Non-shaven FUE

[Rossybop]

Shaved patients seems to be the norm with FUE, however I have discovered a handful of surgeons who apparently do not shave their patients. Dr Saifi and Dr Anastasakis being examples. I wonder why is this?

[Gatsby]

Some surgeons will do FUE with an unshaven head but here is my take on it. For the small inconvenience of people seeing you with a shaved head and maybe the donor and recipient region post surgery, I would much prefer doing everything I can to make the surgery as easy as possible for the surgeon. If he/she has to work around hair that I want to keep it could be my loss in the long run. A week or two of scabs, etc is nothing compared to maximizing the greatest results for the rest of your life. All the best!

[Bill-Dr-Rahal]

I didn’t shave every week he is an interesting concept and what it does is allows the patient to see what the end result will look like even before it sheds and grows it. That is a nice perk for some however, it doesn’t prevent the postoperative shedding 4 to 6 weeks later and the awkward healing stages to come. Moreover, it makes the procedure more difficult for the doctor and staff which then begs the question… Does this potentially increase the risk of transection during extraction? If so, is it really worth the risk since you have to go through the shedding. anyway?  Also, I think the procedure might cost more but I’m not sure  

at the end of the day, I think it’s an interesting option but I’m not so sure it’s really worth it in the long run.

best wishes,

Bill

[jolly]

hey Bill

it would be of interest to the community if you could post your latest pics showing all angles and under harsh lights , its been a while we haven't  seen your pics , also what is your present day regimen?  , among all things this would  be a good educational interest considering that your transplants  were done years ago , so how much the results have sustain etc ..... just my suggestion .

[Rossybop]

Guys I can see your point. But I've noticed Anastasakis for example doesn't have any shaven results visible online which suggests he doesn't shave at all.

[DrTBarghouthi]

Long hair FUE is getting some momentum certainly. A recent study showed that the transection rate with this technique (which has a learning curve ofcourse) can be higher. In contrast, by keeping the hair in the donor long, the extracted numbers can be higher than the shaved technique, because the surgeon has the visual effect of long hair in the donor, which might allow him or her to extract a higher percentage per cm2 than if shaved. It is ofcourse a new area that some are getting into. I see the attraction to some patients. However, I think there is a learning curve and shouldn't be done by anyone or offered to everyone. 

[Rossybop]

Interesting stuff. Are you a HT specialist yourself?

Saifi and Anastasakis don't shave all their patients and they seem to be well-esteemed. To me it looks as if non-shaven FUE is the norm for them.

[DrTBarghouthi]

Hi @Rossybop

Yes I am. I think something needs to be clarified here. There are two techniques for “non shaven” fue out there and both are being marketed in a similar way but the techniques are different. What some doctors do (i do it myself at times) is shaving thin random strips across the donor whereby the longer hair over those strips will cover the fue extraction sites. This is technically a shaved fue but is more concealed. It is useful for smaller touch ups or smaller sessions or what became to be know as a VIP or celebrity FUE. You can plan multiple small sessions like that and eventually reach the number needed over 3-4 sessions. 
The newer trend I was referring to is Long hair FUE, which extracts the hair with a long shaft. No shaving done at all. 

[Rossybop]

Cool! Interesting stuff and great to be hearing this from an industry professional. These new methods sound exciting.

[Rossybop]

I've just researched you and I've discovered that you have very impressive credentials. That's amazing, congratulations on all of your achievements thus far. I also noticed that you have trained and worked in Ireland - I live in Dublin. I have visited HRBR but I probably won't get a transplant there because of there high prices. Out of interest what do you think of HRBR - are their standards good, bad, average? Are they amongst the best in Europe or the world?

Your clinic looks awesome btw. How much do you charge for a high quality FUE procedure?

[DrTBarghouthi]

Thanks @Rossybop

Yes I did my undergraduate medical degree and surgical training in Dublin before heading to the US for a hair restoration fellowship. Thanks a lot for your kind words. I certainly miss Ireland. I lived there for 15 years so I really know my way around and I do visit whenever I can. 
 

I think HRBR is a good facility with good doctors. I haven’t worked with them to comment on their work unfortunately but I am aware that Dr Collins and his team have a long track record in this field. 

