Dr. Umar’s Use Of Nape Hair

Dr. Umar is a world-leading follicular unit extraction surgeon. He is a recommended surgeon on the widely respected online patient community the Hair Transplant Network, where a member recently raised this very topic. The question was even specifically targeted toward Dr. Umar, as his impressive FUE and use of nape hair is creating a buzz.

It’s no wonder people are inquiring about non-traditional donor sources—who would want to have a hair restoration transplanting nape hair to later find out that the long-term graft survival rate is low? Patients want hair that looks great, and that will last permanently. Dr. Umar’s reply to the online community is reassuring—through his years of practice and experience, he confirms that nape hair is not always DHT susceptible, regardless of its location outside the SDA. In fact, it is more resistant to DHT than hair in the balding areas and is ideal with regard to the artistry of hair restoration. He has transplanted nape hair with lasting success to refine hairlines, and has even used other non-traditional donor sources (such as facial or chest hair, with body hair transplant) for those whose baldness is beyond the correction capabilities of strip harvesting.

Regardless of what a hair transplant surgeon recommends, it is up to the patient to decide if he trusts a non-traditional donor source like nape hair. It is true that the use of non-SDA hair hasn’t been around as long, but Dr. Umar’s results are showing long-term promise.

FUE hairline refinement using nape hair.

• A minimally invasive surgery
• Donor hair is not confined to the mid-back portion of the head
• No staples, stitches, or sutures of any kind
• No more linear scarring (as with strip harvesting)
• A quicker healing time than other methods

FUE Branches Out

With the advent of follicular unit extraction, another major advantage followed suit: the vast potential for development and further use. There are several ways in which follicular unit extraction has been refined or expanded to reach a broader scope of hair loss sufferers. Today, FUE is a multi-faceted technique branching out into:

• Eyebrow transplantation: the use of specifically selected donor hairs to restore thin or bald eyebrows. People may lose eyebrow hair for congenital reasons, an accident, or over-plucking. Ideal donor hair comes from the legs.
• Hairline Design or Hairline Refinement: the use of nape hair or other fine hair to build a softer more gradual hairline. Often done as a corrective procedure after another surgery.
• Body hair to head transplant: an advanced form of FUE that incorporates the use of body hair for donor sources. This can include the beard, shoulders, chest, stomach, arms, and legs.
• Facial hair to head transplant: an advanced form of FUE that incorporates the use of only or mostly beard hair as the donor source.

Leg healed after BHT surgery with cosmetically negligible scarring.

In the early 1900s hair loss became a prominent enough problem for someone to develop a technology to combat the condition. The dawn of hair restoration developed in Japan during this time, and has continued to evolve ever since. We have seen scalp reduction, flap surgery, and in the 1950s we saw the first of hair transplantation with punch grafting. Hair transplantation itself has come a long way; from the punch graft, to strip surgery, and now, to follicular unit extraction (FUE).

The follicular unit extraction technique first came about in the 1980s, also in Japan. It was an improvement of the punch grafting method, which used 4mm punch grafts for hair transplant. The result with punch graft hair transplantation was always unnatural and pluggy hair, with 4mm round bald scars in the donor area (generally the back of the head). To vastly improve results, they refined the size of the grafting area, making it much smaller and more precise. But what is follicular unit extraction, really?

How Follicular Unit Extraction Is Done

Follicular unit extraction is the removal of hairs from the donor area, generally being the back and/or sides of the head, in follicular units—natural groups of one to four hairs. These follicular units are then implanted into the recipient area, which is usually the crown, hairline and temple points.

Follicular unit extraction requires a highly skilled practitioner, as surgery is long, laborious, and detailed. FUE hair transplant surgeons generally use a manual handheld device resembling a pen to excise the follicular units one by one. Of late, there have been campaigns for powered follicular unit extraction machines, such as the NeoGraft and Artas. These machines are flawed for several reasons and use of them for FUE hair transplantation is strongly opposed by advanced FUE hair transplant surgeons.

