FUE – Questions for Your Doctor Checklist

This is a checklist that you should consider printing and bringing with you when meeting prospective FUE hair transplant surgeons. It covers many of the important questions that some people forget to ask (or simply don’t know to ask).

  • How many FUE procedures has the doctor performed? What variables does the doctor consider when choosing FUE over the strip method?
  • What has the doctor found to be his/her average transection rate? The transection rate of hairs (hairs cut apart into non-viable hair fragments) portend to poor surgical execution of FUE. Transected hairs may die, so one can expect that the yield will be less if the surgeon experiences any significant transection rate. Transection rates should be under 5% and they can be tracked by the surgeon. In a follicular unit consisting of three hairs, if only one out of three hairs comes out intact and two are transected, the surgeon may consider that a survivable graft is present, even if 66% of the hairs in the graft may not be viable. As the charge for these grafts are usually graft driven, one survivable hair out of three potentially viable hairs will have the same fee as three survivable hairs. Think about value as you ask about transection rates and if you believe what you are hearing.
  • Does your doctor prefer “chubby” grafts or skinny ones? FUE hairs are frequently stripped of the fat around them and the hair bulb and dermal papillae may be damaged. Hairs that have good fat around them and maintain the presence of the dermal papillae will produce the most robust hairs. Stripping of the critical “outer root sheath” (ORS) that surrounds the hairs within the follicular unit, particularly at the distal portion of the hair, may produce a thinner hair.
  • What does your doctor do should cysts develop? In the process of performing FUE, a limited number of grafts may get buried in the scalp (grafts that are pushed below the skin surface when removal is attempted). These buried hairs can:
    a)   trigger a foreign body reaction when they occur
    b)   form occasional cysts and abscesses
    c)   be reabsorbed by the body
  • Are the doctors published in the field? Have they contributed to the field? Ethics are always a concern when selecting a physician. Consider the doctors reputation amongst other patients and among their peers.
  • What tools and technique does the doctor use and why? Where did the doctor learn the technique?
  • What percentage of the doctor’s practice is FUE? What criteria does he/she use in selecting candidacy of a patient for FUE?
  • Is there are reasonable limit to the number of FUEs that can be done in a single session?  Does the doctor extend the donor area outside the permanent zone to achieve the targeted number of grafts?  I suspect that in many patients, a high number of FUE grafts (i.e in a Caucasian  who gets over 2000 and had a previous hair transplant surgery) or in an Asian (who generally has a significant lower density than the typical Caucasian) or in a typical African (almost all such patients), would extend into the non-permanent zone to yield this number of grafts. The permanent zone measures 3 inches high (7.5cm) so any grafts above that area will be non-permanent hair. Ask you doctor about this and get to see his patients who have had this type of surgery at those number of grafts.
  • Does the FUE cause scars in the donor area? The answer is absolutely yes, they do form scars. When the FUE donor area is shaved, these scars can be easily seen. Depending upon the instrument used, the scars can be as large as 1.5 – 2mm, which is easily seen.
  • What happens if I have over 6000 FUE grafts over a series of surgical sessions? Will my donor area be thin enough to see through it?  The answer here is yes, a high number of FUE grafts taken from a donor area, even in a person who never had a previous hair transplant, may become see-through. This is certainly true of Asians and absolutely true of Africans. Does your doctor discuss this with you?
  • Do you think that your doctor was honest with you in discussing the above issues? Do you find your doctor skilled in this art form? Is he/she believable?