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Does the single hair graft and double hair graft affect the survival? which one has a more successful rate? Example: a doctor likes to claim that in eyebrow transplants you will get single hair grafts, which make eyebrow transplant more successful. Is that true?

If the surgeon knows what he/she is doing, it does not make a difference. In fact, if one divides a two-hair graft into two one-hair grafts, then there is a risk that the growth center, which is largely located just below the sebaceous gland, could be damaged resulting in the death of that particular hair. Making one-hair grafts out of two-hair follicular units is a special skill obtained with lots of experience.

Just to clarify as well: eyebrow transplants are not any more successful than a scalp hair transplant. So the argument of a one-hair graft being more successful, in my opinion, is not valid.

Excellent website. I have a question about FUE and strip surgery. I have read on forums and other hair loss websites that say its better to have a FUE transplant first if it is your first time getting a HT done rather then doing strip surgery. The strip method should be saved for any additional surgery that is needed or if you can in a second time. For some reason, they didn’t specify what type of surgery to get based on the size of the balding or number of grafts needed. I have read on this website that the larger the balding area the better it is to do strip because you can take out more grafts.

I am contemplating getting a surgery done, however, I am worried in the future my balding will progress and if I have to shave my hair in the future I don’t want a ’smiley face’ in the back of my head. Not to mention, if I need additional surgery and do choose to do strip again for some reason, I don’t want two smiley faces on the back of my head. I also wanted to add, I am 30 years old and have temple recession and a little thinning on my hairline and mid scalp. I know I will need a surgery in the future. I am on propecia so the crown has been holding well.

Take care.

For less extensive balding patterns in the Norwood class 3 range, either FUE or strip will get you where you want to be. If you start with FUE for a class 3, then you should finish with FUE. The choice here may be price of the procedure, as FUE is generally more expensive. The bond with the doctor you link with is also a factor. For the advanced balding patterns (class 5, 6, and 7), extensive harvesting with strip surgery is well understood with considerable experience in the hands of most surgeons. The FUE technique may not get you the yield in the 7,000+ graft range typically harvested with extensive restorations in some of the advanced balding patterns. I am assuming that the surgeon does not go outside the permanent zone for additional donor grafts.

For a graft yield in a Caucasian male, 5,000 - 8,000 follicular units may be an upper end for donor supply in FUE. The yield goes down in Asians and Africans, as the density is lower in these races. These numbers were calculated as follows:

The permanent zone contains 25% of the original hair. In Caucasians birth hair numbers are 50,000 follicular units, in Asians it is 40,000 follicular units, in Africans it is 30,000 follicular units. For FUE, the doctor can harvest no more than 2/3rd of the follicular units safely in the donor area in a Caucasian (that is 8,250 follicular units). If the density is higher than average for that particular individual, then the numbers can rise. For example, if a person is born with 60,000 follicular units (not uncommon in a Caucasian male with higher than normal density), then the surgeon may be able to harvest over 10,000 FUE grafts. That requires a high density birth hair presence which is present in less than half of Caucasians, rarely in Asians, and almost never in African hair type individuals.

Doctor, compare about eyebrow transplant and hair transplant. Which has higher success rate and why?

3-4 days after eyebrow transplant I have a very little crust and scabs. Is it a good sign? Do I have to use vaseline petroleum to my eyebrow right away after procedure?

Hair transplant results are the same for eyebrow or scalp. The eyebrows tend to crust less, but the key to keeping crusting down is to use a good washing technique daily after the transplant. I have never recommended Vaseline petroleum after a hair transplant.

I’ve had a total of 5 transplants. Two in the front (700 grafts each) and one on the crown (1000 grafts). These three surgeries together produced a beautiful result. I should have stopped there but I was under the illusion that another transplant (1.5 years later) would give me even thicker hair. The Doctor that did the transplants is a pioneer and very well known and respected. I’m not going to mention his name because you would automatically know who he is.

