Friday, May 11, 2007

FUE and strip hair transplants compared

I only recently discovered FUE (Folicular Unit Extraction), and this has been a revelation for me. FUE leaves no scars, and the recovery after surgery is a lot less painful than strip surgery. To me, this makes a huge difference.

Disclaimer: Please note that this is not an unbiased comparison of the FUE and strip surgery methods, as I'm now strongly biased towards FUE because of previous bad experiences with strip surgery. Still, I hope to shed light on some important issues pertaining to FUE and strip surgery.

It's easy to think that the strip scar is no problem, that it is easily hidden underneath the hair, and thus does not cause worries. This has not been the case for me.

I have had several issues with the strip scar which are worth considering. To me they are more then ample reasoning to choose FUE surgery instead of strip:

  • The strip surgery made me loose much of the feeling in my neck. Even now, 6 years after my last strip surgery, I still have very reduced sensibility, like a constant numbness.

  • The strip scar made me very selfconcious. I no longer enjoyed small things like being tickled in the neck for fear of having my scar discovered. And forget about going to the hairdressers. It's difficult putting a price on these small things, but to me, this has been a real pain, as I end up driving people away for fear of being "found out".

  • The strip scar steals a lot of energy. The scar always has my attention. Is it visible? Will someone notice? Should I comb my hair again? This is the real killer for me, as it kills my spontaneousness. I hate going swimming, for example, because it messes up my hair so the scar becomes visible.

  • I can't wear my hair short anymore. I'd love the ability to just shave my head, or at least being able to wear it short. With little hair on top, it looks strange to wear it longer in the neck to cover the scar.

  • The strip surgery forces you to continue transplanting. In most cases, you continue loosing hair. With the strip scar to cover up, you have lost the option to just shave your head. Also, to cover the scar, you usually need longer hair, making the need for more hair on top more pressing. I feel FUE leaves you with more choice in this respect.
I quoted a person suffering from a bad hair transplant in another blogpost:
"I have really lost a good five or more years of my life worrying about hair, when I should have been worrying about living. It is such a monumental waste of anyone’s life"
This quote describes how I feel about my strip surgery scar. I realize that not all patients will have the kind of worries I have described, but I still think it's important to take them into account when choosing between FUE or strip surgery.

Largely because of the reasons above, I decided to have a FUE hair transplant in an attempt to cover up my strip scar. Earlier this week I had FUE surgery at Dr. Mohammad Mazhar Hussains' clinic in Pakistan (see - mainly to cover up my strip scars. Now I'm patiently awaiting the results. Graft growth is usually poorer in scar tissue, but I'm hoping enough hair will take root to cover my scar.

New Hair Clinic (which performed my strip surgery) adviced me to get "hair simulation" in the scar in the form of permanent makeup which is tattooed on the scar. I tried this, but the result is plain ridiculous, and doesn't look natural.

Dr. Mohammad Mazhar Hussain has a table comparing FUE and strip surgery hair transplantation on his website. This was how I first gained interrest in the FUE method.

I only wish I'd waited with my own transplants until FUE surgery was available.

Update: It's now been two weeks since my own FUE operation. I can assert that the recovery is really as quick as promised, and it's a big relief not having to shy away from work for months on end. I have my first day at work tomorrow, but I'm not worried at all. I'll try to put up some pictures later on in a separate post.

FUE hair transplant by Dr. Hussain

Update: Looking at this post now, it reads as a shameless plug for My Hair Clinic. But I'm really content with the results so far. It's now a little over two weeks since I had my procedure done, and I have my first day at work tomorrow. The surgery is virtually invisible already. The donor area is fully healed, and the redness visible in the pictures below is gone.

Last week (may 2007) I had a FUE hair transplant of 2000+ grafts at Dr. Hussains hair transplant clinic in Pakistan (My Hair Clinic).

Let me jump right to the conclusion: I'm extremely happy with having chosen Dr. Hussain's clinic!

Dr. Hussain specializes in FUE hair transplants, which means I could avoid another strip surgery scar in my neck. FUE hair transplants means moving individual hair follicles from the neck to the top of the head. The procedure takes a lot of time, but produces amazing results.

Improving my hairline by disguising old, big grafts

I had Dr. Hussain placed new hairs in the hairline, to help hide the bigger grafts used by Nobel Clinic, and soften the odd direction of the grafts placed by New Hair Clinic.

