Last week I had a hair loss consultation with a patient that asked me the question “What is good FUE?” It was an interesting question, and in the current landscape of hair restoration surgery; a valid one. It is certainly a question that is not asked often enough.
Dr Knudsen, Dr Zhen and myself recently returned from Los Angeles where we attended the 26th ISHRS World Congress. During that time, I was impressed by the explosion in popularity of FUE as a procedure. I also had the opportunity to meet a variety of doctors from around the world that are performing Mega and Giga sessions in FUE. It is truly impressive to see the transformation of an individual before and after having 4000-5000 grafts transplanted into a frontal and mid scalp area. The fact that these grafts have grown well and have been transplanted to create a natural and dense looking hairline is a testament to the surgical prowess of the doctor. My fear is that our focus, both as doctors in the field and the general public relates too much to the recipient transplanted area and not enough to the donor site.
In all forms of hair restoration surgery, in essence we are ‘robbing Peter to pay Paul’. The hair that is removed from the back of the scalp will not grow back. This is becoming more of an issue when we perform a FUE procedure as we are effectively reducing the density of hair at the back of the head. It logically follows that the more hair you remove from the back, the less dense that area will appear and the less ideal the cosmetic outcome will be at the back. And whilst it is impressive to harvest predominantly 3 and 4 hair grafts; by doing so and leaving mainly the 1 hair grafts, you run the risk of the back of the head looking bare. Another slightly worrying trend is that as the popularity of hair transplant surgery increases a large number of younger patients are requesting and expecting high density surgical procedures.
At this point in time, we have no way of predicting the nature and extent of an individuals’ hair loss. How long will the balding process go on for? How much hair will they lose over their lifetime? When a patient presents for a consultation with hair loss, they are effectively presenting with a ‘snap shot’ of what their hair loss is at that time. To offer large surgical procedures where there is a finite donor resource in a younger individual is not only leaving a lot to chance, but also runs the risk of leaving a poor cosmetic outcome in the back of the head that most individuals are unable to see themselves. As doctors in the field of hair restoration surgery we are ethically obliged to counsel our patients with regards not only to surgical technique but also the extent of the surgery. More is not necessarily always best.
FUE is a wonderful technique and can produce fantastic cosmetic results. Good FUE is as much what goes on in the front of the scalp as it does at the back as well. It is indeed a question we should ask ourselves more often.