Automation FUE Still Not Ready For Primetime

FUE, or follicular unit extraction, is an ever-growing hair transplant method. It is not only gaining popularity, but also seems to be constantly developing in technology to improve surgical hair restoration capabilities overall. By nature, its individual follicle extraction was an improvement from other methods in invasiveness, recovery time, scarring, and hairline design. Of course, FUE has also seen somewhat of a tools race—the development of various extraction tools to get the job done as quickly, safely, and efficiently as humanly (or robotically) possible.

However, many of these new FUE machines are not yet advanced enough for the most advanced niche of FUE—body hair transplant (BHT). In recent years, follicular unit extraction paved the way for the development of BHT, a hair restoration technique that expands the donor supply to include almost all hair on the body. This advanced method still requires the use of a handheld tool.

Different FUE Machines

All FUE machines work on a punching mechanism, anywhere from .8mm to 1.2mm in diameter. Classic tools are handheld and rely on the steady, trained hands of a skilled surgeon. Handheld tools can be manual, with a rotary punch, or electrically powered. This is the only type of FUE machine currently available for use in body hair transplant. uGraft is one example of such a tool.


FUE Procedure Tools

Powered handheld FUE tool.

Other tools growing in popularity and use include ARTAS and NeoGraft. These FUE machines are both largely mechanized, with ARTAS being entirely robotic.

These systems can only be used on the scalp. At the moment, they  are not yet ready for the extremely advanced nature of body hair transplant, since they are unable to extract hair outside the traditional donor zone.

Why Handheld FUE Machines Are Ideal for Body Hair Transplant

BHT enables the use of hair from the nape of the neck, beard, shoulders, chest, stomach, arms, and legs. Surgeons using handheld FUE machines like uGraft are able to navigate these areas with minimal invasiveness and minimal scarring. In addition, with body hair follicles often being more curved in nature than scalp hair, keeping each graft in tact necessitates the eye and precision of a human hand.

Hair Restoration Through Scalp Reduction

Scalp Reduction  is a procedure that hair loss patients will often hear about in their search for the best restoration treatment.

Scalp reduction involves reducing the surface area of the bald region through surgery.  Here is an illustration of several ways this can be done.


Scalp Reduction

Diagrams of four ways that scalp reduction can be performed for hair restoration


In a scalp reduction procedure, bald sections of the scalp are removed. The part of the skin that has hair is then pulled to reduce the size of the bald area. The edges of the wound are then closed.

Is Scalp Reduction A Good Choice For Hair Restoration?

Scalp reduction is now considered to be an outdated procedure for addressing hair loss. It incurs high risk of complications and deformities.

Overall its disadvantages outweigh the potential benefits of the procedure. These include:

1)      Risk of necrosis, or tissue death due to a lack of blood and oxygen.

2)      Abnormal elevation of the periauricular hairline caused by pulling the scalp area inwards

3)      Reduced hair density in the donor region caused by stretching

4)      Possibility of the skin stretching in the opposite direction, restoring the original surface area of baldness. This of course defeats the purpose of hair restoration

5)      Formation of a slot, where a visual dichotomy is evident as regions of hair with opposite growth patterns are placed side by side. (figure 1A) This is more likely to occur in the of patients with a relatively small balding area in the crown.

6)      Expansion of the scar

7)      Hair loss, or alopecia around the scar

8)      Loss of feeling due to damaged nerves (hyposthesia)


Scalp reduction procedures are no longer considered to be viable treatment options in hair restoration. Follicular Unit Extraction is able to give results that do not include any type of linear scarring. And advanced techniques (e.g. body hair transplant) can be customized to address a wide range of hair loss challenges to give excellent results without the risk of cosmetic disfigurement.

However, scalp reduction can be performed for accident patients, burn victims and individuals with certain types of congenital birth defects.

