eyebrowqueen

I had an eyebrow transplant with doctor Rahal. One eyebrow did not grow in as well as he other. He couldn't tell me exactly why one didn't grow (there are lots of factors involved, one of which could be genetics) but he did offer me a free touch up procedure and put me up in their guesthouse at no charge. While I was unhappy with the initial results of my surgery, I have to say that his customer service is excellent. I can't speak to the result of my second surgery yet (I just had it 2 weeks ago) but I can say that I think the reason it is hard to find a negative review is because if a customer is unhappy they do everything in their power to satisfy them. I think it's important to consider how a doctor will handle a result that doesn't go as planned. I hope this helps.

Thanks for the replies/encouragement. I did have holes in my skin for almost 6 months after the procedure. They looked like little pits. I was told that this is micro scarring from the incisions. I think the redness did make it look worse though. My skin is still pink and shiny in the recipient area. I'm told that it will eventually go away. I wish I was told before that it could take 6 months for my skin to return to normal. I was definitely not prepared for it to take this long!

Here is my 6 month photos. There are still some areas that haven't grown in but you can see that the condition of my skin has improved.

Hi everyone, I just wanted to give an update. I am not just passed the 6 month mark. The scarring on my recipient area has improved a lot in the past 6 weeks. I still have some lingering pinkness and microholes from the incisions, but the "pitting" I was most concerned with has smoothed over a lot. I guess it really does take 6 months for some people to heal fully. I think this is really important for eyebrow patients to know going into the procedure as it is a huge investment of time.

I am 6 months post-op and I still have some pinkness in the recipient area. I'm told this is due to my fair skin. I guess it takes longer for the redness to fade for some people.

Can anyone tell me how to edit a post on the hair loss forum? It says in the hair loss forum rules that you can eidt your posts but I can't figure out how to do it. Thank you.

Hi Joe, Thanks for your reply. I don't have any bumps on my eyebrow. What I have is holes or "pitting". I am currently at 5 months post-op. These holes have not improved since the procedure. Is it possible to have permanent scarring from an eyebrow transplant? If so, is this due to the incisions or the placement of grafts?

Hi Jaynine, I was wondering how your progress is going? I had my eyebrow transplant 5 months ago and I have really bad scarring on one of my eyebrows. There are indentations that look like "pits" on my skin. Dr. R says that this is normal and that there will be "minute scarring" whenever an incision is made in the skin. I posted some pictures on a different thread if you want to take a look at them. I was wondering if you had any scarring on your eyebrows from this procedure and, if so, did it go away? I'm really worried as it looks really bad

Hi everyone, I was able to take a very clear photo of the "pitting" on my right eyebrow. The last picture I attached shows the scarring above my eyebrow, but this picture shows the scarring below my eyebrow. Dr. Rahal called this "minute" scarring which he said is invisible to the naked eye. What do you guys think. Can you see the marks I am referring to?

It's not a matter of whether the hairs grow to cover the scarring, I don't think I should have scarring like this to begin with. I don't see how these pits in my skin are going to go away. I was told this procedure would leave no visible marks on my skin and that I could shape my eyebrows however I want later. How am I supposed to shape them if the skin underneath is scarred? I have attached another picture of the area. The scarring is very visible and I've had no growth where the pitting is so I have nothing to hide it. Makeup doesn't work because it just sinks into the the holes. I am so upset I would rather have no eyebrows than have scars on my face. I am almost 5 months now, and my other eyebrow is fully healed with NO scarring.

There was a message posted to thread by a user named "HareUpThere" that seems to have been deleted it so I am just reposting it. "Eyebrowqueen, I also had an eyebrow transplant with Dr. R. and can relate a lot with what you are going through. I think your brows look great, but I can see your concerns in your pictures if I take time to study them (ever so slightly). If you didn't mention the pitting/scarring I wouldn't have honestly noticed it at first few glances."

