FUE common questions

[Sara Wasserbauer, MD]

I just had a consult where a younger guy brought his older uncle and his Dad and ALL of them wanted to know about various aspects of FUE. It is true, FUE as a technique is evolving rapidly. Between the advent of the Robotic ARTAS system, and newer practitioners getting the hang of it, it is now more available to patients than ever. Here are a few questions from that "group consult" about the limits of this technique that I wanted to share;

1) If I have done a previous hair transplant with the traditional "strip" technique, can I still get an FUE hair transplant?
-Yes, you can. Just realize two things: FIRST if you want to get the highest number of grafts from the session you will need to shave your head on the back and sides and thus your old linear scar may be visible, and SECOND the area immediately surrounding the scar is not easily harvested. That is to say about 1 cm above and below an old linear scar the hair gets pulled in odd directions under the skin and transection rates become unacceptably high. In those cases it can do more harm than good to harvest close to the scar so most experienced FUE surgeons will leave a band of unharvested hair on either side.

2) Does FUE get fewer grafts than the strip technique?
- In general, yes. However, some heads are great for this sort of surgery and yield many more grafts than others, and some surgeons are able to get more grafts than others, too. Realize that there is a learning curve to performing an effective FUE procedure. Surgeons who do it often can get their transection rates down to percents in the single digits (1%-5% is mine) and graft counts to over 2000 (my last surgery was 2400+ grafts). This is one technique where experience definitely counts.

3) Can you do FUE with curly or white hair?
- Again, the answer is yes. Here are the caveats; a doctor may dye the hair temporarily if the white hairs cannot be seen easily and the robotic hair transplant is not approved for this hair type (although it may be used off-label for that with an experienced surgeon), AND curly hair can result in transection rates of 20-30%. I find those rates unacceptably high but some patients and some surgeons are willing to lose that much hair in order to achieve a less-visible level of scarring.

Remember - FUE is NOT SCARLESS! The scarring is just less noticeable. Furthermore, FUE is just as invasive as a "strip" surgery in that the incision is the same depth in the skin, about 3-4 mm. I think some patients are swayed by the words "minimally invasive" in FUE advertisements when in fact a traditional surgery would be a better procedure to fulfill their individual needs.

I hope that helps everyone! Good luck with your choices!