An Expert Hair Transplant on Oahu
Approximately one-half of the men in the U.S. are affected by hair loss, resulting in a thinning of the scalp hair or varying degrees of baldness. Hair loss is also very common in women. While some people are not concerned about their hair loss, others may feel a loss of self-esteem, become distressed and look for ways to correct their condition.
What Causes Hair Loss?
Despite myth and popular belief, frequent shampooing, the wearing of hats and poor circulation are not the cause of hair loss.
Androgenetic alopecia, or pattern baldness, is the leading cause of hair loss in men and women. In this condition, hormones combined with a hereditary predisposition produce thinning hair and pattern baldness. Less common causes of hair loss include high fever, severe infection, diet, certain medications, birth control pills, thyroid disease, childbirth, and cancer treatments. During the consultation, the cause of one’s hair loss will be discussed and best form of treatment will be optimized to your personal needs.
FUT Hair Transplant
Strip method is an excellent method for hair replacement when you need many hair follicles at one time.
During your initial consultation you will be able to speak to Dr. Watkins directly and the Strip method will be discussed and planned in detail. Please feel free to ask any and all questions and concerns you have. We want to make sure you feel comfortable with your decision and that we are able to meet your expectations.
On your surgery day we will bring in several specialists that work along side Dr. Watkins to make sure you receive the best possible and most efficient care. Once seated in our pre-operating room we will then measure, mark, and shave the hair on a small part of the back of the head just below your natural ridge. By taping up the hair in the back of the head and only shaving the small area that will be used as the strip, you should not be able to see the shaved area after surgery. We give you a sedative so you can relax and sleep and Dr. Watkins will then administer a local anesthetic to numb the area in the operating room. You should be able to lie down comfortably and sleep most of the time on the day of surgery. The skin strip is then removed by Dr. Watkins. The strip is then handed off and divided in the natural follicle groups under the microscope. You are welcome to bring a laptop or electronic device with you for entertainment to use after the strip procedure has been completed.
Small micro incisions are then made in the area where we will put your new hair transplants and each graft is individually placed. This is a time consuming process so expect to spend the day with our team in the operating room. We will provide lunch and beverages for you during your stay.
When the last hair follicles are in place, the area is thoroughly cleaned and we will go over post operative care with you. Stitches are usually removed 1-2 weeks after surgery.
FUE Hair Transplant
Follicular Unit extraction or FUE is a highly popular and evolving hair transplant technique in which a small round punch is used to extract follicular units from a patient’s bald resistant donor areas one at a time. These 1, 2, 3 and 4 hair groupings (called follicular unit grafts) are then transplanted into a patient’s balding areas.
Whether it’s the lack of linear scar associated with traditional follicular unit hair transplantation via strip harvesting or FUT, its less invasive nature or its potentially faster healing time, the popularity and demand for FUE has increased significantly over the last several years. While follicular unit extraction has been historically overhyped or oversold to eager patients, due to recent developments and increased patient interest, it’s evident that FUE is here to stay.
The lasting power of follicular unit extraction seems to stem from both patient demand and the dedication of talented hair restoration experts who continue perfecting the procedure and innovating more precise FUE tools.
FUT vs FUE: Comparing Follicular Unit Extraction (FUE) to the Standard Strip Procedure.
Follicular Unit Extraction (FUE) and Follicular Unit Transplantation (FUT) are sometimes mistakenly viewed as opposing hair transplant techniques. FUE, in fact, is a sub-type of FUT where follicular units are extracted directly from the scalp rather than being microscopically dissected from a strip of tissue that has already been removed (via the strip harvesting technique). Thus, during FUT, individual follicular units can be obtained in one of two ways; either through strip harvesting and microscopic dissection or via FUE.
When comparisons are being made between FUT and FUE, what is really being compared is the way follicular units are obtained (strip harvesting and dissection vs. direction extraction). The type of grafts (follicular units) and the process for transplanting grafts in the recipient area is the same.
Results produced by today’s FUE hair transplantation and Strip Procedures are very natural and dense in the hands of expert hair restoration physicians. However, FUE and strip harvesting are very different techniques and are handled very differently.
How a FUE Hair Transplant is performed.
During the Follicular Unit Extraction or FUE hair transplant procedure, individual follicular unit grafts (hair groupings of 1, 2, 3 or 4 hairs as they occur naturally in the scalp) are harvested one at a time using a tiny punch typically ranging from .7 to 1 millimeter in size. Typically the patient’s hair in the donor area where these grafts are being removed is cut short so that the physician is able to see the patient’s scalp.
Follicular units (called grafts) are extracted from DHT resistant areas on the sides and back of the scalp (called the donor site) using a multiple step process. First a small sharp punch scores the skin around a follicular unit. Then a small dull punch typically ranging from 0.7mm to 1.0mm is used to go deeper into the soft tissue surrounding the follicular unit. Since the direction and angle of the follicular unit beneath the skin can’t be seen and can often differ from the direction of the hair on the surface, a sharp punch if used below the surface of the skin might transect or sever the underlying follicular unit. However, the dull punch tends to envelope the follicular unit, while separating it from the surrounding soft tissues. This process is typically referred to as “blunt dissection”.