Hello, I wanted to give everyone an update. I am now 4.5 months post eyebrow transplant. The scarring on my eyebrows has not seemed to improve. In addition to the pitting, I have two red, raised scars on the tail ends of my both my eyebrows. I tried to capture this in the picture but it is difficult because there is hair covering it. I know there is a risk of keloid scarring on the donor site, but has anyone ever heard of raised scarring in the recipient area?

Hi MAGNUMpi, Thank you for your post. My doctor said that I need to wait until 6 months post op to reevaluate. He has offered to fly me to Ottawa to follow up with him in person which I appreciate. He said that my skin changes will calm down in the next few months. Hopefully this is the case and I am just overreacting. There is not a lot of information about eyebrow transplants so I am somewhat in the dark about what is and is not normal. I am really self conscious about the condition of my skin right now and it is causing a lot of anxiety for me. I was told that this procedure leaves no visible marks on the skin so I was really not prepared for this. Sean told me that he had visible scarring on his recipient area that has healed a bit so I am hoping for the same. I think the fact that it's on my face makes it worse because I see it every time I look in the mirror. I will keep you posted on my progress.

Hi Rawkerboi, No I don't have a blog on the Rahal website. That is a different patient. I actually choose my username on here while I was still reseraching the procedure (before seeing her blog) so it is just a coincidence that we chose the same name

Here is a photo of my left eyebrow. You can see the growth is considerably less.

Hi Sean, I actually had the same doctor as you. They took two small strips from behind each ear where my hair is the finest. I'm not sure the size of each strip, but the pos-op sheet I was given says that the size of my strip was 4.8 cm. They placed a total of 760 grafts. I know that very small needles were used to make my incisions - I think it was 0.8 mm and only single hair grafts were used. From what I was told, the healing time should be the same for the eyebrows as for the scalp, as should the growth rate. What is concerning to me is that there is no hair growing in the areas where I have the pitting so that makes it that much more visible. At this point, I don't think I will be able to shape them at all unless my recipient area heals considerably. The problem with this is that the shape is not symmetrical. One comes in farther than the other and one is a little lower. They were also done thicker than what had been drawn on prior to the procedure. I was shocked at how thick they were after the surgery and when I expressed this to the doctor, he told me that the marker smudged a bit so it made the line less defined. These concerns have become a moot point however because his response was that I signed off on the shape prior to the surgery. My other concern is that one of my eyebrows has considerably less growth than the other one. They have told me that this is normal but I am still worried as it seems strange that one would grow and not the other. I'm trying to figure out how to post another picture but when I click on the "insert image" icon it asks me to enter the URL of my image which I don't understand. I looked at your website and I saw that you did not have good growth from your first transplant. How did the second one go?

Hi Sean, Thank you for your reply. The doctor removed the strip and made the incisions. The technicians placed the grafts. One technician seemed to be less experienced that the other as she took an extra 40 min to place my grafts after the other technician had finished. This is the eyebrow that has the scarring. I have followed up with the doctor multiple times. At one month post-op, I was told that the holes were just delayed healing and would go away. At 3 months this was the first time I was given the response that there will always be scarring whenever an incision is made. I just followed up again (at 4 months) and expressed concerns about the difference between the two eyebrows. My left eyebrow has tiny pinprick marks which would constitute "minute scarring", however, the holes on my right eyebrow are much bigger and deeper. The doctor just gave me the same response as before and won't give me any reasons as to why the big difference. He is also saying that I was told before the procedure that I would have scarring on the recipient site, which is simply not true. Were you told before your procedure that you would have scarring on your recipient site? I feel like he is avoiding me and not taking my concerns seriously. I don't know what I can do?