The Advantages of Follicular Unit Extraction Over Strip Surgery

On the matter of hair transplantation, the superior between FUE and strip surgery is a popular debate. There are many reasons one researching hair transplantation will find that follicular unit extraction is the better choice. Some of those reasons include:

• Follicular unit extraction avoids leaving an embarrassing linear scar.
• The tiny, individual incisions made during follicular unit extraction result in cosmetically insignificant scarring.
• Follicular unit extraction is a less invasive hair transplant procedure, thus the recovery time is quicker.
• Follicular unit extraction makes it possible to extract specifically chosen hairs, such as those from the nape of the neck or behind the ears, to design a most natural-looking hairline.
• Follicular unit extraction widens the pool of donor hair by enabling body hair transplantation (BHT).
• Those who were once considered poor hair transplant candidates due to a depleted donor pool are now in the running due to BHT.

FUE is defined as a hair transplant technique in which a small round punch is used to extract follicular units (meaning groupings of 1, 2, 3, and 4 hairs) from a patient’s bald resistant areas. These grafts are then transplanted into a patient’s balding areas. In the state of California for example, the punch cutting of each hair graft by the FUE technique is considered surgery and must only be performed by a licensed doctor. The success of the procedure lies in respecting the integrity of each and every graft from the point of extraction to the point of implantation.  Any rough handling of the grafts or air drying of the graft would compromise the integrity of the graft and the success of the procedure.

Neograft is a device currently being marketed as an FUE tool. The premise on which such machines work is based on speeding up the delicate process of FUE. The principle is based on a 3 step process:

1. A electromechanically rotated punch cuts around the follicle to separate it from surrounding attachments
2. Next, a suction mechanism sucks out the separated graft to a receptacle were it is stored.
3. Next, using a pneumatic (air) system the graft is pushed into premade slits in the balding area.

In the opinion of Dr Sanusi Umar who is a pioneer and world renowned leader in the field of FUE hair transplantation; these principles upon which the neograft and similar machines are based upon could constitute a problem to the integrity of the graft hence the success of the procedure. He states that points of concern for him include:

1. The use of air suction to transport the grafts from the cutting end to the receptacle poses a potential threat to the survival of the graft. He states that the most common cause of graft death is air drying. For that reason, the use of a method that literally air dries the graft even for a few seconds is potentially deleterious to the graft “we are suppose to baby in the FUE method”.
2. The air suction method would potentially strip the graft of some of the tissue surrounding it. This tissue serves as a protective buffer from inclement elements like air, dryness and trauma. Removing this buffer is potentially deleterious to the survival of the graft
3. As the graft is forced by suction forces through a tube that leads to the receptacle, it will be exposed to further trauma
4. Any process that is based on air used in pushing grafts into the balding area again introduces the potential for deleterious drying forces and may harm the survival of the FUE process

The net result is a graft that has been through the ringer. It has been subjected to deleterious drying forces, stripped of some of its protective tissue coating and banged and knocked about tube walls. Time would tell if the survival of grafts that are extracted using devices like the neograft would compare favorably to FUE grafts that were treated more delicately.

Dr Umar’s views regarding the neograft have been voiced by Dr William Rassman and Dr Robert Bernstein who were the first to coin the term Follicular Unit Extraction – FUE.

Dr Umar advices that all patients seeking FUE must ask the clinic or Dr to provide ample pictorial and / or video evidence of patient results that they have done using the FUE device in their arsenal. Very that  you are not shown at HT results performed by the strip method that is being passed off as FUE.

Dr Umar, mentions that the claim made by the proponents of neograft in that it is good for performing body hair transplantation aka BHT needs to be proven. Dr Umar who is perhaps the world’s leader of body hair transplantation with a very impressive portfolio of BHT based results states that the grafts derived from the beard and other body locations are more delicate when compared to head derived grafts, and would be less resistant to the destructive forces of air drying to which that grafts produced by neografts and similar devices could be subject. Dr Umar again advices patients to ask for proof of BHT results before committing to surgery by any clinic or individual. If they claim to be capable of performing BHT, ask them to show you results on patients they have performed BHT on using the neograft machine. In the case of BHT; ask to see these patients. Examine the beard and body areas from which the grafts were extracted.

