Is FUE permanent?

[N-6]

Im asking about patients who want to undergo FUE in their 20s, 30s or 40s whose hair loss pattern may not be completely established. I know docs look at family history, medical history and study the patient's scalp. However, isn't it true that even with this, a doc cant predict a patients ultimate hair loss? And since FUE is many times taken above what is considered the permanent safe zone, isn't that FUE patient at risk of possibly losing those grafts years later? Are these issues discussed by a doc with a patient before FUE?

[Thehairupthere]

I dont' know why you think FUE is taken from above the "safe zone", because it's not. It's taken from the same zone as the FUT, which is the "safe zone" and those grafts are just as permanent as the FUT grafts. Some patients have different size "safe zones" so if one patient appears to be a bit higher than others it's not necessarily true that it's out of the zone. The only difference is the total yield which is a bit lower with FUE as opposed to FUT.

[N-6]

To say that FUE is taken from the same permanent zone as FUT is really inaccurate in my opinion. Look at the number of photos posted, many FUE grafts are taken way above the area of FUT. I do agree that a patients safe zone will vary from patient to patient but how does a doctor know what the permanent safe zone of a patient in his 20s, 30s or 40s will ultimately be? Are you saying that a doc can reasonably predict the norwood scale for a patient at these ages?

[NEWHAIRPLEASE]

To say that FUE is taken from the same permanent zone as FUT is really inaccurate in my opinion. Look at the number of photos posted, many FUE grafts are taken way above the area of FUT. I do agree that a patients safe zone will vary from patient to patient but how does a doctor know what the permanent safe zone of a patient in his 20s, 30s or 40s will ultimately be? Are you saying that a doc can reasonably predict the norwood scale for a patient at these ages?

 

N-6

FUE is taken from the safe zone...no doubt about it! Or at least it should be..One thing to keep in mind is your safe zone may differ from my safe zone which will differ from someone else's safe zone..that is why it is imperative to get an accurate plan and consult with a top quality surgeon.

[N-6]

Newhair, this is not clear cut in my eyes at all. There are two issues here:

 

1. Is FUE taken from the same area as FUT? I completely disagree with Thehairupthere that it is. In the back of the head, FUT donor is taken from an area of scalp just below the occipital bone. Any quick search on here of FUE patients' results show that in the back of the scalp, FUE is clearly taken in many cases from above the occipital bone. Obviously, this is very different. Take a look at the hair blogs of FUE3545 and Hadenuf as examples.

 

2. Also, you assume that a doc will take FUE from the safe zone but in an younger FUE patient, how can a doc even know what the safe zone will ultimately be if its not easy to predict eventual hairloss?

[Sean]

I think many experienced doctors can detect future hairloss or the pattern. They have seen thousands of heads and have examined patients from all ages. Safe zones do vary from patient to patient and I think knowing a patient's history is an important factor to consider. Knowing family history and the level of norwood can help plan this in a younger patient I think.

 

I got FUE and I am 29. According to my family history, I think the donor was extracted carefully and within the safe zone.

 

I was actually reading a good article about this. Take a look at page 4 of this journal.

http://www.eshrs.com/journal/ESHRS5%283-1%29.pdf

 

Here, look at my balding pattern prior to surgery, the area the FUE was extacted, and how it is now:

 

August 30, 2010- Hair Restoration Journal -1 YEAR BEFORE SURGERY

 

September 3, 2011 - Hair Restoration Journal -Post Op (DONOR AREA)

 

December 6, 2011 - Hair Restoration Journal -THIRD MONTH POST OP CONTINUED

 

 

I think my FUE will be permanent. This was one of my concerns too but I think the doctor knows where to make the extractions. I don't think he would have proceeded if he knew the zones he was extracting would not be within the safe zone.

 

Take a look at this as well. http://en.wikipedia.org/wiki/Safe_Donor_Zone

 

I also think the doctors can see the zone with their magnification goggles and detect where there is hairloss or hair susceptible to DHT. I think after determining that they purposely extract the hairs a cm or few below that point and determine that would be the safe zone for the patient. I have read this somewhere too but I can't recall where.

