Articles Tagged with: FUE
5 Benefits of an FUE Hair Transplant

5 Benefits of an FUE Hair Transplant

The world has changed a lot in the last 16 years. That includes the way we approach hair restoration. Advancements in technique and technology have radically altered and improved hair transplant surgery. Specifically, the dawn of the Follicular Unit Extraction (FUE) technique in 2004 and the development of the advanced ARTAS System shortly after that have dramatically improved the process and results we can obtain through hair transplant surgery.  

Miami Hair Institute’s Dr. Rose was one of the developers of the FUE technique. Both Dr. Rose and Dr. Nusbaum have performed the procedure on thousands of patients since 2004 with exceptional results.

Here are the top five benefits of FUE hair transplant surgery:

  1. Minimally invasive.

We perform FUE transplants on an outpatient basis in our comfortable, welcoming offices using only local anesthesia. Patients arrive on the morning of the procedure and can go home the same day.

  1. Unmatched precision.

Our approach utilizes the image-guided robotics of the ARTAS system, which provides unmatched precision in hair transplantation. The ARTAS procedure restores your hair by transplanting permanent hair from the back or side of the head into thinning areas, including the hairline.

Using the ARTAS system, we digitally scan the scalp, identifying hair in its natural groupings. High-resolution digital imaging provides crystal-clear detail of the donor area. We then carefully remove the selected follicles while most of your hair is left untouched and undamaged so that the donor area retains its natural appearance. We transplant the donor hair into thinning areas where it will then grow naturally, just as it did before.

  1. Quicker recovery time.

One of the benefits of FUE is that healing and recovery after an FUE procedure tend to be quicker and involve less post-operative restrictions than other hair transplant methods.

  1. Minimal and barely visible scarring.

During an FUE transplant, we remove follicular units from the scalp one-by-one. By doing so, we avoid the more apparent linear scar often associated with other hair transplant methods. Instead, scarring occurs in a dot-like pattern that is virtually undetectable after healing and regrowth. This minimal scarring means that patients can wear their hair very short (but not completely shaven) without any visible evidence that they have had a hair transplant procedure.

  1. Higher graft survival rate.

FUE transplants have a 90-95% hair graft survival rate compared to the approximately 75% survival rate of the older FUT method. The precision harvesting of FUE minimizes trauma or transection of the hair follicles during the harvesting process.

Learn More About The Benefits of FUE. Schedule an Appointment for a Hair Loss Evaluation Today

If you would like to learn more about FUE transplants and how we can help you restore your hair, we invite you to schedule an evaluation at the Miami Hair Institute. Drs. Nusbaum and Rose are internationally acclaimed hair restoration surgeons with more than 40 years of combined experience. To receive a personalized evaluation and treatment plan, contact us online or call our office directly at 305-925-0222.

FAQ: Can I Color My Hair After an FUE Hair Transplant

FAQ: Can I Color My Hair After an FUE Hair Transplant

One of the many advantages of the Follicular Unit Excision (FUE) hair transplant technique – developed and implemented by Dr. Paul Rose of the Miami Hair and Skin Institute – is that healing tends to be faster and involves fewer post-operative limitations than other hair transplant methods. 

But it is important to remember that hair transplant surgery is, in fact, surgery. As with any surgery, there will be some things you can’t or shouldn’t do in the days and weeks after your procedure as your body recovers and heals. With hair transplant surgery, you should be able to return to work within a day and resume most day-to-day activities in a week to 10 days. But when it comes to how you treat your newly transplanted hair follicles, caution, care, and patience are key to ensuring optimal results.

This includes waiting a bit before coloring your transplanted hair. It’s not that you won’t be able to use gels, dyes, colors, straighteners, and similar treatments – you will – it’s just that you need to hold off a bit before you do so. 

That’s because your transplanted hair follicles will be more sensitive and prone to damage than your existing hair. The chemicals, bleach, and peroxide in most hair coloring treatments are particularly harsh, and if you use them on follicles which have yet to take hold and develop their own blood supply, you can be sending those follicles to an unfortunate and avoidable demise. 