 FUE Instead of Flap Surgery For Hair Restoration

Temporoparietal Occipital flap surgery tends to have high complication rates and results are cosmetically unacceptable.  Follicular Unit Extraction for the restoration of hair can be used as an alternative to the flap surgery. Or it can be customized to repair the outcomes of this antiquated form of hair replacement.

The newer technique of extracting follicular units (natural groupings of hair) has a wide range of applications. For example, finer hair from the nape and other parts of the body can be artistically used for detailed hairline transplant purposes. FUE can also offer severely bald individuals excellent results through body hair transplantation, as Dr. Umar has demonstrated.  The extraction of individual hair grafts leaves small round wounds in the donor area that eventually heal. There are no linear scars to hide or worry about.







Hair Restoration Through Temporoparieto-Occipital Flap Surgery


The Temporoparieto-Occipital Flap procedure was first performed in 1975, long before modern techniques in hair transplant procedures. It is considered to be an outdated form of hair restoration surgery. However it is not obsolete as it can be useful in certain cases which include: cosmetic repair of burn victims, accident victims or individuals with congenital birth defects.

How Is Tempororparietal Occipital Surgery Performed For The Restoration of Hair?

The name may sound very complicated. But the basic idea behind temporoparietal occipital surgery is to reposition a flap of scalp tissue which has hair so that it provides a level of coverage in other areas of the scalp. This includes:

  1. Hairline
  2. Front
  3. Mid top portion of the head

This diagram illustrates how this procedure is generally performed.



Hair Restoration and Temporoparieto Occipital Flap Surgery

Schematic diagram of temporoparietal occipital flap technique for hair restoration


A flap (often referred to as the Juri flap) of hair bearing skin is partially excised from the side of the head and rotated into a new position across the front where a hair line is needed.

One of the downfalls is the abrupt and harsh looking results:

Hair Restoration with Temporoparieto

Hair restoration results of a temporoparietal occipital flap surgery



Consequences and Risks of Flap Surgery for Hair Restoration

In addition to a hair line that has an obvious scar, other consequences and risks include:

1) Unnatural hairline around the ears. We normally don’t think about the border of hair around our ears, which is also referred to as the Periaucular hairline. But from the diagram above, using the flap as illustrated in process A will require stitches to close the resulting gap. And this will raise the hairline behind the ears. This will look unnatural compared to someone who hasn’t undergone the surgery.

2) Hair restoration sirgery may be followed by the additional progression of hair loss. Baldness may continue in the regions behind the flap. It may also continue in the back and sides of the head, thus revealing scars in the donor region.

3) Necessity for additional surgery procedures. A dog ear deformity can form and requires revision.

4) Persistent hyposthesia (lack of sensation) which can result from the unintentional severing of nerve fibers from the flap’s excision

5) Damage to the spinal accessory nerve  can result from the flap hair restoration surgery. In turn, this may result in the weakening of the trapezius muscle.

FUE Instead of Surgery for Hair Restoration

Temporoparietal Occipital flap surgery tends to have high complication rates and results are cosmetically unacceptable.  Follicular Unit Extraction for the restoration of hair can be used as an alternative to  flap surgery. Or it can be customized to repair the outcomes of this antiquated form of hair replacement.

The newer technique of extracting follicular units (natural groupings of hair) has a wide range of applications. For example, finer hair from the nape and other parts of the body can be artistically used for detailed hairline transplant purposes. FUE can also offer severely bald individuals excellent results through body hair transplantation, as Dr. Umar has demonstrated.  The extraction of individual hair grafts leaves small round wounds in the donor area that eventually heal. There are no linear scars to hide or worry about.





Rapunzel! Rapunzel! Let Down Your…Hair Grafts?

