In Hair Transplant Repair, Can You Remove Plugs By Follicular Unit Extraction?

In Hair Transplant Repair, Can You Remove Plugs By Follicular Unit Extraction?

Q: I was wondering if it was possible to use Follicular Unit Extraction (FUE) on the old plugs instead of graft excision. — N.B. ~ Westport, C.T.

A: Graft excision generally works better than FUE in removing old plugs and mini-grafts. The reason is that, in these grafts, the hair is not aligned due to the scar tissue that tugs on, and bends the hair. Because the hair direction is altered from the scar tissue, there is much more damage when the grafts are removed with the tiny FUE punches. In addition, FUE only removes a very small part of the plug. If the hair in the plug is pointing in the wrong direction or the plug is in the wrong location, the entire graft needs to be removed.

Another benefit of graft excision is that we can remove the underlying scar tissue and improve the appearance of the underlying skin. In FUE, only a tiny bit of the scar tissue is removed and, since FUE holes are left open, FUE actually causes its own scarring. With graft excision, the sites are sutured closed so some scar tissue is removed and the quality of the underlying skin looks more natural.

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Robotic Hair Transplant Case Study with Bernstein Medical Patient

Restoration Robotics, the company that developed the ARTAS® Robotic Hair Transplant system, has published a white paper case study on how Dr. Bernstein utilizes the robotic system’s tools to minimize scarring after Robotic FUE.

The paper describes how a Bernstein Medical patient — a 45 year old man with Norwood Class 5A male pattern baldness — had 2,540 follicular units harvested with the ARTAS robot, generating a total of 2,768 grafts. Some of the tools and techniques that Dr. Bernstein employed include:

Small 19g dissecting needle — the small needle leaves a smaller wound that heals more rapidly than previous needles.
Software programmed to avoid 1-hair follicular units — the extraction of follicular units with more than one hair maximizes the number of hair follicles per graft and reduces the number of donor wounds that need to be made.
Minimum distance between harvest sites — by increasing the distance between harvested follicular units (from 1.7mm to 2.0mm), Dr. Bernstein enabled “feathering” between harvested and non-harvested zones. This blending of harvest zones into non-harvested zones makes the harvested area less noticeable.

In the third month after his Robotic FUE hair transplant surgery, the patient’s donor area was reviewed for scarring with hair shaved at four different lengths.

See images of the patient’s donor area below:

Before Robotic Hair Transplant

Day 2 Following ARTAS Procedure

3mo Post-op: Shaved with #2 Clipper

3mo Post-op: Shaved with #1 Clipper

3mo Post-op: Shaved with Peanut Clippers

3mo Post-op: Shaved with Peanut Clippers (Close Up)

3mo Post-op: Shaved to the Skin

3mo Post-op: Shaved to the Skin (Close Up)

The case study illustrated that the ARTAS Robotic Hair Transplant system’s suite of tools can minimize the detectability of scars after an FUE hair transplant.

Dr. Bernstein describes advanced Robotic FUE techniques used at Bernstein Medical (VIDEO)
Read about Robotic Hair Transplantation

Posted by Robert M. Bernstein M.D.

Risk of Visible Scar Long-term, FUT or FUE?

Q: What are the chances of the donor scarring being visible long-term in FUT compared to FUE? — M.M., Altherton, C.A.

A: Both FUT and FUE produce donor scarring; FUT, in the form of a line and FUE in the shape of small, round dots. With FUT hair transplantation, the line is placed in the mid-portion of the permanent zone, whereas in FUE the dots are scattered all over the donor area.

If a patient becomes extensively bald (i.e. the donor fringe becomes very narrow), the line of FUT will generally still remain hidden, whereas the dots of FUE will be seen above the fringe of hair. In the less likely scenario of the donor hair actually thinning significantly, both the line (of FUT) and the dots (of FUE) may become visible.

Posted by Robert M. Bernstein M.D.

Do You Perform Hair Transplants With Body Or Leg Hair?

Q: Dr. Bernstein, can you please comment on leg and body hair transplants? — J.R., Ridgewood, NJ

A: I’ve tried the technique in the past but have been dissatisfied with the results. Scalp hair, unlike the rest of the body, has multiple hairs rising out of each follicle. With leg and body hair, you have only one hair per follicle, not follicular units of multiple hairs. Leg hair is also very fine. It might thicken up a little bit after it is transplanted, but not enough to be clinically useful. In men you want full thickness hair, so fine hair can make it look like it is miniaturizing, as it does when you’re losing it.

Body hair has been successful in softening hairlines, but most people have enough scalp hair to due this, since it often requires very little if properly placed. Another issue is that because leg hair emerges from the skin on a very acute angle, more wounding of the skin occurs as each hair is individually extracted and this leaves marks.