That said, your transplanted hair will eventually become as strong and resilient as the rest of your follicles if it is allowed to recover and start growing in peace for a bit after surgery. Therefore, you should wait at least one month before considering coloring your hair or using styling gels and blow dryers. 

Of course, you should always follow the specific post-operative instructions your hair transplant surgeon gives you. If you have questions or concerns about resuming the use of hair coloring or any other styling products or techniques, don’t hesitate to ask your physician. They will want your hair transplant to be as successful as you do and will be happy to work with you after your surgery to make sure you take all the steps and precautions necessary to maximize your results.

Schedule an Appointment Today For Your Hair Loss Evaluation

If you want to learn more about the FUE hair transplant technique and post-operative care, or if you are ready to take the first step on your hair restoration journey, we invite you to contact us at the Miami Hair and Skin Institute. To receive a personalized evaluation and treatment plan, contact us online or call our office directly at 305-925-0222.

The ARTAS iX Robotic Hair Restoration System Upgrade in Detail

Everything You Need to Know About ARTAS iX

At the Miami Hair & Skin Institute, Our award-winning surgeons are renowned for their mastery in the field of hair restoration. But they are also committed to staying at the cutting edge of technological innovation.

Perhaps the best example of our leadership when it comes to the use of advanced technology has been our pioneering work with the ARTAS system, which provides unmatched precision in hair transplantation. We do approximately 200 ARTAS cases a year and are NUMBER ONE in the Eastern United States in procedures performed.

Now, we continue this proud tradition with the introduction of the latest advancement in precision hair restoration: the ARTAS iX™ Robotic Hair Restoration System. Our own Dr. Paul Rose, MD recently gave a presentation at the South Beach Symposium in Miami about this technology and how it dramatically moves the needle on how natural- looking the results of hair transplant surgery can be. 

What is ARTAS iX?

ARTAS iX is the only hair restoration solution which utilizes machine-based vision, machine learning, and artificial intelligence to provide precise, minimally-invasive, repeatable harvesting and implantation functionality in one compact system. It is the first and only physician-assisted system that can dissect and assist in the harvesting of follicular units directly from the scalp, create recipient implant sites using proprietary algorithms, and implant the hair follicles into the designated sites.

The system is equipped with a 3D-camera stereoscopic vision system with improved 44-micron resolution and a 7-axis robot arm to deliver unmatched procedural analysis, precision, repeatability, and clinical workflow efficiency.

How is ARTAS iX Used in Hair Restoration Surgery?

When performing a follicular unit extraction (FUE) procedure with the ARTAS iX, the surgeon loads 25 harvested grafts at a time into rectangular cartridges. He or she will then insert the cartridges into the arm of the robot that implants the grafts directly into the scalp. 

A significant advantage of using cartridges, rather than a manual technique, is that the grafts are more delicately handled, reducing the risk of graft injury. When surgeons implant grafts manually, they typically grasp the follicles by the bulb, or just below the sebaceous glands, and then bring them into the incision risking considerable damage to the follicles while doing so. With ARTAS iX, grafts are held at the epidermal end and then gently placed into the cartridge. This eliminates unnecessary and avoidable injury to the growth of the transplanted hair by avoiding the lower and mid-portions of the follicles.

The hair restoration physician uses the ARTAS iX to digitally create a recipient site plan that communicates directly with the robot. The surgeon programs the specific size, distribution, density, direction, and angle of the sites for the follicular unit grafts. The ARTAS iX’s vision system identifies where the grafts will be placed and leads the robotic arm into position. Once the system automatically orients itself over the patient’s recipient area, implantation begins. The ARTAS iX can implant up to 500 grafts per hour, making it as efficient as it is precise.

Learn More About the ARTAS iX at the Miami Hair & Skin Institute. Call Today For Your Personalized Evaluation.

