What Are the Benefits of Pre-Making FUE Hair Transplant Recipient Site Incisions?

This question, from a member of our hair loss social community and discussion forums, was answered by a staff physician from Coalition hair transplant clinic Shapiro Medical:

I have had a total of 5 strip hair transplants over the last 15 years, with 3 different hair restoration physicians. The first four, the incision and grafts were placed the same day within an hour or so. The last one which was done about 8 months ago, the surgeon I used did the incision the day before he inserted the grafts.

I’m not seeing any new hair growth like I did the previous times after 8 months and wondering if it’s because he did the incision the day before. Is this practice common? I have not been back to the surgeon because he is several hours away. Any one familiar with is practice and should I be worried?

This is a good topic of discussion. At Shapiro Medical we also routinely make the incisions the night before a large follicular unit extraction (FUE) case. It does sound strange, I know, but you must look at the logic behind it. All grafts, especially FUE grafts have a limited time they should stay out of the body. The sooner they can be placed back into the recipient sites the better. Having said that, we routinely like to make sites prior to extracting any grafts. If the surgery is somewhat smaller, (1800 grafts or less) we can make the sites in the morning and then extract the grafts followed by planting in the afternoon. If the grafts are extracted first in the morning and then the site are made, the grafts must wait an extra 1 -1.5 hours (average time it takes at SMG to make sites) before being planted. This is not ideal.

The reason we would make sites the night before is that if we plan on doing a larger hair transplant surgery (1800-2500) we won’t be able to make sites in the am and do 4+ hours of extraction followed by placing. The patient would be in the office until 8 or 10 at night! That is not good for the grafts or the patient experience.

Finally, on the question of practicality of making sites the night before. We typically have the patient come in around 2pm and we go through the plan thoroughly. We cut the hair and make the sites. The patient is out of the office in 2-3 hours. We dye the sites so that they are easily visible the next day. Believe it or not, the sites are very easy to work with the next day. Our staff at SMG routinely pre-dilate the sites (open them with forceps) prior to planting the grafts anyway so we put as little trauma on those fragile FUE grafts. Our staff actually feels that the premade sites are sometimes easier to work with and the grafts may be less likely to pop in a dense packing situation. Also, there may be some theoretical benefits to making the sites earlier. There may be some growth factors and early revascularization occurring overnight to the area that may make the grafts take better. We don’t have any good data on that, but it is a possibility.

In my mind, the only negative issue is that the patient would have to be numbed another day. In our office, we don’t rush our procedures, so prior to making sites the night before, we had all 2 day FUE cases where we would do 50% of the case on each day.

~Shapiro Medical
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David
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.

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