As Seen on


All FUE related posts


I had the the Artas® procedure performed on me, but unfortunately. I ended up with tinnitus (ringing in the ear) in my left ear. I would appreciate telling you the the potential hazards of the Artas® procedure to warn unsuspecting “hair transplant” people.

Block Quote

Yours is actually the second email I’ve received from someone asking about tinnitus following a procedure done with the ARTAS. I did probe another doctor who has the ARTAS, however, he did not report this side effect on his patients. I do not have this system in my office, so I don’t have personal patients I can reference.

For those of you who do not know what the ARTAS sytem is, it is a robotic hair transplant system used for extracting grafts. You can learn more about it here and here.

Tags: tinnitus, hair transplant, artas®, robot


Dr. Russell Knudsen (from Australia) wrote in informative article in this months “Hair Transplant Forum International”. Clearly, the ability to harvest the donor area with FUE will be more restrictive in individuals who have more extensive balding patterns (Class 5, 6 and 7 patterns of balding). The donor area around the sides and back of the head reflect 25% of the original total hair count on the head (I call it my 25% rule). If one targets somewhere between half or 2/3rds of the follicular units found in the donor area, as the maximum safe yield for FUE over time, then for Caucasians with average hair density (100,000 hairs on their head or 50,000 follicular units in the permanent zone) might be able to safely harvest as much as between 6,250 (half) or 8,250 (2/3rds) from the 12,500 follicular units in the permanent zone (25% rule).

In those individuals with higher densities than 100,000 hairs on their head, the harvestable follicular unit numbers may safely go higher, while in the typical Asian, for example with lower hair densities (80,000 hairs on their head or 40,000 follicular units), the donor area would contain only 10,000 follicular units. With half of the Asian’s 10,000 follicular units harvested, that leaves 5,000 follicular units behind (this reflects a calculation of 25% of the birth hair follicular unit numbers which are permanent). I believe that extracting between one out of every two follicular units from the permanent zone may be pushing the limit on people with low density hair.

There may be reasonable limits for a typical Asian based upon hair density (we calculate hair density on every patient undergoing hair transplant surgery). To complicate matters, Asian follicular unit hair counts average less than two hairs per follicular unit, so to get out an average of two hair FUE grafts, it takes more follicular units to yield an average of two hair FUE grafts. Asians (or Caucasians with low hair density) who have a high number of FUEs will, in my opinion, be thin looking around the back and sides of the head. I have seen some Asians with significant track marks from the punch scars created by FUE, particularly when the harvesting numbers are high and the remaining donor hair is significantly lessened.

Many doctors are taking hair from the non-permanent area to give the patient the benefits of more hair in the transplant; however, this may spell disaster for the patient who develops more extensive balding (suggested by Dr. Knudsen). Hair taken from the non-permanent area will be lost with aging and/or advancement of the balding patterns. Over zealous FUE beyond the permanent zone, has long term consequences for some patients and they must be warned. I have seen some patients who’s balding had accelerated from multiple FUE procedures and have loss hair in areas where FUE grafts were taken while leaving visible scars.

I want to raise blood supply issues here as I have seen one patient already who had received 6700 FUE grafts in two sessions and lost more hair in the permanent zone than was removed by the surgeon during the FUE. I actually counted the grafts and the hairs on the head and had done density studies on him before another surgeon did surgery on him. When FUE numbers are pushed, this patient’s findings suggested vascular compromise may have occurred impacting the remaining hair in the donor area. I have heard, second hand, that at the last ISHRS meeting some cases of necrosis have appeared in the donor area when too many FUEs were done, possibly too close together. I don’t believe we really understanding the complications of large FUE sessions, or that doctors are not reporting their complications out of fear of professional ridicule and/or malpractice risks, all of which may become a factor in the long term future of this surgery. As we do many FUE cases in our practice, we are not anti-FUE; however, aggressive FUE megasessions in the wrong hands could be a problem.

In conclusion, “do FUE surgeries change donor area planning”, the answer is YES. FUE will impact long term planning and may impact strip surgery in future surgeries. Low density donor areas, resulting from FUE, make for less donor hair for a strip surgery, which will only make any scarring more visible as the hair is cut short.


Regarding the articles you posted recently about FUE versus strip procedures, I was wondering why FUE 2 isn’t the gold standard for transplant surgery. If the graft yield is just as good as strip from FUE 2, doesn’t that mean It has all the advantages of FUE and none of the drawbacks?

Block Quote

There is a series of reasons as to why FUE2 isn’t the gold standard, and I’ll list and expand upon that to address why the traditional FUE also isn’t the gold standard:

1- FUE2 is not available at this time for commercial use. We have not proven that the FUE2 can be as effective in 100 consecutive patients with comparable results, as we have shown in the two examples we demonstrated here. When we get it manufactured, it will have to compete with all of the other FUE drills out there, including the ARTAS robot. There will be a general reluctance for those doctors who feel comfortable with what they are presently doing, to switch to the FUE2.