I am 4 months post-op eyebrow transplant by one of the top surgeons in Canada who is also a coalition member and recommended by this site. There were two different technicians who placed the grafts - one on each eyebrow. My left eyebrows is fine, but my right eyebrow has visible scarring. There are holes in my skin that are much bigger than the size of the needle that was used. They look like the type of scars you get from acne. I contacted the doctor about my concerns and his response was "There is always a minute level of scarring anytime you make an incision in the skin.Typically the scarring is invisible to the naked eye but it does exist; this is how the skin heals." This is contrary to what I was told prior to the procedure as I was told that this procedure would leave no marks on the skin. I went to see a local surgeon who told me that the holes I have is called "pitting". He told me that this is not caused by the incisions but by the placement of the grafts. He told me this happens when the grafts are placed too deeply. This makes sense since there were two technicians who placed the grafts and I only have these holes on one side. I am getting conflicting information and I would really appreciate other opinions as to what would cause this scarring. Could it be due to inexperienced technicians? I asked the surgeon how much experience the technicians have who placed my grafts and he did not respond to the question. It is hard to get a close up picture of the scarring, but I have attached a picture. You can see the holed above and below my eyebrow where it is not camoflauged by hair.

Thanks so much for your reply. I was wondering if you had any hair in your recipient area before the surgery? If so, did your native hair fall out with your grafts? I have eyebrows but they are very thin and I'm having this procedure to add density to it. After reading this I am worried about losing my native hair permanently. I was told there is a small chance that I could get shock loss but that the hair will grow back. Did this happen to you? Thanks for sharing.

Jaynine9, How did your transplant with Dr. Rahal go? I have an appointment in 2 weeks. Is there anything I should be concerned about?

Jaynine9, How did your transplant with Dr. Rahal go? I have an appointment in 2 weeks. Is there anything I should be concerned about?

Hi everyone, I have decided I want an eyebrow transplant and I have been diligently researching surgeons. I came across a surgeon in LA, Marc Dauer. He has numerous before/after photos posted on his website which, in my opinion, are among the most natural looking results I've seen. He charges more than other surgeons but I'm willing to pay more for superior results. He has phenomenal reviews on both google and yelp and I can't seem to find a single negative review. I've been told he even places every graft himself instead of having a technician do it. I was wondering if anyone on here has had any personal experience with him? Why is he not a recommended surgeon? Is there a reason for this or has he just been overlooked? Thank you!