 

 

Here is more talk about it here:

http://www.hairrestorationnetwork.com/eve/141758-extractions-taken-safe-zone.html

 

Taking Grafts from Unsafe Areas of the Scalp for Hair Transplant Surgery? | Hair Transplant News

[NEWHAIRPLEASE]

N-6

Exactly what Sean said! That is the reason you get with a top notch surgeon. Like I said, the safe zone for some may be above the occipital bone. Also, you do have a choice..you can choose not to have FUE...or certainly express your concerns to your choice of surgeon so he will put your mind at ease! Anyway you choose, if you pick a recommended doctor he is not going to steer you wrong!

[N-6]

Sean, I really appreciate you taking the time to post some interesting articles. This is the type of stuff which really helps this discussion. I don't think an ethical doctor would extract grafts via FUE from an area he knows is unsafe.

 

That said, however, even ethical doctors make mistakes and make judgments that are incorrect. What concerns me about FUE is not the 50-year old plus patient whose hair loss pattern may be fairly well-established and more predictable at that stage of life. What I'm concerned about is the lack of predictability regarding future hair loss for a patient who's in their 20s, 30s and 40s where its harder to predict even though the doc meticulously elicited a wealth of family and medical history from the patient and conducted an in-depth analysis of the scalp. Hair loss patterns become more uncertain for these patients. The wiki article you cited states as follows:

 

"Of course, the safe donor area represents a generality that cannot be reliably depended upon for any particular individual. For example, the likelihood of the long-term survival of hair outside of the "safe donor area" will be greater in an older patient than in a younger one - in whom ultimate fringe width and fringe hair density is less predictable than in an older man. What can be depended on, however, is that the closer the donor sites approach the advancing edges of MPB (the upper and lower borders of the fringe) the more likely the previously noted risks will become a reality".

 

In the below link, Bill states

 

Unfortunately, hair loss is mostly unpredictable and though a dermatologist can perform hair miniaturization tests (which can be helpful), he/she can only draw conclusions from your present state of baldness. The future remains unknown. A new genetic test that may help predict early onset of female and male pattern baldness, called HairDX is also available. It does not however, predict how far it will progress.

Hair Loss News - Can Future Hair Loss be Predicted and What Treatments Work to Prevent it? - Hair Loss Open Topic

 

Wiki (I know wiki isnt gospel so check cites) on FUE

 

However, with FUE, the follicles are harvested from a much greater area of the donor zone compared to FUT, estimated to be eight times greater than that of traditional strip excision so requires patients to have hairs trimmed in a much larger donor area.[12][13] As a result, the hair in the lower and upper parts of the donor area, where the grafts were taken from, may thin and this can make the donor scars visible.[5] Follicles harvested from borderline areas of the donor region may not be truly “permanent,” so that over time, the transplanted hair may be lost.[12]

 

http://en.wikipedia.org/wiki/Follicular_unit_extraction

 

 

This is what concerns me. The higher you go above the occipital bone in the back of scalp of certain younger patients, maybe the higher the risk of those grafts not surviving long term. Im talking about 10-20 years down the line. I just hope that FUE doctors are very clear with younger patients about those potential risks.

 

Btw, your hair looks great Sean, excellent result.

[aaron1234]

Is FUE permanent? The answer is simple. It's permanent as long as the transplanted hair/graft was genetically predetermined to be permanent. If it's taken from outside the permanent zone then it may or may not last. Same applies to strip. Some FUE docs like Umar use nape which is subject to the effects of DHT - so there is more risk of losing those hairs later on.

[N-6]

Newhair/Aaron, here is my point, if its difficult for a doctor to reliably predict the eventual hair loss pattern of a younger FUE patient, then how in the world can they determine what the "permanent" safe zone is for that patient?

 

Also FUE has not been widely performed long enough (maybe 8 years at best) to assess its long term yield especially for mega-session FUEs which extract grafts from areas way outside the FUT permanent safe zone in order to yield the required number for a mega-session.

[aaron1234]

Newhair/Aaron, here is my point, if its difficult for a doctor to reliably predict the eventual hair loss pattern of a younger FUE patient, then how in the world can they determine what the "permanent" safe zone is for that patient?

 

 

With microscopes they can tell which areas are miniaturized or not. If the hairs are smaller and thinner then that area is more susceptible to future loss. This is how they determine the boundaries of the safe zone. They usually leave some room for error around these boundaries just in case the patient progress further than expected. But it is an educated guess as to what the patients final pattern will be.

