Dr. Chris Bisanga FUE Donor Education

Hair Transplant
1

I have decided to split this into three sections, as below; hopefully it will help show different aspects of FUE extraction and donor management

Extraction Pattern

This post will seek to discuss some Extraction Pattern issues and present our own findings. It will be ongoing rather than a “one off” post and look at the issue in stages as presented below.

Allowing for an educated and well planned extraction pattern will not compromise the donor as much and give greater options for more grafts using FUE in the future. The pattern of extraction is random to the point it is has to be calculated to not leave obvious areas of no hair or any uniform signs of pre-meditated extraction, “factory extraction” with an obvious pattern seen when short/shaved.

We have so many hairs in the donor area so…

  1. Why are there not more large FUE sessions

  2. Why do many people feel the results are not the same as that which Strip yields,

  3. What are the implications to the donor area?

FUE may not leave a linear scar like FUT but if not performed correctly with an educated extraction pattern scarring can become obvious and areas of the donor can become compromised making future FUE or FUT a problem.

Spread the extraction pattern over the largest area possible, try not to limit the surface area whenever possible. It is known that different areas of the donor are easier to extract from than others and also, for example, the “better/bigger” follicular units (FU) groups are also in an area easier to harvest from. The occipital or back of the scalp is richer normally in density and in the number of hairs per FU, making it easier to extract and a richer zone to take from.

The amount that can be removed from the donor is always up for debate, Dr. Bisanga feels around 25-30% per cm2 on a good donor density and little to no miniaturisation is about the limit without causing potential problems in the future.

Why do we not see bigger FUE sessions like FUT?

Dr. Bisanga limits his FUE sessions to 3000 grafts over two consecutive days; he has learnt over time to harvest more puts added strain on the scalp during the crucial first days post op healing with the potential to increase visible scarring in the donor and reduce yield in the recipient due to so many multiple open wounds reducing the capacity for the scalp to heal to its best ability.

The more extracted at one time means the closer each punch has to be to the other, this makes it harder to not leave visible “hair less” areas as the extraction pattern becomes more confined. Each extraction has to allow for FU’s to surround that point, you cannot punch two points adjacent to each other, so the more removed makes this pattern harder and harder to adhere to.

Possibly another reason is time; to manually punch each FU and ensure transection is kept to a minimum, considered by Dr. Bisanga to be below 5%, takes time. Physical and mental pressures play a part when working in so close proximity to the scalp and under magnified conditions as the doctor is dealing with scales less than a mm at times. There is also the strain on the patient having to be in the same position for lengthy periods of time and remaining still becomes harder mentally and physically. The time aspect though is connected to the rate of extraction, be the doctor only able to extract 500 or 1500 per day, realistically an FUE procedure should not last more than 2 consecutive days for the wellbeing of the patient.

2

» I have decided to split this into three sections, as below; hopefully it
» will help show different aspects of FUE extraction and donor management
»
» Extraction Pattern
»
» This post will seek to discuss some Extraction Pattern issues and present
» our own findings. It will be ongoing rather than a “one off” post and look
» at the issue in stages as presented below.
»
» Allowing for an educated and well planned extraction pattern will not
» compromise the donor as much and give greater options for more grafts using
» FUE in the future. The pattern of extraction is random to the point it is
» has to be calculated to not leave obvious areas of no hair or any uniform
» signs of pre-meditated extraction, “factory extraction” with an obvious
» pattern seen when short/shaved.
»
» We have so many hairs in the donor area so…
»
» 1. Why are there not more large FUE sessions
»
» 2. Why do many people feel the results are not the same as that which
» Strip yields,
»
» 3. What are the implications to the donor area?

Great post. I hope you don’t mind a bit of 'devils advocate’but I want to clarify some things.

One
Your comment,
The amount that can be removed from the donor is always up for debate, Dr.
Bisanga feels around 25-30% per cm2 on a good donor density and little to
no miniaturisation is about the limit without causing potential problems in
the future.

My question
We are constantly told that 50% loss of hair needs to happen before balding is noticeable. And that is on the most exposed parts, let alone the back which can be more easily disguised. Why does Dr. Bisanga ‘feel’ this? You open with the gambit, “it is always open for debate”, but then close it with Dr. Bisanga “feelings” without stating the rationale. Of course it obvious to anyone that you have to scatter the extractions in a cunning way so that obvious blothches don’t appear (I’m not saying that is easily done by the way, but just the concept is easy) I’m talking numbers here.

