Hair, like you've
never lost it.
HAIR TRANSPLANT SPECIALIST
With wider awareness about FUE surgery, it is no surprise that a lot of clients are opting to undergo FUE surgery. The ISHRS statistics quote that in 2015, clients seeking FUE surgery was around 30% compared to 5% in 2010.
Wider availability has given clients a wider choice of surgeons and clinics to pick from. Possibly as a result of poor client selection or lack of planning, this has led to a significant increase in poor surgical outcomes.
In my practice, I have seen a significant increase in clients seeking corrective or remedial surgery to fix poor outcomes of FUE surgery performed elsewhere.
One of the most common reasons for poor outcomes according to my assessment has been overzealous extraction from donor area, more specifically from the non-permanent areas.
I have observed an increasing number of clients coming to me with grafts starting to shed a couple of years after FUE surgery. My observations have yielded a common denominator of grafts that were extracted from the non-permanent zones possibly shedding along with the grafts that were traumatized during the transplantation process.
Non patterned shedding of transplanted grafts leads to a very unnatural look and along with grafts that have poor angulation and direction can lead to significant distress to clients.
These scenarios can be heartbreaking when attempts are made to extract hair from an already over exhausted donor area. Any further attempts to extract grafts from these zones will lead to extensive scarring and poor-quality grafts.
This client came to us seeking corrective surgery having undergone 2 FUE surgeries elsewhere. A closer look at the scenario suggests a few things:
There is extensive scarring of the donor area and some of the grafts have been extracted from a non-permanent zone.
The angulation of the transplanted grafts is poor and also there appears to be extensive gaps between grafts.
Judging by the number of extraction sites in the donor, the yield appears to be very poor.
Given the limited availability of donor hair, we had to take a conservative approach and set reasonable expectations to the client.
Long term implications of hair transplants
One of the key factors that need to be considered whilst counselling a client for a hair restoration surgery is to factor in the long-term implications for the client.
Whilst it is common knowledge that under the guidance of a well-trained surgeon, the outcomes of hair restoration surgery have become fairly universal, the client needs to be aware of the long-term implications, both in terms of long term medications & also need for further surgery to preserve a natural looking hair.
This was one of my primary concerns when I chose to have my FUE 10 years ago. Whilst FUT had better outcomes 10 years ago, the thought of a big scar at the back of my head for the rest of my life led to me undergoing FUE.
Whilst I was lucky in being able to get a bad surgery fixed, not many clients are in such a situation as we have come to understand that an aggressive approach to both FUT & FUE extraction can lead to shock loss in the donor area, hence limiting further availability of donor hair.
Part of the reason why I disqualify more than 80% of my clients in pursuing surgery is to make sure a client enjoys at least a good 25-30 years of a reasonable head of hair once they undergo a hair restoration surgery.
Both with FUT & FUE surgery, one needs to understand that the donor area cannot be exhausted to such an extent that the extraction scars become visible even when the donor hair is long.
Secondly, with a well performed FUE, the client might get away with a cropped haircut at the back or even styling their hair extremely short all over. This option ceases for the client when they start pursuing more surgical procedures.
Both the client & the surgeon need to understand that hair restoration surgery is unique with a law of diminishing returns with every eventual surgery. Hence the onus is on the client to seek the right surgeon to perform one good procedure rather than trying to do corrective procedures.
Main Issues That Are Generally Overlooked
Patients For A
Strip Surgery Are:
After the strip is dissected, it is generally passed on to a team of technicians who trim the strip into individual grafts. During the process of trimming there is an unknown entity that becomes into play. That is the skill and motivation of the technician. Hence it is a known fact that surgeons that have consistent teams achieve far better results than someone that relies on freelance technicians. Whilst exploring options of a strip surgery, it is advisable for a patient to meet the team and get to know the team that will be operating.
It is a well known fact that strip surgery can produce significant scarring in the donor area, when performed by untrained hands. A simple test a patient can perform is to pinch the back of the scalp to check for signs of laxity. If the client is known to have a tight scalp the chances of poor scarring with a strip surgery increase exponentially.
Historically strip surgery has been promoted as a surgery that has better outcomes because of the presence of galar fat at the bottom of the grafts. Whilst it might offer better leverage for the technicians whilst replacing the grafts, studies have shown that the growth of the grafts is not dependent on the presence of the galar fat. With improvements in extraction and placement of grafts by FUE, the outcomes are much better with a strip surgery.
During the process of extraction of follicles using strip surgery, the number of follicles per graft is significantly less compared to that extracted by FUE. This is because most of the grafts that are extracted with a strip surgery have follicles containing single and double hairs. Whereas with a FUE, the surgeon has complete control over the grafts and he can pick and choose the ones that give maximum benefit to the client. Besides, the technicians are encouraged to keep the grafts skinny by dissecting most of the tissue surrounding the grafts as this helps in quicker placement of grafts. I believe the preservation of the pilosebaceous unit is key maintain the natural appearance of follicles and this is where FUE trumps FUT.
There is a common misconception that FUE leads to pitting scarring. Though it is a fact that badly performed FUE can lead to visible ‘dot’ like marks on the back of the scalp; with improvements in FUE, the chances of visible scarring is negligible and by following certain protocols and extraction there is evidence to suggest that the scarring is almost invisible.
Whilst everyone acknowledges the fact that FUE takes a lot longer to perform and hence the grafts might stay outside the body for a longer duration than in FUT, my argument is that one can achieve good outcomes with FUE with fewer grafts than with FUT. This helps with improving the yield as it decreases the duration of the surgery and also the fatigue factor associated with technicians replacing a large number of grafts associated with FUT surgery.
Our clients have voted our FUE as one of the least painful surgical procedures they have undergone. Most of our clients are back at work in under 48 hours.
We believe in a business model that is solely based on recommendations and hence 90% of our clients come through a personal recommendation. With the personal trauma suffered from sub-optimal surgery, Dr Reddy has a personal motto of making sure that none of his patients go through the same