Read on to see what’s changing in the world of hair transplants.

I had a great time presenting at the World FUE Institute conference in Morocco. Below are some of my takeaways. I was flattered that many of the people I interacted with had seen the channel and were keen to chat. 

Not too long ago I presented a workshop on artistic hairline designs at The World FUE Institute hair conference in Morocco. Did I ever appreciate the opportunity to exchange information, teach, and learn from an international crowd of enthusiastic and kindred surgeons – ones who are constantly improving their craft, seeking excellence, and doing what’s best for the patient. 

So, what were my takeaways from the event? 

One of the standout messages was that choosing the right surgeon – someone you can trust and will deliver the best results for you – is still the best way to ensure a great outcome.

Beyond that? There were three topics that stood out to me as being worth discussing here at length: the right number of FUE grafts, long hair FUE (preview FUE), and medical therapy. 

 

Mega and Giga sessions

Too many grafts transplanted into to small an area… Even though mega and giga sessions offer visual gratification and immediate impact, I still don’t recommend them. Your donor supply is precious, and you don’t want to waste it. Image by Freepik.

I’ve spoken a length about the ‘right number’ of hair grafts for an FUE transplant to address advanced hair loss (Norwood 6/7). There are still two main schools of thought – do it all at once or slowly over time. The options are:

A series of up to 3000 graft FUE transplant surgeries spaced 4 to 12 months apart. 

A mega session where 3,500 to 10,000 grafts are transplanted over 1 to 2 days.

A giga session where 10,000 + grafts are harvested and transplanted over 2 days. 

First, let’s talk about the obvious appeal of big sessions – impact. The promise of more density and coverage sooner is appealing and impactful. Another benefit people cite is that if you’ve chosen to travel for surgery, it allows the transplant to be performed in one trip. I understand the appeal. 

Unfortunately, there are some significant downsides that come with these mega and giga sessions patients need to be aware of. If you’re considering one, you need to think hard about what risk level you’re comfortable with. 

Giga and mega sessions harvest at a higher density from your donor area and your donor supply is finite. Once a graft is transplanted, it’s gone (from the donor area). Because so many grafts are being transplanted to an area at once, there’s an increased risk of reduced regrowth (when compared to smaller transplants) as all those hairs are competing for a limited blood supply. 

The length of these surgeries also poses a risk to graft viability. They take a long time and surgeons and technicians – being human – can and do get tired. The higher density of harvesting can pose a greater risk of scarring in the donor area, leading to moth-eaten appearance if hair is too short. 

It’s risky to go for that big homerun. That’s why I still prefer treating a big hair transplant in stages with smaller sessions and incremental improvements over time to protect the viability of the grafts and the donor hair supply. Between sessions, I get to see how the grafts and donor area heal, which can help curtail unpleasant surprises. 

Minimizing complications, maximizing satisfaction – in my mind, that’s visually impactful. 

 

Long Hair FUE

Another hot topic that came up at the conference was long hair FUE, or preview FUE. Contrary to popular belief, hair doesn’t need to be shaved for FUE hair transplants. Sometimes only the donor area is shaved, sometimes the recipient area is shaved, and sometimes there’s a fully ‘no shave’ approach, and newer techniques are making that option easier. 

Long hair FUE, also known as a preview hair transplant, can give you an idea how your transplanted hair might grow out. Keep in mind that those longer hairs will fall out. Image by Freepik.

In a no shave approach, the hairs that are transplanted can be trimmed or left long. The benefit is that you get a ‘preview’ as to how the hair will look once it grows in. The thing you have to remember is that those transplanted will fall out, leaving the transplanted follicle behind – hence the name ‘preview’. 

It can be very satisfying to patients, and it makes it easier for surgeons to place hairs well. I’m excited about potentially incorporating this method into future eyebrow transplants. 

But, as with any technique, there can be drawbacks. First, we know these transplanted hairs will fall out, and we can’t predict if all of them will regrow. That can set people up with unrealistic expectations. 

It’s also a very technical surgery – longer hairs are more difficult to handle (they can tangle) and spend more time ‘in transit’ which can decrease viability. The surgery takes more time – often a whole day – making it a more expensive option. There’s also a risk of dislodging the grafts once a patient gets home and it’s not an option for truly curly hair types – it just doesn’t work. 

That doesn’t mean it’s a bad option – the trick is knowing which cases it’s appropriate for. 

 

 

Medical therapy for managing hair loss 

I’ve talked at length about how crucial a step stabilizing hair loss is before surgery, and the consensus at the convention was that medical therapy makes a huge difference for long term results, regardless of what age you’re at. 

 

Another takeaway from the conference? Advanced age is no longer a reason to avoid prescribing hair loss medication. It can be effective and helpful to manage hair loss whenever it occurs. Image by Freepik.

 

Finasteride is still the gold standard therapy available for maintaining the hair you still have. I usually start patients on a standard dose of 1mg/day and monitor for side effects. 

If a patient is still losing hair, the more potent Dutasteride is an option. Many men are still concerned about post finasteride syndrome, where side effects linger after medication is ceased. Not to downgrade the possibility or discredit the potential of the condition, but the consensus is that it’s incredibly rare – so rare in fact that none of the doctors I spoke to had come across a case, some after decades of practice. 

What does that mean for you? Post finasteride syndrome is not a reason to avoid seeking medical therapy for hair loss. 

There were a handful of other interesting topics I talked about in my video about the conference – quantitative versus qualitative approaches, the death of FUT – if you’re interested in my thoughts on those or a more in-depth discussion, check out the video here. 

If you’re considering medical therapy for hair loss or contemplating a hair transplant surgery, consider a consultation at City Facial Plastics or exploring affordable hair loss medication at Feelconfident.com. 

The content of this newsletter is for entertainment and educational purposes only. This content is not meant to provide any medical advice or treat any medical conditions. Patients must be evaluated by an appropriate healthcare provider on an individual basis and treatment must be tailored to meet that patient’s needs. Results and particular outcomes are not guaranteed.