Can hair transplants get any better?

[JakeVig]

It seems like we have come along way from the plugs and mini/micrografts of old.

 

So now we have FUE and FUT where we are able to move the naturally occuring follicles which now can create almost undetectable hairlines.

 

So I'd like to pose the question if hair transplants can get any better?

 

So to find out I thought I would identify things that are not perfect and could possibly improve:

 

- Shock Loss (still happens)

- Donor Scar (is still detectable)

- Yield of transplanted hair (still not 100%)

- Dense packing (Is 45-55 the max that can be achieved at the moment)

 

Im thinking maybe the future is FUE as it would eliminate the donor scar. Still the disadvantages of FUE is cost and yield.

 

What else can be improved? does everyone else agree that a perfected FUE technique would be the future? Anyone have any other thoughts on the topic?

[JakeVig]

It seems like we have come along way from the plugs and mini/micrografts of old.

 

So now we have FUE and FUT where we are able to move the naturally occuring follicles which now can create almost undetectable hairlines.

 

So I'd like to pose the question if hair transplants can get any better?

 

So to find out I thought I would identify things that are not perfect and could possibly improve:

 

- Shock Loss (still happens)

- Donor Scar (is still detectable)

- Yield of transplanted hair (still not 100%)

- Dense packing (Is 45-55 the max that can be achieved at the moment)

 

Im thinking maybe the future is FUE as it would eliminate the donor scar. Still the disadvantages of FUE is cost and yield.

 

What else can be improved? does everyone else agree that a perfected FUE technique would be the future? Anyone have any other thoughts on the topic?

[dhuge67]

The future-future would be cloning and replicating new hairs, from a couple that are FUE'd from the head. It has been discussed before, but the reason I say it is "future-future" is because the cost of such a thing would be insane.

 

Maybe a pill will be developed that will make surgery and graft placement a thing of the past? It's possible that if there is some way to block the DHT and stimulate the dormant follicle, then the future of the industry could be pills in a bottle, rather than people in operating rooms. Propecia is somewhat like this, but I'm talking about a Super-Propecia-on-steroids kind of thing.

[the B spot]

I think we are seeing the BEST hairtransplantation via strip we will ever see. Yes, additional refining will be done, but at this point it will be slight improvements in the process itself. Much like the trico closure, we are seeing the best surgeons repeatedly churning out outstanding ht's. At this point, we have the lateral slit, advanced closure methods, the tiniest blades, the best microscopes, great techs, etc... BUT... regardless of technique, you simply cannot teach artistry. The separation between the very good, and the great is how they go into the native hair, and design a natural hairline (undetectable). In addition, we are seeing clinics routinely doing sessions of 3000+, with H&W pushing the envelope at 6000+ sessions. I think any advancements in the strip sessions will be slight, as some surgeons can dense pack up to 80cm/2 in one session. Of course, there is ALWAYS room for improvement, but can we honestly look at what is being done today and think things can get that much better? I think what can get better is the AVERAGE HT doc who is doing 1000 to 1500 graft sessions with 1 or 2 assistants, without the benefit of modern technology. They can step up across the board, period.

FUE, (IMO) still requires a great deal of work. two things-- 1. I would only suggest FUE if you have had several strip surgeries and you only need 700 to 1000 grafts to complete your transformation/ if you have a tight scalp

2. The yield must go up, and cost must come down, period.

Regardless of what anyone tells you, it is virtually impossible to judge the follicle root under the scalp, resulting in transection. While I think FUE is great in some instances, IMO it is not a viable option for those of us needing 3000 to 8000 grafts. If and when FUE can yield these types of results in 1 or 2 sessions, possess a 97%+ success rate, and cost the same as strip, is when I will sign on the FUE bandwagon. Until then, we just have to be smart, research, and go to proven docs.

[Alexander]

The problem with FUE is that it requires the additional skill of removing follicular units (as with any technique there is a learning curve with this), and it is more work. The cost is relative to the physical effort and extra time that it requires to take out the grafts one by one. It also is still a relatively new procedure, so few docs have embraced it. A few very experienced FUE docs in the world are practicing this method, and they are able to make the necessary adjustments to bring down the transection rates during a procedure to a rate comparable to that of the top strip docs. This requires a feel that can only be achieved through thousands of surgeries and a dedication to the development of new extraction tools. FUE in the wrong hands will yield poorly, but in the right hands there is no reason why a person couldn't get up to maybe 4k to 5k grafts via FUE, with a similar yield to that of strip. You might have to do it in two passes, but for some the absence of a strip scar means everything. If you need more than that, in the 6 to 8k range, then strip is the way to go. Most strip docs have abandoned FUE because it is too labor intensive for them, and they would have to become beginners again, but a few FUE docs have taken the science to a very competitive level.

