Does Follicular Unit Extraction (FUE) Hair Transplantation Cause More Ingrown Hairs than a Strip Procedure?

This question, from a member of our hair loss social community and discussion forums, was answered by Coalition hair transplant surgeon Dr. David Josephitis:

I had a FUE (Donor was back of scalp + beard hair) about 2 months ago. I saw a few ingrown hair pimples in the donor area at month 1 mark which I addressed via some antibiotics (prescribed by my hair transplant surgeon) and also topical antibacterial cream.

Recently I have been seeing much greater incidence of ingrown hair: especially in the beard section as well as a few spots in the donor scalp. I have been told that it is sometimes expected as the hair growth starts around the 3 month mark. I have continued to apply the antibacterial cream as advised and even though the number of pimples is now more than a dozen, it is still somewhat manageable.

Have others faced a similar experience post FUE? I never had this problem before with my prior three FUT hair transplants. One reason I was told by the doctor was that sometimes there is transection of other hair during the FUE extraction process that can cause this. A factor which is less relevant during strip.

Yes, we too have seen a slight bump in the number of ingrown hairs in the beard area. Follicular unit extraction in general, can lead to occasional ingrown hairs followed by some inflammation on the scalp or beard. These are usually relieved with warm compresses and topical antibiotic ointment. Rarely, if it does not improve on its own, an oral antibiotic can be prescribed. This is not harmful on the overall results, it is just troublesome to the patient.

It is theorized that patients that frequently get skin infections are more likely to get these infections. Also, if there are any partially transected hairs from the FUE procedure, there may be more or less ingrown. At Shapiro Medical Group, we have worked with many different types of FUE devices. We have used the robotic, dull, sharp, motorized, and manual systems. All the while, we are trying to minimize the transection rate and improve the overall quality of the harvested grafts. The most recent device we have been using is the WAW trumpet hybrid punch by DeVroye out of Belgium. It has given us the lowest transection rate to date and delivers a very high quality graft. Our transection rates are typically less than 5%.

My thought as to why there are more ingrowns being seen especially in the beard area is not that the transection rate is high, it is just that we, (and perhaps other clinics as well) are doing many more beard/ body FUE than we have been in the past. More patients are asking for it, and more repeat FUE patients are running out of scalp donor hair and looking to the beard and body for more.

I think that although the transection rates are incredibly low, the beard may just have a higher chance of developing ingrown hairs.

Dr. David Josephitis
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David
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