[N-6]

Microscopes can determine current miniaturization but I don't think there's really anything which can reliably predict future (10 years plus) hair loss patterns and this is what makes some FUE procedures in younger patients concerning.

 

It would be great if we could hear from some surgeons about this topic, including what kind of conversations they have with these patients about risks pre-op.

[NEWHAIRPLEASE]

Microscopes can determine current miniaturization but I don't think there's really anything which can reliably predict future (10 years plus) hair loss patterns and this is what makes some FUE procedures in younger patients concerning.

 

It would be great if we could hear from some surgeons about this topic, including what kind of conversations they have with these patients about risks pre-op.

 

N-6

It sounds as if you want someone to say " I 100% guarantee you are not gonna lose anymore hair in this area " I don't think that is possible..to a point you are right..there is a slight risk, however, you have to go with what the expert says..in theory, yes a 40 yo male can be a Norwwod 2 and then by the age of 50 be a Norwood 7...I get that..that is why it is extremely important to speak with a recommended surgeon and also to take meds!

[Thehairupthere]

If you were to see miniaturization in the safe zone then it would be bad for FUE or FUT. People can see the density of the safe zone get worse over time, but it's not going to be similar to the pattern of loss on top of your head. That is very unlikely to happen, especially if you're using preventative medication. The safe zone is called that because even if you go toward a norwood 6 you still have your donor supply available to you, just not necessarily as much as someone else. With FUE the scarring is very minimal so if you were to lose hair in the donor area, which I doubt would be significant, you'd still not notice the extraction points. I also think you may be confusing the safe zone with the exact incision line of what FUT procedures take. The safe zone is from the occipital bone (sometimes a bit lower than that) to a point 2-3 inches higher than the occipital bone, and it goes all the way around your head from ear to ear. That is the safe zone and that is where FUE and FUT are taken from. I haven't seen any results on this forum from leading doctors that have gone beyond these safe parameters.

[NEWHAIRPLEASE]

If you were to see miniaturization in the safe zone then it would be bad for FUE or FUT. People can see the density of the safe zone get worse over time, but it's not going to be similar to the pattern of loss on top of your head. That is very unlikely to happen, especially if you're using preventative medication. The safe zone is called that because even if you go toward a norwood 6 you still have your donor supply available to you, just not necessarily as much as someone else. With FUE the scarring is very minimal so if you were to lose hair in the donor area, which I doubt would be significant, you'd still not notice the extraction points. I also think you may be confusing the safe zone with the exact incision line of what FUT procedures take. The safe zone is from the occipital bone (sometimes a bit lower than that) to a point 2-3 inches higher than the occipital bone, and it goes all the way around your head from ear to ear. That is the safe zone and that is where FUE and FUT are taken from. I haven't seen any results on this forum from leading doctors that have gone beyond these safe parameters.

 

Well said and good description of the safe zone!

[Sean]

This is an interesting read too, check it out:

 

Hair Transplantation - Marc R. Avram, Nicole E. Rogers - Google Books

[Sean]

Sean, I really appreciate you taking the time to post some interesting articles. This is the type of stuff which really helps this discussion. I don't think an ethical doctor would extract grafts via FUE from an area he knows is unsafe.

 

That said, however, even ethical doctors make mistakes and make judgments that are incorrect. What concerns me about FUE is not the 50-year old plus patient whose hair loss pattern may be fairly well-established and more predictable at that stage of life. What I'm concerned about is the lack of predictability regarding future hair loss for a patient who's in their 20s, 30s and 40s where its harder to predict even though the doc meticulously elicited a wealth of family and medical history from the patient and conducted an in-depth analysis of the scalp. Hair loss patterns become more uncertain for these patients. The wiki article you cited states as follows:

 

"Of course, the safe donor area represents a generality that cannot be reliably depended upon for any particular individual. For example, the likelihood of the long-term survival of hair outside of the "safe donor area" will be greater in an older patient than in a younger one - in whom ultimate fringe width and fringe hair density is less predictable than in an older man. What can be depended on, however, is that the closer the donor sites approach the advancing edges of MPB (the upper and lower borders of the fringe) the more likely the previously noted risks will become a reality".

