Hello, I am trying to decide between FUE or surgery. I do not have substantial thinning and am concerned that the transplanted hair may not match the density of the existing hairline. I had several consultations and was told that a small 300-350 graft procedure should correct the asymmetrical portion of my hirline and advance the center to a more proper position. How dense can grafts be placed, and how many foliceles would naurally be in square centimeter? What risk with Surgery? Thanks
Hairline Advancement Surgery or FUE?
Doctor Answers (4)
Surgical Hairline Advancement (SHA) vs. Follicular Unit Extraction (FUE)
The SHA technique is a 2 hour procedure performed usually under local anesthesia with some oral sedation (but if desired, can be performed under intravenous sedation) that involves making an incision along the hairline and advancing it, lowering it by as much as 1 ½ inches (3.5 cm) or more in a single procedure, removing the excessively high forehead skin, with virtually instantaneous results. The sutures along the hairline are removed at 5 to 7 days, leaving a fine line scar that is designed so that hairs actually grow through it. To secure the advanced hairline in its more forward position, oftentimes small Endotine" hooks are placed below the scalp, which dissolve after 4 to 6 months (they cannot be felt unless you push down directly on them). This procedure is best for patients with a flexible scalp to allow for sufficient advancement, and can be combined with a browlift for patients desiring a more youthful eye region if the eyebrows have fallen with age. To assess your scalp laxity, you need to place your index finger right on the midaspect of your hairline, and see how far it can move back and forth- this total excursion is a reasonable estimate of just how far the scalp can be advanced with the SHA. Another requirement for being a good candidate is that there should not be any thinning of the frontal hairline, and that the hairline hairs are stable. Lastly, some patients choose to undergo hair grafting after the SHA to both round out the hairline, allowing filling in of the temporal regions, as well as to help further conceal the fine line scar that may be visible in the occasional patient. This grafting can be performed as soon as 3 months after the SHA, and typically ranges from 300 to as many as 800 grafts.
The more commonly chosen procedure to advance the overly high hairline is hair grafting. This is a typically less "surgical" procedure, involving the transplanting of 1200 to as many as 2400 grafts (depending on how much lowering is desired) in a single procedure, taking 3 to as many as 8 hours to perform (it is a very meticulous procedure). Every graft is placed into tiny recipient sites (0.5 to 0.8 mm in size) each one made by me- these sites then determine the direction, pattern, and angulation of growth to assure a natural appearance. The transplanted hairs typically fall out within 3 weeks, then start to regrow at 4 months, taking a full 10 months or longer for final results. The hair grafting procedure is ideal for hairlines that are thin or thinning out, for those who want a hairline that not only is lower but also is more rounded, and for those who opt not to have or are not good candidates for the SHA.
In your case, you sound like a much better candidate for hair grafting, but this needs to be decided in conjunction with your surgeon.
FUE for Hairline Refinement
FUE allows for more freedom in hairline design, which is exactly what you need. An advanced FUE practitioner will typically be able to use donor hairs from the nape of the neck, which are finer in nature than hairs from the traditional donor zone, and are well matched to an existing hairline. FUE hairline refinement will be less invasive than a hairline advancement surgery and better able to address your detailed concerns about symmetry, shape and softness.
FUE vs. advancement surgery
First of all, FUE is a method for harvesting follicles for a hair transplant and the result can be no better than grafts harvested by the classical strip technique.
If you have dense hair in the front, it is doubtfull that one session of 300-350 grafts will do what you want. Normal non-balding density is the equivalent of 90-100 follicular units/square cm. Unless you have very fine hair, 50 grafts/square cm is the most that is done in one session.
The hairline advancement should be considered with caution if you are balding. It might work well under certain conditions, especially if you are not adverse to having grafts at a later time in life. If you are female this is not an issue.
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Hairline lowering or grafting.
You will get a better result and much cheaper with an advancement if you want a significant lowering. 350 grafts is hardly anything if you count the hairs in 1/2 inch on your scalp. Hairline advancement which we developed with and without a tissue expander is a procedure that the surgeon must have experience with to get an excellent result. If you just need a small area get transplants.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.