The International Society of Hair Restoration Surgery’s website posted a position statement on scalp surgery and a paper that presents a fair and balanced view on the topic of FUE versus donor strip harvesting. I found it very informative so I thought I would share it. I am not advocating one method over the other, I just think it is important to have all the information possible in order to make an informed decision. The following is the official position of the ISHRS August 2010 – Comparison between Strip Harvesting and Follicular Unit Extraction: A Fair and Balanced View ISHRS Position Statement on Qualifications for Scalp Surgery Ten years ago the use of follicular unit extraction (FUE) was advocated as an alternative to traditional strip harvesting of the donor tissue. The use of the technique has been slow to be accepted as a new standard. Many physicians have, in fact, tried the technique but with markedly varying success. The recent promotion of mechanical devices and powered follicular extraction devices has sparked renewed interest and controversy regarding this method of harvesting. A great deal of discussion by physicians, ancillary personnel, and the general public has occurred on the Internet and multiple media sources about the value of FUE versus strip harvesting and vice versa. Sadly, many of the claims of “superiority” of the newer technique seem more related to marketing and self-promotion rather than a clear scientific evaluation. This article discusses advantages and disadvantages of both techniques to provide a more accurate and balanced view of the two approaches. The Donor Area and Scar Formation Strip harvesting produces a linear scar. The appearance of the donor strip scar can be a significant concern for patients who wish to wear their hair very short. The vast majority of patients who undergo strip harvesting have minimal scars that are easily concealed by the hair above the scar. And in many instances the scar may not be evident at all except on careful inspection. There are, however, some patients who have scars that have widened, and there are also patients who have several scars from multiple procedures. In some instances the apparent widened appearance of a scar may actually be due to damage to follicles along the incision line during harvesting rather than true scarring. Judicious planning on the part of the surgeon can largely diminish the problems associated with strip scars. By limiting the width of the strip to be taken and avoiding tension on the wound, the surgeon can minimize the donor scar. To avoid multiple scars many physicians who use strip harvesting employ a single scar technique even if multiple procedures are performed. By utilizing careful dissection along the incision line, damage to hair follicles can be diminished. The use of the trichophytic method of closure for strip harvesting can also be extremely helpful in improving the appearance of the strip harvest scar. As noted above closing under minimal or no tension can help to avoid the widening of a scar. This allows hair to camouflage the scar and the hair growing through the scar can limit the stretching. Avoiding damage to the hair follicles along the incision lines is crucial in preventing the appearance of a prominent scar. Some physicians advocate the use of a layered closure and undermining as techniques to minimize scars. Other surgeons feel that undermining and layered closures do not seem to alter the healing except in situations where tension is a problem. There are patients such as those with Ehlers Danlos syndrome, who because of alterations in collagen deposition, are prone to widened scars and poor wound healing. There is little that can be done to prevent such scars in these patients. The circular scars produced by FUE may suffer the same fate and be stretched in these patients. The primary rationale for the use of FUE is that a linear scar is avoided. Several proponents of FUE market the procedure as a technique that does not involve cutting, is less invasive and does not result in scars (i.e., “scarless”). While a linear scar is not created with FUE, circular scars are created. The length of incision is greater with FUE than with strip harvesting. This is apparent when one calculates the circumference of a 1mm punch (1mm x pi = 3.14) and then multiplies this by the number of grafts, for instance, 1000 grafts (1000?3.14 =3140mm which equals 31.4cm). In comparison, a strip harvest of 1000 grafts assuming an average density of 80 FUs per sq cm and a 1cm strip width the length of the scar created would be 12.5cm (1000/80 = 12.5). “Cutting” is clearly involved when using a punch. Although a linear scar is not produced with FUE, scars are created and evidenced by virtue of the fact that hypopigmented or hyperpigmented “dots” may be visible when the hair is cut very short. These “dots” may be a scar reaction or actual post inflammatory pigment changes, particularly in darker skinned individuals. Also the human eye may pick up “spaces” where follicular units are missing in the normal pattern. The depth of the incisions with FUE is usually shallower as compared to strip harvesting. The punch depth is to the level of the fat or at the fat-dermis junction. With strip harvesting the depth of incision is into the fat. Some physicians cut to the deeper fat or just above the fascia. When using FUE it is important to recognize that as more and more grafts are harvested the area may appear moth eaten. If grafts are taken too close together there may be an appearance