What’s the difference between the Strip method and FUE (follicular unit extraction) for getting the donor hair?
Answer:

First and most importantly, I make sure my patients understand the greatest limit to any hair transplantation is that there is a fixed and limited amount of good genetic hair that we can transfer to the balding areas.

With that in mind, I explain that no matter how experienced the surgeon, when I remove the donor area with either method, I am removing it blindly (i.e. – I can not see under the skin until after the donor tissue is removed). The problem is that I can not see if the follicles have been damaged or transected until after it’s been removed. So it’s best to have as little tissue as possible exposed to any device removing the tissue.

With the strip method, we minimize the amount of donor area being exposed to the risk of damaging hair follicles while obtaining the donor hair. With F.U.E., the patient no longer runs the risk of having a linear scar on the back of their scalp, but there is a significant increase in the amount of surface area being blindly dissected and with that a significant increase in potential damage to the hair follicles.

While I use both methods to obtain donor hair, I make sure the patient understands the risks and implications of both and I help the patient make an educated decision.

Paul J. McAndrews, MD
http://www.hairgrowthdoctor.com
IAHRS Recommended Hair Transplant Surgeon

I will be 30 years old in November and have been on Propecia for 21 months to prevent further hair loss. Fortunately it has significantly slowed the rate of loss, but did not regrow any hair. I am mostly stable now, although there is still some slight regression. Currently, I am a NW2.5V patient on the scale with more loss on the crown and less at the hairline.

I prefer to have the FUE procedure to fill in the existing frontal hairline (as this has not receded from its original location, but rather has become less dense), the mid scalp, and the crown. My goal is to restore adequate density to provide coverage over the affected area.

I am concerned about shock loss in the transplant area due to the relatively broad coverage of the existing hair, so please address this issue in your response. Please advise my options, including the estimated number of grafts to achieve the desired results and the associated costs of the procedure.

Answer:

At 30 even using Propecia, you could and probably will lose more hair. For this reason I’m not a big fan of grafting the crown in men less than 35. The only one exception to this rule is if FUE is used. If extensive loss ensues you could cut your hair short without seeing a linear scar. You do have noticeable loss in the hairline which is more amenable to transplants and where results would be noticed. You have diffuse loss behind the hairline to the crown, more loss in the crown. I’m not sure what you mean when you say “adequate density to provide coverage over the affected area.” Some would think the coverage you have now in the mid-scalp is adequate.

The density could be increased in the crown but the change wouldn’t be as noticeable as in the hairline. The mid-scalp looks pretty thick from the photos. There could be shock loss where the hair is the thickest. The more grafts one attempts to place between existing hairs the greater the chance of shock loss. The density you have in the crown and mid-scalp is difficult to work with, too thick to dense pack without significant shock loss which would limit a big visible increase in density.

It would help to clip your entire scalp with a clipper without a guard. This would need to be done in the donor area anyway. Clipping the recipient area reduces shock loss and allows me to see the spaces better. Plus if there is shock loss you won’t notice as the new hair grows in with the shocked hair to some extent. I do everything possible to avoid shock loss.

It’s difficult to say how many grafts without examining you. Roughly I would say I could get up to 2000 in the hairline and between existing hair back to the crown if the entire area where clipped short. It may be fewer. That’s the good thing about FUE; you can stop when you fill the spaces. With strip you have to use all you take, which generally isn’t a problem.

You can view fees on my website at: http://www.wolfhair.com/service/fees.shtml I hope I haven’t confused you. But the bottom line is from the photos, it would be difficult to get a lot of grafts between existing hairs behind the hairline due to existing density.

Bradley Wolf, MD
http://www.wolfhair.com
IAHRS Recommended Hair Transplant Surgeon