2- I’ve discussed in great detail the limitations of traditional FUE in the hands of many surgeons (see part 1, part 2). Doctors may want to believe that FUE is better than strip surgery, something that I presently doubt with traditional FUE mechanical solutions. The strip harvesting produces the best quality grafts in most surgeons’ hands. I am certain there are many doctors who claim FUE expertise, that are not being honest with their patients. I know this because I often see the failures of FUE from known surgeons who claim expertise in this technique.

3- It is not generally agreed by many knowledgeable surgeons that the donor area can supply as many total grafts as strip surgery. In strip surgery, the surgeon always takes out the strip in the “sweet area”, which means its best concentration of quality grafts. This area can be harvested over and over again with only the risk of scarring. FUE, on the other hand, may produce irreparable damage to the donor area as the number of harvested grafts increase. In recent presentations given at physician meetings, there are suggestions that the donor area does get damaged as more and more grafts are excised with FUE.

Tags: fue, fue2, hair transplant, follicular unit extraction, hairloss, hair loss


Have you used this Ugraft tool before ? Is this a next generation FUE tool?

Video link: UGraft FUE tool

Block Quote

I have not used this tool.

Follicular unit extraction (FUE) is a difficult technique for many surgeons. There are many inventions and tools constantly being developed all over the world, but a new tool does not necessarily mean it is the next generation. From what I’ve seen in the video, it appears that it was developed due to difficulties Dr. Umar faced when performing body hair transplants (BHT).

Tags: ugraft, body hair transplant, bht, fue, hair transplant



12 days post FUE, I wet my hair, put conditioner on for 15 minutes, and then rinsed and shampooed my hair to start dislodging crusts. Though the scabs on my scalp were black, it looks like lighter color grafts/scabs are coming out.

Am I dislodging grafts which may have become swollen with water, or is it the scab which becomes lighter in color after wetting?

Block Quote

Yes, the scabs will turn white if they become waterlogged… but at 12 days after surgery, you should not have scabs. That tells me that you were not instructed in the proper post-operative washing routine. I would ask your surgeon for some aftercare information.

My patients are usually without scabs the next day.

Tags: fue, follicular unit extraction, scabs, hair transplant, aftercare


A couple weeks ago, we wrote a post titled: FUE vs Strip — A Technical Analysis. In it, we discussed how the anatomy of SOME follicular units in SOME patients get disrupted, stripping off the fat from the lower part of the hair follicles.

We had two patients this week that provided some good examples we can delve into —

1. Patient #1 had a strip surgery, and we harvested two 2-hair grafts and two 3-hair grafts for this example. Note that all of the anatomy is present (sebaceous gland, fat to the bottom of the hair follicles) as shown in the photo below (click to enlarge):


2. Patient #2 had FUE performed, and if you look carefully, the bottom of the grafts have some missing tissue on them. This resulted when these grafts were pulled from the scalp after the FUE was cored. Parts of the end of the graft (surrounding the bulb) are devoid of the capsule and fatty covering that can be seen in the strip grafts. The photo below shows 7 follicular units extracted by FUE in a FOX negative patient (click to enlarge):


From the left, grafts #1-3 had loss of fat with intact follicular sheath (glistening membrane surrounding the hair follicles). These grafts should grow well; however, no studies on such grafts have ever been done.

Grafts #4 and #6 showed that some hairs were pulled apart within the follicular unit, probably when it came out of the scalp (a common occurrence in FOX negative patients). The missing parts of the lower half of these follicles were probably not transected with the punch instrument and will not produce hair; however the remaining follicles should grow. Again though, no studies on such grafts have ever been done.

Grafts #5 and #7 show intact follicular sheaths; however there is some mechanical “fracture” at the end of the intact hair shafts. We do not know if this will impact graft growth, but these changes are not uncommon in the FOX negative patients. These grafts should grow well, but… well, no studies on such grafts have ever been done.




This comes from prominent New York hair transplant surgeon, Dr. Michael Beehner:

With FUE, it is easy to fracture the neck of the base of the follicle when the bulb is “naked” and then grasped for placement, while in microscopic dissection with a strip harvest, there is good fat around the base of the follicle and fracture of the hair follicle almost never occurs during placement. When all of the people placing the grafts have to grasp the naked follicle, I think this causes a kink on the end of the exposed follicle and may be accompanied by poor growth.

Quite frankly, I wish that, instead of our always talking to the patient about the choice between FUE and “strip” harvesting, I would rather talk about FUE vs. “microscopic dissection of grafts”, because this is where the biggest difference is between the two procedures. Also, the FUE often strips the end of the graft as it is being pulled out, leaving less tissue and fat on the end. With strip harvest and microscopic dissection, the doctor’s staff have total control on how that graft will be produced and we never see stripped grafts. Also, the fact that in a strip surgery, we are always taking the strip from the absolute richest center of the scalp where the best hairs are, this makes the choice difference for me a “no-brainer”.