of a scar. In some patients as large numbers of grafts are removed there can be a clear demarcation between the areas that have been harvested and areas left alone. This is opposed to the strip technique where hair of similar density is brought back together at the suture line. Opponents of strip harvesting would note that if hair does not grow well in a strip scar and the scar widens, then the scar might be apparent if the hair above it is short or otherwise thin. Some promoters of FUE have stated that nerves and veins are not cut. This claim is untrue. By entering the skin with the punch arteries, veins and nerves are cut. It is important to point out that with FUE the patient’s hair usually must be trimmed quite short for harvesting. This is the case especially when large numbers of grafts are required. A way to avoid trimming all of the donor hair is to set up rows of short hair between rows of long hair. The short hair grafts can be harvested within the existing long hair. But again, this is only suitable when relatively small numbers of grafts are needed. Graft Survival Debate exists as to the rate of survival regarding FUE versus strip grafts. There is some concern that because the FUE grafts may have very little tissue surrounding them that they are less likely to survive. Such grafts are more prone to dehydration, which has been shown to be a major cause of diminished graft survival. The lack of perifollicular tissue is often a result of “pulling” on the graft to remove it. Because there is added manipulation in trying to remove a graft this may also contribute to diminished survival. Sometimes the ends of the bulbs are splayed or unusually far apart. This makes the bulbs more susceptible to trauma, as a result of increased graft manipulation during implantation. As of this time there are not adequate studies to compare survival rates. Clearly there are patients who have undergone the FUE procedure and have excellent results. Some physicians might argue that less successful results may be due to technical surgical skill rather than the nature of the more fragile graft created with FUE. With FUE there is a greater chance of transection of hairs as compared to strip harvesting and this could result in poor growth or lack of growth depending on the level of transection. The rates of transection seem to vary widely with FUE. Conversely, with strip harvesting, grafts may be damaged in making the initial skin incisions and subsequent dissection of the tissue, but this is considered minimal. The use of the microscope for dissection of the donor strip should limit transection rates to 1-2%. Grafts created with strip harvesting generally have a greater amount of surrounding tissue and fat. This may decrease the chance of dehydration and allow for greater leeway in manipulation of the grafts during placing and hence, better graft survival. Placing of Grafts When manual placement of grafts is utilized there is no difference in regard to the technique of placement of strip harvested or FUE harvested grafts. There may be some concern about the fragility of the FUE grafts and the fact that they may be more susceptible to drying and over manipulation. When a machine that uses pneumatic pressure is used it is the contention of the manufacturer/distributor that the machine places the graft with less manipulation. Some surgeons who have used the machine have indicated that the graft placing capability of the machine is limited at times and not always reliable. Perfectly harvested grafts may be damaged during the placement phase and fail to grow. Trauma and graft drying are well known factors that may occur in inexperienced hands and will effect graft survival. Regardless of how grafts are harvested, there is a considerable amount of artistry and technical expertise necessary to place them to produce an excellent or even acceptable result. The surgeon must be able to create an aesthetic “blueprint” for graft placement, determining the distribution of 1, 2, and 3 hair grafts. Hairline design is obviously important, as is the grafting plan over the rest of the scalp. The experienced hair surgeon will create gradients of density to achieve natural looking results with adequate density. In addition, the incisions must be made at the proper angle and direction. Even single hair grafts will look unnatural if placed at the wrong angle. Technical Expertise A somewhat different skill set is required for FUE harvesting. The surgeon must be able to align the small punch correctly, find the right depth and adjust the punch to account for changes in direction of the hair. The primary concern with FUE is the rate of transection. That is, if the hairs in a follicular unit are transected they are less likely to grow. This is in part dependent on the level of transection. The reports from physicians performing FUE indicate that the rate of transection is higher than with strip harvesting. As noted above, the physician must be able to adjust the punch to account for change in hair direction. Patients with curly or very wavy hair may be difficult to treat when FUE is used. In comparison, strip harvesting is suitable for all types of hair. The use of the blunt punch can be helpful in harvesting curly or wavy hair with the FUE technique. FUE can be a tedious process and both patient and physician may experience fatigue. This can limit the amount of grafts that can be harvested in a single session. Because of the time usually involved in harvesting and the possible strain on the surgeon performing