We are proud to offer our patients the benefits of ARTAS iX technology and are among the first clinics in the United States to do so. This is just the latest way that the Miami Hair & Skin Institute continues to lead the way in hair restoration. Our Drs. Nusbaum and Rose are internationally acclaimed hair restoration surgeons with more than 40 years of combined experience. To receive a personalized evaluation and treatment plan, contact us online or call our office directly at 305-925-0222.

FUE Scarring

Dr. Paul Rose Discusses FUE Scarring in ISHRS November/December Edition

FUE Scarring

In the November/December 2018 edition of the Hair Transplant Forum International (ISHRS), Dr. Paul Rose of the Hair Transplant Institute of Miami authored a case report, reporting on a patient that underwent a prior FUE procedure. 

As one of the originators of the FUE procedure, Dr. Rose holds incomparable experience when it comes to method and accuracy. From his findings, this case report serves to demonstrate that the wounds created by the FUE process can result in scarring after the healing phase. 

Click here for the full PDF article from ISHRS

At the Hair Transplant Institute of Miami, we have created the most comprehensive approach for evaluating and treating patients with hair loss, while providing the very latest in scientific techniques at our state-of-the-art facility. If you are interested in exploring your options for addressing hair loss, please schedule an appointment with the Hair Transplant Institute of Miami today by calling 305.925.0222.

5 Follicular Facts You Should Know

Make a Full Head of Hair Your New Year’s Resolution

Make a Full Head of Hair Your New Year’s ResolutionEvery December 31, the holiday season concludes with promises we make to ourselves about how we’re going to do things differently when the calendar turns to the new year. We’re going to lose weight, start exercising, stop smoking, be more grateful, or make ourselves better in some other way. If you are one of the millions of men and women who experienced hair loss in 2018 (and 2017, 2016, 2015…), consider making 2019 the year that you get back the full, youthful looking head of hair you once had.

At the Hair Transplant Institute of Miami, we may not be able to turn back time, but we can turn your hair into a source of confidence and pride rather than something to worry about or be embarrassed by. Our world-renowned hair transplant surgeons are masters of the art and science of hair restoration. At our welcoming and comfortable facility, you’ll find experienced professionals who are committed to finding the optimal solution for your hair loss issues.

We offer patients a range of treatment options tailored to their specific concerns and goals. These can include the most advanced hair transplantation procedures available, other revolutionary treatments such as stem cell therapy, and non-invasive treatment options such as medication and low-level laser therapy. All of our therapies, treatments, and procedures are safe, proven, and effective, and thousands of men and women in South Florida and around the country offer living proof of our exceptional work.

We see ourselves as true partners with our patients as they begin and continue their hair restoration journey. We provide assistance and guidance for those struggling with the psychological impact of hair loss. We also help our patients make lifestyle changes – such as stress reduction and healthier diets rich in hair-strengthening nutrients – that can slow hair shedding and promote the retention and growth of healthy, resilient hair.

You may have tried shampoos, medication, or other home efforts to slow down or reverse your hair loss with no success, or maybe you’ve done nothing at all.

There is no time like the beginning of the year to finally do things differently. By taking action, you’ll improve your self-esteem and overall sense of wellness, and you will feel a sense of pride in successfully addressing a problem that had likely been bothering you for a long time.

The first step is a phone call to our office to schedule a hair loss consultation at the Hair Transplant Institute of Miami. At your initial evaluation, you’ll meet with a doctor, not merely a “consultant.” We will evaluate your hair loss using a comprehensive and proven methodology, obtain a detailed medical history, perform an in-depth scalp examination using state-of-the-art diagnostic tools and if indicated, use blood tests to detect any underlying imbalances or deficiencies that may be contributing to the hair loss problem. With this information, we can determine the cause of hair loss and the most effective treatment option.

Start Your New Year With A Hair Restoration Resolution

To ring in 2019 on a positive and hopeful note, schedule your personalized hair loss evaluation at the Hair Transplant Institute of Miami today by contacting us online or calling our office directly at 305-925-0222. Happy New Year!