 

The problem, as the B spot mentioned, is that getting more than 3k via FUE can become pricy, and will require more time in the chair. A good FUE doc will probably be able to move around 800 to 1000 in a day, maybe more if things are going really well. So you will prob have at least 2 days in the chair. But, the pros of FUE can outweigh the cons for many if you choose the right doc.

[the B spot]

Good Points Alexander!

(from my standpoint though)--My biggest concern with FUE is simply that we (THE SUFFERERS) possess a finite donor source and the waste or transection associated with FUE is simply something I am not willing to accept, especially due to the outrageous costs involved. Transection rates can range up to 15-20%, with the median probably "truthfully" around 10%. For 2000 grafts that is 200 grafts lost, 3000 grafts 300, etc... (you get the point)

The technique itself is solid, but it still involves some guesswork,and whatever doctor is doing the procedure can NOT guarantee a 95%+ yield, that's all. Again, I am all for using FUE to finish off someone who has had a couple of large strip sessions, but as an alternative to strip, you could end up destroying several hundred grafts that cannot be regrown.

This is only my opinion, of course........

Good discussion!!!!!

[JakeVig]

B-Spot I thought that you could also lose up to 200 grafts for every successive surgery since the strip will contain the scar tissue from the previous HT. I also heard that the bigger the HT (# of grafts) the lower the yield.

 

Does anyone know what is the optimal HT strategy to get the most yield from your donor hair?

[the B spot]

Jake, yield refers to growth AFTER a follicle has been transplanted. When you hear of losing 200 to 500 grafts due to second strip being removed, that is because the scar tissue does not contain many fu's, not due to to transplanted hairs not growing. This is simply a by-product of the first HT, so you do not actually lose grafts, they simply are not there to harvest. Many clinics will compensate for this drop-off in grafts by simply taking an additional .2 or .3 cm of tissue when removing the strip (if possible) (example- first HT strip 1.0 cm wide/ 2nd ht 1.3 cm wide)

Reffering back to FUE, the techs trim the graft itself, the surgeon makes a recipient slit, and the graft is implanted, and then does not grow. Of course, some of these hairs might be identified before they are transplanted, but still get thrown away.

Strip surgery in the best clinics have close a perfect growth yield. FUE in the hands of the best surgeons still involves guesswork and a 5 to 15% graft loss.

[Alexander]

B-spot, I'm not sure where you get that rate, but those rates of transection seem outdated to me. 15-20% might have been an average rate 4-5 years ago, when FUE was still in earlier stages. However, if an FUE doc claims he is avging 15-20% transection, then he is way behind the curve at this point. The best FUE surgeons are producing transection rates comparable to that of strip, in the 3-6% range, sometimes lower.. The problem is that FUE requires a real commitment, and a low transection rate can only be the result of doing FUE day in and day out, perfecting the tools, constantly obsessing over technique refinements, etc. Docs who originally seemed to be committed have dropped off significantly, once they discovered that FUE was more labor intensive and involved more variables. While many strip docs now offer FUE, they often price it out of range, and leave it for the touch-up jobs and repair work. But generally it is discouraged as no more than a touch up procedure. Unfortunately, the top FUE surgeons who have commited to FUE are extremely few. I would personally let one, maybe two FUE docs in the entire world work on my head. But these docs are the best, and will get the same transection rates as strip, if not better.

 

Remember strip in the hands of the absolute best docs transects 1-3% of the grafts during the taking out of the strip, and grafts are transected during the dissecting process as well- good techs will have a small transect rate of maybe 1-3%, but mediocre techs can have a much higher rate. So, the top notch strip docs will transect in the 3-6% range, but lesser docs will transect more, depending on their skill with a blade and the ability of the techs they have on board. Using tricho closure can transect grafts further during the beveling process- it is hoped that these grow back into the scar, but this doesn't always happen. So, with strip, you can transect during strip removal, during the process of cutting grafts away from the strip, and during the trico closure process. That's why a top notch FUE doc can get a really low transection rate if he has mastered the FUE process, since the extraction is the only time the risk of transection really exists. Once the graft is out, that's it. There are many good docs out there, but the difference between good and great is huge. In either case, FUE or Strip, I would only go to 1 maybe 2 strip docs in the entire world, and the same goes for FUE. But that's me- I wouldn't want to screw around with mediocre. HT is an artform, yes there is technique involved, but at the end of the day some guys will always be better with a blade in their hand than others.