 

In the below link, Bill states

 

Unfortunately, hair loss is mostly unpredictable and though a dermatologist can perform hair miniaturization tests (which can be helpful), he/she can only draw conclusions from your present state of baldness. The future remains unknown. A new genetic test that may help predict early onset of female and male pattern baldness, called HairDX is also available. It does not however, predict how far it will progress.

Hair Loss News - Can Future Hair Loss be Predicted and What Treatments Work to Prevent it? - Hair Loss Open Topic

 

Wiki (I know wiki isnt gospel so check cites) on FUE

 

However, with FUE, the follicles are harvested from a much greater area of the donor zone compared to FUT, estimated to be eight times greater than that of traditional strip excision so requires patients to have hairs trimmed in a much larger donor area.[12][13] As a result, the hair in the lower and upper parts of the donor area, where the grafts were taken from, may thin and this can make the donor scars visible.[5] Follicles harvested from borderline areas of the donor region may not be truly “permanent,” so that over time, the transplanted hair may be lost.[12]

 

Follicular unit extraction - Wikipedia, the free encyclopedia

 

 

This is what concerns me. The higher you go above the occipital bone in the back of scalp of certain younger patients, maybe the higher the risk of those grafts not surviving long term. Im talking about 10-20 years down the line. I just hope that FUE doctors are very clear with younger patients about those potential risks.

 

Btw, your hair looks great Sean, excellent result.

 

 

N-6, you got valid concerns. I think if you have extensive hair loss then anything above the occipital bone could be of great concern in the future if you are very young. Especially, if you are bound to lose the entire crown and then some. Miniturization is a big factor to consider too. I think the doctor looks at a lot of stuff when determining the safe zone. The border beneath the crown is inspected and with the goggles they can see what's going on and then they create the cut off point after evaluating. Some doctors purposely add a cm or more from the distance of that border/cut off point to be on the safe side. I also see what you are saying with the 30 year old guy vs the older guys when it comes to hair loss progression. There was another debate about this here:

 

http://www.hairrestorationnetwork.com/eve/160767-hasson-wong-donor-extractions-well-out-safe-zone.html

 

 

There could be a possibility that some patients may have serious balding in the future and it will continue into their 50's. However, I think most of those patients already have extensive hairloss in their 30s. I think by age 30 the pattern of future hair loss could be determined by many doctors.

 

The medications also keep it under control in many people for many many years. Look at my crown and how it recovered.

 

I hope some doctors on this forum can chime in and give their professional opinion on the matter. It's a good topic. You do make sense too, but I think that would apply more to individuals with higher norwood history in their families. whether your in your 20s or 30s, family genetics can help determine it really well.

 

Thanks for the comments on my hair restoration pics. I appreciate it. That's only like 3 1/2 months of growth since my transplant. I still have plenty of time for my transplant to grow.

[N-6]

Thehairupthere, isn't it true that no currently available exam of the scalp, including one which analyzes miniaturized hairs, will allow a doctor to reliably predict future hair loss in a younger patient? It will allow the doc to see where not to harvest from currently but certainly cannot predict eventual miniaturized hairs years later. This is where I think the problem lies.

 

As far as the safe zone, I know the safe zone isnt the scar. The scar is just the end result of a slice of donor being removed. The width of the donor is dependent on the number of grafts.

 

I really don't understand saying that the safe zone is 2-3 inches above the occipital bone. This is a first for me. That's the equivalent of 5 cm - 7.5 cm. Do multiple strips ever amount to that much donor taken out? I thought the average donor was 1 cm wide? Also, if the safe zone was really that far up the back of the scalp, then Norwood 5s and above shouldnt undergo FUTs because their hair loss can dip into the 2-3 inch safe zone.

 

Look at the results of hadenuf and FUE3545, does that look like the safe zone we generally see? If the back drops to the point where they become a NW5 or 6, they're partially screwed as the grafts transplanted from that part of the scalp will fall out. Of course, it may be that this never happens but I think this is a very real risk with younger patients. I definitely think that for these patients, propecia/rogaine/nizoral are essential to ensure they keep as much hair as possible.

 

Another interesting article, thanks Sean, keep up the great growth!

 

Thanks all for your responses to this topic. Pretty interesting stuff, well maybe for a nerd like me.