As for prices, we do charge 3 usd for the first 2000 grafts and 2.5 usd for anything after. Most steps are done by me apart from implantation which I would supervise. 

[Rossybop]

You're very welcome!

I'm glad to hear that you enjoyed the Dublin. Your prices are certainly better than the standard rate over here. It would be great to have a considerate doctor like yourself carry out a quality procedure. I'm personally trying to decide whether to get FUT or FUE. I'm intrigued by FUT because of the high graft yield. Its a wonder more people don't opt for FUT. Do you ever reccomend FUT yourself?

[DrTBarghouthi]

I do in certain cases. The truth is that the majority of clients are opting for FUE nowadys for reasons you probably know. Limited donors are really the ones going for  FUT nowadays. I find that people could be more appreciative of FUT as they grow older. I therefore always try to leave a nice central portion of the donor untouched while doing FUE, as I would know if down the line an FUT is chosen, then I or someone else will be thankful for leaving that unharvested. 

[Rossybop]

Cool. That's a nice touch to apply. 

I'm fascinated by FUT because of the high graft yield and I'm starting to explore the possibility of FUT right now. The biggest worry for me though is the scar! However, I've discovered that FUE is not entirely scar-free either. Also, I've read some stuff suggesting FUE is better for hairline surgery because it allows the surgeon to cherry pick single-hair follicles, whereas FUT does not create as good a hairline (I don't know how true this is?).

I like to cut my hair to a #1 back and sides, also I need to restore my hairline and not my crown. If FUT was appropriate for me right now I would choose it rather than FUE, but sources seem to suggest it is not suitable because of my wants/needs. What's your opinion on this?

[DrTBarghouthi]

FUT can create good hairline grafts as we need to dissect all follicles individually and may need to refine single hair ones similar to FUE. 
The scar in an FUT is definitely more obvious then the FUE gun shot scarring ( which in most cases the eye does not fixate on).  Shaving on #1 can be quite risky at times with FUT. I’ve seen some nice scars that show on #1 still. It is just the linear nature of it that makes it obvious. Recovery post FUT can also be slower in terms of pain and precautions. 
I guess the main thing is the type of hair loss you have. What stage is it?

[Rossybop]

I see. Perhaps if a really good FUT surgery is still obvious with a #1 haircut I should consider FUE instead. I've been told I need about 2,300 grafts or so. I'm probably a NW2/NW3, maybe more NW3. I mostly need to fill in the receded temples.

[DrTBarghouthi]

Please feel free to share some photos here of your hair loss and donor areas. That would help a lot. Also what age are you? Any family history? 

[Rossybop]

[Rossybop]

[Rossybop]

[Rossybop]

I am 30. I just started using finasteride 3 months ago, also started using Regaine two weeks ago.

My dad is 70 and still has a good bit of hair, not a totally full head but probably more than most 70 year olds. However my grandads were bald, but not until later in life, one grandad died at age 90 and he was bald enough at that stage, but I think he had a good bit of hair for most of his youth. My other grandad I think went bald younger, and he was proper bald. I have two brothers and they both have no hair loss at all, male cousins don't seem to have it and uncle has a fair share of hair at age 62. The baldness gene is definitely there and I seem to be the unfortuneate one in my fsmily thst has got it.

[DrTBarghouthi]

Thanks a lot for that. It seems you do have a great donor. Your hair is somehow find and straight. I would probably thing you will need more than 2300 to match the density of your forelock. Based on photos I would probably say 2800 grafts and strict maintenance will be better in my opinion. 

[Rossybop]

Cool, thanks. Wow - 2,800. That is a lot. Every surgeon gives a slightly different estimate. I think I'll definitely use finasteride long-term if its really good.

[DrTBarghouthi]

It is true. There is no right or wrong really. It is hard to be accurate with photos especially that the exact hairline height, shape of temple recessions can vary and thus require less or more grafts. This is the reason for some variations mostly. 

[Rossybop]

I see I see. Interesting. I've actually got an appointment for an FUE plan in HRBR (Dublin) next week. They're going to draw a new hairline on and I guess tell me how many grafts I might need. I trust that they would be able to provide an accurate estimation when they check me in-person next week, but, as far as I know they only do about 2,000 grafts per session, so I'm worried that they will just say "oh you need 2,000 grafts" just because that's the max amount of FUE grafts they do in one session.