What does a FUE scar look like?

[darkhorse0510]

I've seen alot of pics on here and have a pretty good idea of what a FUT or "strip scar" looks like.

 

But I'm a little confused about the scarring that results from an FUE procedure.

 

From the immediate post-op pictures I've viewed, I generally see what appears to be several red dots on the back of the head. I guess these follicular extractions are kind of "interspersed" among other hairs that are not touched among the general donor area.

 

I understand why the scarring is the way it is from an FUT procedure.. A long "strip" of skin is removed, and the scalp is then stapled shut resulting in a linear scar that could possibly stretch from ear to ear. Is it because of the way FUE extractions are "spaced" that they are more easily "masked" by remaing hairs from the donor area? Does the scarring simply look like small punctures?

 

The following is from a message to me by a "veteran" on these forums:

 

"To be clear, regardless of which technique you opt for, you will always have a scar. Anyone that tells you different is either lying or doesn't have a clue what they are talking about. It is simply the difference in the type of scarring that separates the two procedures. "

 

Can anyone provide some clarification, or better yet, post some decent pics of scarring from an FUE procedure? I'd like to have a better idea of what scarring from FUE looks like.

[Mickey85]

FUE scarring is much much less evident than fut. You will always be able to shave down to a grade 2 very easily(sometimes grade 1 if dense donor and minimal grafts taken). You cant do the same with fut. That is even considering if the FUT scar does not stretch. No Doctor can guarantee a 1mm 'pencil thin' scar, if he does, get it on paper and I will pay for your surgery.

Edited November 11, 2012 by Mickey85

[TommyLucchese]

FUE scarring is much much less evident than fut. You will always be able to shave down to a grade 2 very easily(sometimes grade 1 if dense donor and minimal grafts taken). You cant do the same with fut. That is even considering if the FUT scar does not stretch. No Doctor can guarantee a 1mm 'pencil thin' scar, if he does, get it on paper and I will pay for your surgery.

 

I don't think this was a thread for FUE v FUT scars.

 

I'm interested in seeing some FUE scars too, btw. Can anyone oblige?

[Mickey85]

I don't think this was a thread for FUE v FUT scars.

 

I'm interested in seeing some FUE scars too, btw. Can anyone oblige?

 

I was referring to the quote given by the 'veteran' who said that it is merely 'the difference in the type of scarring that separates the two procedures' so naturally some comparison has to be made. FUT was brought up. I thought I would make it clear how exactly the scarring differs. It was implied strongly that either way you will have a scar or scars which is very vague. I just thought I would elaborate..

 

I can't post videos up because the surgeon is not recommended here but type in 'injerto capilar' into Youtube and look at the videos titled 'Can you shave your head after FUE'. You will see videos of them shaving a patients head after they have had more than 3,000 grafts extracted. Looks pretty good considering the graft numbers.

[TommyLucchese]

Apologies. My mistake, didn't read the whole post where he mentioned FUT scars or the 'veteran'. What a rookie mistake!

 

I do have to speak up for the FUT scar though. At 3 months, 3 weeks and 2 days, my dearest mother just checked my scar for me and it's disappeared to the 'pencil thin' variety in lots of places, and is just slightly red in others. Of course, this isn't guaranteed, but it's worked out well for me and I also saw two great FUT scars in person at my consultation.

 

I'd never recommend anyone doing FUT based on my potential results though, I just have to say how my experience and results so far have been.

 

Anyway, again, my apologies for my comment.

 

I just watched that video. Amazing transformation! You can still see the white dotted scarring in the donor area, but considering just how shaven his head is, that's incredible. Why is this doctor not recommended?

 

[edit] ah it's Dr. Lorenzo, nevermind, I know about him.

[Mickey85]

Apologies. My mistake, didn't read the whole post where he mentioned FUT scars or the 'veteran'. What a rookie mistake!