Body hair, from the chest or back, does hold better potential for success than leg hair, particularly if it is plentiful, but it still is extracted one hair at a time and can leave significant scarring when done in large numbers.

Read about the traditional donor area on the back of the scalp

Posted by Robert M. Bernstein M.D.

Dr. Bernstein Discusses Benefits Of Robotic FUE On Bloomberg TV

Dr. Bernstein Touts Benefits Of Robotic FUE On Bloomberg TV

Dr. Bernstein discusses the ARTAS Robot for FUE

Dr. Bernstein spoke with Bloomberg’s Matt Miller about the future of hair transplantation in a segment called, “The Bald Economy: Surgical Solutions to Hair Loss.”

Here is an excerpt from the segment:

Bloomberg’s Matt Miller: Riding the wave into the future happens to be one of the pioneers of FUE, Dr. Robert Bernstein.

Dr. Bernstein: “The robot now allows a mechanized system to do [follicular unit extraction] very, very quickly and very consistently, so that the human error in this part of the procedure is now gone.”

Matt Miller: That’s right, a robot. Dr. Bernstein is piloting a high-tech solution called ARTAS.

Dr. Bernstein: “What it is very precise at doing is getting around the follicular unit to separate it from the tissue.”

Matt Miller: The procedure, which costs twice as much as the standard surgery, has one clear advantage.

Dr. Bernstein: “The difference is, in the back, in the area where we take the hair, there will be little tiny dots that just fade into the scalp.”

Posted by Robert M. Bernstein M.D.

Does Robotic FUE Leave Donor Area Scars?

Q: Does Robotic FUE leave any scars? — T.B, White Plains, NY

A: Robotic FUE leaves the same tiny, white scars in the donor area produced by manual Follicular Unit Extraction.

Posted by Robert M. Bernstein M.D.

Should I Have an FUT or FUE Hair Transplant, or Should I Wait for Hair Cloning?

Q: I heard that there have been some new advances in hair cloning and that it may be available sooner than we thought. I was planning on doing a hair transplant soon. Considering that hair cloning may be available at some point in the future, should I do FUE or FUT, or wait for cloning? — K.R., Fort Lee, NJ

A: Although there has been a major development in hair cloning with the use of ACell, an extracellular matrix to simulate hair growth, the model, at this point, is still in its earliest stages of development. It is hard to know when the technology will reach a state where it can be useful in hair restoration.

With respect to which you should do FUE or FUT if, theoretically, cloning is around the corner, the answer would be FUT, since FUT will give you the fuller look.

If the goal is to eliminate any trace of the traditional hair transplant, again FUT will most likely be the best choice, since the single linear scar would be easy to camouflage with cloned hair. With FUE, this would be much more difficult, since there are literally thousands of tiny scars. However, neither FUE nor FUT will preclude a patient from fully benefiting from cloning if, and when, it becomes available.

Hair Cloning

Pros & Cons of FUE

Posted by Robert M. Bernstein M.D.

After Hair Transplant, What Is Recommended Hair Length To Hide Scar?

Q: I never kept my hair really long, what length can I wear my hair after a hair transplant to hide that I had a procedure? — D.F., Chappaqua, N.Y.

A: Hair transplants, whether using the strip method to harvest the donor hair or by extracting individual follicular units one-by-one directly from the scalp, will leave some scarring. If the hair is long enough so that the underlying scalp is not visible, these scars will not be seen.

The quality and density of a person’s donor hair will affect this coverage and determine how short a person may keep his hair. In some cases the back and sides can be cut to a few millimeters, in others it would need to be kept longer. Since there is no scarring in the recipient area (the front and top of the scalp where the grafts are placed) the hair in these areas may be kept at any length.

Posted by Robert M. Bernstein M.D.

After an FUE Hair Transplant at the Hairline, Will Bumps Go Away?

Q: I have had a hair transplant done in the hairline of 1,000 or so FUE grafts. However, as the hair sheds, under natural light the recipient skin seems bumpy with incisions and holes that are noticeable. Do these tend to go away with time once they have healed? — S.S., Glencoe, I.L.

A: If a follicular unit transplant is performed properly (using either extraction or a strip) there should be no bumps or surface irregularities. When the hair restoration is totally healed, the recipient area should be appear as normal looking skin.

With FUE it is important to sort out the grafts under a microscope, to make sure that all of the grafts placed at the hairline are 1-hair grafts and that the larger grafts are place behind the hairline. They should not be planted without first being sorted under a microscope.

Posted by Robert M. Bernstein M.D.

After an FUE Hair Transplant Can I Shave My Head?

