Hair Transplant

Hair Transplant Technique Comparison

Hair Transplant Technique Comparison

Hair Transplant techniques have evolved drastically in the past few decades. These techniques range from FUT technique to the latest Robotic Hair Transplant (RbHT). In between these two there is plethora of hair transplant techniques. Hair Transplant surgeons or Trichologists have given various fancy names to these techniques which are a slight modification of FUT and FUE technique.

Hair transplant techniques FUT and FUE which are the most common hair transplant techniques are compared in this article. The advantages and disadvantages of FUE and FUT techniques will be discussed in details. I expect that the readers have gone through the website and know the basics of both of these techniques.

Here I will compare the two Hair Transplant techniques on 10 points which matter most to the clients:

  1. Cost of Hair Transplant: For many clients Cost of Hair Transplant Surgery is one of the most important deciding factors. FUE technique cost is almost 1.5 to 2 times that of the FUT technique. FUT is the most affordable hair transplant technique.
  2. Result of Hair Transplant: Equally important factor is the expected results of hair transplant surgery. Result of hair transplant depends on many variables which are same for both the techniques. The Most Important Factor Deciding the Result of Hair Transplant Surgery is the number of hair follicles transplanted. The more the number of hair follicles transplanted the better result of hair transplant. Without any doubt the number of hair follicles which can be harvested from the donor site is maximum in FUT technique. The number of hair follicles which can be harvested in FUT technique is almost two times the number of hair follicles which can be harvested in FUE technique. So FUT technique has advantage over FUE technique in this aspect.
  3. Long term results of Hair Transplant: In FUT technique of hair transplant, hair follicles are harvested from the area of scalp whose hair follicles are programmed to last till lifetime. Whereas in FUT technique hair follicles have to be harvested from the areas of scalp whose hair follicles are not programmed to last for the lifetime. Some of these hair follicles are programmed to last for few more years specially it Hair Transplant done in 40s. Again FUT technique of Hair Transplant gives Better Results in the long run.
  4. Scar over the donor area: among both the Hair Transplant Technique Minimum/Least Scarring is with the FUE technique. The total area of scarring in FUE technique is about 30% less than that with FUT if same numbers of follicles are to be harvested. The advantage with FUE technique is that the scar is spread over a very large area and due to this the scarring is most of the times not visible. FUE technique of hair transplant is a clear winner in this aspect.
  5. Post Hair Transplant Care: In FUE technique almost no post operative care is required for the donor site. Post-operative care of the hair transplant site is same for both the FUT & FUE technique. In FUT technique there is care required for the donor site in the form of removal of the sutures after 10-14 days of Hair Transplant. FUE technique is better than FUT in post-operative care.
  6. Post Hair Transplant Complications: Post hair transplant complication rates are same in both FUT & FUE techniques. The rates of oozing and infection and other complications are same for both the techniques. So both the techniques are same in this aspect.
  7. Duration of Hair transplant surgery: among both the Hair transplant surgery if we calculate the time duration keeping the number of hair follicles constant then FUT technique is much faster and hence takes less time than the FUE technique. FUT technique is team work and hence if the team size is increased then the time needed decreases drastically. In fact one can finish FUT hair transplant in half the time required for FUE technique. FUT technique is better than FUE technique in terms of duration of hair transplant surgery.
  8. Patient Comfort during Hair Transplant Surgery: FUT technique of Hair Transplant is more comfortable for the patient. There are multiple reasons for it: less over all duration of hair transplant surgery, less duration of time patient has to be in prone position, less local anaesthesia requirements, less number of needle pricks for graft harvesting and less number of times patients head position needs to be changed. FUT technique of hair transplant is a clear winner in patient comfort.
  9. Hair Follicle Damage during Graft Harvesting: harvesting of hair follicle from the scalp is a blind process and surgeon’s skills are very important to prevent damage to hair follicle during harvesting the graft. Now we keep surgeon’s skill constant in both techniques of hair transplant and then compare both the techniques. In FUE technique the punch passes around/near every other hair follicle where as in FUT technique the blade passes around/near every 10th Hence Hair Follicle Transection Rate or Hair Follicle Wastage in FUE technique is 10 times more than that of the FUT technique. Best hair transplant technique is FUT technique in this regard.
  10. Donor site availability for Second Hair Transplant: An important factor to be considered is that the availability of donor site if second hair transplant surgery is needed to increase hair density. The FUE technique of hair transplant utilises almost the whole of the available donor site in the first hair transplant itself. There is no visible scarring in FUE technique but the whole of the donor site gets scarred after the first hair transplant. No donor site is available over the scalp after using FUE technique for the second hair transplant. If we see the complete picture of less follicle unit graft harvest by FUE technique and non-availability of donor site for second hair transplant then FUE technique is absolutely wrong choice beyond grade III alopecia. In FUT technique of hair transplant, the initial graft harvest is twice in number than that in the FUE technique and a large area of virgin donor site is still available for the second hair transplant. Therefore FUT technique is regarded as the gold standard and Best Hair Transplant Technique.