Two
Your comment,
“Why do we not see bigger FUE sessions like FUT?”

“Dr. Bisanga …has learnt over time to harvest more puts added strain on the scalp …potential to increase visible scarring in the donor and reduce yield…”

My question

This of course, implies that your clinic has actually carried out more than one procedure above 3000 BHT over two days nad has learnt through actual experience. So if the doctor did stick to his 25-20% thing during these 3000 plus/two day sessions, how did the trauma manifest itself? I’m not disputing it one bit, but what bugs me is that strip is more traumatic AND, certainly when one considers that some patients now actually combine strip AND FUE in one session - what does that suggest? It seems intuitive that the trauma of a deep chunck of flesh cut out ear-to-ear plus a few hundred FUEs musn’t, in the terms you’ve suggested, be just as bad?

has actually had the experience of doing larger sessions. What was the maximum and what percentage do you estimate the compromise
» The more extracted at one time means the closer each punch has to be to
» the other, this makes it harder to not leave visible “hair less” areas as
» the extraction pattern becomes more confined. Each extraction has to allow
» for FU’s to surround that point, you cannot punch two points adjacent to
» each other, so the more removed makes this pattern harder and harder to
» adhere to.
»
» Possibly another reason is time; to manually punch each FU and ensure
» transection is kept to a minimum, considered by Dr. Bisanga to be below 5%,
» takes time. Physical and mental pressures play a part when working in so
» close proximity to the scalp and under magnified conditions as the doctor
» is dealing with scales less than a mm at times. There is also the strain on
» the patient having to be in the same position for lengthy periods of time
» and remaining still becomes harder mentally and physically. The time aspect
» though is connected to the rate of extraction, be the doctor only able to
» extract 500 or 1500 per day, realistically an FUE procedure should not last
» more than 2 consecutive days for the wellbeing of the patient.

3

I hope you made sense of that. It was rather messy. Oh…and obviously I meant 3000Fue over two days, not 3000BHT. Hope it’s clear

4

Hi scar5,

No problem, all very obvious and valid questions.

The first part, as to why only 30% when we are told you can lose more before it becomes noticeable, this is actually going to be covered later in the follow up posts, but I can go into it now.

One argument for removing more from the donor is that hair loss does not become noticeable until around 40% plus has gone; but this observation was originally to describe the recipient area hair loss stage, not the donor area.

The two areas are very different and cannot be compared in this context; the hair lays in different directions, angles and has very different illusion qualities of thickness. Also the comparison loses credibility as we are talking about an area that naturally loses density in most men (recipient) and needs to be replaced with a hair transplant, where the illusion of density with the artistic placement of the grafts can in some create the look of very good thickness even though like for like is not replaced.

Obviously more than 30% can be taken but we have to be mindful that almost all of us will thin as we age, even in the donor area sometimes; so not over harvesting preserves the donor in the best possible fashion. Is this conservative or realistic, that is for you to decide when you make your choice of doctor and his protocols.

A benefit to the donor removing with FUE is the lay of the hair, from the base of the crown the hair generally lies down so each hair covers the next moving down to the base at the nape of the neck. Because each hair lays over the next more coverage is achieved, so it is possible to remove the FU without it being obvious. This to a point is why it is possible that over 30% is removed; will the donor feel thinner, yes, it will be say 50% thinner, will it look obviously thinner, maybe dependent of hair characteristics and how the hair is styled. Can removing such a high amount create potential problems, for sure, future harvesting with FUE impossible, even FUT maybe difficult if the density is dropped to say 40 FUcm2 (implying that the original density was above average at 80). I would suggest if a virgin scalp walked into most doctors surgeries for a consultation with a starting density of 40 they would be told they are not suitable candidate for a HT.

Secondly,

By removing much more than 3000 grafts can lead to the ripple effect, peripheral micro trauma to the surrounding hair, and obviously the more concentrated the extraction pattern the greater the chance of damage to the surrounding hair. Damage can be in the form of transection to surrounding groups of hairs, miniaturisation, more obvious scarring, changes in hair characteristics and direction as well as laxity.

