Increasing FUE case size by adding beard hair - Shapiro Medical Group

[Dr. David Josephitis]

FUE has become more prevalent over the past few years. There are many good reasons for this including an increase in the number of high quality results. Although, many clinics claim to do very large “mega” session FUE cases, at Shapiro Medical we have stayed cautious and conservative with our large FUE cases. As we all know, the “SAFE” donor zone is a defined area and venturing out of that area will indeed give more grafts, albeit grafts that may not last a lifetime. At our clinic, an average “large” FUE case is 2400-2700 grafts. This type of FUE will also typically take 2 days as we do not like to put additional stress on the patient as well as the grafts by doing it all in one day.

 

I wanted to briefly present a recent case of our done at SMG where we increased our overall number of grafts by adding beard donor hair. Typically beard hair has been used as a donor when all of the other areas of donor are depleted. This has been for good reason as beard hair is typically only one or two haired grafts. Also, the characteristics of beard are not the same as scalp. Finally, although, beard grafts grow well when transplanted, they don’t typically have a lower yield (growth rate) than scalp.

This patient was a 28 y.o. male with a 5+ year history of hair loss. He has not yet started preventative meds. He was a Norwood 4 with a donor density of 68 FU/cm2. This patient wanted as much covered in one session as possible. With his lower density and the patient choosing FUE over FUT (FUT can often get more grafts on the first pass) we looked for additional areas of donor in this patient. Beard was the likely choice. Risk of scarring or hypopigmentation, although still a risk, is not common in the beard. Also, the beard that was used was under the chin, so it is less visible. Because of the increased number of grafts, the patient came into the office for a total of 3 days. The first day was relatively short as only the incisions were made in the scalp. Day 2 and 3 consisted of FUE extraction of the scalp and beard. All the grafts that were extracted each day were transplanted on the same day. We ended up extracting 2600 from the scalp and 499 from the beard for a total of 3099 grafts.

These are the pre and post op photos.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

This is a close up of the beard after extractions. The scalp donor delivered a somewhat average distribution of grafts. The beard gave 400 single hairs and 99 double hair grafts. Thankfully, beard hairs are typically thicker than scalp hair so they do help with density. Also, the beard grafts were only placed in the midscalp and used for added density. Beard should not be used in the hairline or other areas that are readily visible.

[home1212]

definitely very exciting news that a reputable US clinic such as SMG is doing FUE with some non-traditional donor such as beard

[esrec]

Very interesting.

[Melvin- Admin]

It's great news to see doctors like Shapiro start doing BHT, I just saw another post from Dr. Vories add scalp hair to the beard to increase density of the beard, literally could not tell the difference between scalp and beard hair, it makes me think, beard hair is an excellent option for increasing density once coverage has been established with scalp hair, because when both hairs are blended it's hard to tell the difference. Please keep us updated on the results.

[gbhscot]

If the patient has a different coloured beard to scalp hair, would the strategy be to spread beard grafts out throughout the scalp area instead of grouping them together? Do you think this would be noticeable if someone with light blonde hair had dark beard grafts transplanted, even if they were well dispersed?

[Dr. David Josephitis]

gbhscot,

 

Yes, we typically always will spread out the beard grafts amongst the other scalp donor grafts. I like to think of beard hair as "filler hair." It is there just to give more numbers and volume of hair to the overall result. It would most likely not have a good aesthetic value by grouping beard hair.

 

Also, I think that not all are good candidates for the addition of beard as donor hair. You mentioned the example of a light-haired patient with dark beard. This patient probably would not be a good candidate as the beard hairs no matter how dispersed they were might be noticeable.

[gbhscot]

gbhscot,

 

Yes, we typically always will spread out the beard grafts amongst the other scalp donor grafts. I like to think of beard hair as "filler hair." It is there just to give more numbers and volume of hair to the overall result. It would most likely not have a good aesthetic value by grouping beard hair.

 

Also, I think that not all are good candidates for the addition of beard as donor hair. You mentioned the example of a light-haired patient with dark beard. This patient probably would not be a good candidate as the beard hairs no matter how dispersed they were might be noticeable.

 

Thanks for the reply - it's a topic I'm very interested in currently. I suppose it wouldn't be a dealbreaker though assuming the patient was happy to dye the hair a bit. I think it's great to see this approach being taken on a younger patient who still has the option of more grafts in the scalp donor. I'm inclined to want more density now with the knowledge that some more grafts can be extracted from the scalp later when things progress...although none of the docs I've spoken to about it here in europe agree

[Melvin- Admin]

Interesting point, I have dark hair, but I do have a few light colored hairs in my beard, at first I thought they were grey hair, but I looked closely and they were reddish, but they're few and far imbetween certainly not enough to make a difference.

 

What's your opinion on using beard hair in the donor to make up for depletion? I'm certainly more interested in using beard hair in my donor than my recipient, but I haven't seen many clinics take this approach. I would much rather thin out my donor to the point of depletion than transplant beard hair to the donor and include smp, I think this is a viable approach for those of us who cut their hair really short on the sides.

[Dr. David Josephitis]

I think using beard hair for depletion is a very interesting and valid approach. At SMG we have only been taking this approach for the older style surgeries where patients had the larger scars from "plugs." This works very well with beard hair.

 

We haven't yet had to use beard into the scalp of a contemporary FUE patient. I think it is an excellent idea and feel that with the right patient we might do this more often. I think as more patients get second and third FUE procedures, we may see more of a need to replete the scalp donor area.

[Melvin- Admin]

I think using beard hair for depletion is a very interesting and valid approach. At SMG we have only been taking this approach for the older style surgeries where patients had the larger scars from "plugs." This works very well with beard hair.

 

We haven't yet had to use beard into the scalp of a contemporary FUE patient. I think it is an excellent idea and feel that with the right patient we might do this more often. I think as more patients get second and third FUE procedures, we may see more of a need to replete the scalp donor area.

 

You're the first physician to agree, I think that's the best way to get the most out of FUE for those of us who cant get FUT, I mean I'd be willing to deplete my donor and transplant beard hair to the donor, I'm interested in getting my third FUE next year, I've had close to 4,000 grafts I think another 2,000 grafts would probably deplete my donor but I wouldn't mind as long as I could transplant some beard hair there. I think when all is said and done I could even add some smp to really make things look good.

 

Do you have any examples of the beard hair to the donor for those men who had old style punch grafts?

[Dr. David Josephitis]

HTsoon,

 

I am not sure I would recommend knowingly depleting your scalp donor area only to follow up with beard hair into the area. I feel a safer approach is to take only the amount of scalp donor available with FUE and then to have beard and SMP as a back up. It is always nice to have additional hair resources available to improve the scalp donor if the patient decides over time to cut their hair shorter, certain areas of the scalp are inadvertently thinner now because of FUE harvesting, etc.

 

Unfortunately, we don't have any post pics of beard into FUE sites as it is not as common of a procedure.

 

I am glad you brought up SMP. In our clinic it is becoming more important as an adjunct to FUE into the strip scar or into FUE sites. I think it does well to help camouflage areas.