Now based on the above mentioned parameters if we try to give score to FUE and FUT techniques then FUE will score 2.5/10 and FUT technique will score 7.5/10. For patient’s point of view FUT is the Best Hair Transplant Technique.

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Right Hair Transplant Age

What Is the Ideal time for Hair Transplant

Hair transplant is the surgical part of the process of Hair Restoration. In hair transplant patient’s hair from the occipital area of scalp are taken and transplanted over the bald areas of scalp. The whole process of hair transplant is successful when the hair transplant look natural and they grow in natural way.

Hair Transplant at Younger Age

Hair transplant is most commonly done in younger age group (20 to 35 years of age). This is the age group when a person is most conscious of his looks. Young people go for hair transplant for various reasons. Some go for hair transplant because they have lost hair very fast and there is fear of becoming totally bald. Some handsome men go for hair transplant because the bald areas over their head have ruined their personality. Some are in marriageable age and their baldness has threatened their prospects of getting good match. Some go for hair transplant as they want to get rid of their stressed/aged looks because of hair loss.

One gets the Best Hair Transplant results at a young age. The person’s metabolic rate and physical activity has kept the scalp blood circulation ripe so as to supply sufficient nutrients to the hair transplanted. The hair follicles are young and the stem cells have retained the coding for many decades to come in a person’s life. Hence the hair transplant procedure benefits them for their lifetime. The response to other medical treatment options is also very good at young age. They also have social and family support for getting their hair transplant done. Excellent hair transplant results are expected at young age.

Hair Transplant in the Middle Ages

More people have hair loss problem in the middle ages than any other age group. Ageing, stressed life and some other unavoidable factors have led to hair loss which is more over the vertex region. There is only a thin rim of hair connecting the frontal area of baldness to the vertex region. The need for getting hair transplant is there but other things in life keeps the person preoccupied. The condition remains neglected and at some point everyone starts asking why he is so stressed or is everything alright in his professional or personal front.

Hair transplant at this age has still good results. The reason for good results of hair transplant at this age is also due to the fact that only few people opt for it and they are in real need of it. Financially they are more stable and they can afford hair transplant and other treatment options which they could not have at an earlier age. The overall compliance for hair transplant and other procedures is also good. They are also more regular in follow ups and are more patient than their younger counterparts. The condition of scalp is still good and the condition of the remaining hair follicles and stem cells in them is still dependable. Though they not get the best hair transplant results but still the results in them are good.

Hair Transplant at a Later Age

At an age more than 55 years only few people suffering from alopecia opt for hair transplant. Only those who have realized that they have only one life to live and they should live it fully go for hair transplant. They have realized that the best investment is to invest in one’s own self and live a fuller and happier life. They have realized that all the money earned by them is of no use if it cannot make them live a happy and healthy life.

The results of hair transplant at this age are not so good but they are really happy to have hair transplant done. Hair transplant improves their personality and social well being. They get a good moral boost after hair transplant which transforms their personality and infuse a new life in them.


Single Most Important Factor Which Decides the Result of Hair Transplant

Hair Transplant result is influenced by multiple factors, but the most important factor is Hair Density. Hair density is the count of hairs transplanted per cm square area of the scalp. The recommended hair density to be given is between 40 -60 hair follicle per centimeter square. The more you give hair density to your patient the better will be the results.

Among the various means of giving the hair density, the most commonly used path to achieve a good hair density is by doing hair transplant 2-3 times keeping a gap of 3-6 months between each procedure. The advantages of this path for the Hair Transplant Team are: easier to perform, less time consuming, less tiring and financially more viable.

Though beneficially for the Hair Transplant Surgeon, this method has few disadvantages for the patient which are: longer downtime (the time taken to get the final desired results), loss of working days, discomfort of going through the same procedure again and again, more chances of scarring and finally cost escalation. Each time the patient is posted for hair transplant the cost of everything except the hair follicle price gets escalated. And the rest of these things can amount to 30-50% or more of your hair transplant cost.