Once the underlying follicular unit is separated from the surrounding tissues it can then be extracted, often by a forceps gripping the hair above the surface.
The small hole left behind after the follicle is extracted then heals over the next few days. This tiny wound contracts as it heals making the resulting round scar smaller and less noticeable. The FUE patient typically ends up with hundreds of small round white scars, which are normally undetectable to the naked eye even when a patient’s hair is cropped extremely short.
Each follicular unit graft is carefully placed into tiny recipient sites made by the physician in balding/thinning areas of the scalp. Placement is typically performed using forceps or a similar tool. Follicular units are placed into pre-made recipient sites immediately after each graft is harvested or after the extraction process is complete.
Follicular Unit Extraction: Advantages and Disadvantages
Like FUT hair transplantation, FUE comes with a unique set of advantages and disadvantages and patients considering follicular unit extraction should become familiar with them. Below, we discuss some of the unique benefits, limitations and potential problems with the follicular unit extraction technique.
FUE Hair Transplant: Less Invasive Nature
Unlike Follicular Unit Transplantation (FUT), where a “strip” of follicular unit-bearing scalp is removed, dissected, and the wound is closed via a two layer suture or staple technique, FUE grafts and immediately surrounding tissue are extracted individually with punches typically ranging from 0.7mm to 1.0mm. Thus, no closure of the post-extraction wounds is necessary. Because of this, many view FUE as less invasive than FUT and feel this is a distinct advantage.
Decreased Scarring and Ability to Wear Hair Short or Cropped
Along with its less invasive nature, FUE also does not produce the “linear scar” associated with Follicular Unit Transplantation. Although many talented hair transplant surgeons are able to produce virtually undetectable “strip scars” with cutting edge techniques such as the trichophytic closure, FUT will always create a thin, linear scar in the temporal (above the ears) and occipital (back of the head) regions of the scalp. Additionally, some patient’s physiology or post-operative activity can cause unnecessary stretching and poor healing of the FUT wound site. Often, this trauma and increased tension creates a raised, wider scar in the donor region.
Despite some hype still surrounding the procedure, FUE is not a scarless procedure and does create a series of small, circular scars in the donor region. When done right, these tiny dots are often undetectable providing patients with the ability to wear shortly cropped hair without any noticeable scarring.
Faster Healing and Recovery Times and Reduced Post-operative Pain
Many hair transplant surgeons agree that the less invasive nature of FUE hair transplant surgery leads to faster healing and recover times over FUT. Because of the lack of wound closure, staples or sutures; and no increased tension in the donor area during healing; FUE generally creates less pain and discomfort in the donor region.
Follicular unit extraction patients typically sleep better after surgery and return to work and their daily routine / activities more speedily. This includes strenuous exercise and weightlifting, which are inadvisable for up to 3 months with FUT or strip surgery.
Decreased Total Yield (from Increased Graft Transection)
Today’s advanced FUE hair transplant surgery is associated with lower transection rates and higher yield than ever before. However, because the direction and angle of the follicular unit beneath the skin can’t be seen and can often differ from the direction of the hair above the surface, this “blind” extraction sometimes leads to slightly higher transection and lower yield than traditional follicular unit transplantation (FUT).
Thinner, Less Viable Grafts
Some experts believe the “thinner” nature of FUE grafts may affect total yield. During strip dissection, technicians are able to leave extra insulating tissue around the follicular units which better protect the grafts against the potential mishandling, dessication and/orcrushing that can occur outside of the body and during placement. During FUE hair transplant procedures, the small (0.7mm – 1.0 mm) extraction punches leave follicular unit grafts with less insulating fatty tissue, leaving them more vulnerable to potential damage. While larger extraction punches may sound like a logical solution and create thicker grafts, it also comes with an increased risk of visible donor scarring.
Possible Reduced Patient Candidacy
Because the follicular unit extraction procedure is more complex, some patients are not ideal candidates. For example, thick, curly hair is often difficult to extract, and patients with these characteristics (like African Americans) may experience high transection and poor yield from FUE. Additionally, because the procedure normally requires shaving in the donor region, it is usually not suited for female patients with long hair. The potential for increased transection rates with a large number of extractions may also make FUE less effective in patients with advanced balding patterns.
A Single FUE Hair Transplant Session May Take Multiple Days
Although FUT is still likely more effective for advanced balding patients, FUE practitioners are starting to perform large (3,000 – 5,000 graft) FUE procedures with high yield. However, while larger FUT sessions can be performed in one sitting, FUE “mega sessions” often require multiple days. FUE procedures exceeding 2000 grafts often require 2 to 3 days to complete, and this may inconvenience some patients.
Though FUE is increasing in popularity, session size and yield, one significant disadvantage for many patients is the increased cost associated with the procedure. Although FUE costs have decreased significantly over the years, the graft prices still remain higher than strip surgery. While cost is variable, FUE costs typically range between $6 to $8 per graft. While a direct comparison is difficult to obtain, FUT surgeries of similar size are generally almost half the cost.