 

I do have to speak up for the FUT scar though. At 3 months, 3 weeks and 2 days, my dearest mother just checked my scar for me and it's disappeared to the 'pencil thin' variety in lots of places, and is just slightly red in others. Of course, this isn't guaranteed, but it's worked out well for me and I also saw two great FUT scars in person at my consultation.

 

I'd never recommend anyone doing FUT based on my potential results though, I just have to say how my experience and results so far have been.

 

Anyway, again, my apologies for my comment.

 

I just watched that video. Amazing transformation! You can still see the white dotted scarring in the donor area, but considering just how shaven his head is, that's incredible. Why is this doctor not recommended?

 

[edit] ah it's Dr. Lorenzo, nevermind, I know about him.

 

No worries

 

You are lucky you have a pencil thin scar, once the redness goes it will be indistinguishable unless you shave down to a grade 2 or less. Alot of other people are not so lucky. With FUE that possibility is eradicated.

 

Yeh it's Lorenzo. You can see the white dots for sure but we are talking several thousand(5,000) grafts and they are shave down to a zero or very close to it. I have had conversations with him via email and he says he is interested in being recommended here but he is so busy. I heard he is fully booked out for all of 2013 so I don't think he would be able to fit in the increased demand if he was on this site. I think he is the king of FUE lol.

[s2thoudriver]

It depends on the size of the FUE punch and the skill of the surgeon.

 

Anything 1mm or above and you might have visible white fits, but only when shaved down to a grade 0 or 1

 

I had punches between 0.68 and 0.9 (sizes differed depending on no. of hair follicles in the graft) and my punch marks are undetectable.

 

The 'red dots' only last for a few weeks whilst the donor area heals.

 

Regards

 

Rob

[Dr. William Lindsey]

It depends MAINLY on what size punch the doctor uses. And significantly less on the pigmentation of the skin.

 

Shown are 2 pictures. The first one is a guy who was "sold" an FUE case in our area. Look at the area, it looks like 2.5mm dermatologic punches to me, but I wasn't there. But we've repaired 5 or so of these guys, all the same scars. Its made worse by his really white skin which stands out against his light orange hair.

 

The second picture is a guy on whom I personally did 3000 FUE punches in order to get 2600 grafts (in 3 separate procedures). This pic is 4 months after the third case. Now we used Feller 0.9 and 1.0 and probably even a few 1.1mm punches and he's an excellent healer.

 

But true FUE should look more like the second picture than the first.

 

Dr. Lindsey McLean VA

[Blake Bloxham]

Great info Dr. Lindsey! Thank you for sharing.

[jobber1900]

It depends MAINLY on what size punch the doctor uses. And significantly less on the pigmentation of the skin.

 

Shown are 2 pictures. The first one is a guy who was "sold" an FUE case in our area. Look at the area, it looks like 2.5mm dermatologic punches to me, but I wasn't there. But we've repaired 5 or so of these guys, all the same scars. Its made worse by his really white skin which stands out against his light orange hair.

 

The second picture is a guy on whom I personally did 3000 FUE punches in order to get 2600 grafts (in 3 separate procedures). This pic is 4 months after the third case. Now we used Feller 0.9 and 1.0 and probably even a few 1.1mm punches and he's an excellent healer.

 

But true FUE should look more like the second picture than the first.

 

Dr. Lindsey McLean VA

 

3000 FUE punches to get 2600 grafts? is that right? 400 grafts sounds like a big number to lose??

[Dr. William Lindsey]

Jobber,

 

Good question. It depends on how you count "lost". When doing an FUE, you are placing a cylindrical punch around a cluster of hairs, incising the epidermis and dermis, and then lifting out the cluster gently, so that the fatty attachments to the bottom of the root bulb avulse without A: damaging the fragile root itself or B: the fatty tissue actually holds the roots in the scalp and all you extract is rootless hair shafts. Its harder than it sounds, hence FUE costs more and is more variable in results than strip.