I did not shave the recipient area, although Dr. Hussain strongly recommended this. I was worried that my old hair plugs would become visible. The short hairs in the pictures are my implanted grafts, and you'll see some redness in the skin in this area.

The left picture shows my old grafts, placed standing up by New Hair Clinic. It's always bothered me how unnatural this looks, especially in areas adjacent to my "real hair," which points forward. Dr. Hussain helped give my hairline a more natural angle, and make a gradual transition from my real hair to the old transplants.

Note the big graft, consisting of 8 hairs, in the picture on the right. These grafts are really visible in the hairline, and I comb my hair to cover them as best I can. Repair work was done by placing individual hairs in the hairline, and between the bigger grafts. The amount of attention Dr. Hussain gave to placing every single hair in a best possible direction really impressed me.

Hiding my strip surgery scar

Hiding my old strip surgery scar was a top priority when deciding to do my FUE hair transplant. I decided to place 500 grafts in the scar to try to cover it. Dr. Hussain informs me that there's often reduced growth in scar tissue, but he expects 60-80% of the grafts to grow. There are several pictures of patients with strip surgery scars on Dr. Hussains website, which helped me make my own decision.

The donor area is shaved before hair follicles are extracted. You'll see in the pictures below that I decided to keep some hair above my strip scar to help keep it hidden.

Recovery in the donor area

Recovery of the donor area has been amazingly fast, compared to earlier experiences with strip surgery.

I had 2000 small scabs in the donor area, one for each graft, but these are really small, and heal quickly. The pictures shows my donor area 4 to 6 days after extraction.

A closeup of the donor area shows the small scabs. After 6 days (left picture), the scabs are almost gone.

I'm really happy the recovery is so quick. FUE hair transplants are a breeze compared to strip surgery. Strip surgery is painful in comparison, and also gave me big visible bruises behind my ears where the skin is thin. The bruises stayed on for more then two months, and I had to use makeup to conceal the blue and yellow color from my colleagues at work.

All in all, there are lots of reasons to avoid strip surgery if you can.

Making my decision

I had a lot of questions that needed answers before I made my decision, and Dr. Hussain himself patiently answered me. This was a key point for me when choosing his clinic, as it enabled me to establish a trusting relationship to him. I've had too many experiences talking with some clinics front office, or seedy consultants which are paid to bring in patients for the clinics, only to discover the results are nothing like promised.

I also met Dr. Hussain in Norway for a consultation, and this made me even more certain about my choice. Dr. Hussains is very pleasant, and came across as genuinely interested in my well being. His skills were also immediately apparent, as he pointed out why my old grafts did not look natural, and how modern techniques work differently. I learned a lot about the natural angle of the hairs and how hairs should not be placed to deep in the skin - things I wish I'd known about when I did my first hair transplants.

I decided to have my hair transplant in Pakistan, as this made it very affordable. At first I was unsure about traveling to Pakistan, but in hindsight this turned out to be a very positive experience.

Final words

Although actual growth is months off, I'm really confident about the result already.

Researching this last hair transplant was a long process. I wanted to make absolutely sure I avoided the mishaps and disappointments I've had with earlier transplants, as documented here in my blog.

Thankfully I found Dr. Mohammad Mazhar Hussein, and I can warmly recommend a visit to his clinic. I gave his clinic top ratings at

Now my head is itching and scratching, and I'm looking forward to seeing the full results of Dr. Hussain's work.

Strip surgery at the New Hair Clinic in Sweden

Disclaimer: It's more than 6 years since I had my hair surgery at New Hair Clinic. They have probably updated their methods since then, and some of my experiences might not be relevant anymore.

I had three treatments at New Hair Clinic, first to cover my previous punch grafts done by Nobel Clinic, and then two to increase my hair volume.

All in all, I'm quite content, although there are issues with unnatural looking hair and a visible strip scar in my neck. The transplants have given me confidence by helping me look younger, but have also made me very self conscious about my hairline and the strip scar in my neck.

These worries steal a lot of energy, and has often distanced me from close relations. I have never liked people touching my hair, lying on someones lap, or being too close. This is the sad part to me, as it has somewhat changed me as a person. These are some of the reasons I don't recommend strip surgery hair transplants, but natural looking hair is of course equally important.

Note: I have no knowledge of the quality of work produced by New Hair Clinic today (6 years later), but I do know they still use the strip surgery method.