With FUE almost every scalp can bring up different complications, hair directions, depth, splay, skin healing etc, obviously the more FUE procedures a doctor does it has to be hoped he learns and develops protocols to deal with these situations. Also seeing others’ work you learn and maybe adapt your methods or realise what can and cannot work in a positive manner. The FUT strip is isolated to a relatively small area, whereas FUE is distributed over the entire donor safe zone, maybe 4 times greater the surface area. The effects are quite different to the scalp, healing and changes to the scalp characteristics.

Dr. B has performed the odd FUE over 3000 over the years but not many at all, and we are not talking 4000, or even 3500 grafts, he never personally believed in these sessions for FUE for many reasons; he learnt quickly for himself anyway that the risk factor did not outweigh the benefits of a little extra hair quicker. Yes, of course FUT seems more aggressive in the extraction and is in many ways obviously; but they are two very different extraction techniques, both with pros and cons but cannot be measured against each other in some ways. Combining FUT and FUE on the right candidate is not a problem, that said Dr. Bisanga would personally not perform more than 2 days surgery still, FUT first then FUE second, 1000-1500 grafts. Because the strip is localised the FUE can be removed away from the area, leaving reasonable distance from the strip to not aggravate healing of either strip or FUE punches; it is limited obviously and care should be taken. Everyone wants a result as quick as possible, but how many people would turn the clock back if they could and do things differently in hindsight, many would.

5

Everyone wants a result as quick as possible, but
» how many people would turn the clock back if they could and do things
» differently in hindsight, many would.

Potential patients just do not realize there are implications to everything a doctor does when performing surgery. It’s too easy for doctors to ignore those implications, not educate the patient and just take their money. I know because I have watched this industry for the last 25 years. It has happened to me and many others. It really takes a clinic with integrity to tell you they will only take so many grafts and here is the reason why.

Personally if I was aware of the implications of past decisions I would have made different choices. Unfortunately I was a patient of clinics that put profit before ethics, to hell with the implications. Learning the hard way, is the hard way.

Anyone considering a hair transplant should heed the words of advice offered by Stephen. You simply do not get a second chance if you decide to just roll the dice and see what comes up. Slow and steady wins the race.

6

» The amount that can be removed from the donor is always up for debate, Dr.
» Bisanga feels around 25-30% per cm2 on a good donor density and little to
» no miniaturisation is about the limit without causing potential problems in
» the future.
»
» Why do we not see bigger FUE sessions like FUT?
»
» Dr. Bisanga limits his FUE sessions to 3000 grafts over two consecutive
» days; he has learnt over time to harvest more puts added strain on the
» scalp during the crucial first days post op healing with the potential to
» increase visible scarring in the donor and reduce yield in the recipient
» due to so many multiple open wounds reducing the capacity for the scalp to
» heal to its best ability.

If 3000 grafts = 25% then you are assuming the patient has 12,000 grafts available which I find rather high. I don’t remember seeing anyone getting over 10,000 grafts from head donor.

7

» If 3000 grafts = 25% then you are assuming the patient has 12,000 grafts
» available which I find rather high. I don’t remember seeing anyone getting
» over 10,000 grafts from head donor.

Hi damraak,

I think you might have mis-understood the concept here.

You are correct 3000/12K ratio, but that does not mean you have 12K to take, it means that is how many approximately are in the measured area. This is the argument for and against how much is available, 20/30/50% plus of the total in the area.

Donor surface area X donor density = TOTAL FU X EXTRACTION %

Example: 180 CM2 [30cm x 6cm safe zone] X 80 [density] = 14,400 FU [in whole area] X 27% [amount to safely harvest] = 3888 FU TOTAL FUE @ 27% EXTRACTION RATIO

I hope this makes sense, so the amount one can harvest is different from the amount of grafts residing in the donor safe area.

8

Stephen, since this thread is about fue donor education, can you tell us the clinics thoughts if any on when the donor source is the beard area or maybe this is better addressed on a seperate thread. Personally I am okay with having zero beard hair, but is it safe to have all of it extracted. Maybe there is a limit on how much can be taken at any one time. It’s really important for those that lack enough scalp as a donor source, thanks.

9

I do not agree with most of your rationalisation as to why only 30% of the donor can be removed but the short story is that empirically you have found this to be true. The donor lies at an acute angle to the scalp compared with the recipient so more hair should be able to be removed but counter to this the donor area is viewed head on wheres the recipient is less often viewed in this way (which would be a birds eye view). All the same you clearly state and know as do others clinics that 30% is the sensible number. This does raise the question as to why Armani and a few others think that they can remove more.

