Concept Behind Hair Transplants
If you look at any balding man you will notice that he never goes bald on the sides or the back of his scalp, we call this his "hair bank". We can take this hair and transplant it anywhere and it will usually grow forever. This is what we call "Donor Dominance", if you transplant hair from a certain part of the body it will always grow like it did from the original donor site. So in a hair transplant, we just take hair from the patient's "hair bank" and transfer it to the balding area.
There are two recent innovations that have revolutionized hair transplants. The first is transplanting each individual natural grouping of hair as a unit and the second is the use of the stereoscopic microscope to dissect the hair to be transplanted into follicular units.
Hair does not just come out of the scalp individually, one by one, but actually grows naturally in groups of one to four hairs with a fibrous sheath surrounding group. Since that is how God designed everyone's scalp, that is how I perform a hair transplant. I transplant the single hair grafts on the hairline and the natural groups, with three and four hairs, farther behind for density. The benefit of transplanting individual, "natural hair groupings" is the completely natural look I achieve and the higher survival rate of the transplanted grafts.
To try to obtain a natural look, many doctors now perform transplants with what is called "single hair micro grafts." They separate the "natural hair groupings" into single-unit hair grafts and transplant the hairs individually. By separating the natural groupings of hair, the transplant surgeon is going against nature. A study published in the Journal of Dermatologic Surgery showed that the survival and quality of these grafts markedly decreases.
The stereoscopic microscope is probably the most important innovation in hair transplants. The "natural hair groups" must be preserved intact during dissection to insure increased survival and growth. Many doctors dissect with the naked eye or with minimal magnification. That leads to increase transection and destruction of the hair. When dissecting the donor hair without the stereoscopic microscope it is nearly impossible to ensure that the "natural hair groupings" will remain intact.
For a balding man seeking a transplant, his most precious commodity is his donable "hair bank." The use of the "stereoscopic microscope" to dissect the grafts enables me to visualize each and every individual "natural hair grouping." By using the "stereoscopic microscope" the trauma to the surrounding hair is greatly reduced and our patients receive superior quality grafts with a much higher incidence of survival. I can now achieve survival rates of 95 to 100 percent, as compared to other techniques where the survival rate is much less. The "stereoscopic microscope" also enables us to trim excess tissue away from the hair follicle, therefore, smaller incisions can be made, which enables us to pack the grafts closer together to give a denser, more natural look.
Comparing Strip Excision Follicular Unit Hair Transplants to FUE (Multiple Punch Excision) Hair Transplants
There are four main segments to the hair transplant process.
1. The extraction of the donor hair via-
a. Punch Excision (i.e.-FUE [0.8-1.25 mm punch excisions] and how hair transplant first started in the 1950's with 4-5 mm punch excision
b. Strip excision
2. The dissection/trimming of the donor hair
3. The making of the recipient incisions
4. The planting of the grafts into the recipient incisions
The only difference between strip excision hair transplant and FUE (more accurately described as Multiple Punch Excision [MPE]) hair transplant is how we extract the tissue out for the donor area. Steps 2 through 4 are the same. Both techniques have their strengths and weaknesses; therefore, it is very important to know this and use the appropriate technique depending on the patient and the circumstances.
The advent of FUE Hair Transplants has brought about a lot of very unethical marketers, doctors and non-doctors, and companies that have very little knowledge of the pathophysiology of hair loss and even less knowledge of the art of hair transplants. Unfortunately they are making claims that are outright lies and mistruths.
Claim- FUE hair transplants are scar-less. This is a claim that is commonly made by doctors who have purchased the Neograft punch excision machine who commonly have had no prior experience in the field of hair transplants so they many times allow an unlicensed technician do the surgery for them.
Truth- This is absolutely false. The punch excision tool used to perform FUE has been used by dermatologist for a century and we known it creates scars for the last century. A 1mm punch excision tool used in FUE creates approximately a 1.2 mm white circular scar. In the 1950's , hair transplants got its origins in the United States from this 4-5mm punch excision tool.
Claim- FUE Hair transplant is non-surgical and incision-less.
Truth- This is absolutely false. Every form of hair transplants is surgical and involves incisions (i.e.- the cutting of tissue). In matter of fact FUE hair transplants creates over ten times the surface area of incised tissue as strip excision follicular unit hair transplants. There is much more cutting of tissue with the FUE technique.
Claim- FUE Hair transplants are painless.
Truth- This is absolutely false. Any form of hair transplants has to have local anesthesia which involves a certain degree a discomfort. Many times FUE hair transplant involve much larger area of donor area removal in order to spread out the scar tissue; therefore, the discomfort would be greater since a greater area would have to be anesthetized.
Claim- Strip surgeries create spread scars.
<Truth- Strip excision follicular unit hair transplants typically create very thin linear scars that even short haircuts hide and are hard to find. The biggest risk of a spread scar is when a doctor takes out too wide of a strip and closes the wound under tension. This is typically caused by doctors performing mega-sessions since they typically need to take wide strips to get the number of grafts they are doing. Stopping mega-sessions hair transplants will prevent most patients from getting spread scars.
Below is a chart of the short term and long term pro's and cons of a patient a 2000 graft FUE/Punch excision hair transplant versus a 2000 follicular unit hair transplant via a strip excision.
FUE- 2000 thousand of punch excisions
|Short Term Pro's||Short Term Cons|
|No need for sutures||Scalp needs to be shaved so do not have hair to hide the healing process|
|Takes weeks to month for the hair to regrow to hide the hide the 2000 thousand healing punch holes|
|Much more surface area of donor scalp exposed to surgical cutting/ excision—i.e.-more trauma to the donor area|
|Short Term Pro's||Short Term Cons|
|No need to shave the scalp so the donor site and sutures is hidden the day you walk out of surgery||The donor site needs sutures that are removed in 1 week.|
FUE- thousands of punch excisions
|Long Term Pro's||Long Term Cons|
|Patient will not have a linear scar||The patient will have 2000 1.2mm circular scars which equates into 2400 mm2 of scar tissue to the donor area. Strip excision for 2000 grafts typically creates a 1mm x 200mm linear scar which equates to 200 mm2 of scar tissue. Therefore there is approximately 12 times more scar tissue with FUE/punch excision technique|
|In order to spread out this increased amount of scar tissue, many doctors punch excise hair outside the boundaries of where of the good genetic hair. Therefore those grafts are only temporary and with eventually miniaturize and go away.|
|FUE/Punch excision technique exposes each graft to "blind dissection" which means the doctor cannot see through the tissue he is cutting with the punch therefore he does not know if he has transected and destroyed the hair follicle until after it is already done. Transected hair follicles have much poorer survival.|
|With much more surface area of scar tissue it can lead to the donor area looking "moth eaten" if over-harvested.|
|Long Term Pro's||Long Term Cons|
|Much less surface area of scar tissue than FUE/Punch excision technique||Will have a linear scar- however this should easily be hidden by even short haircuts and hard to find|
|Can dissect the strip tissue under the stereoscopic microscope in order to have full visualization while dissecting the hair follicles, as opposed to blind dissection. Being able to fully visualize the hair while dissection gives greater ability to decrease the transection rate of the grafts which increases the survival of the grafts.||At an increased risk of a spread scar if the surgeon tries to take out too much tissue in order to do a mega-session. Solution- don't let your surgeon do a mega-session hair transplant. You can always do another hair transplant tomorrow, but if you destroy the donor area you cannot.|
|Can remove the tissue from the area of the best genetic hair|