Dear brunette, Thank you for writing in with this question. The diagnosis of hair loss is fairly straightforward, and involves not just a patient history but a physical examination of your scalp with a dermatoscope. A dermatoscope is essentially a microscope designed to closely examine skin, and during a consultation appointment I examine everybody’s hair carefully to assess where there is hair loss. First I check the areas that are not supposed to have any hair loss (the areas on the back and sides of the scalp that usually do not thin out) and then I compare that to the area(s) in question. What I’m looking for is the percentage of hairs that are in a miniaturized state. In normal, non-thinning hair it’s normal to have up to 15% of these hairs in a miniaturized state. I can use the dermatoscope to take photos of the follicles as they exit the scalp in the areas of permanent hair and the area(s) in question for direct comparison on the computer screen. The patients can see for themselves, and I find that provides a tremendous amount of peace-of-mind for my patients. If there is hair loss present then something can be done about it. If there is none present then a re-check as necessary is indicated. In terms of repairing an area that has suffered from trichotillomania in the past, it too will need to be examined. It’s a general rule to wait until there has been no picking for at least 2 years prior to any surgical intervention. For FUE/ARTAS: yes, the hair must be trimmed. The singular advantage to the FUE procedure (which is Follicular Unit Extraction, the type of hair restoration the ARTAS performs robotically) is that it doesn’t leave a linear scar, which is a major concern mainly for men who would like the option of wearing very short, military-style haircuts, or for men who’d like the option to just shave their heads later in life. For women scars on the scalp tend not to be as big of a deal, as there is typically no plan to shave the scalp in the future or wear very short hairstyles. Thus, most women opt for an FUT procedure because they don't’ want to trim down their hair for obvious reasons. Many surgeons around the country and around Atlanta have acquired new devices for hair restoration, like the NeoGraft machine, and are suddenly holding themselves out to the public as hair restoration experts. NeoGraft has done a tremendous amount of marketing, and I see physicians who have never done a hair transplant around the country acquire this machine, piggyback on the marketing done by NeoGraft, and start to offer this complicated, and permanent procedure to the public. In much of the country, the doctor will simply hire a technician (the going rate for a NeoGraft tech in Atlanta is $70/hour) to perform the procedure. Whether using the NeoGraft, or the much more advanced ARTAS robotic hair restoration system, or any other device, including a 50 cent 1mm biopsy punch, it is the experience and dedication of the surgeon and his team that will determine the outcome. All this to say that if you look online you’d certainly think the FUE procedure is the new wave and much better than a linear procedure (FUT). This is due to the financial opportunities as outlined above. However it’s important to note that the vast majority of women undergo an FUT. It’s also important to note that according to the International Society of Hair Restoration Surgery that the FUT method remains the “gold-standard” for hair restoration today. If you still have questions, I would suggest making an appointment with an experienced hair restoration surgeon who has dedicated his or her career to the field of hair restoration, not one who acquired a machine in the last year or so and are having a go at a brand new field. I hope this information is helpful to you. Kind Regards, Ken Anderson, MD Atlanta, Georgia, USA