Understanding the Terminology Around Shaving or Not Shaving Hairs During Hair Transplant Surgery
Introduction
Understanding what is meant by shaven and unshaven hair transplant surgery can be confusing and the internet presents conflicting definitions and scenarios. In order to clarify the terminology, one needs to separate the discussion into donor site, recipient site, and implantation implications.
Donor site
There are two donor harvesting methods in hair transplant surgery – Strip Follicular Unit Transplantation (Strip FUT) and Follicular Unit Excision (FUE). It is important to recognize that FUE has an incision step (cutting the skin) and an extraction step (removing the follicular unit). The ISHRS position is that incising the skin constitutes surgery and guidance regarding who can do each step can be found under Qualifications for Scalp Surgery
A comparison between the Strip FUT and FUE donor harvesting methods can be found here:
COMPARISON BETWEEN STRIP HARVESTING AND FOLLICULAR UNIT EXTRACTION
In Strip FUT, prior to removing the strip of scalp skin, the hair within the strip can be shaved or left long. With either option, the closed wound can be fully hidden with the hair from above.
In FUE, the hair in the donor area can be fully shaved, partially shaved, or left unshaven. Patients who are used to wearing their hair quite short at the sides and back of their head might not mind having a fully shaven donor area. However, those patients who want to keep their hair very long at the sides and back have the option of a partial shave where the hair is lifted up, a zone of scalp is shaved for FUE harvesting, and then the hair is let down to hide the shaved area.
The dimensions of a single shaved area will vary depending on the number of follicular unit grafts required. For patients who do not want a full shave and whose hair is not very long, thereby limiting the height of the shaved area that needs to be hidden, multiple narrow areas can be shaved in a similar manner. There is now increasing popularity of completely unshaven FUE with more and more hair transplant surgeons offering this option.
Unshaven FUE can result in long hairs being extracted if the hair shaft is not cut by the punch during the skin incision step. Unshaven long hair FUE is technically demanding and there is a risk of increasing the follicle transection rate, that is, the hair shaft is accidently cut under the surface of the skin. Unshaven FUE can also be performed by trimming each target follicular unit individually with a scissors prior to excising it.
Alternatively, the surgeon can purposely cut the shaft with the punch during the incision step. Both of these techniques will yield a short hair follicular unit graft for implantation. An advantage of unshaven FUE is that the surgeon can assess how many follicular units can be extracted while monitoring for possible visible thinning of the donor area, thereby avoiding over-harvesting.
Recipient area
With regards to the recipient area, the hairs can be shaved as part of a full-head shave in FUE. Alternatively, the hairs can be shaved but the donor hair left long after a Strip FUT harvest, or the hairs can be left long. The decision on which option is selected will be made by the patient, taking into account the surgeon’s advice. The advantage of shaving the recipient area is so that the long hairs do not get in the way during incision making and implantation.
The more hair there is in the recipient area, the less densely it might be possible to make the incisions and the more technically demanding it will be to implant the grafts. Using sharp implanters is one way of more easily making recipient site incisions and implanting grafts whilst maintaining long hair in the recipient area.
Several reasons exist to leave the recipient area unshaven. Leaving the hair long will allow an easier recovery for the patient, especially those who wear a longer hairstyle in this area. The surgeon can preview the density of the transplanted hairs intermixed with the native hairs if long-hair preview transplantation is undertaken. The surgeon may be able to visualize areas of greater thinning that may require additional density of recipient sites.
Implantation
When implanting follicular units, whether with forceps, dull implanters, or sharp implanters, the surgeon can utilize long hairs or shaved, trimmed, and cut hairs. The long-hair preview method refers to using long hairs to get an immediate visible hair transplant result. This can aid with deciding the implantation density to achieve a desired aesthetic appearance. Long-hair preview applies not only to scalp transplants but also to eyebrow transplants.
With both long hair and shaved/trimmed/cut hair, the hair shafts are likely to fall out in the ensuing weeks after the transplant before regrowing. Advising patients on how to wash and comb the transplanted long hair after the procedure is crucial in order to avoid accidentally pulling the grafts out.
Conclusion
Hair transplant surgeons and clinics should be explicitly clear on their websites, social media, and marketing materials about what they mean when they refer to unshaven hair transplant surgery. There are pros and cons of shaving the hair during a transplant procedure, and an open discussion with your surgeon will help see if there is a role for this type of procedure for you as a patient.