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Is donor area regrowing after FUE?

A most frequent questions our surgeons are being asked is “Will my donor area grow back after FUE?”.

After we carefully check the donor measurements and take the time to calculate a reasonable harvest number, this question comes often as a surprise to us. Over time, we have come to realize that many rumors and pseudo-scientific claims are propagating throughout the internet, encouraging the myth of unlimited donor area. Some clinics even openly claiming a measured regrowth rate on the website. Therefore, it is no wonder that patient expect the impossible.

When it sounds like magic, looks like magic, promising magic: you can be sure there is a trick! In this case, the trick is called the “Playing on the transection rate”.

Donor area regrowth after FUE, an amazing fairy tale.

Wouldn’t it be great if ….

…If the hair follicule would regrow in the donor area after FUE harvest, we could just wait until for harvested hair to regrow in the receiver area and the donor area, and just harvest it again and again ( by the way, that’s what the Extracellular matrix ACell researches are all about).

…If the hair follicule would regrow in the donor area after FUE harvest, we could make infinite donor area and fill all the bald part, no matter it’s size.

…If the hair follicule would regrow in the donor area after FUE harvest, it would mean that hair surgery by FUE is a no-consequence surgery for the donor area. Take 1 hair from the donor and get 1 in the receiver area, and 1 in the donor area, therefore 2 for 1. it’s a “Buy 1 get 2” permanent sale with 0 impact on the donor area.

Hence, the question? Why are surgeons even bothering to check the donor area? why the measurements? why calculate the hair density and hair caliber ? And even why bother with the receiver area surface? If your follicular unit respawns after harvest, you have an unlimited donor area.

Wound’t it be great !

Frankly, we wish for it too…

But it’s simply not real.

Truthfully, those claims are very good marketing use of FUE’s potential risks.

Does hair multiplication by FUE exist?

Many researches have taken place on follicular multiplication by cutting the follicule. The principle is similar to plant cloning, we multiply the plant by cutting it and making the cut parts grow.

But the human body is complex, and results up till now have been mostly coming to the same conclusions: it is impossible to produce 2 healthy follicules each producing 1 healthy hair from the same starting follicule. According to where the cut is done on the follicule, it happens that both parts survive. But it those cases the hairs produced are not healthy and are similar to velus hair ( no color , no length, no caliber) ( Dr M Kulahci / Dr Ergin Er- ISHRS 2005).

Dr Ali Emre Karadeniz has posted very promising research on post transection regrowth( ISHRS 2015). Those research deserve to be more largely investigated and repeated as these research are opening new paths to follicular unit regrowth after transection, but these findings remain at a early stage and need deeper analysis.

Follicular transection, the number 1 risk with FUE

When the FUE punch ( the cylinder blade) comes into the skin to isolate the follicules, the follicules are still inside the skin. therefore the doctor isolating the grafts cannot see around the follicular unit and therefore can only “guess” where the edges of the follicular unit are actually situated. The aiming part is crucial to the good harvest. If the aiming is slightly off target ( and we are literally talking about aiming at hair diameter precision) the punch blade could cut into the follicules. That happens with every FUE operation; and because it’s specific, doctors have named it:  it’s called transection.

. as  Lorsque le punch FUE isole le follicule à l’intérieur de la peau, le punch peut venir couper ou endommager le bulbe si le praticien “vise” un peu à coté. Ce geste est réalisé à l’aveugle, et demande une grande expérience afin d’isoler tous les bulbes avec le moins de “transection” possible. Plus le bulbe est recourbé, plus il est difficile de l’isoler sans l’endommager. C’est la plus grande difficulté de la FUE et qui fait justement dire à certains praticiens, que certains follicules “repousseront” dans la zone donneuse prélevée, ce qui est vrai, puisque ces follicules n’auront pas été prélevés correctement.

Par contre, il est important de noter que ces follicules ne pousseront pas dans la zone de transplantation, et qu’il n’y a aucune garantie que le follicule repousse aussi dans la zone donneuse. Statistiquement, les follicules meurent dans leur grande majorité, lorsqu’ils sont transectés. Si ils repoussent, ils produisent un cheveu velus. La perte est donc double: dans la zone donneuse et dans la zone receveuse.

Le taux de transection est l’élément qui peut permettre aux patients de juger de la qualité d’une FUE. Plus celui-ci est bas, plus le praticien obtient des follicules parfaits et entiers.

Note: cet article a été écrit le 26 mai 2013 , puis ré-édité et complété le 1er avril 2016.

Auteur : P Hollenbeck