the harvesting one has to wonder if less emphasis is placed on the recipient area. The learning curve for FUE can be slow for physicians who are used to excisions with scalpels and unaccustomed to the use of punches for harvesting. The physician may need to use high power loupes 4x-6x. Working at a shorter focal distance can be tiresome and lead to neck problems. Some physicians have used ophthalmic microscopes to facilitate the surgery. An important issue associated with a particular mechanized FUE is the marketing to physicians that unlicensed personnel may be able to perform the harvesting. This raises significant legal issues in many countries, including the U.S. There are states where it is clearly illegal to have a non-physician, non Physician Assistant (PA) or Nurse Practioner (NP) perform such surgery. The laws in other countries may present similar medico legal problems regarding who can harvest tissue. For example, in Austria, Israel, Italy, Korea, Georgia, Thailand, Turkey, and Japan, only physicians are allowed to make incisions, and regulations vary as to the role of assistants in graft insertions. In some countries including the US, entrepreneurial nurses and medical assistants are setting up hair transplant clinics, and hiring physicians as medical directors who may have limited or no hair transplant experience, but who “supervise” the procedure. Many U.S. states allow the physician to delegate responsibilities to staff under supervision, but both the degree of supervision, and the extent of staff responsibilities is not clearly defined. To date, this issue has not been challenged or reviewed by any state medical board. The following is the position of the International Society of Hair Restoration Surgery: ISHRS Position Statement on Qualifications for Scalp Surgery The position of the International Society of Hair Restoration Surgery is that any procedure that involves tissue removal from the scalp or body, by any means, must be performed by a licensed physician in the field of medicine. Physicians who perform hair restoration surgery must possess the education, training, and current competency in the field of hair restoration surgery. It is beyond the scope of practice for non-licensed personnel to perform surgery. Surgical removal of tissue by non-licensed medical personnel may be considered practicing medicine without a license by state, federal or local governing boards of medicine. The Society supports the scope of practice of medicine as defined by a physician’s state, country or local legally governing board of medicine. Number of grafts per session In general most physicians who perform FUE are not able to do as many grafts in a single session as can be done with strip harvesting. With strip harvesting, sessions of 2000-3000 grafts are very common and some physicians frequently perform sessions in excess of 4000 grafts. There are, however, exceptions and some physicians, routinely performing motorized FUE, report similar in excess of 2000 grafts. Unfortunately, the rates of graft transection in these larger FUE sessions has not been studied or reported. Cost The cost of FUE is usually significantly more than that for strip harvesting on a per graft basis. The costs may exceed double the price of strip harvesting. Body Hair FUE can be very useful for harvesting body hair. In such situations the majority of follicular units are single hairs. Evidence of the surgery is often visible as hypo or hyperpigmented “dots” in these non-scalp donor areas. Small number of grafts When small numbers of grafts are needed FUE may be an excellent choice of technique. Using the technique where narrow rows of trimmed hair are used it would be relatively easy to camouflage the work and avoid creating a linear scar. On the other hand using a 2.5 cm long and 1.2 cm wide strip a surgeon could easily obtain 240 or so grafts. (2.5 x 1.2 =3.0 sq cm) assuming a density of 80 FU per sq cm (80 x 3 = 240 grafts). Thus, evidence of removal of 240 FUE grafts would be a 2.5cm long scar. FUE into scars FUE can be used to try to camouflage linear donor scars. This is considered by many hair restoration surgeons to be another excellent use of the technique. Some surgeons have suggested that a combination of strip harvesting and FUE is the optimal use of the techniques. Instrumentation The cost of instrumentation for strip harvesting and non-mechanized FUE is modest. With the advent of mechanization the cost for machines that can be used for FUE can be expensive. Powered or motorized devices can cost several thousand dollars and one system currently sells for approximately $80,000 (USD). With the motorized systems there is debate as to the rate of transection. Some physicians who perform FUE but do not use the motorized systems feel that the rate of transection is higher with such devices. Other surgeons indicate that transection rates are the same or lower. This may depend on the training and skill of the physician performing the work. Increased donor supply Advocates of FUE have stated that FUE expands the donor area in the scalp. With FUE the surgeon can harvest in the nape of the neck more easily as well as the areas superior and more anterior to the ear. This apparent advantage is somewhat negated because the area can become moth eaten in appearance as more and more graft are obtained. In addition going into the nape of neck area or high onto the scalp can be a problem later in life for the patient as some men lose hair in this area as a result of male pattern hair