 

But, I do agree with you that it isn't cheap, and the really skilled FUE docs are even more costly. Each type of HT, strip/FUE has its advantages/disadvantages, it all depends on personal goals ultimately. But the high transection rate for FUE only applies to the less-skilled.

[the B spot]

Dr. Harris Article

 

Read through this article and see where Dr. Harris points out that 15 to 20% transection rates occur regularly with dr.s using the "latest" technology, namely the sharp 1mm punch extraction tool. Dr. Harris is touting his new method, which had a controlled study done where the MEDIAN transection rate is 6%. That means in a controlled study with the doctor who perfected the new technique, some patients had a greater than 6% transection rate. Notice the article does not do a yield study for grafts that do not grow after being transplanted.

I understand where you are coming from A, but FUE is wasteful and expensive to be anything other than a "top-off".

[Alexander]

B-Spot, I'm loving this debate btw Always a good thing to toss around ideas.

 

I read that article quite some time ago. The same doctor did another study with his patented style of FUE that produced avg transection rates of 6.14%. This is another way of saying that he perfected his tools and his personal technique of FUE to get his transection rates down to a level comparable to that of strip. But even this rate is even a bit high. Better FUE docs are getting better rates. Bad FUE docs are getting 15-20% rates- don't go to them. This basically supports my argument, that docs who are COMMITTED to FUE achieve transection rates comparable to that of strip.

[Alexander]

Btw..Where are pics/patients of Dr Harris? Any grown out FUE results to see? He might be an up and comer, but he's really just another HT doc who developed his own unique tool for FUE and calls himself a pioneer. How many FUE surgeries under his belt, and once again, where are the results? I would hardly say his results have been established in the FUE realm. I've been around these forums since FUE started catching fire, and I have yet to see very much at all from Dr. Harris. However, there are some well established FUE docs with tons of results out there. Patients I've seen in person, online, etc, with grown out results from FUE-only surgery. FUE has been moving forward for some time, and at some point, other docs might catch up.

[the B spot]

Me too A!!! I will end with this: I believe Dr. Harris is the only doctor to provide the results of a controlled FUE study over a period of time, as far as anyone knows, without smudging the numbers. Second, I wish the experts of FUE (NOT DR. WOODS!!!!) would provide us with the real data, in an uncontrolled study. I think we would see even the best surgeons still possess an 8 to 10% transection rate. I only say this because when extracting naturally occuring follicular units, it is almost impossible to tell where the roots are going, because they do not all go straight into the scalp on the same angle as the hair itself. In addition, depth control can be difficult to control, regardless of instrumentation. This is a great discussion Alexander, and thanks for keeping it informative because I think quite a few people will benefit from it. Cheers!

[Alexander]

I'm curious, has there been a similar, recent controlled study of strip transection rates? I honestly don't know or recall hearing of any.

 

Once again, Dr. Harris might have done a study, but he is not a proven commodity in terms of FUE results. I'm also curious about why Dr. Woods wouldn't be considered an expert? Hasn't he been performing/modifying/perfecting the FUE technique longer than anyone on the planet?

[JakeVig]

Ok I thought I would weigh a little more on this issue as I posed this same question to Dr Ron Shapiro while having my HT done.

 

Firstly he does believe that the current techniques to achieve an illusion of density with an optimal number, combination and placement of grafts (i.e. best use of 1's, 2's etc) is excellent but he thinks they can still be improved. The idea is to get the best illusion of density under varying light conditions and viewing angles.

 

I should note that contradictory to previous posts splitting grafts to get more 1's will definately does NOT provide a better illusion of density when placed on the top of the head. It seems that Ron uses mostly 1's for the hairline and 2's, 3's and 4's at the top of the scalp.

 

Secondly one concern he had about FUE's was that the grafts extracted would not be as cleanly disected as they could be with FUT and using the microscopes to disect them.

 

Lastly he mentioned that there was a new instrument in the future that would be able to extract the donor strip without damaging any grafts as part of the donor extraction process.

 

P.S. I recalled this information while I was under sedation, hopefully I havent missed any details.