[Thehairupthere]

There isn't a device that can predict a hair from becoming miniaturized, but if you see a doctor today and there is no signs of miniaturization than you can proceed. It's an impossible thing to do to predict something that hasn't occurred yet, or even showing signs of it. So if you're a young patient and you're showing a very healthy donor, then you will be considered a good candidate. If you're young though your doctor will tell you that your hair loss can get worse over time, and they will not recommend being too aggressive early on because you will want enough donor to complete other thinning areas in the future. I'm not going to start arguing with you about measurements of the safe zone, because for every patient it's different and that is typically what it is for most patients. If you are showing signs of thinning that are progressing into the safe zone then you are not a great candidate and you would be warned by your surgeon before proceeding, maybe even leading them to deny treatment. From the examples you show, that is the safe zone and those grafts should grow fine if all was done correctly and no complications occurred.

 

Just because the safe zone is that large does not mean you can actually harvest that entire area, that depends on the patients skin and elasticity. If the scalp is too tight then he cannot remove that tissue, and he can only get grafts through FUE, because it could cause serious scarring issues.

 

The safe zone is called that for a reason, and with a preventative medication which I believe is very beneficial for all patients experiencing hair loss (specifically younger patients) the odds are very much in your favor to not lose that area and you will not show any signs of hair loss, especially if you don't plan on shaving your head.

[aaron1234]

The safe zone is called that for a reason, and with a preventative medication which I believe is very beneficial for all patients experiencing hair loss (specifically younger patients) the odds are very much in your favor to not lose that area and you will not show any signs of hair loss, especially if you don't plan on shaving your head.

 

Amen. This is why I preach to all full blown NW6's and even 7's that Fin is still worth taking even if for nothing else but just to maintain the health of the donor hairs.

[orlhair1]

Amen. This is why I preach to all full blown NW6's and even 7's that Fin is still worth taking even if for nothing else but just to maintain the health of the donor hairs.

 

I agree. I think these concerns also support consideration of a more conservative approach, especially for younger patients who potentially could need 2-5 thousand additional grafts over the future to cover additional hairloss. I an a big believer in the meds, but people should not think that the meds will stop hairloss forever. It seems the length of years the meds work varies from person to person, so a younger patient needs to keep a good bit of donor in the bank for the future.

[N-6]

I respectfully disagree about the safe zone. Calling it a safe zone over and over doesnt magically transform the area into the safe zone. If a doc cant predict a young patient's ultimate hairloss pattern, then I just don't see how they can say a zone of scalp is safe in the long run. The distinction I'm making is between short term and long term yield. At the end of the day, if a younger FUE patient is well-informed by his doc about the procedure and the patient agrees to do the procedure, then that's between the doc and the patient. FUT has a track record but I guess we will see what FUE procedures will look like 10-15 years down the line.

 

I definitely agree that propecia and rogaine are essential especially for young patients but we all know that their effects could have a shelf life.

[NEWHAIRPLEASE]

N-6

Sometimes we all have to agree to disagree..

[iwokeuptoabaldpatch]

To say that FUE is taken from the same permanent zone as FUT is really inaccurate in my opinion. Look at the number of photos posted, many FUE grafts are taken way above the area of FUT. I do agree that a patients safe zone will vary from patient to patient but how does a doctor know what the permanent safe zone of a patient in his 20s, 30s or 40s will ultimately be? Are you saying that a doc can reasonably predict the norwood scale for a patient at these ages?

 

You do seem to jump to conclusions and than blindly follow them. I would listen to these guys i think on balance what they say is very reassuring

Edited December 20, 2011 by iwokeuptoabaldpatch

[aaron1234]

N-6, you do have a legitimate concern regarding the permanency of transplanted hair. But it really doesn't matter if the graft was extracted via strip or FUE if the "safe" or "permanent" zone is destined for future thinning and miniaturization. Below I've attached a link to a great post by Gillenator in which he discusses the variables that effect the longevity of transplants.

 

One choice quote:

"I believe the main reason why any patient may lose their transplants at a future date is because some of the donor hair is in fact DHT receptive. In other words, I am realizing more and more, or better stated, I am becoming more convinced with time that terminal hair is not a black and white issue."

 

http://www.hairrestorationnetwork.com/eve/162054-transplanted-hair-permanent.html