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I’m 32 years old with near norwood 4 loss and am still confused over both these techniques. There were two previous posts that you replied stating that both procedures are identical but according to Dr. Coles website he claims that FIT is much better than FUE.

My personal search has led me to either pursue your new FUE² or Dr. Coles but I’m at a standstill and not sure which path would be better. IF both procedures are the same then the only criteria left for me in my decision would be $ cost per graft. My last question would be how much you charge per graft for a shaved head for a FUE² procedure? Thank you!

Follicular unit extraction (FUE) is the core terminology that I used to define the surgery when it was first published and is the recognized term worldwide. Could there be marketing hype used here? I would think so (my opinion). The tools have been overblown and unless the technique is substantially different, an FIT is an FUE. The FUE² is different from the FUE in the basic technique deployed, because it uses a dissecting technique with high pressure fluid to assist in the extraction.

Our fees for FUE are as follows:

• $10/graft for procedures done by Dr. Pak
• $15/graft for those done by me (Dr. Rassman)

Some doctors charge more if the head hair is not allowed to be clipped close (shaved), though our fees are the same. At the moment though, by not allowing us to clip the hair, the total number of grafts available will be less.

FUE VS FUT…

I am 28 year old male, i am planning for hair plantation never had it before and very confused to what method should i pick…strip or fue…i want denser and more hairs ofcourse..my donor area is pretty dense and good..

Please suggest

Either technique (FUT or FUE) can produce the density you may need. The choice of harvesting should include:

1. The doctor and his/her skills
2. The quantity of grafts needed
3. The costs (usually FUE is more expensive that FUT)

Either technique can produce great densities and hundreds of these can be seen on our website here.

Its been 6 months since my HT Follicular Extraction surgery, and I notice that i have been shedding hair for the last month. The hairs that have been falling out have been robust and as thick as my donor hair. Initially after my HT, I never remembered any of my transplanted hairs falling out. Is it possible i never had an initial shed?

As I usually map out the scalp hair for miniaturization in advance of a hair transplant, I know quite a bit about what is happening when someone like you has this type of problem. Shock loss can occur as long as 6 months after a surgery, but I agree with you that it should not impact normal, non-miniaturized terminal hairs.

I have a small, linear non-transplant scar above my ear. It has healed pretty well, and is looking more and more like normal skin each day. I’ve been thinking about transplanting hair into the scar by an east-coast doctor, about 100 grafts is my guess. If this were to be done with FUE, is there a huge risk that the scars produced from such a small FUE procedure will be worse than my linear scar? I want to be able to wear a buzz cut (somewhere around #2) as I believer my hair is thinning and short hair is a better look. Should I be very worried about moving just 100 grafts from the back of my head into this scar to minimize it?

Follicular unit extraction (FUE) is a good way to fill in a scar, but not all FUE is the same. Different doctors use different techniques and instruments. As long as the FUE instrument is less than 1mm (ideally 0.8 of 0.9mm diameter), you should be OK.

I am flattered you would ask me, but I would ask this question to your doctor since you need to trust the surgeon that will be performing the procedure on you!

Hello Dr.

I have a short but interesting question for you.

Is there a way to get a hair transplant which caters to a shaved head? what I mean is, since it’s less important to have such a packed in and natural look when you shave your head; is it easier or cheaper to get some sort of thinner coverage on your head which still looks natural when you shave it really short?

I really don’t know what your expectations are, but I think that the answer is a hair transplant will not add value to your bald areas in the front, top, or crown in very low densities and wide distributions. If you want the easiest and cheapest way to have a shaved head look, use a razor and just take off whatever hair you have left.

Otherwise, the follicular unit extraction (FUE) technique doesn’t leave any linear scar in the back of the head, but there are tiny pinhole size scars that could be visible upon close examination. I’m not sure how short “really short” is for hairstyles.

Dear Dr Rassman,

What is direct hair transplanation. Is it different from FUE or strip transplants?

thanks

It appears that this is a marketing term applied by some medical groups for follicular unit extraction (also known as FUE, the procedure I first published and pioneered). Whatever you call it, it is FUE.

Dr. Rassman,

I have used the search function and read all about telogen effluvium and shock loss post-transplant. I just had a very minor FUE procedure of 400 grafts performed a few days ago.

I have been on Propecia (1 mg) for over a year and have diffuse alopecia. However, I am now experiencing hair loss all over my head (including what I believe to be the donor area). Is this telogen effluvium from the shock of surgery or just ordinary shock loss? The doctor said it was probably just some shock loss. What the are long-term effects of something like this?

I notice the hair loss by doing a gentle (very gentle) pull test in all areas. Thanks for your help.

I honestly do not know. I am not trying to brush you off, but every case and every patient is different. What is your age? What did your hair look like under miniaturization mapping prior to your follicular unit extraction (FUE) procedure? Did you have diffuse unpatterned alopecia (DUPA)? If you had done a proper pull test, you might have developed a telogen effluvium (TE). Differentiating TE and shock loss may be difficult at this time. If you had DUPA, you could be at the forefront of disaster. If it is TE, then the hair may return, but if you are under 30 years old, I would want to know, because shock loss is often permanent in the very young men. For shock loss, it does not matter if you had a small surgery or a big surgery, as just the anesthesia can precipitate the process (even without the surgery).

