Is Follicular Unit Extraction (FUE) the Solution for Young Hair Loss Sufferers?

Are young men with extensive hair loss more suitable for follicular unit extraction (FUE) due to the lack of a linear scar?   After all, I can always just shave my head later right?

This  hair loss  question was answered by  Dr. Cam Simmons of Toronto, Canada, who is one of our recommended hair restoration physicians.

I think patients need to be just as cautious about starting follicular unit extraction (FUE)  hair transplantation as they would be about starting  follicular unit transplantation (FUT) by strip.

FUE is still a relatively new technique and it is too early to know all of the long term consequences. There are not a lot of hair transplant photos of patients who have had thousands of follicular unit extraction grafts transplanted. I have not seen one photo of a class 7 patient on the Norwood scale of hair loss  treated by scalp FUE alone. I have been quite disappointed by the results I have seen online and in conferences of extensive body hair transplant FUE.

More and more I hear the notion that it may be OK for someone to have FUE transplantation into their hairline then shave the head later if they lose their hair and don’t want or can’t do more surgical hair restoration. If a patient had a hair transplant then went quite bald and buzzed their head or shaved it slick, they would still have a five o’clock shadow in an unnatural pattern. The texture of the skin in the recipient area may be better than it would have been in the old days of the bigger graft but it won’t be perfect.

FUE scars are small but not invisible. If a patient comes in with medium or long hair I can always find the FUE or trichophytic scars with back-combing and careful examination. I can always see the scars from either method if someone has shaved their head. I have seen patients who had lots of FUE with grafts taken from well outside the safe donor area. I have also seen the start of a moth-eaten look in the donor area after extensive FUE. This is not to overlook the consequences of strip surgery but just to state that FUE is not perfect either.

I believe that hair transplantation of any kind should be considered a permanent step with long-lasting benefits and long-lasting consequences. The trade-off for having more hair on top is that the donor area will have some hair missing and some scarring. This can be minimized but not eliminated. It would be better for a young man not to start hair transplantation until they are committed to continuing hair restoration when and if they lose more hair. Surgical hair replacement by any method can never be completely undone. Not everyone can get the coverage or density they would like with hair transplantation but with careful planning they can have natural looking hair in a natural pattern that is better than they would have had without a hair transplant.

To make a good decision it is important to have realistic expectations. FUE transplantation requires just as careful planning as FUT strip transplantation – especially for someone who could lose a lot of hair.

Generally speaking, men in their early 20s have a more unpredictable future and higher expectations to look like their peers. In my experience, intellectual understanding does not equate to emotional satisfaction. A conservative approach for someone who already has a class 7 pattern on the Norwood scale makes a noticeable difference and can be quite satisfying. The same approach for someone who has thinning hair but is headed toward a Norwood 7 pattern will have less visual impact and will be much less satisfying. Decisions must be made on an individual basis but I would encourage very young men with thinning hair to first consider all other options before considering hair transplantation.

Once started, a patient can no more undo their hair transplant than a sky-diver can climb back into the plane. In either case, “Don’t jump until you are ready to commit!

Cam Simmons MD ABHRS

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Bill Seemiller
Associate Publisher/Editor

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