FUE Scars: How to Avoid Them and How to Manage Them

Hair Transplant Donor AreaWhile it may not require a trip to the hospital, involve a scalpel, or a doctor operating deep inside your body, hair transplant surgery is, in fact, surgery. While certainly not as invasive as many other surgical procedures, a hair transplant does involve incisions in the skin, though they are minimal. That means there is always the potential for scars to develop in the donor areas where hair is harvested for transplant. Fortunately, advancements in hair transplant technology and techniques have gone a long way towards minimizing the scarring that was more prevalent in older procedures.

One of the many benefits of the Follicular Unit Extraction (FUE) hair transplant technique – developed and implemented by the Hair Transplant Institute of Miami’s Dr. Paul Rose – is that it results in minimal scarring. Nevertheless, scars can still develop depending on the patient’s natural healing capabilities or if a patient fails to take proper care of their scalp post-procedure.

The FUE Technique

During an FUE transplant, we remove follicular units from the scalp one-by-one. Donor hairs are removed with a one-millimeter punch device, and the procedure is abetted with a head positioning device to minimize movement. With FUE, patients can completely avoid a more obvious linear scar often associated with other hair transplant methods. Instead, scarring occurs in a dot-like pattern and is virtually undetectable after healing and regrowth. The minimal scarring means that patients can wear their hair quite short (but not completely shaven) without any evidence that a procedure has been done.

Avoiding FUE Scars: It’s in Your Surgeon’s Hands

The most important step you can take to minimize or avoid visible scarring is to ensure that your hair transplant surgeon has the skill, technique, and experience to perform an FUE transplant with the precision needed to prevent scarring. Precision is the key to a successful FUE procedure, and the key to precision is experience and the skillful use of the most advanced technology available. Dr. Rose was one of the originators of the FUE technique, performing the procedure on thousands of patients since 2004. Our approach utilizes the image-guided robotics of the ARTAS system, which provides unmatched precision in hair transplantation. 

Managing FUE Scars

Though scarring should be minimal and heal quickly, you’ll want to be gentle with your scalp and hair after surgery to keep it that way. You’ll be able to return to work and engage in your regular activities in a matter of days, but for the first few nights, try to sleep with your head elevated. Wait a few days before shampooing as you usually would, but don’t be too vigorous when doing so.

Schedule an Appointment for a Hair Loss Evaluation Today

If you are concerned about your hair loss and are ready to do something about it, we invite you to schedule an evaluation at the Hair Institute of Miami. Drs. Nusbaum and Rose are internationally acclaimed hair restoration surgeons with more than 40 years of combined experience. To receive a personalized evaluation and treatment plan, contact us online or call our office directly at 305-925-0222.

After Hair Transplant

Maintenance After Hair Transplant

After Hair TransplantThe world’s best hair transplant surgeons (like our very own Drs. Nusbaum and Rose) use their experience, skill, and advanced technology to transform balding or thinning areas of the scalp into full, robust, and youthful heads of hair. When you go home from the Hair Transplant Institute of Miami after your procedure, your transplanted hair will go with you, but your hair transplant surgeon will not. While your surgeon has positioned you, your scalp, and your transplanted follicles for success, ensuring that you get the best results from your transplant after you return home falls largely on your shoulders.

Proper maintenance after hair transplant surgery is a critical part of your hair restoration journey; you need to “stick the landing” if you want your new hair to truly grow and thrive.

Here are some key tips for maintaining your hair and scalp after your surgery.

