Is New Hair Transplant System Over-Hyped?

JeffreyEpsteinMD on 25 May 2011 at 1:30pm

For the past 11 years, follicular unit grafting (FUG) has been the procedure of choice for hair transplants.  Requiring a large team of experienced technicians, every graft -- each containing a follicular unit that consists of one to three, sometimes four hairs --  is dissected under microscopes, then planted into tiny incisions in the scalp- in my practice, made with blades 0.5 to 0.8 mm in size.  The donor strip incision is sutured closed, healing in the great majority of patients as a fine line scar 2 mm or less in width, usually permitting hair to be trimmed short with a razor. With the innovative plastic surgery trichophytic technique, hairs can actually grow through the scar.

Before and after strip hair transplant

Dr. Jeffrey Epstein on Neograft transplantFive years ago, the follicular unit extraction technique (FUE) quickly grew in popularity upon its introduction, but this growth has largely leveled off.  The FUE grafts --  each containing a follicular unit -- are harvested individually, leaving hundreds to thousands of essentially undetectable dots in the scalp.  This allows the patient to cut, even shave their head as short as they wish without having any detectable linear donor site scar. 

FUE can be the best procedure for patients who are young, usually male, keeping open the option of shaving their head, African-American, and/or having reparative work with a limited supply of donor hair.  Over the past three years, FUE has composed approximately 30% of my hair practice (12 to 15 hair transplants procedures performed weekly).  Amongst my top 20 or so peers nationwide, this makes me one of the busier FUE surgeons. Most of them perform fewer of these procedures, due to several disadvantages that include:

  • Lower percentage of hair regrowth-  70 to 80%, versus 90% plus with FUG.  There are also some patients who have a much lower percentage of regrowth from FUE for reasons not fully understood, perhaps due to the somewhat traumatic nature of harvesting these grafts from the surrounding scalp tissue
  • Need to shave the scalp to obtain more than 350 to 400 grafts
  • The grafts are slightly larger, meaning the recipient sites need to be a bit larger, reducing the potentially density that can be obtained
  • Longer operative time --  in  a single day procedure, typically no more than 1200 to 1400 grafts- and maybe 1800 with a highly efficient team-  can be transplanted
  • Higher cost

The advantages:

  • No linear donor site scar
  • Viewed as a less invasive procedure, thus higher acceptance

Before and after FUE hair transplant

Three years ago, an automated FUE machine came to market -- NeoGraft.  Failing to be adopted by nearly all hair transplant surgeons, the device is now marketed to all cosmetic doctors as a turn-key approach to adding hair transplantation to the practice.  Despite claims, the device does not seem to overcome any of the disadvantages associated with FUE performed manually other than shortening the surgical time and reducing the need for trained assistants. 

Of the claims made by on their website, none could be further from the truth than “a more natural looking result than traditional strip methods”.  Unless a thinner look -- due to a lower percentage of hair regrowth --  is “more natural” (something we saw years ago with the promotion of laser hair transplants), then this claim is simply false.  The few patient results that have been legitimately presented are for the most part disappointing in terms of density, and the ability to create natural appearances is an artistic skill, not provided by the use of technology.

Ed. Note: After our first post on NeoGraft, Dr. Epstein contacted us and asked to share his passionate and thorough opinion about the usage of this system.


Hair transplant before and after pictures


Comments (5)

And what we know in medicine is always changing. Currently, FUE procedures constitute over 50% of our work, and this number increases quite dramatically every year. We have developed a system using a manual drill combined with the punches we like that are 0.8 and 0.9mm in size. The results we have found to be the most reliable with the least scarring.
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Nice and informative….. Successful communication is key in every successful learning …. Medical surgery is best performance depends on Medical .Understanding your subject and having good knowledge on your blog topic is always essential for a successful blog… Thanks for this post…..
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Hi My name Is Shlomo and 3 years ago I had a hair transplant. In order having the best results I did a wide research on the subject of hair transplant. After I achieved an extreme makeover I decided to build a website on the subject of hair transplant and hair loss in order to share my experience and knowledge. Sincerely yours Dr Shlomo (PhD)
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I enjoyed reading your article Jeff,

We performed a research to compare three different methods of FUE transplant, namely, manual, automated with Safe System and NeoGraft about a year ago. We extract graft with each of those techniques for one hour each and examined the quality of grafts (number of intact grafts) and the number of grafts per hour. Here is my blog post on the study: Hair Restoration Blog

Only by reviewing the initial results from these techniques (trasection rate and time of surgery), we stopped using NeoGraft in the experiment.

We currently use other automated methods in a regular basis as well as manual FUE for more limited sessions of hair transplants.

I believe companies that bring a new technology should be able to present reproducible results from multiple clinics before they start promoting their product.

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I enjoyed reading your article comparing less invasive FUE hair transplants with the linear harvesting method.

In Boca Raton, 90% of our cases are performed with FUE/NeoGraft. Only 10% opt for a linear harvest.

In our hands, the NeoGraft has allowed us to harvest a higher hair per graft average than manual techniques, as well as improve the total numbers of grafts harvested per hour and therefore per session.

I think the higher accuracy of the harvest (less transection and/or missed follicles) has mainly to do with both the very finely adjustable depth of the device and the contra-angle handpiece.

We "set the depth" for each patient individually at the start of the harvest. This can be adjusted to a fraction of a millimeter allowing for the 'perfect' release of the intact follicular unit from the scalp, without going too deep (a common cause of transection).

The angled handpiece allows for excellent visualization of the angle of exit of the hair shaft--critical for accurate harvesting.

In addition, in our hands, FUE grafts obtained using NeoGraft seem to grow as well, if not better, than microscopically-dissected grafts so "survival" is not an issue.

Some of this can be seen in the six-month post-op photos from the past 2.5 yrs... to me, many seem to be 'ahead' of what would be expected for that time-frame.

Another advantage of FUE/NeoGraft is of course the return to physical or athletic activity in days instead of weeks.

Overall, though, great article!


Alan J. Bauman, M.D.
Bauman Medical Group
Diplomate, American Board of Hair Restoration Surgery

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