Q: I am trying to have my donor scar repaired after a 1000 graft hair transplant. I was told the FUE’s placed into the scar would conceal it enough to shave my head? I would like to shave my head completely bald with a razor. — N.R., Poughkeepsie, N.Y.

A: In general, after a scar correction with follicular unit extraction you can clip your hair very short, but not shave your head. If you shaved your hair completely bald, you would generally see a vague outline of the linear scar as well as the small scars from FUE.

Posted by Robert M. Bernstein M.D.

Does an FUE Hair Transplant Leave a Scar?

Q: Can you shave your scalp after a hair transplant with FUE without noticing scarring in the donor area? — A.A. Bronxville, N.Y.

A: Although there is no line scar in follicular unit extraction, there are tiny round ones. You can clip your hair very short after FUE, however, shaving your head will make the very fine white scarring visible.

Posted by Robert M. Bernstein M.D.

What are Follicular Unit Transplantation and Follicular Unit Extraction, and How do They Differ?

Q: What is Follicular Unit Transplantation and how is it different from Follicular Unit Extraction? — H.L., White Plains, NY

A: Follicular Unit Hair Transplantation, called FUT for short, is a procedure where hair is transplanted in the naturally occurring groups of one to four hair follicles. These individual groups of hair, or units, are dissected from a single donor strip using a stereo-microscope. The area where the donor strip was removed is sutured closed, generally leaving a thin, fine, line scar.

In Follicular Unit Extraction, or FUE, the individual units are removed directly from the back or sides of the scalp through a small round instrument called a punch. There is no linear scar. There is, however, scarring from the removal of each follicle. Although the scars of FUE are tiny and round, the total amount of scarring is actually more than in FUT.

In addition, since in FUE the bald skin around each follicular unit is not removed, the total amount of hair that can be removed in FUE is substantially less than in FUT. This is because if one were to remove all the hair in an area, it would be bald. In FUT, the intervening bald tissue is removed along with the follicles in the strip.

Read our page on FUE vs. FUT

Posted by Robert M. Bernstein M.D.

Can I Have an FUE Hair Transplant Using Beard Hair?

Q: Can you use beard hair for a hair transplant using Follicular Unit Extraction? — A.C., San Francisco, CA

A:It is possible to use beard hair for a hair transplant, but there are three main differences between harvesting from the donor area and harvesting from the beard that should be taken into account. These are: 1) scarring 2) ease of extraction and 3) hair quality. Let’s explore these differences in turn.

First, in FUE, although there is no linear scar, there are small white round scars from where the hair is harvested. Normally these marks are hidden in the donor area and are not visible, even if the hair is clipped very short. However, if the scalp is shaven, these marks will become visible. When the beard is used as the donor source for the hair transplant, the patient must continue to wear a beard after the restoration, even if it is tightly cropped, or the faint white marks will show. The tiny round scars from FUE will generally be visible on a clean shaven face. As each person heals differently, we would perform a test before doing the actual procedure to make sure the marks from the extraction are not noticeable at the length that the person wants to wear his beard.

Second, FUE performed on beard hair differs from extraction from the scalp because of the greater laxity — or looseness — of facial skin. This makes extraction with minimal transection more difficult in some cases. A test prior to the hair transplant is particularly important in beard FUE so that the ease of extraction may be determined in advance.

Third, beard hair is coarser than scalp hair. Although the hair seems to take on some of the characteristics of the original hair in the transplanted area, the transformation is not complete. This makes beard hair an imperfect substitute for scalp hair.

A solution to the problem is to transplant beard hair behind the hairline for volume and scalp donor hair at the hairline for naturalness.

Read about FUE Hair Transplants

Posted by Robert M. Bernstein M.D.

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Follicular Unit Extraction Scarring

In Hair Transplant Repair, Can You Remove Plugs By Follicular Unit Extraction?

Robotic Hair Transplant Case Study with Bernstein Medical Patient

Risk of Visible Scar Long-term, FUT or FUE?

Do You Perform Hair Transplants With Body Or Leg Hair?

Dr. Bernstein Discusses Benefits Of Robotic FUE On Bloomberg TV

Does Robotic FUE Leave Donor Area Scars?

Should I Have an FUT or FUE Hair Transplant, or Should I Wait for Hair Cloning?

After Hair Transplant, What Is Recommended Hair Length To Hide Scar?

After an FUE Hair Transplant at the Hairline, Will Bumps Go Away?

After an FUE Hair Transplant Can I Shave My Head?

Does an FUE Hair Transplant Leave a Scar?

What are Follicular Unit Transplantation and Follicular Unit Extraction, and How do They Differ?

Can I Have an FUE Hair Transplant Using Beard Hair?

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