 

So on one hand you could certainly say that you "lost" 400 grafts because you pull out 400 or so rootless hair shafts that won't grow and need to be discarded. And you made a 0.9mm hole in the scalp that will take 5 days or so to heal with virtually no visible scar.

 

But in fact you didn't lose anything except an opportunity to make fewer punch sites on the head. Because the root remained and was not extracted, those hairs will grow back with the next cycle of hair growth.

 

I take care to explain in just those terms, FUE prior to starting. Sometimes I'll make 100 holes and get 95 grafts. Fantastic. Othertimes getting 50% is tough...particularly in patients with scar tissue in the donor area or really curly hair.

 

For example, I've done now maybe 20 FUEs on black guys. ALL heard me recommend strip, and chose FUE due to their plans for short hair or scar potential in spite of my fairly blunt discussion that FUE may result in weaker results than they or I want. And unlike in straight hair-ed guys, where that cylindrical punch fits around the hair cluster reasonably well, with black guys' hair, its a bit like trying to remove a corkscrew....the cylindrical punch does indeed cut through the roots at a higher rate simply because the location of the root is so difficult to predict. Now if you switched to a 2 or 3mm punch, like some of my local competitors appear to do....well you could pull fue's out all day long with no trouble. But then you are really just doing a plug case and calling it something fancy and charging more....and getting scars like the first picture that I put up.

 

I hope this helps explain the numbers.

 

Dr. Lindsey McLean VA

[darkhorse0510]

Dr. Lindsey, I really appreciate the thoroughness of your posts.. You really make an effort to explain things in great detail!

 

But your recent post made me think of a couple more questions.. I've seen many statements that FUE often produces less effective results.

 

Is this, in general, referring to the lack in yield of viable extracted punches (meaning that an attempt was made but didn't result in the root being extracted), OR the viability of those follicles (with the root) once transplanted elsewhere?

 

I'm assuming that it's more the former. I find it at least a little bit reassuring to know that if an attempt is made, and the root/root bulb is unsuccessfully retrieved, that at least it will grow back. Can an attempt then be made, at a later date to extract that same follicle?

 

Your explanation gives me some more appreciation for the increased cost associated with FUE.. but it also makes me want to ask, how much time does it take, on average, for a doctor to perform one extraction? And finally, a general billing question.. for FUE, do docs bill for each graft "by the punch" (for lack of a better way to phrase it) or by successful extraction (with root in tact)?

 

For example, you say that you may only get 95 grafts out of 100. In this example, am I paying for 95 or 100 grafts? As a future patient, I guess I'm trying to see both sides. On one hand, I can see being charged for 100 because you are doing a delicate and tricky procedure, attempting to extract the delicate root and the fatty attachments to the bottom of the bulb. On the other hand, I feel like I should be charged only for the grafts which were able to be successfully extracted (I mean, that's what I want, right?), and then implanted.. in this case 95. This may not seem very relavant in a case with 95% success, however, I'm sure this quickly becomes financially significant to a patient with 50% (or less) success. Again, my guess is that the answer is probably former, and perhaps rightfully so. It seems that the associated increase in cost, coupled with increased potential for disappointment may be the most compelling reasons to dissuade someone from going the FUE route.

[s2thoudriver]

FUE is more time consuming for the surgeon and therefore more expensive.

 

With FUT, the strip is cut, then the strip is handed to technicians to discect to get the grafts. If the technician isn't very skilled, they could damage some of the grafts.

 

With FUE, the surgeon is removing each of the grafts themselves using a punch, not the technicians.

 

FUE has evolved massively in terms of tools and techniques, with more and more fantastic results being shown. With either FUT or FUE, the results are only as good as the skills of the person extracting and handling the grafts, therefore the FUT 'superior yield' argument is wearing a bit thin.

 

Rob

[jobber1900]

thanks for clarifying Dr Lindsey, i understand your explanation and appreciate your response