The myth of the transplant without scars

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I would like to propose to all readers of our blog the translation of an article related to scarless transplantation, in my opinion very interesting, written by Joe Tillman, known internationally as the hairtrasplantmentor.

I would like to talk about the issue of scars resulting from FUE surgery (follicular unit extraction) and the myth of so-called “scarless” hair transplant surgery.

 

The birth of the myth of scarless transplantation

This myth continues to exist until 2019 and is used not only by clinics that offer only FUE surgeries, but also of clinics that in the past offered strip surgeries and at that time warned patients that a scarless transplant was not possible.

FUE leaves scars and this is as true today as it was 15 years ago when the concept of follicular unit extraction was first addressed in North America. Whenever the skin undergoes surgical trauma, a scar inevitably forms.

The reason is quite simple, scars are generated because the human body has not evolved to the point where it can regenerate its own skin when required, when needed. We are not salamanders!

No one can know how well a wound will heal or how it will heal after a hair transplant via FUE or FUT.

The only thing a clinic can rely on to speculate on recovery timelines is the history of results, but that’s a simple statistical calculation – we don’t necessarily have average healing abilities.

Why? The answer is simple, because the only variable you don’t know is your own physiologic response to the problem.

 

The optimal hair length after an FUE transplant, be careful

If you are considering a hair transplant operation and have decided to undergo surgery via FUE, then you need to understand that you will not be able to get your hair to the exact length you want, as well as for STRIP surgeries even though FUE allows you to keep your hair shorter on average.

It should be remembered that the only reason FUE was conceived was to create an alternative to poorly performing strip surgery (in some cases the scars were very ugly), and to follow the evolution of men’s fashion style which was going more and more towards shorter, shaved haircuts. There are no other reasons that led to the invention of the FUE technique.

Follicular unit extraction was not invented because it offered better regrowth rates or better quality of follicular units than those obtained through STRIP harvesting. The reality is that it took at least 10 years before the best FUE clinics were able to match the quality of follicular units extracted through FUT, and in many cases, the units extracted are still not at the same level.

 

The quality of follicular units extracted via FUE and STRIP compared

My position on the subject is that the follicular units extracted through FUE by the most important clinics are qualitatively very similar to those extracted through FUT and that this difference does not generate a substantial difference in results in terms of aesthetics. However, if we want to analyze the issue from a technical point of view, I believe that follicular units extracted through FUE still have a slightly lower survival rate than those extracted through FUT (strip), if we compare similar sessions in terms of follicular units.

 

The concept of follicular unit extraction or “FUE” began to gain momentum in 2002, when patients and supporters of this technique tried to “pass off” FUE as the panacea for all surgical ills, which was referred to as a scarless hair transplant technique. In response to these claims, many supporters of the STRIP technique have pointed out that every time the skin is cut, a scar is produced but FUE proponents have countered by saying that the scars are so small that they are not visible.

This diatribe dates back to the time when the average diameter of the PUNCHs used for extraction was between 0.9 and 1.35 mm.

Some surgeons and FUE advocates have tried to replace the word “scar” with “hypopigmentation,” arguing that the scar visible after FUE extraction would not actually be scar tissue but a simple lack of pigment. The use of the term hypopigmentation is meaningless and has no reason to exist. This, my dear friends, is simple marketing.

 

I was told that they underwent a transplant without scarring:

If a doctor or clinic member has told you that you can undergo a scarless transplant, you should be aware that they are lying to you. Anyone who expects FUE hair transplant to be scarless should stop and reconsider their priorities and reasons for wanting to undergo surgery.

What are your goals and reasons for getting a hair transplant? Do you think you will have more hair, shave your head and look like someone who has never suffered from hair loss? I’m sorry to say that this is not going to happen.

The idea that you can get a hair transplant without scars and shave off zero or very few millimeters (military type), without any visible signs of surgery is totally wrong.

Will you be able to afford to wear your hair short? Potentially yes, as long as the position of the follicular units follows the angles and directions of the pre-existing hair. In this case, you will have a great result, but you won’t be able to fool people by looking like someone who has never suffered from baldness. What you can legitimately expect is definitely a less thinning appearance, but if you expect surgery through FUE with an immaculate donor area, you will be disappointed with the end result.

 

EVITATE EXTRACTION SCHEMES TO MAXIMIZE THE OUTCOME OF FUE TRANSPLANTATION.

There are a few things to remember if you want to keep your hair very short after an FUE hair transplant. The reason the STRIIP scar may attract attention is because it appears as a visible line between the hair surrounding it.

Scars resulting from FUE extraction do not generate this problem because they are simple dots, which are noticeable when shaving hair to zero, but even with very short hair they appear as minimal spaces where hair may be missing. This is actually quite common in nature, even in people who have not had a transplant, and if these lower density areas are well distributed the situation is quite normal.

The problem arises when FUE extractions are done in too narrow an area and this leads to a less dense area of hair than the surrounding area. By extracting in this way, the surgeon (or the assistant who performed the extractions) has followed an incorrect extraction pattern that enhances the negative effects of FUE on the donor area by making the extraction area visible.

Therefore, it is important to make contact with a clinic that does not follow an extraction pattern that involves removing an excessive number of follicles from a restricted area of the donor area.

The traditional donor area for hair transplantation is still viewed from the perspective of strip surgery and is identified as a narrow area of hair located in the center of the occipital area at the level of the ears. This horseshoe-shaped area is considered insensitive to the effects of DHT. This way of looking at it is essentially correct, but the donor area available for FUE extraction does not have the limitations of STRIP extraction and it is therefore possible to remove follicles from a much larger area.

 

I WANT TO RADIATE TO ZERO AFTER MY TRANSPLANTATION

If you are one of those people who wants a scarless hair transplant because you want to shave yourself to ZERO after an FUE extraction, I suggest you reconsider getting a hair transplant. You need to have excellent physiological characteristics (density, caliber, color difference between skin/hair), find the right surgeon and have that surgeon perform a flawless follicular extraction to achieve certain goals.

Patients with very fair complexions have the best chance of achieving nearly invisible scars due to the lower color contrast between the skin and scar tissue.

Even these individuals, however, should avoid excessive sun exposure to prevent pigment buildup in the donor area. In fact, this would make the extraction scars more visible as the scar tissue does not tan.

If your complexion tends to be olive or dark, the FUE extraction marks are more likely to contrast sharply with your skin tone and this is what you want to avoid.

FUE is a fantastic surgical technique and allows you to wear your hair shorter than the strip, but it is not the perfect solution. Before you think about undergoing a hair transplant with any surgical technique, think carefully and remember that with a hair transplant you risk creating a new problem instead of solving it.

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