With wider awareness about FUE surgery, it is no surprise that a lot of clients are opting to undergo FUE surgery. The ISHRS statistics quote that in 2015, clients seeking FUE surgery was around 30% compared to 5% in 2010.
Wider availability has given clients a wider choice of surgeons and clinics to pick from. Possibly as a result of poor client selection or lack of planning, this has led to a significant increase in poor surgical outcomes.
In my practice, I have seen a significant increase in clients seeking corrective or remedial surgery to fix poor outcomes of FUE surgery performed elsewhere.
One of the most common reasons for poor outcomes according to my assessment has been overzealous extraction from donor area, more specifically from the non-permanent areas.
I have observed an increasing number of clients coming to me with grafts starting to shed a couple of years after FUE surgery. My observations have yielded a common denominator of grafts that were extracted from the non-permanent zones possibly shedding along with the grafts that were traumatized during the transplantation process.
Non patterned shedding of transplanted grafts leads to a very unnatural look and along with grafts that have poor angulation and direction can lead to significant distress to clients.
These scenarios can be heartbreaking when attempts are made to extract hair from an already over exhausted donor area. Any further attempts to extract grafts from these zones will lead to extensive scarring and poor-quality grafts.
Scenario 1) This client came to us seeking corrective surgery having undergone 2 FUE surgeries elsewhere. A closer look at the scenario suggests a few things.
- There is extensive scarring of the donor area and some of the grafts have been extracted from a non-permanent zone.
- The angulation of the transplanted grafts is poor and also there appears to be extensive gaps between grafts.
- Judging by the number of extraction sites in the donor, the yield appears to be very poor.
Given the limited availability of donor hair, we had to take a conservative approach and set reasonable expectations to the client.
One of the key factors that need to be considered whilst counselling a client for a hair restoration surgery is to factor in the long-term implications for the client.
Whilst it is common knowledge that under the guidance of a well-trained surgeon, the outcomes of hair restoration surgery have become fairly universal, the client needs to be aware of the long-term implications, both in terms of long term medications & also need for further surgery to preserve a natural looking hair.
This was one of my primary concerns when I chose to have my FUE 10 years ago. Whilst FUT had better outcomes 10 years ago, the thought of a big scar at the back of my head for the rest of my life led to me undergoing FUE.
Whilst I was lucky in being able to get a bad surgery fixed, not many clients are in such a situation as we have come to understand that an aggressive approach to both FUT & FUE extraction can lead to shock loss in the donor area, hence limiting further availability of donor hair.
Part of the reason why I disqualify more than 80% of my clients in pursuing surgery is to make sure a client enjoys at least a good 25-30 years of a reasonable head of hair once they undergo a hair restoration surgery.
Both with FUT & FUE surgery, one needs to understand that the donor area cannot be exhausted to such an extent that the extraction scars become visible even when the donor hair is long.
Secondly, with a well performed FUE, the client might get away with a cropped haircut at the back or even styling their hair extremely short all over. This option ceases for the client when they start pursuing more surgical procedures.
Both the client & the surgeon need to understand that hair restoration surgery is unique with a law of diminishing returns with every eventual surgery. Hence the onus is on the client to seek the right surgeon to perform one good procedure rather than trying to do corrective procedures.
Dr. Raghu Reddy
FUE Hair Transplant Specialist
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