Hair transplant surgery has always been confusing for patients since its inception over fifty years ago. Back then, the only information you had was usually inside a small brochure and what you were told during your consultation. That has obviously changed a lot in the 21st century due to the internet. But does having so much more information at your fingertips make the procedure any less confusing than it was five decades ago?
When you look at the evolution of hair transplant surgery over the years and decades, there have been four variations that have been considered to be the standard of care. These include “plug” hair transplantation during the 1960’s through the 1980’s. Then “strip” hair transplantation which is subdivided into mini-micro grafting (1990’s) and follicular unit grafting (early 2000’s). Lastly, we have FUE (follicular unit excision) which started to gain in popularity in the early 2000’s but really took off after 2010. FUE is the most recent evolution of surgical hair restoration and while strip or “FUT” is still widely offered today, FUE is the most common graft harvest method utilized worldwide. (Per our 2017 Practice Census,53% FUE, 44% FUT, 3% combo.)
There is a fundamental difference between strip surgery and FUE in that FUE does not involve removal of a strip of donor hair bearing tissue, thus it does not result in a linear scar. This is the driving force behind the popularity of FUE. However, there is another difference that a lot of people haven’t realized. The difference is that FUE, and many of the clinics that offer it, allows for many more marketing opportunities than strip surgery ever has, or any surgery before it. This is evidenced by the various names that are applied to the procedure in an attempt by clinics to separate themselves from their competition.
FUE hair transplant surgery is fairly simple when you look at the basic fundamentals of how it is performed. A qualified surgeon will use a small punch to isolate, score, and incise a follicular unit. It will then be removed very delicately with forceps or tweezers (some FUE devices will remove the grafts by suction and the grafts are stored inside the device itself) and placed into a stable holding solution until they are ready to be placed back into the scalp.
The surgeon will then place the grafts back into the scalp where hair loss has occurred in one of two ways. Incisions will be made into the scalp and then the follicular units will be placed into these incisions utilizing small forceps. The implantation can be done after all the incisions required have been made or after each incision has been made – known as the ‘stick and place’ method.
The alternative way to place these grafts into the scalp is through the use of a surgical device referred to as an “implanter or “inserter”. Implanters are tools where the grafts are loaded into a channel and then a plunger is deployed to insert the graft into the skin. Implanters can be dull or sharp.
Dull implanters are used to insert the grafts into pre-made incisions.
Sharp implanters are used to make an incision in the skin and immediately implant the graft.
Since the use of sharp implanters involves making a skin incision, patients should refer to the ISHRS Position Statement on Qualifications for Scalp Surgery with regards to who should make skin incisions.
The advantage of implanters is that the hair follicle bulb is not handled directly and therefore is potentially subject to less trauma than when grafts are handled with forceps.
The term ‘DHI’, which stands for Direct Hair Implantation, is another name for the implantation technique using sharp implanters. It is not a hair transplant method and should not be marketed as such.
Sounds pretty simple overall, doesn’t it? But the art and technique are complex and many clinics are coming up with new names to describe exactly what FUE is, but with the goal of making you think that their FUE is different. In some cases, they are trying to convince you that their FUE is not FUE at all, but a new form of hair transplantation that no one else in the world has thought up.
In truth, there are no alternative methods of performing hair transplantation that the ISHRS considers to be realistic. When clinics feel the need to give the most common type of hair transplant a new name, then you would be wise to dig a little deeper into what exactly is going on. When you spend a lot of time researching your hair transplant options, you’ll start to see that many of the clinics that offer these alternative surgical names are clinics that might not be credible and may even be operating illegally. These types of clinics usually have a small army of unlicensed technicians performing some, if not all, of the surgical procedure. Many of these clinics might also be operating outside of the regulations of their given state or province.
So what can you do to sift through the confusion when researching your FUE hair transplant options? One thing you can do is find out if the clinic you are considering is using doctors that are ISHRS members. The ISHRS does not believe that misleading marketing terms should be used to describe a real surgical procedure, and hair transplant surgery IS a real surgery. While technicians play a vital role in assisting doctors to perform to their highest potential, the ISHRS believes that doctors should be the primary person responsible for the surgical aspect of any hair transplant procedure, and you should too. Doctors are not only highly trained medical professionals, but they have also taken and oath to “do no harm” which is taken very seriously in the profession.
So, remember, when you’re doing your research, you should be doing your research for FUE or FUT hair transplant surgery. Try to avoid clinics that try to call their surgery anything other than surgery, and by claiming that their “procedure” is exclusive to them. In the end, safety and good work shouldn’t require fancy or misleading names.