  • The day after the procedure, return to our offices to have the transplanted areas checked and shampooed.
  • Wait at least 24 hours before washing your hair after that, you’ll be able to shower and wash your hair regularly, but during the first 7-10 days, in particular, you will need to do so gently and carefully to avoid damage to the fragile and newly transplanted follicles. Use gentle water pressure and cooler water than you otherwise would and avoid rubbing or intense lathering when shampooing.
  • Avoid brushing your hair for as long as possible after you shower, don’t use hot styling tools for at least one week, stay away from tight clips or bands, and instead of rubbing your hair to dry it, apply light pressure.
  • The Follicular Unit Extraction (FUE) technique we use spares patients from the visible, linear scars associated with traditional transplant procedures, but you will still have small hair graft sites to care for. To avoid infection, don’t swim in pools or the ocean or spend time in a hot tub until healing is complete (about 14 days) as these waters are rife with bacteria and pollutants. Evan after you head back into the water, avoid diving for a while as the impact of your scalp hitting the water can cause strain and pull of the scalp and donor area.
  • Avoid alcohol for at least three days after your procedure, as booze can act as a blood-thinner and inhibit the healing process.
  • Avoid spicy food for at least a week. Your body’s reaction to spicy foods diverts energy and resources which would otherwise be used for healing and repairs.
  • Do not jog, cycle or lift weights during the first three days after surgery. Strenuous exercise or heavy lifting should also be avoided for at least a week.
  • Sleep with your head elevated for the first few days to prevent forehead swelling.

Of course, you should also religiously follow any specific post-surgical directions your doctor gives you, including taking any medication as prescribed. By taking care of your hair in the days and weeks after your hair transplant surgery, you will have the hair you’ve wanted for years to come.

Schedule an Appointment for a Hair Loss Evaluation Today

To receive a personalized hair loss evaluation and treatment plan at the Hair Transplant Institute of Miami, contact us online or call our office directly at 305-925-0222.


Dr. Paul Rose Featured in Hair Transplant Forum International

Dr.-Rose-Appointed-to-ISHRS-Ad-Hoc-Committee-on-FUE-IssuesThe January/February 2017 print edition of Hair Transplant Forum International (ISHRS) includes a study on FUE/FIT harvesting methods, courtesy of Dr. Paul Rose

As outlined in the study, transection can occur when using the FUE/FIT technique if physicians do not accommodate for hair growth variances underneath the skin’s surface. Approximately 60 percent of transected hairs actually regrow, so avoiding transection allows for optimal FUE hair transplant results. Check out the full study in detail below.

This article has been condensed for clarity. To download the original version with references, click here.

Examination of the Exit Angle of Hair at the Skin Surface versus the Internal Angle of Hair as It Relates to the FUE/FIT Harvesting Method

Paul T. Rose, MD, FISHRS, JD* | Miami, Florida, USA; Miguel Canales, MD* | Sunnyvale, California, USA; George Zontos, MD, MSc, PhD | Athens, Greece


The FUE FIT (follicular unit extraction/follicular isolation technique) procedure continues to gain acceptance as a method for harvesting donor grafts. The procedure is based on removing follicular units (FUs) or portions of FUs to use as grafts. A manual punch, mechanized punch or robotic device is used to remove the FUs.

No matter which method of harvesting is selected, there is concern regarding recovering intact FUs and avoiding transection of hair follicles. A common approach is to align the opening of the punch used with the path of the trimmed hair follicles of an FU and dissect along this path. While some hair follicles under the skin may follow the angle above the skin, others may not, which can lead to greater transection rates.

Hair follicles within dissected slivers were examined from 13 patients. The internal and external hair growth angles of over 300 follicles were examined. Below, we examine the approach to harvesting and the means to decrease transection rates by understanding the path of hair follicles within the skin and as they emerge from the skin.


FUE is a method for harvesting donor hair for hair replacement. The technique is based on using a punch, whether by hand or mechanized device, to remove FUs or intact hairs from portions of FUs.

Problems that can occur with the FUE/FIT technique include capping, topping, buried grafts, and adhesion of grafts that can make removal difficult.  The most important problem, however, is transection, which may result in hairs that do not grow. Although some physicians feel that large numbers of transected hairs that remain in the donor area may re-grow, extensive studies on this are lacking. Devroye demonstrated that approximately 60% of transected hairs regrew after FUE removal from the donor area.