Hair Grafts

Image courtesy of

Rapunzel had thick, lustrous, golden locks, flowing from the window of a tower down to her beloved prince. But what if Rapunzel had experienced female hair loss, like so many women do? Lifeless hairs raining from her head, diffuse thinning across the top of her scalp—it would have made her rendezvous with the prince much less romantic. While Rapunzel was not depicted as such, nearly 30 million women in the United States—damsels, distressed, or otherwise—are struggling with this cosmetic misfortune. In fact, fifty percent of all “princesses” will suffer female hair loss by the age of forty. Sure, all of Rapunzel’s gorgeous hair was in tact at her supple young storybook age, but what about life after the “happily ever after?” For women of the real world, life goes on after the Brothers Grimm have told their tale, and even after Disney rolls the credits.

What Can Be Done About Female Hair Loss?

This is where those hair grafts come in. There are many sources of female hair loss, including pregnancy, stress, anemia, thyroid dysfunction, diabetes, and drug use, to name a few. However, those causes are mostly temporary and the hair will grow back with the right treatment.

Hair grafts are often used to correct permanent causes of female hair loss. The most common one is pattern baldness; a condition wherein the hormone DHT causes susceptible hair to permanently fall out. Other common ailments that lead to permanent baldness include traction alopecia and lupus. Had Rapunzel suffered any of these three, she could have tried a daunting daily application of Rogaine, or had permanent hair grafts implanted into the balding area.

What Are Hair Grafts?

Hair grafts are created during hair transplant, and are derived from the donor areas of the patient’s scalp (usually the back and/or sides of the head). Methods like follicular unit extraction (FUE) are an ideal permanent solution for correcting female hair loss, and leave little scarring. Today, hair grafts look completely natural and have the ability to restore a thinning scalp to the lustrous flowing locks of youth. That way, when the prince comes to your window, you don’t have to be embarrassed to let down your hair.

Dealing with Hair Loss on The Fourth of July

Fireworks on the Forth of July

Image courtesy of

The Fourth of July means cookouts, sunshine, sports on the front lawn, swimming, and fireworks. For those 40 million American men suffering with hair loss, the Fourth of July is another social event they’d rather not attend. For many of them, if they’re not worrying about who’s staring at their ever-receding hairline, they’re wondering if anyone will notice their hairpiece or the Toppik they sprinkled on in the morning. There are temporary hair loss solutions, but when it comes to the Fourth of July, or having fun in the sun on any other summer day, these options become practically futile.

Temporary Hair Loss Solutions

The following are not ideal for high temperatures, sporty activities, or windy weather. However, if you can find an indoor party on the Fourth of July, or a party where you can relax and observe the activities, they will work fine. Here’s a list of what and why:

  • What: The classic hairpiece.
  • Why: This temporary hair loss solution is rendered useless during outdoor summer fun because of its limited functionality. Hairpieces do not easily stay on, and can become displaced while playing sports, while swimming, or during windy weather. Stay away from the football and away from the pool if you have to wear a hairpiece.
  • What: The baseball cap.
  • Why: You’d think this option would be perfect—it shades your eyes from the sun and is expected sportswear. The one drawback of a baseball cap is you can’t swim in it. If you do, it might seem obvious that you’re covering something up. This option gets you out of the house and in the game, but not in the pool.
  • What: Toppik.
  • Why: This cosmetic “sprinkle-on” concealer made of magnetized keratin fibers sounds like the perfect day-to-day solution. But in summer, there are a few reasons it is not ideal. For starters, it appears unnatural and obvious in direct sunlight. Additionally, though water-resistant, it is not completely water proof. Sweating or swimming would loosen the fibers and cause them to “run” in a paint-like drip. Avoid embarrassment and stay indoors with the air conditioning.

Permanent Hair Loss Solutions

The only permanent hair loss treatment is hair transplantation. Cost of hair transplantation seems like a lot up front, but when you consider a lifetime supply of hairpieces, Toppik, Rogaine, and Propecia, it pretty much balances out. The results of surgical hair restoration these days look completely natural and is DHT immune. New hair reaches maximum maturity at one year to 18 months after the procedure. Schedule a consultation with a hair transplant specialist and by next year on the Fourth of July, you may not have to deal with hair loss anymore.

