DONOR HARVESTING METHODS: There are two methods in common use today for harvesting donor hair for hair transplantation. The “gold standard” for the past 25 years has been the “strip method,” which importantly includes the use of microscopes to dissect the grafts. The newer method on the scene is referred to as FUE (Follicular Unit Extraction).
We offer both methods, but in most instances recommend to our patients using the traditional strip method. However, there are several situations in which using FUE is a good fallback strategy – such as for the patient with no other donor hair and chest or beard hair needs to be harvested. Also, for some military or police males with a limited area of hair loss, it can work very well and they can keep their hair ¼ inch long.
The main reason for our recommendation of strip/microscope dissection over FUE is that we feel strongly that FUE grafts are not as good. In “plucking” the grafts out of the small hole that is made around the follicle, the fat is very often ripped off of the follicle, leaving it “naked” and very susceptible to drying and trauma. FUE is a more time-consuming task and thus is more expensive also. And last but not least, it is not “scarless” surgery as is promoted by some advertisements. A tiny white dot remains after each tiny hole is made, and if a man goes on to the traditional U-shaped Norwood VI balding, he will need probably 6000-8000 of these FUE grafts, and that will very often result in a very thin donor appearance and these white dots coalescing and being visible.
With the “strip/microscope dissection” method, there is only a very thin line of a scar, which is almost always hidden by keeping the hair ¼ – ½ inch long. The donor hair is taken from the densest part of the scalp at the mid-height, whereas FUE grafts are taken from all over, including up high near the fringe and low near the nape of the neck. Many of these grafts will be lost later in life as those areas naturally thin. Most importantly, with “Strip/microscope dissection” the grafts are carefully dissected under a microscope and have a protective coating of fat around the follicle, which insures their safe placement into the recipient sites and they have protection against drying out.
The above is intended to simply give you some background concerning these two methods and our reasons for recommending one method over the other for most of our patients.
GRAFTING METHODS: There are two methods for determining what size grafts to use for a person’s hair transplantation. One is the “all FU” method (FU stands for “follicular unit,” which is the small bundle of 1-3 hairs which exist together as a small clump coming out of our scalp. These sessions are usually of 1500-2500 grafts, and are packed very closely together. In some instances, when the area being transplanted is relatively small, we can “hit a home run” and accomplish the final result desired in one session. In the majority of cases, however, a second session is needed to “fill in the cracks” and achieve that density.
The second grafting method is the “combination method.” This technique is used in probably 60% of our patients and consists of using FU grafts for the great majority of the sites, but also includes using DFU grafts (double FU grafts of 4-6 hairs) in the central areas. There are a few advantages to doing this: They survive at 100% in research studies (vs. 90% for FU grafts); they save the patient money, since more hairs are moved for the same price per graft. They create more visible density than an equal number of follicles spread out as FU grafts, since the closeness of the hairs blocks light better, thus minimizing any “see-through” aspect to the result. It should be emphasized that these are not “plugs.” That term refers to the old “large grafts” of 30 years ago, which had around 20 hairs in each graft, or the “mini-grafts” of that era, which contained around 7-9 hairs per graft. When the DFU grafts are carefully angled, planted in a dense irregular alignment, and only placed in the center, they are an invaluable help in creating a great final result. The front hairline, crease areas, and rear crown area are always filled in only with the small FU grafts for naturalness. In the consultation the physician will go over this with you and make a recommendation as to which method would work better.
“FU Grafts” “DFU Grafts”