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Are You Trying to Choose Between Follicular Unit Extraction
vs. Follicular Unit Transplantation?

Follicular Unit Extraction (FUE) Follicular Unit Transplantation (FUT) Dr. Bolton's Technique
(Multiple Follicular Unit Grafts)

How long is a hair transplant surgery?

Surgery is Longer (as many as 15 hours up to a period of 2 days)

Surgery varies depending upon the doctor, the staff, the technique and how many surgeries are done at the same time. A surgery could last anywhere from 4 hours to 14 hours. A large clinic may have as many as 20 tech's who vary in skill and tenure.

Surgery is 4 to 5 hours. Dr. Bolton does only 1 surgery per day. He uses the same highly skill staff every time year after year. The use of multiple follicular units makes this the most efficient surgery with the most natural results.

How many hairs are moved?

As little as 800 - 2000 hairs are transplanted It depends on the clinic. Generally doctors charge by the graft not by the hair so there is no real way to know how many hairs are transplanted unless you know the length of the donor tissue. Depending on the size of the patient's scalp Dr. Bolton can harvest as much as 35 square cm of hair or potentially more than that if the elasticity of the scalp permits. Dr. Bolton will will harvest as much as he possibly can to maximize the results. There are approximately 200 hairs per sq cm of donor tissue. That can result in as many as 7000 - 8000 hairs.

Is there scarring? or other side effects? Advantages or Disadvantages?

Donor area could be visibly thinned after transplant. Hair will never grow back in places where follicles were taken leaving empty places in the scalp. Instead of a linear scar the patient will have multiple polka dot miniature scars throughout the donor area.

 

Your donor area will be compromised during future hair transplants because of fibrotic adhesions. It will be more difficult to obtain non transected follicles due to this donor harvesting technique.

A small strip is taken from the donor area. Scar results depend on the skill of the surgeon. See a botched hair transplant by a popular South Florida Clinic.

 

For some people, a scar can be seen with very short hair under a quarter inch in length.

A strip is taken from the donor area based on the the amount of tissue needed leaving little or no evidence that there was a hair transplant.

 

For some people, a scar can be seen with very short hair under a quarter inch in length. In most cases no scar is visible with Dr. Bolton. See Dr. Bolton's scar videos.

What about the health of the hair follicles?

Harvesting is done with a punch biopsy instrument or a neograft machine. Harvesting can easily damage follicles by nipping the roots or tearing the follicle. Some patients are not good candidates for FUE. Doctors should conduct a FOX test to see if healthy follicles can be harvested from each individual. In worst case scenarios, if harvesting fails, the entire procedure could be shut down in mid-surgery due to the lack of healthy follicles. See more about follicle damage.

 

 

Strip harvesting and tissue separation under magnification is the safest way to preserve the health of the hair follicles. However with FUT, grafts are separated more than needed into 1,2 or 3 hair grafts. The smaller the graft, the more separation, the longer the surgery and the more chance for follicle damage.

Strip harvesting and tissue separation under magnification is the safest way to preserve the health of the hair follicles. By using multiple follicular units, fewer grafts are needed because they contain more hair per graft. Fewer grafts mean less separation and less potential damage during the separation process. More hair is preserved in its natural occurring pattern for more natural looking results.

What is the cost of surgery?

Hair for hair, surgery is more expensive than any type of hair transplant currently on the market today. Surgery can be $6,000-$20,000 per procedure.

Multiple procedures are usually required due to the limited amount of hair moved per session. Eventual cost could exceed over $100,000.

Surgery varies per clinic

anywhere from $5000 - $20,000 per procedure. Multiple procedures are usually required due to the limited amount of hair moved per session. Eventual cost could exceed over $100,000.

Hair for hair, surgery is generally less expensive than other qualified surgeons of the same caliber. Surgery varies based on the amount of procedures needed $4,000 - $12,000 per procedure. Our average patient only requires 1 - 2 procedures.

Will the donor area be visible the first day after the procedure?

Entire donor area is shaved on the day of the procedure leaving it clearly visible until the hair grows back. Multiple 1mm sized holes are left open to heal on their own. The amount of open holes on the back of your head will be based on the number of grafts that were extracted. For example, if you had 500 fue's extracted, you will have 500 open holes in your donor area. Suture line 'may be hidden' beneath hair immediately after surgery depending on the skill of the surgeon. Suture line is hidden beneath hair immediately after surgery so it is completely undetectable. See example surgery

How much density will I get?

grafts contain 1 - 3 hairs only. Many follicles may get damaged during harvesting and fail. Density will be sparse. Micrografts (1 hair grafts) are used in the frontal hairline and follicular units (2-3 hair grafts) are used behind the frontal hairline. 1-3 hair grafts are not enough to give patients adequate density. Micrografts (1 hair grafts) are used in the frontal hairline, follicular units (2-3 hair grafts) are used behind the frontal hairline, and Multiple Follicular Units containing as many as 5-8 hairs boost density in the mid-scalp region which doubles the results of other types of surgery.