Why You Should Choose A Good Hair Surgeon Over Automated FUE Technology

Choosing the Best FUE Hair Doctor Is A Better Option To Neograft

With all the press and media attention received by Neograft, many hair loss patients are interested in undergoing this procedure.

Neograft is essentially Follicular Unit Extraction that is performed with vacuum suction technology. Adding a vacuum feature to the procedure is intended to facilitate speed. However, speed and quality outcomes do not necessarily go hand in hand.

Follicles are fragile structures. During a hair transplant repair, each follicle  must be treated with the utmost care. An important piece of information that deserves greater awareness is that air drying is the leading cause of follicular death during hair transplantation.

Therefore using a vacuum in Neograft surgeries to extract and reinsert hair follicles is likely to damage them. And this may have a negative affect on hair yield following the procedure.

However, patients of Neograft can request to have the suction turned off.

A Highly Skilled FUE Practitioner Is A Better Alternative to Neograft

The features of Neograft may seem to be very impressive. Upon closer inspection, it entails risks that may compromise quality outcomes. The best hair transplants can only be possible through a skilled and experienced surgeon who has a track record of excellent results.


Neograft Patient

Before and after pictures of a patient who underwent an FUE body hair transplant procedure. The speed of FUE technology like Neograft can’t surpass the skill level of an experienced hair doctor for quality results


Here are some guidelines to choosing the right FUE service provider

1) Get written verification that a licensed physician will be performing the surgery.

Many companies who provide FUE technology have been reported to provide younger clinics with “trainers” to perform Follicular Unit Extraction procedures as needed. These trainers are not medical doctors and nor are they licensed to administer any type of surgical procedures. In California and other states, this is illegal. If a patient has chosen a clinic to perform an FUE procedure, a written statement should be issued:

  • to verify that only a licensed medical doctor will be performing the surgery.
  • to specify the names of the physicians who will be administering the procedure.

 2) Ask for photos of actual results.

It is important to choose an FUE service provider who is capable of delivering excellent outcomes. The use of highly touted technology may seem very sophisticated and advanced to many people.

But ultimately what matters are the results of the procedure. Ethical clinics who prioritize patient satisfaction should have no issues with presenting before and after pictures of real patients whom they have worked on in the past.

While Neograft certainly aims to improve Follicular Unit Extraction, Derm Hair Clinic believes that it has much room for improvement.  Also it serves to demonstrate how important it is for individuals to learn how procedures work and ask their own questions to make the best decisions.




Hair Transplant Repair: Stuck in a Rut with FUT

FUT, or follicular unit transplant, is one of today’s most common methods of surgical hair restoration. While it is not the best in terms of quality and outcomes, nor the safest, it remains the most popular method based largely on cost. However, a prospective patient should be warned as to the consequences of compromising results to save money. Dr. Umar—an exclusive practitioner of follicular unit extraction (FUE)—has dealt with many patients who’ve had FUT, and then become stuck in a displeasing cosmetic rut in the face of long-term results. Hair transplant repair is frequently required to recover from that rut.

How Follicular Unit Transplant Works

FUT excises the donor hair in a long, horizontal strip of flesh from the mid-rear portion of the scalp. This area, known as the “safe donor zone” is slightly different for each patient, but rests in such a place that the resulting scar should theoretically be easy to conceal with a half-inch of hair. Once the strip is excised and the wound stitched or stapled closed, technicians dissect the flesh into follicular units to be implanted into the recipient area.

Why Follicular Unit Transplant Might Beget Hair Transplant Repair

There are a few main reasons FUT might cause problems for a patient in the long run. Any of the following reasons have brought patients to DermHair Clinic, seeking a second corrective surgery with the use of follicular unit extraction’s more versatile capabilities. Reasons for hair transplant repair may include:

  • The linear scar, touted by many physicians to be “paper thin” widens with time and aging. It is natural for the skin to lose density and elasticity as we get older, thus the skin stretches and scars stretch with it.
    Before and After of Hair Transplant Repair

    DermHair Clinic patient who had hair transplant repair of his linear scar.