To perform FUE, the punch opening is usually aligned with the visible hair direction at the skin surface. Pursuing the incision along this apparent course of the hair may be misleading and result in transection. The reason for this is that, in many instances, the hairs within the FU exit the skin surface at a different angle than the internal course of the hairs within the dermis and subcutaneous tissue.

In this study, we looked at the variability of hair exit angle from the skin surface as opposed to the internal angle within the skin. We also reviewed the trigonometry of hair angulation and a means on deciding punch diameter to try to ensure complete removal of FUs and minimize transection.


FUE methodsThe donor area of each patient was marked and anesthetized with 1% xylocaine with epinephrine. After anesthesia, a No. 10 scalpel blade was used to incise the skin to the dermal subcutaneous interface. No tumescence was used. A second parallel incision was made to create a full-thickness “strip” of tissue. The tissue was elevated and removed (Figure 1).

Sections of tissue were removed from the center occipital and the lateral aspects of the strip. Slivers were created from this tissue and photographed. The photographs were reproduced and enlarged. The angle of the hair resulting from the path inside the tissue as opposed to the exit angle above the skin was measured with a protractor (Figures 2 and 3). The data was collected to determine the average angle and range of angles evident in the specimens examined.



FUE methods






In this study, 310 hairs, from 13 patients, were examined within the slivers obtained. It was noted that the hairs within an FU often crossed or splayed away from each other. In addition, a greater change in angles was noted with curly or wavy hair.

FUE methodsThe average angle change (external vs. internal) was 6.43°, which included straight and curly hair. Curly hairs were considered to be hairs that exhibited a prominent curvature creating almost a “C” or a reverse “C” shape. The average angle change with only curly hair was 14.65°, however, sometimes a “curly” hair could be found amongst straighter hairs (Figure 4). In our study, the greatest angle change was 31° for straight hair and 35° for curly hair.

In trying to ascertain a means to ensure less transection, we also looked at the trigonometric relationship between the punch size, approach angle, and the skin that would be required to obtain the full FU while decreasing transection.

Where ” D” is the diameter of the punch, “0 ” (theta) is the change in angle of the follicle below the surface of the skin, “Y” is the depth of the punch insertion, and “X” is the lateral offset of the follicle bulb.

Using the relationship tan (“0” theta) = X/ Y, it is apparent that d/2 is > X. For example, if theta is equal to 6°, and Y equals 4mm, then X = 4 tan (6) = 0.42.

Therefore, if the punch size D is 1mm, then there should be little or no damage to the follicles in that FU. On the other hand, if the punch is 0.75mm, there is a significantly greater likelihood of damage to hair follicles. This assumes a depth of insertion beyond the epidermis and into the papillary dermis.

An important question is: What is the maximal curvature of the follicle that can be accommodated by a given punch?  What is the maximum theta? For example, if y = 4, then x = d/2 (maximum allowed) and the punch size (D) is 1mm, what is theta?

To determine theta, theta = tan x/y == tan (0.5) /4 = 7.1°.


FUE/FIT is a technique for harvesting grafts that requires understanding of the relationship of the path of hair within the skin with the exit angle of the hair(s) from the skin. As this study demonstrated, the course of hair in the skin can differ dramatically from the exit pathway. Often, the hair exit angle from the skin is actually more acute than the path inside the skin. Failure to recognize this and make appropriate adjustments with the punch can result in high transection rates.

A modification of the surgical technique to consider is to raise or lift the punch slightly a few degrees more perpendicular after the initial entry into the skin. This motion may allow the surgeon to compensate for the typical change in angle that occurs when going from skin surface, through the epidermis, and into the fat. The angle change is usually less acute than it appears on the skin surface. The use of a blunt punch may provide an added measure of safety in terms of avoiding transection.

This study demonstrated that hairs within the same FU can travel in very different routes and at times even curve back­ wards. This can create problems, especially with patients with very wavy or curly hair.