Unnatural looking hair

The biggest issue for me has been somewhat unnatural results produced by New Hair Clinic at the time. This was not too apparent at first, as I had some of my natural hair left between the grafts. But as my own hair disappeared, it's been gradually more visible.

There are two issues in particular causing the unnatural look:
  • Unnatural angling of the hair
    The transplanted hairs have been placed standing straight up on my head (perpendicular). This looks particularly unnatural, especially at the temples, where my new hairline meets my natural hair on the sides. Natural hair points forward in this area, not straight up, and thus it's very visible where my transplanted hair begins, as the angle shifts very abruptly.

  • Grafts placed too deep. This is somewhat the reverse effect of the "cobblestone" appearance seen on some patients. The grafts are placed too deep in the skin, creating small dips or holes in the skin around each graft. The skin is very uneven, and the result is quite visible in the hairline.

  • Unevenly placed grafts. A large portion of my transplanted hair was placed on the right side of my head, producing a somewhat unnatural look. Also, there are large areas where no grafts were placed at all, while other areas have tightly placed grafts. Because of this, I've had to maintain small "comb overs" to cover the bald spots, and cut my hair shorter on the right side.
Luckily, I have curly, frizzy hair, which dampens the effect somewhat.

The strip scar

At the time I had my operations, strip surgery was the best option, and in this light I'm quite pleased with New Hair Clinic.

After three transplants, my strip scar is still quite thin. At least they've done a good job on me compared to what you can see on other strip surgery patients. Dr. Hussain showed me a patient with particularly brutal scars on his web pages. Note that this is not a patient of New Hair Clinic.

After my last surgery, the stitches on my right side came undone, causing some bleeding. This is probably also why my scar is more visible on this side.

Deciding against New Hair Clinic

After discovering FUE I did not want to do another strip surgery. After all, hiding the strip scar was a big point to me, and I didn't want a new one.

New Hair Clinic now offers FUE hair transplants, but this does not seem to be their area of expertise. As I also had some uncertainties based on my own results from 6 years back, I wanted to make sure I got the very best results for my latest hair transplant. I guess I just needed extra reassurance for my last hair transplant.

I got the reassurance I needed when I met Dr. Hussain from My Hair Clinic for a consultation in Norway. Being able to meet in person made a world of difference to me, and so I stopped scanning for other alternative clinics, and thus ruled out New Hair Clinic.

It's difficult for me to judge the quality of New Hair Clinics work today. It's been 6 years, and the hair transplant field has evolved enormously. I can only recommend that you think through the issues concerning strip surgery, and maybe make some extra inquiries about hair placement and angling of the hairs (see above) to ensure a natural look.

You can also check out my experiences with Dr. Hussain.

Avoid Nobel Clinic at all cost

I had my first hair transplant at Nobel Clinic in the UK, after a referral there from their local branch in Norway.

My only advice is to avoid Nobel Clinic at all cost.

Although this is now many years ago, their methods were already antiquated back then. The procedure itself involved "punch graft" extraction of hair from the neck. These punches were then cut into what I believe they called "micrografts". These are grafts containing 5 to 8 hairs, which is far too much to give a natural appearance. The result I got was what is popularly referred to as "dolls hair", and my neck was painful and full of ugly bald areas.

Their own website states that "The treatment is a minor surgical procedure that takes 2/3 hours". From this, it's evident that they have to compromise on quality. Modern hair transplant surgery takes much longer time, because hair follicles are placed one by one, not in large groups of up to 10 hairs (which means 10 times the work). Also, great caution is used when placing the grafts, to achieve a natural appearance. It's important to get the angle of the hair right, and to avoid placing the grafts too "deep". Nobel Clinic fails on all these accounts.

I ended up going to New Hair Clinic in Sweden to cover up the work done by Noble Clinic.

It seems I'm not alone in having bad experiences with Nobel Clinic. A blogger calling himself "Nobel Victim" writes "I have really lost a good five or more years of my life worrying about hair, when I should have been worrying about living. It is such a monumental waste of anyone’s life [...]" I certainly know the feeling. My results weren't as bad as his, but I'm inclined to think it was only because I had a smaller transplant.

Read about my further experiences with
New Hair Clinic in Sweden, and just recently, uplifting experiences with FUE at Dr. Mohammad Mazher Hussains clinic in Pakistan.