  • The hairline is made up of harsh, dense hairs instead of the finer hairs that would naturally be found along the hairline. Because of the fact that follicular unit transplant extracts hairs from the place on the scalp where they naturally grow thickest.
  • FUT is limited by its own nature—that is, its invasive method of extraction eventually renders it inadequate. Follicular unit transplant is stuck using only mid-rear scalp donor hair, which means prior patients who are losing more and more hair with age are forced to seek a more advanced method of hair restoration—a method like FUE, that branches outside the traditional donor zone.

Treating Hair Loss: Will Bimatoprost Replace Rogaine?

There’s been a lot of talk lately about the Allergan-made drug bimatoprost. Can it be used on the scalp? Would it work long-term? What side effects might there be? Could it replace Rogaine? In the world of hair loss, a new drug on the horizon is very exciting business. And if it actually works, it’s like the holy grail of hair loss treatments. But first things first—We need to know what bimatoprost is and how it came to be.

What is Bimatoprost?

Bimatoprost is a prostaglandin analog/prodrug initially developed for the treatment of ocular hypertension and glaucoma, under the brand name Lumigan. With the use of Lumigan, people began to notice their eyelashes thicken and lengthen dramatically. Allergan followed up on that convenient side effect and got bimatoprost approved by the FDA in December of 2008 for use as a cosmetic. Under the recognizable brand name, Latisse, this prostglandin drug has been a popular product for promoting eyelash growth. And for users of Lumigan, this favorable cosmetic outcome is still listed as a side effect.

How Does Bimatoprost Grow Hair?

It has been found that certain prostaglandins promote hair growth and, more recently found, that certain others cause hair loss. Latisse thickens and lengthens the eyelashes by using two known hair-growing prostaglandins called PGE2 and PGF2. In theory, if this drug works on the eyelashes (and can even grow hair on the cheeks—listed as a side effect in the event of misapplication), it should have the same effect as a hair loss treatment for the scalp. Thus, those poor withered hairs that have been miniaturized by DHT can grow thick and strong again and restore density to a balding scalp.

Bimatoprost has been spotlighted even more so recently, with new studies involving genetic scalp tissue analysis. These studies have revealed that the prostaglandin PGD2 is found in higher amounts in the places where pattern baldness manifests and becomes prominent. Which leads us to a new conclusion—DHT isn’t the only culprit causing baldness. Perhaps a drug combating PGD2, in combination with the hair growth properties of PGE2 and PGF2 will be the hair loss cure we’ve been searching for. Or, perhaps just bimatoprost will be enough.

As of now, there is no telling. Allergan is in clinical testing to get their product FDA approved for wider application over the scalp. Most of the known side effects currently pertain to ocular usage with Lumigan or Latisse, and include:

  • Eyelid redness
  • Blurred vision
  • Darkening of the iris
  • Eye discomfort
  • Hyperpigmentation in the area of use
  • Optic nerve damage or blindness with over-use

The only one of these that might conceivably affect the scalp is hyperpigmentation. But this is merely speculation. No one will know if bimatoprost might replace Rogaine until the clinical trials are through, and the FDA hammers down its all-decisive gavel.

A Cell May Hold More Promise For Wound Healing Than Hair Cloning


A company in Maryland called ACell  has bioengineered an extracellular matrix called MeristemMeristem was designed to facilitate the body’s own regenerative abilities to restore damaged tissue through processes like neovascularization ( creating new blood vessels) and recruiting stem cells.

This dynamic carries some potential for hair cloning for the replacement of hair.  Theoretically, the extracellular matrix created by Acell enables plucked hairs to develop new follicles when they are transplanted into bald areas. Also according to this concept, transected pieces of follicles would also develop into whole and functioning follicles that grow hair.

While this has huge implications for increasing donor supply, these possibilities still require further development before they become a reality for actual hair transplant patients.