This question points out a series of problems for me when trying to answer some questions here. I sometimes get minimal information and am asked about diagnosis and prognosis. What I do when I see a patient is get a complete medical history, including significant discussions on the hair loss history. Then I perform a very thorough examination, which includes mapping the scalp for miniaturization. I put it all together at that point. As you can see from the above email I received, when little information is available to me it is difficult to really help.

Consider a visit to my office for an appointment and then maybe I can help you more extensively. The cost of a trip to Los Angeles has to be minimal when compared to a large amount of hair loss, which is priceless. Or please speak with your doctor regarding this matter. In your case only time will tell and following it with your doctor may give you some comfort in what is happening to you.

Dr. Rassman,
I wanted to know what you thought of the NeoGraft system. The “FDA-approved NeoGraft automates the surgical removal of individual hair follicles, one at a time”. Do you think this will be just another flash in the pan invention or could it help assist hair transplant surgeons in the future?

Here is the link to the story: New NeoGraft Device Improves Hair Transplants

Regards

The story is actually a press release, which explains why it enthusiastically approves of the tool. One thing I’m disappointed with right off the bat is that it claims “no visible scars” occur if this tool is used, and that is simply untrue. Any puncture made to the scalp will result in a scar to some degree. I know what they were going for, but saying “barely visible scars” or “no linear scar” would’ve been more truthful.

I watched the video and it appears that the doctor is using a drill to remove the grafts from the donor area. It still seems tedious and I could not inspect the follicular units for transection rate analysis (damage done to grafts), which I would need to do to make a judgment on this FUE instrument/technique.

This is Part 2 of 2. If you missed Part 1 from yesterday, that can be found here.

—

What is FUE2?

Ever since we announced the FUE2 technique a few months back, people have asked me how it is different from the traditional FUE procedure I invented and published in the medical journals back in 2002. The basic difference is the addition of a water jet for enhancing the dissection of the excised graft. The pressure of the water jet adds to creating a plane of dissection which produces clean grafts as good in most situations as strip harvested grafts (the golden standard for follicular unit transplants).

What is better, the strip or the FUE2? First lets assume that the FUE2 produces comparable quality grafts to the strip harvesting method. When the donor density is low, the missing follicular units from FUE2 become obvious when the hair is cut short. There can be a moth eaten look in these low density people. In high density people, the FUE does not show up so there is generally not a moth eaten appearance, but the many white dots created by the FUE scar can be seen and this will absolutely limit a shaved head. When a strip is performed and a good wide lower trichophytic closure is created, the scar is less in most patients than any scar from FUE. The problem is that most FUE doctors have created illusions around what they do and produce hype that will never be substantiated in most patients, particularly those with low to average densities and a high number of FUE grafts. I always tell the patient that I get 50% more $$$ for an FUE procedure (graft for graft), so if I recommend the strip as a viable alternative, it is clearly not a financial issue for me. The results of the evolution in my thinking is based upon following many patients (mine and other doctor’s patients) with regard to scarring.

THE FUE2 is a better procedure than the standard FUE, but not better with regard to strip harvesting in quantity and quality. FUE fails to grow at the 90% plus rate much of the time in most doctor’s hands, but strip grafts do not. I am afraid to tell you that honest doctors who do FUE are few and far between, but they do exist. With our FUE2 procedure, we clearly can do it better than most doctors. And as our survival rate following FUE2 is comparable to strip harvesting and significantly better than traditional FUE, the choice with us is clearly in the hands of the patient. I try to present a balanced approach in the analysis when patients come to my office and ask about FUE.

This is a long piece, so I’m breaking it up into 2 separate parts. Here’s part 1, with the 2nd part coming at the same time tomorrow…

Do you believe that the FUE 2 (or standard high yield FUE) process could completely replace the strip method of hair transplantation? Why or why not?

There are practical problems with the FUE2 method of harvesting. First, the patient must have his hair clipped widely if he wants/needs extensive grafting above 600-800 grafts (the number of grafts which can be taken from a small area is very density dependent). Most people will not allow us to clip their hair that short and certainly people who have had previous strip harvesting will often not want to have their hair clipped that way either. Many patients who come for FUE end up switching to a strip technique, because of the haircut issue alone.

The FUE’s maximum number of grafts, compared to a strip harvest, will produce less hair with FUE. The strip method of harvesting obtains the donor hair from what the surgeon calls the sweet spot. The FUE can not get the number of grafts from the sweet spot as well as the strip, but the FUE may be limited at each surgery. I read a great deal about the reported FUE megasessions and although I am convinced that much of the hype of 3,000 graft FUE sessions are misrepresented and promoted based upon false claims by less than honorable doctors, the public wants to see this happen and they are ready to believe almost anything a slick doctor tries to sell.

So for the patient who is bald and needs a high numbers of grafts, the strip harvesting method is superior because more hair can be moved in a single session, minimizing the number of sessions when compared to FUE harvesting. For those people who want to get the job done quickly and they need graft numbers in the thousands of grafts, the strip method is far more time efficient.

On the other hand, a new dynamic can be created where people take multiple sessions of 500-800 grafts every 6-8 months until they add enough hair to create what they want. A slow approach has many advantages including:

1. Spreading the costs over a longer time
2. Developing a changed image very slowly so that nobody will ever recognize the change
3. Minimal pain and very fast recovery without limitations on any activities from weight lifting to scuba diving, and so on.

There is a place for both choices and for those men who are not very bald, the ability to achieve reasonable results in one or two sessions are a practical approach to the problem.

Check back for part 2 tomorrow…