I have no trouble convincing 95% of my patients who walk in seeking FUE to go with strip when I present the FUE problems to them this way. I explain all of these things and reassure them that many patients have almost undetectable strip scars.

Block Quote

We wrote about Follicular Unit Extraction (FUE) vs Strip (FUT) nearly two years ago: FUE vs FUT — Which is Better?

When you look at a follicular unit, you will see all of the anatomical parts that are traditionally created from a strip harvesting technique. All of the critical anatomy is preserved as the grafts are dissected under a microscope from the strip harvest. Damage, providing that the grafts remain hydrated, is rare and growth is excellent.

When FUE’s are done, the follicular units are not-infrequently disrupted in some manner, and these grafts may not grow as well as a result of the disruption. This is shown in some grafts that we put aside for trimming when a patient had the type of collagen that resisted the extraction in the FUE process. This is viewed here. Once these second class grafts are trimmed, they must be grasped with a forceps at the bulb or just above the bulb, which can fracture the hair shaft (this is what Dr. Beehner was talking about above).

With good instrumentation and considerable experience, FUE can be done as successful as with a strip; however 100% of patients do not have a tissue anatomy that allows such a clean FUE. This was discussed in our pioneering article that introduced FUE to the medical profession.

Tags: follicular unit extraction, strip procedure, fue, hair transplant, grafts


Hi Doc,
I have been following your blog closely & am really grateful to you for all your help. I had a FUE surgery done 2 years ago but now I wish I hadn’t. Basically I have a big bald spot & after reading the articles should have had strip. Now my problem is I dont like to have my hair long as its thin & doesn’t look good. Wearing them short as I do now exposes the donor & the recipient areas..By short I mean buzz. I dont shave my head.

What do you suggest i should do? Please help as I am losing my self confidence & getting depressed.

Block Quote

When there are large follicular unit extraction (FUE) sessions done on a patient with low density hair, it will show thinning in the donor area and a leave the patient with a more see-through back of the head. We have treated many FUE patients with Scalp MicroPigmentation (SMP) in the donor area to add some contrast to the skin. It also works wonders on the recipient area, making the hair look fuller in both locations.

Take a look at the site SMP site and see the many patients who have been treated with this modality. Particularly, look at this patient below, which shows a before and after treatment for FUE scars. This patient and many more can be found in our SMP gallery.

SMP before/after for FUE scars

Tags: fue, follicular unit extraction, smp, scalp micropigmentation, scarring



i am thinking of having the fue procedure in the uk and would like to know which is the best surgeon to see. Trying to avoid surgeons that have a high rate of fue failure due lack of skill.

many thanks in advance for your help.

Block Quote

You’ll have to do your own research to be sure you’re getting exactly what you want and to be assured that you found a doctor you can trust, but Dr Bessam Farjo is a good place to start (offices in London and Manchester). You can also use our handy guide to selecting a hair transplant surgeon — here.

Tags: hair transplant, fue, follicular unit extraction


A report published by the Journal of Plastic, Reconstructive & Aesthetic Surgery a couple years back has recently come to my attention. Here’s part of the abstract:

Follicular unit extraction (FUE) has been developed as one type of follicular unit transplantation surgery, a widely accepted hair-restoration technique. FUE has many advantages, including a small donor area scar, less pain and a slender graft without extra surrounding tissue. Complications are uncommon in the literature. We describe a case of donor-site necrosis after hair restoration with FUE, leading to cicatricial alopecia in the left half of the occipital region.

Block Quote

Read the rest of the abstract — Necrosis of the donor site after hair restoration with follicular unit extraction (FUE): a case report.

I have seen the impact of large sessions of grafts using FUE on patients who came to our office over the past 10 years. Most of these necrotic areas were small, so they were easily addressed by good, traditional surgical care. I expect that we will see more of these severe complications as more and more doctors start pushing the number of grafts performed in a single FUE session, just as we saw when doctors who did not know enough about FUT caused similar degrees of necrosis. I believe that those doing FUE procedures and their patients need to be aware of this risk. This complication, however, was a disastrous problem for the patient referenced in the above report, as he lost part of his scalp.

The full article states, “One hundred fifty cubic centilitres (cc) of 1/100 000 adrenaline solution was injected gradually into a 10 by 12 cm area in the left occipital region during surgery over 4 hours. Nine hundred fifty follicles were removed using 0.8-mm punches connected to the end of an electrical driver drill“. So less than 1000 grafts were transplanted with a small punch and yet the complication occurred. This punch size should have minimized the risk. The article does not discuss the density of the punch holes in the donor area. On the surface, nothing was really done wrong.



Page 2 of 3712345Last »

Valid CSS!

HTML 5 Validated