The number of work days lost also increases and in today’s hectic life it is very difficult to take out one day from our busy calendar, how to manage 2-3 days of holidays. The downtime for one time hair transplant varies from 9-12 months and for multiple sitting it easily reaches up to 24 months. Most of us don’t have time of two years to wait for hair transplant benefits. Specially for the young men who are planning to get married.

Every time we take out hair follicles from the donor area we are causing injury to the skin. We Plastic Surgeon know that repeated trauma to an area increases the chances of scar complications like; scarring, wider scar, hyper-pigmented patches or hypo-pigmented area, hypertrophic scar and keloid formation. The dictum we follow is not to subject the tissue to repeated trauma and in case one has no other option then let the tissue recovery fully from the earlier insult.

We at Hair Restorz follow the more difficult route to achieve the desired hair density to give maximum benefit to our patients. We give maximum hair density to our patients in the single sitting. The hair density which we give in a single procedure is the maximum which can be achieved even by 2-3 sittings of hair transplant by most other centers. This makes the hair transplant procedure most affordable and convenient for the patients. This also reduces the downtime to get the final results.

How do we do this? We are able to do this because Our Priority is To Give Maximum Benefit To The Patient. We at Hair Restorz are a dedicated team of experts who work hard for our patients. Our Philosophy is Patient First. We have long time experience and have improvised the existing techniques to give best results to our patients. Our speed, quality of work and results are unmatched in the Hair Transplant industry.


Hair Transplant Story of A Wife

This is about a middle aged couple. The husband who was otherwise successful in his career was still short of something. Something about what his wife was too much bothered. It was his hairloss or bald looks. Since past one year she has noticed that her husband was losing his hair very fast. His hairloss had made his head come out of his once so swanky hairs.

She had searched a lot on google about hair transplant. She had found out how effective and life changing a hair transplant procedure is. She learnt about Strip (FUT) technique of hair transplantation and FUE technique of hair transplantation over the internet. Though her husband had sufficient hair over the back of his head but she also read about Body Hair Transplant (BHT) technique. She was fascinated about the robotic hair transplant also. She had also viewed the videos of hair transplant on the YouTube. Though money was not an issue but she felt that robotic hair transplant is not worth the pain and the results might not be so good.

She had also searched the google for various non-surgical or medical treatment for hair loss. Among them she was really fascinated by seeing the results of platelet rich plasma (PRP) treatment for hair loss. She did her graduation in biology and hence it took little time to understand the science behind Platelet Rich Plasma therapy. She felt that Platelet Rich Plasma treatment for hair loss is the best treatment modality among all the medical treatment options for hair loss. She felt that there is no side effect or adverse reactions of platelet rich plasma treatment for hair loss. She was not much impressed by some of the other fancy name medical treatment options for hair loss.

Finally after doing a lot of research she decided that her husband must undergo hair transplant. Now came the most difficult task: how to convince her husband for hair transplant. One day she found an opportune time and discussed with her husband about how his hairloss is bothering her since several months. She also told him that she had studied a lot about the treatment options for hairloss. She told him that his hairloss keeps her bothering day in and day out. She suggested him that he should think about getting hair transplant done. Her husband took a deep breath. He was not aware that his hairloss problem is bothering his wife also since such a long time. Though he was also feeling slightly low due to his hairloss problem but this thought never came into his mind that this is also affecting his family life. He asked his wife to give him some time to think over it and to make up his mind for hair transplantation.

For the past many months he was also worried about his hairloss problem and had done lot of searches for it. He had also gone to few hair transplant centers in Delhi to discuss about the hair loss problem. After few days he got back to his wife and told her that now he has made up his mind for hair transplantation. He had never seen such a good smile on her face since a long time. He also smiled back but from inside he felt guilty with the thought that he had deprived his wife of happiness since many months. She went close and hugged him tight.

Next day they went to a hair transplant specialist and booked an appointment for hair transplant procedure. Her husband has undergone hair transplant procedure few days back and now she is on the top of the world. She told me that thanks to the Hair Transplant procedure she has got her hubby back.

Complications of Hair Transplant Surgery

As with any medical and surgical procedure hair transplantation also has few complications so as to say. As compared to most other surgical procedures, hair transplantation is considered the safest of all. Hair transplantation is an elective (non-emergency) procedure and hence it is or rather it should be done after full optimisation of patient and the operation site (scalp).

Never the less it has few complications worth mentioning. The complications, their causes and how to avoid these complications are listed below:

  • Bleeding: it can be divided into two categories: intra-operative (during the surgery/procedure) and post operative (after the surgery/procedure).