Finally Dr Umar states that there are reports of the vendors of some of these touted FUE machines  supplying novice clinics with a retinue of non physician trainers that in some instances end up performing the FUE procedure in the clinic on an as- needed basis. However, in many states of the United States, that would be illegal. Unlike the traditional strip method of transplantation, each FUE graft must be punched out individually, one at a time directly from the scalp of a living breathing patient. This is considered surgery. Hence the removal of even a single FUE graft by person (s) not licensed to perform surgery in the state or country of jurisdiction would be illegal and must be reported to the controlling medical board for the offense of the practice of medicine by unlicensed persons. The clinics and / or doctors condoning such a practice would be liable to sanctions by their governing medical boards which in some instances might include license suspension or revocation. It is thus in the interest of the public that such practice are not condoned. Potential patients must ask the clinic or doctor before booking for the surgery for a written assurance that all surgical aspects of the procedure would be performed by a person who is licensed to perform surgery in the location of the clinic. Ask the doctor at consultation who would be performing your surgery.  Obtain the names of the persons performing your surgery for future reference.  This concern for the marketing hype heralding the neograft and its potential for its use in performing poor quality transplants by novice clinics and doctors or worse non-doctors is supported by the observations of Dr William Rassman.

Dr Umar opines that neograft as an FUE tool has lot of room for improvement and at this time is not the FUE answer. A device that avoids the use of air and avoids the banging of the grafts against narrow tubes and stripping it of its protective coating would be a step in the right direction and right now, neograft is not it. “The best way to perform FUE is to train with some of us that have been performing the procedure for years with a track record of consistent results.” It is a skill dependent procedure that has a mandatory doctor input that cannot be abdicated wholesale to vacuum device or non physicians.

Sanusi Umar, MD is a board certified dermatologist and the owner of the DermHair Clinic in Redondo Beach California. He is a faculty at the Harbor UCLA dermatology Division in Los Angeles.

You’ve probably heard about a relatively new hair restoration method called Follicular Unit Extraction – FUE for short. It’s an innovative approach in hair transplant technology that surgically restores hair without leaving the linear kind of scarring common with the “strip harvesting” approach. Instead of taking strips of scalp from one part of the head for insertion into another, the FUE approach relocates the units one group of hairs at a time. It’s a delicate, demanding procedure, but the results are worth it.

Recently, the Neograft device, a vacuum-based machine, has exploded on the scene due to heavy marketing. Consumers should make informed choices based on diligent research, rather than TV shows endorsements. Some HT experts have cautioned about potential problem areas with neograft or devices using suction as part of their technology in FUE. There are reports that some of these machines are being marketed to novice clinics and doctors with no formal training in either basic hair transplantation, let alone FUE techniques.

Dr. Umar is troubled by the reports he’s received of failed FUE procedures done by persons in no way qualified to perform them who are using the Neograft machine. Instead of physicians conducting the FUE, Neograft technicians are sent to clinics to perform the actual procedure while the doctor looks on. A patient shows up for surgery expecting his doctor’s hands-on expertise ends up getting operated upon by someone who may not be licensed to perform surgery in the region the clinic is located.

Remember, FUE is a surgical procedure. Every single graft extraction involves cutting the skin. Because it is surgery, it is critical that a FUE hair transplant be done by an experienced, licensed medical doctor. Because it is surgery, it is illegal in many states in America for an unlicensed person to perform FUE transplant. This author opines that when a mass-production device like the Neograft is used by unlicensed personnel to perform a delicate procedure demanding a high level of skill, the potential for disaster is exponential.

Yet, thanks to an aggressive media and marketing campaign, the Neograft machine is hailed as the best solution to FUE procedures, despite the alarm raised by experts such as Dr. Umar. Other pioneers in the field of FUE, such as Dr. William R. Rassman and Dr. Robert M. Bernstein, share Dr. Umar’s concerns about the increasing use of this machine by unqualified, unlicensed persons as well as the flaws inherent to the device even in the hands of experienced FUE doctors.

