Separating Fact from Fiction: A Doctor’s Advice on Hair Transplantation

Aggressive promotion is all too common in the field of hair transplantation, making it difficult for patients to separate objective medical information from marketing hype. And while there have been some noteworthy advances in hair transplantation techniques in recent years, the “latest and greatest” isn’t necessarily the best option for every individual. Here’s the advice I give my patients:

The most clinically proven, effective hair transplantation method today is called Follicular Unit Transplantation (FUT). A follicular unit (FU) is a naturally occurring group of one to four hairs that grow together in the scalp. With today’s technology and surgical techniques, we can harvest and transplant individual FUs. As a result, transplanted hair is distributed evenly throughout the scalp, ensuring a completely natural look.

There are two different methods of harvesting FUs, however, and each has advantages and disadvantages.

The newest – and most-often hyped – technique for harvesting donor hair is called Follicular Unit Extraction (FUE). With FUE, doctors use a surgical device that’s like a hole-punch to score the skin around individual follicular units. Each follicular unit is then extracted and inserted into a small incision at the transplant site.
“Strip harvesting” is the more longstanding method of obtaining donor hair for transplantation. In this procedure, a strip of skin that contains multiple follicular units is surgically removed and the wound edges are sutured or stapled together. The individual FUs are extracted from this strip (instead of directly from the scalp) under a special microscope, then transplanted. The strip usually is removed from back of the scalp where hair is thickest and genetically programmed to grow for life.

The FUE method is often promoted as a scarless procedure because there’s no linear scar as there is with strip harvesting. But in the hands of an expert surgeon, the scar from strip harvesting is so thin that it’s barely detectable, even if the patient wears his or her hair extremely short.

Further, what FUE proponents often don’t mention is that this technique can produce scars of a different sort. How? Each FUE extraction leaves a small (1 to 2 mm) hole in the scalp. Since hundreds – and usually thousands – of extractions are necessary for most transplantation procedures, this can result in golf-ball-like dimpling on the scalp.

Another important consideration about the relative invasiveness – and cost – of the two techniques is that FUE usually requires multiple harvesting sessions to provide the same number of follicular units obtained from only one strip harvest. This not only means the patient must endure thousands of small scalp incisions to extract the follicular units (versus just one – albeit longer – incision for strip harvesting), but it also makes the FUE procedure more time- and labor-intensive and – notably – more costly.

On the other hand, FUE can be a good option for less-extensive transplants. We also can harvest hair from other parts of the body to customize a transplant (taking fine hairs from the nape of the neck and transplanting them at the temples, for example). In addition, FUE is ideal for harvesting the relatively small number of hairs needed to restore eyebrows and eyelashes.

But perhaps the most significant difference between the two techniques is that we end up with greater number of viable follicular unit grafts through strip harvesting tha
FUE. This is because FUE grafts are more fragile since they often lack the protective tissue that surrounds the hair follicle (like the root ball of a seedling). When we microscopically dissect the FU during strip harvesting, we’re better able to preserve this protective tissue – and it ensures optimal growth after transplantation. The more strong and viable grafts we can harvest and transplant, the more successful your results will be.

Perhaps the most important fact is this: expertly performed hair transplantation surgery is an undeniably effective way to enhance your appearance, producing a thicker, fuller and natural-looking head of hair. But before you undergo surgical hair restoration, use your head to separate the medical information from the marketing hype.