Intra-operative bleeding can occur due to faulty operator techniques: wrong choice & concentration of infiltrate, inadequate knowledge and experience leading to deeper plane dissection and cutting of major vessels which supply the scalp and inability to control the bleeding specially by a person belonging to non-surgical background (eg homeopaths, allied medical sciences, dermatologists, ENT specialists & other MBBS doctors). Do ask for qualification of the doctor or hair transplant person before you fix an appointment to avoid wasting your time and energy, least to mention about your money. Even if you happen to get hair transplant done by them then please do ensure that they have support of a surgeon (preferably a well qualified Plastic Surgeon) or get it done in a multispeciality hospital rather than their clinics.

Few patient factors can also lead to excessive bleeding during hair transplantation like familial or constitutional bleeding disorders, platelet deficiency disorders, clotting factor deficiency and capillary fragility disorders. Tell your hair transplant doctor for any past history of prolonged or excessive bleeding from small injuries. And if such history is present then get yourself properly investigated which should at least include complete coagulation profile.

Few drugs specially ayurvedic, Homeopathic or Unani medications, aspirin or other allopathic medications which alter or hamper the coagulation pathway can also lead to increased bleeding during the procedure. Consult your doctor beforehand and stop these medications on his/her advise. The hair restoration procedure can be safely postponed for a specified period (varies from drug to drug) of time as this is not an emergency procedure.

Excessive stress and anxiety also increase the chances of bleeding during the procedure. This can be avoided by taking adequate rest and good night sleep, the day before undergoing this procedure.

Post procedure bleeding can occur from the donor area as well as the grafted area of scalp. Bleeding from the donor area can occur due to inadequate hemostasis during the procedure and reasons being same as mentioned above. Poor surgical technique can result in faulty suturing of the donor areas leading to opening of the donor site at places and continuous oozing of blood from these areas.

Bleeding from the recipient area (area of scalp where follicles have been grafted) can be specially perilous as it can lead to immediate loss of hair follicles (hair follicles come out of the sites where they were implanted) and poor outcome of the hair transplant surgery in the long run. Faulty surgical placement of hair follicles increases the risk of expulsion of hair follicles from their site.

  • Infection: it is one of the most important factors for poor surgical outcome of the hair restoration procedure. Hair shafts will be visible above the skin but the underlying hair follicle cells will get eaten away the bacteria leading to death of hair follicles. Once the hairs fell, new hair will not germinate in their place and the area will become bald again after few months leading to total wastage of time, effort and money. In few cases infection can spread to the whole of the scalp leading to severe folliculitis and abscess formation resulting in severe scarring and loss of hair at the donor area also. Non compliance of the standard surgical aseptic protocol at the centre and by the hair transplant team is the most common cause of such disaster.
  • Anaesthesia problems: this is rare as hair transplant is done under local anaesthesia in which lignocaine is used in various strengths. In few patients there can be drug reaction due to lignocaine. Some other common side effects of lignocaine are light headedness, nausea and vomiting. Though rare but well documented serious adverse affects of lignocaine include seizures and cardiovascular collapse. Proper qualified and well experienced team of surgeons with a well equipped centre is needed to handle such rare unfortunate event.
  • Scar formation: this is the complication which is more unique to the hair transplantation procedure. The donor site scar can be wide if proper surgical techniques and guidelines are not followed as taught during surgical postings. Most common cause of scar formation is poor surgical techniques including single layer closure, poor choice of suture material, poor choice of suturing technique (specially when continuous suturing technique is used by the surgeon/doctor to save his/her time without giving due consideration to the poor final outcome of such shortcuts) and too tight or too lax approximation of the two edges. Sometimes the donor site scar can get transformed into hypertrophic scar due to excessive tension, infection and improper approximation of the two edges. This is more common in persons with hypertrophic scar formation tendencies. Do tell your doctor if there is any history of hypertrophic scarring or poor wound healing in the past. This can also occur due to excessively tight suture placement or from the use of cautery or LASER during the making of donor site incision. There can also be “ridging”, “cobblestoning”, and hypopigmentation over the donor area(s). People with keloidal tendencies can get keloid formation over the donor and recipient areas. Keloid can be understood as an overgrown and enlarging scar. This is more common in people with African origin. In other races it is more common over the presternal area due to continuous move of chest during respiration and over the ear lobule for unknown reasons. There is plethora of treatment modalities to treat this condition starting from intralesional steroids to LASER treatment, but the crux of matter is that people with family history of keloidal tendencies or who have developed keloid in any part of their body should refrain from undergoing hair transplantation procedure.
  • Loss of sensation over scalp: normally there is reduced sensation over the recipient site for few hours following the hair transplantation procedure. But if this persists for more than few hours then it suggests injury of the sensory nerves of the scalp during making slits for hair follicle insertion. Again the only cause for this is faulty technique by the hair transplant surgeon. Lack of knowledge of the anatomy of the scalp and poor understanding of the proper depth of the hair follicle graft placement are the main reasons behind it. If it occurs then one has to wait for few months to a year and half for the adequate sensations to return.
  • Faulty hair line: this is purely due to judgemental error because of lack of understanding and experience on part of the transplant doctor leading to irregular and poorly constructed frontal hairline. Improper planning and execution of the plan leads to such faulty results. Though small errors can be hidden well when the hairs grow in length, major faults are difficult to cope with.
  • Poor hair growth: poor or no growth of considerable number of hair follicles can occur if the transplant procedure is not done properly. Traumatic extraction of hair follicles, dessication of hair follicles during follicle separation, faulty preparation of the grafts, rough handling of the grafts during graft insertion and follicle insertion at wrong depths can all result in limited hair growth. Lack of proper post operative care is also an important factor leading to lack of adequate hair growth. Telogen effluvium is loss of original hairs in the transplanted areas, which usually results from poor circulation or inadvertent trauma to already existing hair follicles.
  • Transplanted look: the head of the person after hair transplantation must not look as if he has undergone hair transplant after 1 year of the procedure. The growth of hair and the pattern of transplanted hair should be uniform and blend well with the rest of the hairs of the scalp. If the technique is faulty then Errors of technique and of poor planning are preventable but occur all too often. The most common of these technical errors, which results in a transplanted appearance, is the use of excessively large grafts and unaesthetic hairline design. The importance of using 1- and 2-hair grafts, placed in the proper direction to create an irregular hairline of gradually increasing density as the surgeon proceeds centrally, cannot be overstated.

