(a) A patient who underwent the old round graft hair transplanting from 1980 to 1995 and who initially had very good cosmetic results in both recipient and donor areas. (b) By 2005 however, some scars in the donor area fringe, adjacent to the balding crown area, had become noticeable, especially when his hair was wet. This was due to the fringe hair gradually becoming less dense and finer textured, thereby decreasing camouflage of the scars by their surrounding hair. (c) Twenty-nine years after starting transplanting, the fringe hair had become sparse enough and fine enough that the problem also involved the temple areas. The hair has been parted in this photo to clarify the extent of scarring. The patient had unsuccessfully tried to improve the appearance in this area with inexpert tattooing. (d) This photo was taken at the same time as (c). Very little hair was left to camouflage the problem scars that were clearly noticeable with the hair dry or wet. In retrospect, too much donor hair had been harvested from the upper borders of the originally assessed fringe hair because the severity of hair loss had not been foreseen. At this point he was only 53 years old and could reasonably anticipate many years of a very serious and worsening cosmetic problem.
Another patient whose donor area looked excellent for many years but as the hairs within the highest portion of the fringe hair gradually became sparser and finer textured the donor scars became easily visible beginning approximately 20 years after his last hair transplant (his recipient area luckily had continued to look quite good at this point!). It is best to stay within the SDA (Figure 6) when harvesting grafts – whether by strip method or FUE.
(a) 1000 FU were extracted by another physician via FUE, 3 years prior to this photo, leaving the donor area with an unnatural moth-eaten appearance with the hair worn at the length shown here. The patient had undergone FUE in the hopes of being able to shave his donor area without scar noticeability. (b & c) Punctate oval/round FUE scars are obvious with the donor area buzzed very short for an additional FUE procedure just above the original donor sites. This time the FU were harvested by me, with a smaller punch and wider site spacing than the prior surgeon had employed. The grafts obtained in the second FUE session were placed into the worst scars from the first session. FUE is not scarless.
This is a copy of a page from a promotional brochure for the Artas robot. While there is minimal noticeability of the scars 7 days post-procedure, the photo also reveals how high the grafts have been taken and very close to the border of a balding area that is destined to get larger in most patients as they age (the younger the patient, the more likely that will occur). Hairs transplanted from areas that eventually lose their hair will result in loss of those hairs in the recipient area in which they were placed, as well as donor scar noticeability. This type of harvesting unfortunately is too common when FUE is carried out, whether by hand punch, motorized punch or robotic punch.
Some FUE operators have referred to FUE harvesting as “minimal excision surgery”! Compare the above intra-operative photos showing a strip wound immediately after surgery in the left upper corner and FUE in the other photos; then decide for yourself which method is more minimal. Note also in the photos on the right hand side, how close an obviously balding area’s border is to areas that were harvested. (The photos on the right are again taken from an Artas Robot promotional brochure.)