The precision required for a FUE procedure leaves little room for novice errors. Although specialized technicians do play an important role in hair transplant procedures, their function is non-surgical. Remember, FUE is a surgical procedure; it involves penetration of the tissues of the body in order to directly insert the grafts into your head. Throughout the United States, as here in California, a license from the state medical board is required before a person is allowed to legally severe or penetrate the tissues of a human being in the course of treating diseases, injuries, deformities, and other physical and mental conditions.

In other words, FUE procedures must be restricted to those licensed to practice medicine. Clinics and doctors who support FUE procedures conducted by unlicensed persons could be liable to sanctions by their governing medical boards. This is not something often pointed out in the aggressive marketing campaigns.

It can be very difficult for a consumer to cut through the noise of an advertising campaign to find the truth. But there are steps you can take to help ensure that you have a safe procedure with the best possible end result.

• Learn a little bit about the FUE procedure and what it involves. By reading this post, you have already taken a necessary step to becoming informed!
• Don’t be afraid to ask questions of the person who will perform your surgery. When you go in for your consultation, ask about – and write down — the names, qualifications and license information of everyone to be involved in your surgery. Find out exactly what each person’s role will be. You are the patient. You have a right to ask.
• Ask the doctor if the device uses vacuum/air suction. A yes answer to this question is a problem in this author’s opinion.

For medical professionals, the answer is also simple. Physicians looking to incorporate FUE into their practice should take time to learn from their colleagues who have the experience and proven track record in the procedure. There is no substitute for this.

Your eyebrow hairs grow from the follicle at a sharp angle, so unlike the hairs on your head, your eyebrow hair is growing flat against the surface of your skin. The growth cycle of your eyebrow hair is also far shorter than that of the hairs of your scalp – about four months, as compared to three to seven years. Unlike your scalp hair, your eyebrow hairs grow as individual strands; there are no follicular groups of hairs in a bunch that can be moved from one area to another. Typically, 50 to 325 hairs are individually moved into the brow during the procedure, another reason a skilled surgeon is needed to perform this delicate task. The hairs must be perfectly placed into tiny incisions that are at just the right angle and direction to mimic natural growth.

Follicular Unit Extraction is an excellent approach for eyebrow restoration, because it involves transplanting individual strands of hair from another part of your body to your eyebrow area, leaving no visible scarring. The new hair will look a little different from your original eyebrows and have a different growth rate, but over time it will begin to mimic your existing eyebrow hair.

The procedure usually takes two hours and is done while you are under a mild sedative.

Have more questions about ways to improve your eyebrows? Contact Dr. Umar for a free online consultation today.

The patient featured in this video came to Dr. Umar after two different clinics left him with painful strip scars along the side and back of his head. Using the Single Follicle Extraction and Transfer procedure to transplant hair from the patient’s beard into his head, Dr. Umar was able to improve the appearance of the scar.

Have more questions about options to strip surgery? Contact Dr. Umar for a free online consultation today.

If you would like additional information about Dr. Umar and his procedures for hair loss, please contact the DermHair Clinic in Los Angeles. A hair restoration consultation can easily be arranged online via for free. For an in-office appointment, please call the office at (310)318-1500 to check about appointment availability. In-office schedules for the most part are a bit more limited, so any information you can provide over the phone is great.

What Are Some Treatments For Hair Restoration?

• Propecia is a common finasteride drug used to stop hair loss by fighting the male hormone, DHT.
• Hair restoration surgery, such as “strip harvesting” or follicular unit extraction.
• False hair, such as hairpieces, wigs, and toupees.

Like with most conditions, early treatment of hair loss is better and will result in more successful results. For this reason, hair restoration patients have started getting younger.

For more information on hair loss or about Dr. Umar and his hair transplant procedures, please contact the DermHair Clinic in Los Angeles. A hair restoration consultation can easily be arranged online for free.