Dr. Cole, can you really get better coverage with fewer grafts using FUE?

Many poorly informed physicians claim that you cannot get as good of a result with FUE as you can with strip surgery. Strip surgeons use this misinformation as marketing for strip surgery. Such is not the case. As I’ve stated for many years, you can get better results with FUE than you can from strip surgery. The reason are quite evident. First, with FUE, the grafts spend less time out of body. Second, the FUE grafts contain more hair in each graft than with strip surgery. In fact, the average FUE graft contains 50% more hair than the average strip graft.

Here is a classic example. Most strip physicians would have done 2500 to 3000 grafts in this case to obtain a comparable result that we obtained with only 1800 grafts. Not only did we show that one can obtain better coverage with fewer grafts, we showed that this FUE result from 2004 has stood the test of time. Seven years later the patient still has outstanding coverage despite further hair loss.

Over all planning includes planning for the future. If a patient agrees to planning for the future, further surgery in the short term to keep up with future hair loss is often avoided for many years.

The following patient had CIT procedure of 1,845 grafts. His results show the benefits of the CIT method of FUE.

Dear Dr. Cole, I have a scar on the top of my head from a traumatic injury.  I reside in Bangkok.  I desire to fill this area in with grafts obtained by FUE.  I am of Asian decent.  Is it possible to graft this scar on the top of my head, and where I should have the procedure done.

Yes, it is possible to graft scars due to trauma.  We recently had a patient return to our office following a procedure to help conceal the scar.  He had an excellent yield and result.  Asian patients are ideally suited for FUE procedures to treat both balding areas and scars.

This patient of Korean ancestry returned following treatment for an area of alopecia secondary to a traumatic delivery.  He developed this large area of hair loss following forceps trauma during his delivery.  The trauma damaged the follicles and the area healed by secondary intention.  The results from the initial surgery are 10 months subsequent to hair transplant surgery using the CIT method of FUE.  Because the grafted area was scar tissue, we did not attempt maximal density with the transplant procedure.  Scar tissue has excellent circulation, but high densities might affect the yield so we generally begin with a lower density of 30 to 40 grafts per square cm.  The patient returned to our office in an effort to add additional density.  In the initial procedure we placed 203 grafts.  In the follow up procedure we added an additional 243 grafts.

We have two affiliate clinics in Asia that can provide FUE.  One is in Singapore and is staffed by Dr. Tyng Tan.  The other is in South Korea and is a Dr. Cole Forhair clinic.

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I am planning sexual reassignment surgery because I am a woman inside and out. Unfortunately, I have androgenic alopecia. Is it possible to undergo a hair transplant to give me a feminine look?

Yes, we frequently treat transgender patients who wish to become more feminine.  The following is an example of such a case.  The patient has androgenic alopecia, unfortunately.  The patient desired to treat the area of hair loss to achieve a more acceptable feminine appearance.  The patient had 3200 grafts placed on the top and front of the scalp.  Initially, she planned to wear a hair system in the crown area, but due to the success of the initial procedure, she elected to also treat the crown area with grafts.

In treating transgender patients who wish to enhance their feminine appearance, it is important to build a feminine hairline and get as much density as possible.  Often times it takes a second procedure to achieve the density these ladies desire.

The grafts in this instance were all harvested using the Power Cole Isolation Device or PCID.  The grafts were harvested at a rate of over 2000 per hour.  This is an excellent example of how FUE can work in transgender patients.

One thing she was very proud of was her conversation with other physicians involved in her care.  They all wanted to know where the strip scar was.  When she informed them that the procedure was done without a scalpel, they are all amazed.  That’s the power of FUE.

There is an abundance of hair transplant ‘before and after’ photos at the fingertips of anyone interested enough to perform a search online.  However, educated consumers need to understand that certain clinics and physicians will deliberately publish misleading photos that do not accurately depict the true quality of their transplant outcomes.

When basing a hair restoration surgery decision on a physician’s photos, make sure the images are large, clear and very detailed.  Doctors who are proud of their work will have nothing to hide and no qualms about posting high-quality images, showing details such as the patient’s hairline.  Excellent hairline work should have a gradual “feathering” effect and a natural look.  Look for consistent lighting in before and after photos; overexposure of the results photos can be misleading.  There should also be consistency in hair styling (whether hair is wet, dry, gelled, styled, etc.) and the angles from which the patient is photographed.

Some doctors’ websites provide only small, dimly lit images, in an effort to disguise details that may detract from the results they wish to convey.  Some photos may even be deliberately out-of-focus or blurred.  Doctors who are trying to disguise the lackluster quality of their work will avoid showing detailed hairlines in their patient galleries, or will style the patient’s hair so as to conceal the hairline.  Some doctors will even digitally alter images, using software such as Photoshop, to blur hairlines.  One way to detect whether the images have been altered is to look carefully for detail; watch out for ‘blobs’ (where an editor may have tried to smooth the hairline appearance) and a lack of individual discernable hairs.  Beware of doctors who hide behind poor quality images in hopes that prospective patients will not notice the lack of clarity or detail in their results images.  A top quality physician will have nothing to hide.