Nine months after the fourth transplant (600 grafts in the front) I did not see any additional density. Three years later I went in for a consult about the front again and he told me that I did not need the fourth transplant but he would be able to do a small one (500 grafts) at that time so I had it done. Six months later I did notice a difference and was pleased with the end result.

It has been six years since and I still have all of my hair. My question to you is: Why would he do a transplant when I didn’t need it? I look back and feel that the grafts were wasted and I was taken advantage of. Like I stated earlier this individual is a pioneer and respected. He certainly did not need the money. Even the nurses joked with me saying that I had “a lot of beautiful hair” hinting that I didn’t need to have the last transplant. What is your opinion on this?

I speak of the importance of ethics at medical meetings. Some doctors push for surgery even if the patient does not need it. This is commonly seen in young men who are too early in the balding process where drugs like Propecia (finasteride) suffice for the sole treatment, and 80% of women with thinning who are not candidates for surgery, yet the doctor recommends surgery on many of them who feel that they must do something about their thinning. For them, the surgical option is an easy sell, even if there is no value for surgery.

My job as a hair transplant surgeon is to always be a patient advocate, pushing those who do not need surgery away from the FUE punch or the surgical knife. It is always good business when I can create a trusted following of patients who believe in my ethics, especially when I steer them away from a surgical decision in examples as those discussed above (majority of women, young men). Many times it is harder to talk patients away from wanting surgery than it is to recommend surgery for an actual candidate. By that, I mean I have to spend more time with each such patient educating them on the ‘whys’ of my decision process.

Hi Doctors, great blog here! It’s an amazing cross-reference and informative place.

Just wanted to know if there are any signs of a successful FUE transplant? (other than growth of hair at 8-10 months!!).

Can the patient tell within a week, or a month, whether the surgery he had would be, say, at least 80-90% successful? Are there any signs which suggest that yes the transplant was a success, and that the roots did not dry out, and were placed correctly etc.? ( I’m guessing, that if the transplanted hair kept growing till it fell out after 3/4 weeks, that means the roots were alive and firmly in place, and the surgery was good? )

I only ask about FUE, because it seems the more delicate procedure with a higher trans-section rate.

Thank you Doctor.

I know the anxiety you have. Everyone with a hair transplant wants to accelerate the clock, but it makes no real difference if the transplant is FUE or strip. In either case, you will start seeing the results (at least some results) somewhere between 4-6 months, with good growth by the 8th month. At one month, the hair sheds in probably 19 out of 20 people. Just be patient.

Snippet from the article:

In the dozen years since the Da Vinci robot has been approved for surgeries in the United States, it’s been embraced by health care providers and patients alike. Surgeons routinely use the multi-armed metal assistant to remove cancerous prostate glands and uteruses, repair heart valves and perform gastric bypass operations, among many other procedures.

Read the rest at Kaiser Health News — Questions Arise About Robotic Surgery’s Cost, Effectiveness

Although this article reflects upon robots used for abdominal, prostate, cardiac surgery, etc… some of the questions asked will apply to the ARTAS robotic hair transplant FUE system. More from the article: “At this time, health insurers generally pay for robotic surgery just as they would any other surgical procedure, and patient out-of-pocket costs are typically no different either. That could change, some say, as more comprehensive data become available that clarifies when robotic-assisted surgery helps improve patient outcomes—and when it doesn’t.”

Robotic FUE with the ARTAS system does what appears to be an excellent job at the FUE itself; however, as the grafts that are created are removed manually, stored in traditional solutions, and placed manually, defects in process that were present before the robot was used will continue even with efficient drilling of the grafts.

“Robot-assisted surgeries are generally more expensive than other methods, however, and don’t necessarily improve patient outcomes long-term,” says the article. Although this statement is not referring to the FUE robot, the message is clear. What is it that the public is buying and what will the long term results actually be for the FUE robots?

