Hair Excellence

Repair Procedures & Body Hair FUE [BHFUE]

Repair procedures are not just medically difficult to perform and hold many complications that a virgin scalp does not, but it can also create a high expectancy and consequently can be an emotional experience.

It also has to be understood that it may not be possible to repair all of the damage previously caused by bad procedures, and it may take multiple procedures to achieve the required goals . When assessing a repair case it is usual to set out priorities, areas that cause the greatest concern are given priority to ensure that these areas are treated with optimum effect; if areas have to be left until a later procedure then rest assured there will be a good reason, the ultimate result. As with any hair transplant there needs to be an honest and open dialogue between doctor and patient, so both understand and agree the goals and the patient is aware that limitations can apply as to what can be achieved.

Many times it will be necessary to remove old grafts and redesign the hair line, this can be achieved with a FUE punch, if the grafts are too big or placed close together a punch may not be possible and the area needs to be sutured. It may not be possible for all grafts to be removed, and some may grow back, as a result a future procedure may be necessary.

With poorly placed or angled grafts normally comes pitting and ridging of the skin; this is either a “crater” created when the graft is placed or a raised area of tough skin around the placement area. Pitting can repair after the graft is removed and over time the skin should return to normal, but this can depend on the size of the graft and how difficult it was to remove. Ridging or cobblestoning is less forgiving on the scalp. Both factors will impair the placement of new grafts and may cause a lower yield than expected from a virgin scalp because of the scarring aspect. This may affect the density or thickness because the yield is lower or the placement was decided to be lower to protect the yield.

The donor area is vital to a repair and will determine the result that can be achieved in the near and longterm future. If the donor area has already been impaired, this may mean it has been over harvested with a large punch via FUE or incorrect position of the strip scar or stretching back of the scar. When dealing with an old strip scar there are options, either to englobe the scar if wanting to remove more grafts, revise the scar or add grafts into the scar to camouflage it. Englobing or revising does not ensure a thinner scar than before, it is impossible until the incision is made to know the depth of fibrosis under the skin or to determine how the new scar will heal. Do not assume the scar will be smaller, and certainly not invisible. To add grafts into the scar can be a good option depending on the size of scar and how well it has healed. It is considered that the yield will be lower when placing in a scar line and it is prudent to place a lower density initially and measure the yield before using too many precious grafts that might not subsequently grow.

Body Hair FUE (BHFUE) uses the same principles of extraction as FUE, but the hair is extracted from various parts of the body and not from the scalp. BHFUE is recommended in cases where there is insufficient scalp donor hair.

BHFUE is a relatively new form of hair replacement; it is important to appreciate that because of genetic variants, hair characteristics and growth rate, BH will behave differently to scalp hair and the yield can be much slower and lower. BHFUE in certain special instances may be the answer to repair or restore hair but only after an extensive consultation period. A patch test would also be undertaken.

The compatibility of scalp and body hair is very important; studies show that body hair has a very short anagen phase and a very long telogen phase, hence the length can be different from scalp hair. In addition the colour and curl must be compatible to the natural scalp hair. Usually the colour is rarely a limitation but the curl can sometimes differs and we need to have a satisfactory degree compatibility to continue.

In some cases BHR may advise a body hair patch test prior to the patient undergoing any extensive procedure, depending on case specifics. Once the patch test is completed and then assessed over six months or longer, if the results are found to be positive then we may proceed for a larger session.