While this study provided important information for an approach to harvesting using FUE/FIT, there are several deficiencies.

The study was not done in vivo and the skin was anesthetized prior to removal. The anesthesia may have altered the hair angle in the sliver examined. Anecdotally, we noted that when saline was injected into the tissue prior to sliver creation, the hair angles could be altered. Saline injection in the dermis caused the hair to rise in a less acute angle. Similarly, saline injected into the fat also caused elevation of hair exit angle in the fat but to a lesser extent.

Some physicians feel that tumescing the dermis prior to harvesting can allow for an easier alignment of hair in the FUE punch. Other physicians advocate not using tumescence. Exerting external traction upward on the donor area to diminish the change in angle between the skin exit angle and the internal hair angle may also help.

Additionally, the use of a shallow incision with a sharp punch has been used by some surgeons. The use of a shallow incision followed by subsequent use of a blunt punch as described by Harris can be an alternative approach to harvesting. A robotic system (ARTAS® Restoration Robotics, San Jose, California, USA) employs an initial sharp superficial dissection accompanied by the almost simultaneous use of a blunt punch to core out FUs to lower transection rates. Many other drills and punches have come onto the market developed by surgeons such as Cole, Rassman, Devroye, Park, and Boaventura that are purported to lower transection rates.


The use of the FUE/FIT donor harvesting method is becoming more popular. When using FUE/FIT, it is necessary to properly assess the hair angle in the skin and the angle upon exiting the skin to ensure limited follicle transection.

This study shows that hair exit angle can vary significantly from the internal angle and the deviation is greater for curly or wavy hair.


Acknowledgment: Thank you to Dr. Mohan Bodduluri for his assistance in preparing the article.


Dr. Paul Rose Discusses FUE Best Practices in ISHRS Forum

Dr.-Rose-Appointed-to-ISHRS-Ad-Hoc-Committee-on-FUE-IssuesIn the November/December 2016 edition of the Hair Transplant Forum International, Dr. Paul Rose of the Hair Transplant Institute of Miami authored an essay reviewing Follicular Unit Extraction (FUE) – a minimally invasive method of transplanting individual hair follicles for natural-looking results. As one of the originators of the FUE procedure, Dr. Rose holds incomparable experience when it comes to method and accuracy.

What is Follicular Unit Extraction (FUE)?

FUE involves harvesting using a circular needle called a “punch.” Follicular units are removed from the donor area with a 0.8-1-millimeter circular tool in a scattered pattern to eliminate the linear scar associated with traditional donor strip harvesting. Because scars are tiny and dot-like in appearance, patients who undergo an FUE hair transplant have the freedom to wear shorter hairstyles post-operation.

Dr. Rose’s FUE Analysis

Click here for the full PDF article from ISHRS

In his article, Dr. Rose discusses FUE and the potential for wounding and thinning at the donor site when a large portion (40 to 50 percent) of follicles are extracted at once. Ideally, physicians harvest one out of every seven units to maintain density. Based on this pattern, the average scalp containing 13,000 to 16,000 units would only be 14 percent harvested, or 1,800 to 2,200 grafts total. He points out that harvesting large quantities of follicular units makes transplants more apparent – the opposite intention behind the procedure itself. It’s safe to assume that surgeons reporting as many as 6,000 FUE grafts are creating areas of baldness greater than 6mm2 – eliminating the possibility for shorter haircuts without obvious thinning. In addition, many patients lack three to four hair units, raising the risk for obvious thinning at the donor site when too many units are removed.

Dr. Rose recommends that patients should be advised of the potential for this thinning at the donor site prior to surgery. Follicular Isolation Technique (FIT) uses partial follicular unit removal to curtail further thinning. Finally, Dr. Rose recommends micro-pigmentation to disguise thinning at the donor site. In an ideal world, devices that decrease wound size could minimize donor wound concerns.

At the Hair Transplant Institute of Miami, we utilize the ARTAS® physician-guided machine – the most advanced method of harvesting hair from the back of the head. In addition, our Mosaic® hair restoration technique, developed by Dr. Rose and Dr. Nusbaum, mimics personalized follicular patterns for optimal results.