The whole 50% observation is probably dead anyway. If the average density is 75Fu/cm2 then transplanting at a density of 37Fu/cm2 should give the illusion of full density going by the 50% rule. It does not so in short the adage that thinning is not noticable until more than 50% is lost is a dead duck and simply wrong!

10

Hi Topcat,

No problem to answer here.

Like any HT scarring and graft survival are issues, to make the effect of the extraction as minimal as possible to the eye and remove intact the FU is important. Beard hair especially is so prominent on the face that scarring would easily be noticeable, especially if clean shaven, and the last thing you want to do is leave someone scarred on the face and having to grow a beard to hide it, and that the beard could look possibly thinner anyway due to the extractions.

Different areas of the beard make extraction harder and easier, the laxity of the skin and bone structure in some areas will cause potentially high transection when trying to punch. So, to take all the beard although possible you have to ask at what cost. Dr. Bisanga generally will do a smaller beard session initially, make sure healing is good then increase the size of the session. Even so, space has to be left between each punch to “design” a natural looking beard still and not just leave patches of thick and thin hair, and different people, skin types heal better than others, some for example are more prone to keloid formation.

To date extraction has gone very well on all the beard hairs we have performed, no obvious scarring at all. I’ve had around 1000 now extracted from my beard and honestly cannot tell, besides it being a little thinner obviously. I do wet shave every day and have really no scarring at all.

I would personally not wish for all my beard hair to be taken, I have the option of growing it when I like and it is still thicker than most peoples, but as you say, it has really come in handy as a donor source.

11

Hi Marco,

I appreciate your logic in why you disagree, I can talk from my own experience, starting with a much higher than average density I still would not much more taken than I have already.

Our remarks are how we see the donor with FUE after many years of performing it, how others perform FUE it’s best to ask them as we cannot speak for them obviously. I’m sure not all perform FUE the same as us and have their own protocols, tools and methods. If this topic can open the door to new revelations how more can safely be removed and allow long term FUE to harvest higher numbers without compromise to the donor it can only be good.

It is a complicated issue and one that can be different for every person depending on their hair characteristics how much would be suitable to be removed, in one or multiple sessions. As I said earlier in the thread, are we conservative or realistic in our approach, well if conservative we are protecting the donor and if more can be removed then great for the patient, if realistic time will then tell. This makes FUE that much more demanding to perform and not as simple as strip. I guess long term results will show, not just recipient but donor management and how previous harvesting effects the outcome when patients need another procedure in the coming years.

12

Hi there,

Since the discussion veered off to beard hair,i have couple of questions-

1-Does increased fatty tissue in beard donor area make extractions harder? example-will the transection rate be higher for a person with double chin?

2-What is the maximum number of beard grafts that can be extracted from an average person without making it very obvious?

3-I have seen that in some people even beard thins with old age(not very sure about this one)-is that a possibility?

THANKS IN ADVANCE,
HAIRLOVE

13

» Stephen, since this thread is about fue donor education, can you tell us
» the clinics thoughts if any on when the donor source is the beard area or
» maybe this is better addressed on a seperate thread. Personally I am okay
» with having zero beard hair, but is it safe to have all of it extracted.
» Maybe there is a limit on how much can be taken at any one time. It’s
» really important for those that lack enough scalp as a donor source,
» thanks.

I think beard hair deserves more attention especially when this thread talks about a sensible scalp donor should be no more than 30% which is hardly enough for most people, I have seen some really good beard hair results from Arvind and Umar and i don’t think doctors are giving beard hair enough attention, so far 99% of the beard results I’ve seen are from Arvind and Umar.

14

Hi hairlove,

I covered a little your first point in my reply to topcat, that areas of the beard make it easier or harder to extract from, that transection can increase. Obviously the “flabbier” the area the harder it will be to maintain necessary control over the angle and direction the punch enters the skin, and the tauter the area the more control can be administered.

I don’t think you can talk averages that easily, different genre, ethnic races all have their own characteristics and pros and cons, so unless a vast study was commissioned covering the average of each it’s not a question that can be answered that accurately. Some skin types heal very well with no visible signs of scarring, others may show minor signs when others, regardless how well the technique is performed can have obvious signs, hence a reason to maybe cautious before extracting a large session and test first.

It is always possible beard hair will thin, and in some men it can thicken with age, skin cells rejuvenate slower, as do all the living cells in our body as we age.