What You Can Expect From Hair Transplant Surgery?

Patients must be given realistic expectations. Furthermore, the importance of joint planning by the patient and the surgeon for future hair loss cannot be underestimated.

The transplanted hair follicles typically appear to grow in the immediate postoperative period. Within a month, the graft follicles (from few to almost 90%) enter the telogenic phase and are shed. Hair regrowth then takes approximately 4 months, but the hair continues to improve in quality and quantity over the next 2-4 months. And at about one year the growth stabilizes and most patients have graft survival rates of over 95% in experienced hands. There are also reports of hair multiplication after transplantation meaning if one has undergone hair transplantation of about 5000 follicles then by the end of one year one

The present techniques and technology of hair transplantation surgery can give a proper candidate realistic and natural appearing transplanted hair. Using 2 or 3 hair transplant sessions, the candidate has a successful outcome.

Advances in Hair Transplant Surgery

Hair transplantation has long history and after decades of hard work by thousands of hair transplant surgeons we have reached at a stage where we can say that “hair problem is not anymore a problem”.

What we have learned

  • Superiority of hair grafting versus bald-scalp reduction and scalp-flap surgery in almost all situations.
  • Acceptance of large-session hair transplantation, also termed the mega session, in which 2500 or more grafts can be transplanted safely in a single procedure.
  • Superiority of follicular-unit micrografting over traditional micrografting and minigrafting.
  • Although technically more demanding and time-consuming than other procedures, it yields superior results in terms of creating a natural appearance.
  • It enables increasing hair density.
  • Follicular unit grafting reduces accidental transection of hair follicles during the graft-dissection process because dissection is performed under microscope visualization leading to minimal wastage of valuable donor hairs.
  • Improved control of hair loss coupled with minimization of adverse effects from the use of 5-alpha reductase inhibitors.
  • Gene therapy may have future application in hair loss treatment. The genes that cause alopecia can be located and potentially replaced with genetic sequences not associated with hair loss.
  • Hair cloning (technically cell multiplication) may offer the surgeon a virtually unlimited supply of donor hairs. Reducing the requirement of donor areas. Follicle stem cells are multiplied and then injected into areas of thinning to initiate the regrowth of hairs.
  • Mechanization of the hair-transplantation process is perhaps the only way to improve the process of follicular-unit transplantation. Instruments capable of rapidly and accurately dissecting the grafts and atraumatically placing the grafts will speed the process and reduce reliance upon assistants.
  • Hair transplantation will remain an aesthetic procedure that requires a skilled surgeon to create natural-appearing results.

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