplating having a consult with Dr. Bernstein for a transplant as he is close to me (NYC), but I am concerned that having a transplant to strengthen my hairline may accelerate my recession and compromise what I do have. I also am not sure whether to opt for FUE or FUT since I beleive around 1000 grafts would do the trick for me at this point. After viewing some of the photos on Dr. Berstein’s website et al., where he strengthens hairlines with approx. 900 or so grafts, the results look so amazing that I want to move forward. Any advice?

Dr Robert Bernstein is a great doctor who worked with me for over 10 years. If you were contemplating seeing Dr. Bernstein, go see him and he will be able to give you good medical advice after he has examined you. At 38 years old, with the type of hair loss you describe above, a transplant can be a good option (obviously I haven’t seen you so I can’t say for 100%). Follicular unit extraction (FUE) or follicular unit transplantation (FUT or “strip procedure”) will both work, but the likelihood of less surgeries with the strip technique has its advantages.

I am really interested in the Fox technique, do you think it will go down in price over time?

The FOX Procedure (follicular unit extraction) is heavily labor dependent and takes much more time to harvest grafts than a traditional strip procedure. Without a new breakthrough, I doubt it will go down in price much, as there are not many doctors who are doing the procedure completely.