Hi fastforward,

I agree with you, having just had my third beard session and very happy with the results of the first two for me it has become a new source to harvest. But I do think on the whole it should still be received with caution and not just jump in with massive sessions. Many things are still unknown, for example it was considered by many that beard hair being coarser generally than scalp would not change characteristics when moved, well on me there has been a definite change in the beard hair placed in my crown. It has, albeit very slowly softened and although not totally the same calibre as the scalp certainly blends so much more than initially.

15

.

16

Thnks stephen for your time and explanations

Hairlove

17

» Thnks stephen for your time and explanations
»
» Hairlove

I’m sure Stephen doesn’t mind…

Now back to the nuts and bolts, or should I say, the spots and the bulbs, - that so…of me, eh emm

Stephen writes…

“…of course more than 30% can be extracted”

Well, of course. I don’t think anyone suggested that theoretically 100% couldn’t be extracted.

What I wanted to really know, was just how did the trauma manifest itself in those patients your clinic extracted more than 3000 scalp FUE from? There was no explanation offered, (other than some generic stuff) and yet those cases are the very cases that you suggest were used as the physiological evidence as to why the 25-30% protocol is understood to be the natural limit of FUE extraction.

I have personally seen 30-40/cm on the rump of heads of 40 year olds that can still get away with it, but I wouldn’t expect this to be any more than incidental evidence. Unfortunately, HT (whatever it’s called) gets conveniently shuffled between being an art and a science, numbers come and go, and so does the rhetoric. Now, for a bit of rhetoric, I put it out to the HT community to consider this. Decent clinics artificially delimit the role of FUE because it is so damn tiring, exacting, stressful, risky and generally a major pain for the docs who have the integrity to actually perform the extractions themselves. And this fact combines with the fact that strip set-ups are economic and reliable for the clinic. (for the patient, that is just another bonus in terms of marketability)
Now i want to add a disclaimer. I see nothing wrong with techs doing extractions, if they are proven to be reliable and I just can’t see how they are. Not to mention, all number of dodgy machines and instruments being bandied around.

18

Hello scar5,

I think you may have misinterpreted what I said, no problem… you said “trauma manifest itself in those patients your clinic extracted more than 3000 scalp FUE from”

I said before…

"he never personally believed in these sessions for FUE for many reasons; he learnt quickly for himself anyway that the risk factor did not outweigh the benefits of a little extra hair quicker. "

and

“Also seeing others’ work you learn and maybe adapt your methods or realise what can and cannot work in a positive manner.”

You in essence do not have to be run over by a car to know it will hurt, or put your hand in the fire to realise it may burn a little. Obviously with years of experience in a field it is credible to expect a professional can make educated assessments as to the pros and cons of a methodology without always having to test it out to the extreme. Knowledge can also be gleaned by sheer numbers of sessions performed on many different types of cases, genres and situations, such as repair cases for example. As I said before, are we conservative with our approach or realistic, well time will tell.

To throw another spanner in the mix, maybe a donor is not suitable for even getting close to 3000 FUE in one session, may not mean they cannot get there and more in the long term but in one pass it may not have long term benefits for future harvesting.

Give me some time and I will try arrange some pictures, hopefully to demonstrate the variants in donors, not just the density factor, but others, on virgin and non virgin scalps. For what I think you are referring to as “Generic Stuff”, if you mean for example aspects such as miniaturisation, over harvesting or potentially larger scarring; not sure this is generic but more specific to the way a technique is performed.

As I was saying to Marco earlier in the thread, this is a protocol we adhere to, we are not speaking for others, just stating that this is the protocol we use, thinking it would be beneficial for the reader to gain some insight into FUE, if someone disagrees, has a different protocol and sustains good donor management then great, anything that can improve the quality of information and results is always welcome as it is for you at the end of the day that will hopefully benefit, and if as your name suggests you have 5 scars then I would think you would appreciate that premise.

Whether clinics limit the number of FUE they do simply because they do not want to do more, cannot talk for them, we do not. We offer both FUE and Strip, we take each case on its own merits when assessing and give the options to the patients within our protocols. If though the limit is imposed for reasons you mention such as risk, stressful then is it a bad thing to limit? surely not.

I’m sure the debate will go on about who does the punching, results… recipient and donor are the ultimate proof, obviously as long as legally under the legislation of the registered Medical body they are under the jurisdiction of. As you say, “if they are to be proven reliable”; how a clinic decides to set itself up is down to the clinic, same for the patient, whom they decide to go to is up to them, if they are comfortable with their decision and made their research then up to them who they decide is right for them.

