Question 1

What is a DHI hair transplant?

Accepted Answer

Direct hair implantation (DHI) is a variation on the popular hair transplant surgery technique known as FUE (follicular unit extraction).

With FUE, the surgeon harvests tiny bundles of donor hair follicles called grafts from a donor area where hair is more plentiful, usually the back of the head. The surgeon then makes a series of tiny incisions in the thinning or bald recipient area and meticulously implants each graft.

The harvesting method for DHI is the same, but then the surgeon uses a sharp hair implanter pen (the Choi pen) to create the recipient incision and implant the hair graft in one step. For this reason, it’s sometimes called the sharp implanter method, or DHI Choi.

There aren’t yet any studies comparing results from the two hair transplant methods, but providers who favor the DHI technique claim that it can lead to more natural-looking results, faster healing, and higher density. Hairs inserted directly into the scalp grip the skin better, they say, which improves graft survival and growth rate.

On the other hand, proponents of the two-step FUE method still consider it the gold standard for graft placement. “Making the recipient sites separately permits me to more densely pack the grafts in and create superior hair density,” says Dr. Jeffrey Epstein, a board-certified hair restoration surgeon in Miami. “It also allows for more acute angulation of the grafts,” giving him more control over which direction each hair graft will go. The result, he says, is a growth pattern that looks more like your natural hair.

One thing all the experts we talked to agree on: the key to great results from any hair transplant procedure is the surgeon's skill. “It’s not something that depends on the pen, but on the person who does the operation,” says Dr. Emrah Cinik, a physician in Istanbul, Turkey, who specializes in hair transplantation procedures. “It’s crucial for individuals considering a hair transplant to consult a skilled surgeon to determine the most suitable technique based on their unique needs and desired outcomes.”

Question 2

What are the pros and cons of a DHI hair transplant?

Accepted Answer

Pros

DHI is an effective hair restoration procedure for people with thinning hair or areas of baldness.
In the hands of an expert, the new hair can look very natural.
Results are very long-lasting.
Implantation with DHI reduces the time the grafts spend outside the body, which may increase their survival rate and improve treatment results. Grafts are also handled less with DHI, which may aid in graft preservation.
The tiny, dot-like scars are often barely visible, even if you keep your hair short.
Healing is relatively fast. Patients can return to their daily routine within a day or two. Usually, by the third day, the donor area is completely healed.
DHI can be used to restore eyebrows, beards, and other thinning areas.

Cons

Because it requires specialized tools that add to the cost of the procedure, DHI tends to be more expensive than FUE. Insurance doesn’t cover hair transplants.
DHI isn’t superior to hand placement of grafts by a skilled provider. Despite claims that implanter pens improve the outcomes of hair transplantation surgery, no studies prove that.
The risk of newly transplanted hairs “popping” (medical jargon for coming out) is high with DHI, according to a recent article, which advocates overcoming this problem by preparing the recipient sites with pre-made slits.
There’s a learning curve with DHI. “Although the sharp implanter method can be easily mastered, it still requires cumulative experience to skillfully perform the procedure,” says the authors of a recent article on DHI. If you opt for DHI, it’s still crucial to choose an experienced provider. (Also be aware that some providers may use implanter pens to cut corners, using fewer skilled technicians to assist in the surgery.)

Question 3

Who’s a good candidate for DHI?

Accepted Answer

A DHI hair transplant is usually recommended for younger people with mild hair loss. The maximum number of grafts implanted with DHI varies by provider, but it’s usually less than with traditional FUE.

“DHI is perfect for stages 3-4 on the Norwood scale,” says Dr. Cinik, referring to the classification system used to measure the extent of male pattern baldness. Stage 3 is often the first indicator of male pattern baldness (your hairline will start to develop a pronounced “M” shape when viewed from above), while stage 4 shows clear signs of hair loss at the temples and crown.

Question 4

What happens during a DHI procedure?

Accepted Answer

Like all hair transplant techniques, DHI is performed under local anesthesia (with or without sedation).

A hair transplant with the DHI method starts out in the same way as a traditional FUE procedure:

Before harvesting the grafts, the donor area is shaved to increase visibility and access to the hair follicles.
Patients are sedated and areas of the scalp are numbed with a local anesthetic.
Individual hair follicles are removed from areas of the scalp (and possibly the beard, back, and chest) for transplantation into the scalp via a punch. Many punches are used in hair transplantation, but they’re often a version of the original FUE instrument—a small circular hollow scalpel used to incise the follicular unit (aka graft) from the surrounding tissue.

With the FUE technique, the surgeon then makes the recipient sites, using a blade or needle to create tiny holes into which they implant grafts of one to three hairs using needles and forceps.

With DHI, providers use an implanter pen to place follicular grafts. The Choi Implanter Pen, the original device, is still the most commonly used. The device features a hollow needle and a spring-loaded plunger, similar to a ball-point pen. A graft is placed inside the needle, which is used to pierce the skin and create a recipient site. The spring-loaded plunger is then engaged to push the graft through the end of the needle into the newly made recipient site. The device is withdrawn from the new recipient site, leaving the graft behind.

As with traditional FUE, each graft is individually placed. The procedure can take up to 8 hours, depending on how many grafts are implanted. You may need two or more sessions to create your desired result.

Question 5

How long does recovery take?

Accepted Answer

Recovery after DHI and FUE hair transplants are the same, due to the similarities of the procedures.

Expect scabbing and crusting, along with mild swelling and redness for the first few days.
Follow the aftercare instructions provided by your surgeon to protect your newly implanted hair and avoid dislodging a graft.
About two weeks after the procedure, the transplanted hair will fall out. Don’t worry; “shock loss” is normal.
Your new hair will start to grow in 3–4 months.
You’ll see your full results after 12–18 months.

DHI HAIR TRANSPLANT

Karyn Repinski

Karyn Repinski

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Karyn Repinski

Karyn Repinski

DHI HAIR TRANSPLANT QUESTIONS

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