Many of the ARTAS systems that have been sold to date were purchased by experienced hair restoration surgeons, so I suspect in their hands, the long term results will be good for them; however, for the novice doctor or the doctor who has not put together the system of people skills behind the robot for moving, storing, and placing the grafts, an imbalance in long term results may result. It will be years before we know, though.

Dear doctors, love the website. I come here as much as i can and its helpful in learning and coping with hair loss, which is the worst thing a man can go thru.

I understand that a lot of transplant doctors tell their patients its better to wait to get a final hair loss pattern rather than going for a hair transplant when the hair is still falling out. So wouldn’t finasteride be a bad thing to take then because if it merely slows down the hair fall out rate and doesn’t stop it, then a patient wouldn’t really reach his final pattern at a proper age where he can have a full HT?

The drug would just keep on delaying the patient from reaching the final balding pattern but he would still be losing hairs, albeit not as many as he would have if he were not on the drug, but he would still be losing hairs and can not get a hair transplant.

Delaying the need for surgery is sort of the point.

The goal for finasteride in many patients is just what you said. Why rush into surgery that may not be necessary? If you are lucky, the drug may delay the final pattern for many decades. Surgery is more of a last step unless the pattern impacts your appearance and you want it restored.

Many young men find themselves in the situation you are talking about and may never develop a pattern beyond a Norwood class 2 and could keep the hair throughout the scalp.

hi, two weeks after a surgery with dr. rahal of 2846 grafts (888 1 hair, 1526 2-hairs, 429 3-hairs, and 3 4-hairs), i experienced a massive shock loss. it has been one month post surgery and i am very worried about even going to my original look, which at this point i would be happy with. i only take minoxidil, because of the side effects of finasteride.

do you see a lot of this shock loss from the pics as being temporary, because although i am thinning, i am not an entirely diffuse thinner, but lost everything. at this point would total of the 5239 hairs even be enough to fill in what i have lost? i should also note that the hairs that are remaining are ones from a previous surgery with ziering that was supposed to be around 2300 grafts, but i am not even entirely sure about his work.

thank you so much for your help and suggestions, greatly appreciated!

Click the photos to enlarge:

It is difficult to make many comments about your exact situation, because the before picture and the change in your hair length are confusing your situation. I will assume that you are young (under 30 years old). Were you afraid of possible side effects from finasteride, or did you actually experience them? Shock loss is common in young men after a hair transplant, unless the young man is protected with Propecia (finasteride). Prior to the appearance of this drug on the market, shock loss was a common problem for hair transplant surgeons. Since the use of finasteride, this type of report is relatively uncommon.

Shock loss usually appears in the first three months after a surgery, when it happens. I do not believe that the size (# of grafts) is related to the shock loss, as a hair transplant of any size can do it. Shock loss reflects your genetic timelines and often accelerates the timelines 1-3 years.

I have a large scar from a head surgery from when I was young. Hair does not grow there, and it looks very bad with my hairstyles.

I am currently 18. Would I be a good candidate for hair transplantation onto the scar, especially as regards to shock loss?

Maybe, but I can’t really say without an exam. You should see a hair transplant doctor for a better idea.

At NHI, we routinely perform surgeries to cover scalp scars as long as realistic expectations are understood. In other words, each case is different.

This is a Norwood class 7 patient who loves the hair he had transplanted a decade ago in a single procedure of 3072 grafts. He is using a comb-back styling technique.

After seeing him again, we decided to do one more 3000 graft surgery to fill in the crown. His entire bald area is huge, so even the next surgery will not give him a full head of hair. The solution we came up with is that we’ll follow-up after the next procedure with Scalp Micropigmentation to thicken its appearance. That will make a huge difference and this patient is thrilled with the idea. I will post some updated photos in about 12 months from now to show the transition.

Click the photos to enlarge (and apologies for the blurriness of the top view Before photo — I can’t go back in time to take a better one).

After:

Before: