Misconceptions About FUE Hair Transplants

[Mr. 4000]

J_B_Davis, you asked an interesting question which I passed along to Dr. Cole. Here is his response:

“I agree with the concerns regarding yield. There have been a handful of studies looking at the yield with strip grafts. You've pointed out many of the technical difficulties associated with these studies. They all depend on accurate counts before and after surgery. In some instances, I am fairly confident that the data has been inaccurate. Yield studies are extremely difficult to carry out and there are many points where experimental error may occur.

As I stated, I carried out the yield study only at the urge of some strip proponents. I was never concerned with the yield because, as you noted, all you really need to do is look at the area several months after the procedure. It is pretty obvious when the yield is good and even more so when the yield is poor. If I had looked at the area and noted a poor yield back in 2003, I would have been far more cautious in performing FUE. The yields were certainly quite good from the beginning and, in my opinion, the results were superior to strip surgery in almost all cases. About 5% to 10% of the early cases of FUE needed some adjustments in the procedure and, more importantly, in the equipment to ensure outstanding consistent results. It took some time to develop techniques that would create outstanding yields in essentially all patients (other than those of African descent). I think there is still some room for improvement with regard to FUE in patients of African descent. This is an important goal because these individuals are prone to wearing their hair short or tight and are therefore particularly concerned with the possibility of a strip scar. Interestingly, those of African descent do not develop white or hypopigmented spotting as their melanocytes seem to migrate into the extraction sites and repopulate the areas with pigment.

When you look at yield studies done to date, you see a wide variety of results. In one study, the investigator found that his strip produced grafts produced a yield of 138%. One might ask how someone could get 138 hairs to grow for every 100 hairs that were transplanted? The answer is not that he used magic grafts. Rather, the answer is that his study was flawed. One of two things occurred: he may not have counted all of the hairs in the grafts that he transplanted, or he counted more hairs than actually grew. Perhaps he counted some of the growing hairs twice. Regardless, his findings emphasis the inherent flaws with studying hair yield. Counting hairs, I mean accurately counting all the hairs, is very difficult. Some studies with strip grafts and higher densities above 20 grafts per square centimeter suggest lower yield in the 70% to 82% range, while others suggests yields of 100%. The wide range of results suggests that the only study that would be of value requires a higher number of patients, accurate data collection, and proper statistical analysis.

You point out another flaw of yield studies. No one has ever counted all the hairs that were transplanted. You may indeed find that in one square centimeter, the yield was 90%, but in the adjacent square centimeter the yield might by 70%. No one has ever looked at the entire recipient area so you are right to be suspicious.

In my own yield study, the number of patients was far too small to completely trust the data. It is not statistically significant, but then all yield studies done with strips are statistically insignificant as well, because the study population was too small.

Yields from properly performed FUE are quite good. There is no reason for anyone to claim that properly performed strip procedures produce a higher yield. There are no good studies with FUE or strip surgery that have looked at the yield. As you point out, yields are generally measured simply by evaluating the growth. This is an excellent observation.

In order to set up a ratio comparing the cost per hair of two grafts containing a different number of hairs. For example, if you look at a graft obtained by strip surgery, they average is almost always 2 hairs per graft and, with FUE, the average is 3 hairs per graft. If you state that the cost per graft for FUE is $8.00 per graft, then you can solve for the equivalent cost per hair for a strip graft with the following formula:

x dollar per graft/2 hair per graft = $8.00 per graft/3 hairs per graft, which simplifies to x/2 = 8/3 or $5.33. This means that a graft costing $8.00 each and averaging 3 hairs each is equivalent to a $5.33 graft that contains 2 hairs in terms of cost per hair. In other words, 5.33/2 = 8/3. Both equal $2.66/hair. This means that a strip graft costing more than 5.33 each, is a poor value and you will get a better deal from an FUE graft. A strip graft costing less than 5.33 each is a good value in terms of the cost per hair, but you need to determine whether the strip scar is worth the better value in terms of the cost per hair."

I agree the entire industry has benefited from the production of misinformation, the that won't change as long as people keep reaching into their wallets.

It is business, so what ever works