19

» I have decided to split this into three sections, as below; hopefully it
» will help show different aspects of FUE extraction and donor management
»
» Extraction Pattern
»
» This post will seek to discuss some Extraction Pattern issues and present
» our own findings. It will be ongoing rather than a “one off” post and look
» at the issue in stages as presented below.
»
» Allowing for an educated and well planned extraction pattern will not
» compromise the donor as much and give greater options for more grafts using
» FUE in the future. The pattern of extraction is random to the point it is
» has to be calculated to not leave obvious areas of no hair or any uniform
» signs of pre-meditated extraction, “factory extraction” with an obvious
» pattern seen when short/shaved.
»
» We have so many hairs in the donor area so…
»
» 1. Why are there not more large FUE sessions
»
» 2. Why do many people feel the results are not the same as that which
» Strip yields,
»
» 3. What are the implications to the donor area?
»
»
»
» FUE may not leave a linear scar like FUT but if not performed correctly
» with an educated extraction pattern scarring can become obvious and areas
» of the donor can become compromised making future FUE or FUT a problem.
»
» Spread the extraction pattern over the largest area possible, try not to
» limit the surface area whenever possible. It is known that different areas
» of the donor are easier to extract from than others and also, for example,
» the “better/bigger” follicular units (FU) groups are also in an area easier
» to harvest from. The occipital or back of the scalp is richer normally in
» density and in the number of hairs per FU, making it easier to extract and
» a richer zone to take from.
»
» The amount that can be removed from the donor is always up for debate, Dr.
» Bisanga feels around 25-30% per cm2 on a good donor density and little to
» no miniaturisation is about the limit without causing potential problems in
» the future.
»
» Why do we not see bigger FUE sessions like FUT?
»
» Dr. Bisanga limits his FUE sessions to 3000 grafts over two consecutive
» days; he has learnt over time to harvest more puts added strain on the
» scalp during the crucial first days post op healing with the potential to
» increase visible scarring in the donor and reduce yield in the recipient
» due to so many multiple open wounds reducing the capacity for the scalp to
» heal to its best ability.
»
» The more extracted at one time means the closer each punch has to be to
» the other, this makes it harder to not leave visible “hair less” areas as
» the extraction pattern becomes more confined. Each extraction has to allow
» for FU’s to surround that point, you cannot punch two points adjacent to
» each other, so the more removed makes this pattern harder and harder to
» adhere to.
»
» Possibly another reason is time; to manually punch each FU and ensure
» transection is kept to a minimum, considered by Dr. Bisanga to be below 5%,
» takes time. Physical and mental pressures play a part when working in so
» close proximity to the scalp and under magnified conditions as the doctor
» is dealing with scales less than a mm at times. There is also the strain on
» the patient having to be in the same position for lengthy periods of time
» and remaining still becomes harder mentally and physically. The time aspect
» though is connected to the rate of extraction, be the doctor only able to
» extract 500 or 1500 per day, realistically an FUE procedure should not last
» more than 2 consecutive days for the wellbeing of the patient.

20

Stepehen,

I think I understand what you (we) are trying to say.

I goes something like this.

  1. Dr. Bisanga doesn’t personally believe in doing more than 3000FUE over two days

  2. He has done the ‘odd one over the years’ against his personal convictions

  3. These experiences confirmed his intuitions about him the physiological problems associated with this degree of extraction immediately post-op.

  4. We aren’t able to get to the bottom of these problems right here, but…

  5. Patients who have come from other clinics where a higher extraction rate has been pursued have shown that indeed, 25-30% is the responsible limit because they show some signs of…? Negative effects (I assume major cosmetic defects, i.e. obvious and unsightly bald patches)

And what do I mean by generic statements?
By generic statements I mean statements like ‘ripple effect’ and spacing out, damage to peripheral follicles, transection etc. All parameters that factor in any equation regarding level of extraction

Now if I could ask one last question, and anyone please jump in. If 25-30% is the reasonable limit for FUE on a non-minaturized virgin scalp, what would the limit be for patients who wish to pursue a strip-FUE combo, or who who already have had strip performed. Covering the scar is a major issue as the donor thins with age, so I presume we are talking a considerably lower figure than 25-30% for these composite-patients.