How many surgeries will I need?

Often more than one surgery is required. More than one surgery is required due to the limited amount of tissue that is being harvested. Sometimes as many as 3-5 surgeries may be needed in the same area. Often more than one surgery is required. More than one surgery is required due to the limited amount of tissue that is being harvested. Sometimes as many as 3-5 surgeries may be needed in the same area. Most often only 1 surgery is required in one area because we can obtain 50% of mother natures density 1 pass 1 procedure. Some patients opt to have a second procedure it incrrease the density and volume. Sometimes only one surgery is required. See our one surgery results.

How long does it take to heal?

It takes an average of 5-8 days to heal. It takes an average of 7-10 days to heal. Depending on surgeon and length of surgery there could be more post operative swelling and numbness.

It takes an average of 7-10 days to heal.

 

FUE, also known as follicular unit extraction, is touted as a breakthrough hair transplant technique. The “breakthrough” is the “no scar surgery.”  The truth is there is no scarless surgery. You will have a different type of scar with follicular unit extraction.  Instead of a linear line the follicular unit extraction will leave a polka dot scar throughout the donor area.


The reason follicular unit extraction has gotten so much attention is because patients are scared of the horizontal scar in traditional FUT surgery.  Every doctor is different. Some surgeons are so skilled that the resulting scar is nearly undetectable even through short hair. Another doctor might leave a half inch wide scar after surgery.


In reality, there are only a small number people who would actually benefit from the few advantages of follicular unit extraction.   A person who will have very little hair loss throughout his life might benefit from FUE. For patients with minimal hair loss now, Dr. Bolton proactively plans for the future and places hair where hair loss will take place.

 

If a person likes to wear their hair extremely short or even shaved then it would be better to get FUE because of the scar. Also, in the rare situation when a patient is out of donor and needs to go outside the “safe zone”, follicular unit extraction might be beneficial.

The Issue of Scarring

Unfortunately, all doctors are not created equally.   You have some patients with horrible scars and others with scars that are barely visible.  FUE is a reaction to horrible scars.  Everyone sees the bad scars.  A good scar is not visible. [ Click here to see videos of Dr. Bolton's Hair Transplant Scars ]

Advantages of FUE?

When you look at the advantages of follicular unit extraction you realize that the pool of patients who would truly benefit from this type of surgery is tiny.  Proponents of follicular unit extraction say the advantages are decreased healing time, reduced chance of hypertrophic scarring, increased donor area. 

 

Decreased healing time?  It takes 5-8 days for the follicular unit extraction to heal.  With sutures it takes 7-10 days to completely heal.  Is a two day difference in healing at double the cost worth the 'advantage'? 

 

Donor area is enlarged?   Do you really want hairs that aren’t immune to DHT for your procedure?  You can take hairs outside the donor area with a strip, too.  You just wouldn’t want to do so. Taking hairs outside the donor area risk implantation of hairs that are genetically pre-programmed to fall out.  A patient who is in a desperate situation might want to take body hair and hair outside the donor area but not a person who is coming in for their first or second procedure.

 
 

With FUE extraction the punch biopsy instrument can accidentally damage or destroy follicles by nipping the root. The root can also be torn when pulled out. Less harvested follicles means less hair for your transplant.

   

"...Dr. Bolton points out that follicular unit extraction is an evolution of the old plug style removal. "

Proponents of follicular unit extraction who are ethical will admit the disadvantages of follicular unit extraction are that you can’t get as much hair per procedure, and the removal process makes subsequent procedures more difficult. With follicular unit extraction there is more damage to the follicle in the removal process, the process of removal becomes the primary objective as opposed to the artistic focus of the transplant itself. Smaller grafts mean less dense results, and spotty scarring in the donor area are typical with follicular unit extraction. Follicular unit extraction may be warranted in rare cases where the patient has a prognosis of minor hair loss over his lifetime.  The reality is most people will not fit the category of limited loss and are paying twice as much for less density and lower growth yield with follicular unit extraction.  Dr. Bolton points out that follicular unit extraction is an evolution of the old plug style removal.  The removal for a plug was done with a 4mm punch and left an open round scar.  Today follicular unit extraction is a 1mm punch that leaves an open round scar.  Dr. Bolton is happy to do this procedure if the patient wants this technique but he does feel that very few people benefit from it.  Few doctors would turn down the opportunity to double their revenue for the day with follicular unit extraction.  Dr. Bolton puts his patients first and offers tremendous value, results and undetectable scars.

 

 


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