Currently the photographic results of using Acell for hair cloning have not been particularly impressive.

ACell For Wound Healing Instead of Hair Cloning

Although the ACell hair cloning and hair restoration application is still in its nascent stages, the Meristem extracellular matrix may be more useful for wound healing. When it is applied to a wound, the site is able to regenerate its own original tissue instead of creating scars.

In strip surgery, a permanent linear scar results from excising hair bearing follicles from a section of scalp tissue. Researchers are exploring the possibility of using the ACell extracellular matrix for healing the wound so that a scar does not form. This scenario has more promise compared to hair cloning. However further studies are needed to deliver reliable results on actual patients.

The wound healing process also occurs in Follicular Unit Extraction. Although the wounds are tiny, round and cosmetically insignificant, the properties of Meristem may be able to shorten the healing time.

With strip surgery and F.U.E. the reinserted follicles can also benefit from tissue restoration. Once they are transplanted they will require a period of assimilation before they start to grow hair and produce a full yield. This Acell biotechnology may be capable of facilitating wound healing in the recipient area as well. But as with hair cloning, further development is needed to help ensure real results on patients undergoing hair restoration.

Outcomes With Follicular Unit Extraction and Body Hair Transplant

The potential of using Acell extracellular matrix for hair cloning and wound healing may seem exciting. However what counts in the end are quality outcomes as opposed to mere ideas.

At the moment advances such as body hair transplant and FHHT (facial hair to head transplant) not only offer hope, but have generated excellent and lasting outcomes for hair loss patients such as these examples:

While Acell hair cloning is still in its developmental stages, reliable hair restoration results are currently being achieved by advances in facial hair to head transplant, such as this patient

While Acell hair cloning is still in its developmental stages, reliable hair restoration results are currently being achieved by advances in facial hair to head transplant, such as this patient

Before and After 1 Hair Restoration

In this patient, donor head hair had been significantly depleted. A facial hair to head transplant using beard follicles solved this issue and provided excellent coverage for both linear scars





Hair Transplant: What to do About Hairline Recession

Hairline recession is a tricky thing. It is perhaps more obvious than crown balding, obviously affects one’s countenance more than any other area of hair loss, and is the most difficult when it comes to hair restoration. So one who notices this very important feature beginning to drift backward will typically panic and ask: what can be done about hairline recession?

Figure Out Why You Have Hairline Recession

Yes, in 95% of cases, the cause of hair loss in men is pattern baldness. However, upon noticing this newfound thinning, one should not just assume the cause. The first response is always to see your doctor. There are many other causes of hair loss, and some of them are serious illnesses, like diabetes.

The Solution to Hairline Recession

In the face of hair loss, there are a few options. These include:

Those who try pharmaceuticals, like the FDA-approved Rogaine or Propecia, will be left wanting—both of those meds prove ineffective along the hairline and only work on the crown. In addition, they only work when application begins at the early onset of hair loss. In addition, they can cause unwanted side effects, including scalp acne, rash, irritation, dizziness, and blurred vision, for Rogaine and impotence, decreased libido, prostate cancer, gynecomastia, and male breast cancer for Propecia.

Hairpieces are also a disappointment, as there will be no hair along the hairline to blend into the hairpiece and make it look natural. Hairpieces are ideal for crown hair loss.

The only real solution for hairline recession is hair transplant. This is especially ideal for people whose only hair loss is along the hairline because this area usually requires less coverage, which means less grafts are needed, which means a more reasonable cost. Another advantage of hair transplant is that it is permanent, without the indefinite hassle of a daily pill or daily application.

FUE (follicular unit extraction) is the best hair transplant technique for hairline recession due to its individual harvest of follicular units. This method enables the surgeon to harvest the most ideal hairs for the hairline, like those from the nape of the neck. With an advanced FUE surgeon, this typically results in the softest and most natural-looking hairline achievable with surgical hair restoration.