loss. Complications Some of the surgeons who prefer FUE feel that patients experience less pain and there is a shorter recovery time. There is little data to support this view. One would need to compare the pain associated with comparable numbers of grafts harvested per session. For instance one would want to compare, for example, 1000 grafts harvested with strip vs. the same number harvested with the FUE technique. The fact that pain is very subjective complicates such studies. Telogen effluvium can occur in the donor area with FUE or strip harvesting, but this is uncommon. Infection is a very rare complication with hair restoration surgery. Dehiscence with strip harvesting can occur but this is quite rare and would be associated with surgical error. Similarly, necrosis of tissue should not occur unless the area harvested is too wide and/or closed under excessive tension. This could also occur if the arterial supply was already compromised. Patients may complain of altered sensation but this can occur with strip harvesting or FUE as small nerves are cut in both procedures. Years ago some strip-harvested patients may have experienced significant dysesthesia as a result of damaging the occipital nerves. As dissection should be at the level of the fat or perhaps at the level of the fascia these nerves should not be damaged. Bleeding occurs with both techniques but more significant bleeding occurs with strip harvesting. That said, bleeding is not considered a problem with strip harvesting and in most cases bleeding is nominal. A complication that is specific to FUE harvesting is the burying of grafts. This happens when the punch pushes the graft into the subcutaneous tissue. The grafts can be difficult to recover and can lead to a foreign body reaction and cyst formation. Hypertrophic scars and keloids should also be rare with FUE or strip harvesting. If patients have a predilection for keloids making punch excision will not limit such scar formation. In general hair must be cut short to be harvested with FUE. At times layers can be created allowing hair to cover the harvested areas but this places a limit on the amount of hair that can be removed at the session. Staffing Strip harvesting requires a larger staff than FUE. For FUE the surgeon can get by with just one or two assistants but if the surgeon has to alter course and use a strip harvest having only one or two assistants could be problematic. Summary Strip harvesting and FUE are both acceptable techniques for harvesting donor grafts. Each technique has advantages and disadvantages. On a cost-benefit ratio strip harvesting would seem to provide the most cost effective procedure. FUE is well suited for patients who insist on not having a linear scar. It may be an excellent choice for young patients seeking small procedures. FUE may be the ideal choice for harvesting trunk, leg and arm hair, and it is an excellent way to camouflage strip scars. It is important that objective data continue to be collected regarding graft survival with FUE. Similarly, it would be beneficial to obtain more information as to the degree of discomfort experienced with the two techniques and the healing times. No matter the technique employed, the surgeon must be well versed in the technical and aesthetic components of performing the surgery in order to produce consistently good results. A single course or training session on one aspect of the hair restoration procedure such as harvesting is inadequate training for a physician to learn how to perform hair restoration procedures. The surgeon must acquire a sense of the aesthetic and technical components of the procedure. He or she must be able to develop a plan for patients with various clinical scenarios and know when to refer to a surgeon with more expertise. The goal of hair restoration seems simple enough, namely to move hair from one part of the scalp to the other. However, any experienced physician will tell you how complex this seemingly simple task is. For example, one of the most important concepts the physician must appreciate is that hair loss is progressive and that any restoration plan must be made with this in mind. When a patient comes to the physician with a given stage of hair loss, the physician must be able to assess the donor area for hair density and quality, calculate the number of grafts needed, give the patient a reasonable expectation for what the result will be, and plan this result with the possibility of future hair loss in mind. The physician must be able to discuss the pros and cons of medical treatments designed to stop or slow future hair loss, such as oral finasteride and topical minoxidil. All of these elements require considerable training and expertise to implement for each patient. Successful graft harvesting is only one small component of surgical hair restoration. Without attention to all of the other aspects, there is a very real possibility of a bad outcome. Finally, the incision of skin and tissue, whether using instruments that create a linear or circular incision, is legally considered surgery and should only be performed by a licensed physician with adequate training and expertise in hair restoration.

Hi Mickey, I actually contacted Dr. Umar for a consultation but never received a response. Are any of those other surgeons you mentioned located within Canada or the United States? When I researched online, a lot of the FUE eyebrow transplants I came across were done by surgeons overseas. I'm interested in learning more about FUE eyebrow transplants.