Adrenal Glands, Stress Hormones, and Hair Loss

The Science Behind Stress-Induced Hair Loss and Telogen Effluvium

Adrenal Glands, Stress Hormones, and Hair LossThe unwelcome feelings of stress and anxiety creep up when you least expect them. While intermittent feelings of worry are relatively normal, damaging stress levels are on the rise. These feelings of despair and anguish sometimes provoke thinning or shedding on the scalp. Stress-induced hair loss, called telogen effluvium (TE), can be short-lived or long lasting. Thinning or shedding inadvertently caused by anxiety and trauma is not only frustrating, but worrisome. In addition, trichotillomania is a less common but very serious hair loss condition perpetuated by stress. Unlike TE, patients suffering from trichotillomania actively pull hairs out habitually when facing stress and anxiety to cope.

A 2014 national poll from NPR in partnership with the Robert Wood Johnson Foundation and the Harvard School of Public Health found more than one in every four Americans suffered great deals of stress the month prior to the survey. Half of those adults, or 115 million people, experienced a major stressful event that year. [1] Per the Anxiety and Depression Association of America, anxiety disorders – often explained as chronic high stress and worry – are the most common mental disorder in the United States. Anxiety affects 40 million adults in the U.S., or 18 percent of the total national population. [2]

The American Hair Loss Association says TE and stress-induced hair loss is likely the second most common form of hair loss seen by dermatologists. [3] Although little research has been done to help physicians understand why some patients see hair loss because of stress while others do not, three possible cause and effect scenarios exist:

TE Scenario 1: Environmental factors shock the hair follicle into a resting state. Because the follicles are not actively producing more hair to replace ordinary shedding, patients see diffuse patterns of thinning on the scalp. The effects of environmental “shock” show up two to three months after a major life event. Depending on the duration of the event, follicles can return to their normal healthy state without surgical intervention. Patients usually see their condition clear up in less than six months with full regrowth.

TE Scenario 2: Hair follicles enter their resting state as normal but do not regenerate properly, resulting in gradual hair loss. Rather than return to the anagen phase of hair growth, the follicles remain in the telogen state for prolonged periods of time. Thus, fewer anagen, or active, hair follicles are available. Because this scenario is prolonged, patients may not see immediate thinning. This is more common in individuals with chronic anxiety conditions.

TE Scenario 3: A less discussed form of telogen effluvium occurs when hair follicles go through truncated cycles. This results in persistent shedding and thinning hair.

Many short-term hair loss cases are considered normal. For instance, many women experience short-term hair loss after giving birth due to fluctuating hormone levels – a condition called postpartum alopecia. Most women regrow their hair normally a few months later. Certain vaccines, antidepressants, extremely low-calorie diets and physical trauma are also common environemntal triggers of TE. Chronic illness, particularly chronic stress and nutritional deficiencies, are alternative instigators. Research shows a link between tension, hair follicle biochemistry changes and increased resting (telogen) hair follicles.

Treating Stress-Induced Hair Loss and TE

Luckily, treatments for telogen effluvium are available. Assuming your hair loss is stress-induced, regular exercise, therapy and meditation can help. When a specific cause is not determined and stress relief does not reverse telogen effluvium, doctors resort to treatments such as low-level laser therapy (LLLT). In cases where stress-induced hair loss transforms into an enduring condition, many patients turn to hair loss surgery.

At the Hair Institute of Miami, we welcome patients suffering from stress-induced hair loss to undergo a comprehensive evaluation. Our treatment plans include low-level laser therapy (LLLT) caps and advanced follicular unit transplant (FUE) procedures. Either alone or in conjunction with one another, LLLT and FUE helps patients suffering from lingering telogen effluvium regain their confidence and sense of well-being. Call us today at 305-925-0222 to schedule your personalized hair loss consultation in Miami.





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