Frequently Asked Questions

All present-day transplants have one common tenant: to extract follicles from a donor area and transplant them to a recipient area. Seemingly simple, hair transplantation is actually quite complex and requires years to master. The greatest factor in a hair transplants’ success is the clinic and surgeon themselves.

Follicular Unit Transplantation (FUT) is an older method that involves extracting a swath of scalp, dividing it into grafts of follicular units, and then transplanting those grafts into a recipient area. Follicular Unit Extraction (FUE), meanwhile, involves diffuse extractions of follicular grafts and then their transplantation to a recipient area. Far less invasive, FUE has a repute for its precision, discreteness, longevity, and less noticeable, if at all visible, scarring.

Regardless of the major hair transplant method, recovery, and results, depend on the body’s natural ability to heal. Hair transplant grafts themselves are all natural -bits of adipose with one or more follicles. They also must originate from the patient themself or the body will reject the graft due to cellular dissimilarities.

Physicians often research formulas to better nourish follicles when outside the body, as this is integral to their viability before transplantation. However, the follicular grafts themselves presently receive no alteration. The scalp then naturally incorporates them upon tissue repair.

A number of FUE variants are available. None, though, currently surpass Cole Isolation Technique (CIT®), Dr. Cole’s namesake FUE variant. Among the most minimally invasive options available, CIT® consistently leaves little to no visible scars and allows exceptional precision for graft placement. Most scientifically notable, CIT® is the only FUE variant that leaves stem cell remnants in donor areas. The addition of ACell, an extracellular matrix common in wound recovery, facilitates these stem cell remnant’s regeneration; 30% to 40% recovery of donor follicles is the result. Put simply, that means CIT® + ACell enables patients to regenerate 300 to 400 hair follicles for every 1000 extractions. This both ensures less thinning in the donor areas and enables future transplants if necessary. Learn more about CIT® by visiting our Procedure Overview page.

I use a variety of needle gauges to make incisions for my single hair grafts. The reason I use needles instead of the scalpel for these incisions is for the staff to know where to place grafts of a specific size. I use the needle incisions to direct my staff, like a roadmap.

Needles cut a larger surface area than scalpels. The needle incision looks similar to the character from the game called Pac Man with his mouth open. A needle with a 1 mm diameter cuts a surface area of 3.14 mm. This is much larger than the surface area from a scalpel that is 1mm wide.

Another thing I don’t like about the needle is that it can be more traumatic to the grafts to place into the needle site if the gauge is very small. We know that Dr. Woods likes to use 23 and 25 gauge needle sites for his grafts. We know that you will have much greater trauma, slower placement of the grafts, long time out of the body, and no advantage cosmetically. In fact, if the incision site is too small, the risk of compression increases.

We prefer to make incisions that are always custom made for the specific graft. We know that every individual has grafts that are of different size. Therefore, we must individualize the graft. Also, some individuals have very hard skin, while others have elastic skin that allows for greater ease of placement. More elastic skin expands and accommodates the graft better. Harder skin is not elastic. It does not expand and dial ate in response to the larger graft. Therefore, you will need a slightly larger incision for a larger graft in the individual with less skin elasticity.

Larger diameter shafts require larger incisions. If a person has finer hair, we can make smaller incisions. Again, all incisions must be customized to the individual patient.

We believe that a recipient site incision should allow ease of placement and provide for a snug fit so that the grafts are less likely to pop out during the procedure or after the procedure. Since each individual has a specific hair characteristic and specific skin character, all individuals must have recipient sites specifically tailored to their individual characteristics. I have several individuals on my staff who are very adept at placing grafts.

Forhair has a number of clinics worldwide. Based in Alpharetta, Georgia, there are also Forhair clinics in Milan and Rome. All clinics feature excellent equipment and expert staff. Forhair’s presence in Italy reflects Europe’s current reputation for top-notch FUE. Dr. Cole is an early contributor to the field but, regionally, Europe was the first area to practice FUE before Asia and the U.S. also began.

An innovator of the field, Dr. Cole’s expertise reflects itself in both excellent results and excellent techniques. Forhair clinics are some of the only in the world to offer Cole Isolation Technique (CIT®), a patented FUE variant that brings excellent results. Applicable for most patients, CIT® offers many benefits over most FUE options:

• Least invasive
• Last likely to leave scars
• Greater precision
• Easier on the scalp

Such advantages, in addition to the clinics’ overall skill, leads to top notch results. With CIT®, patients enjoy an average success rate of at least 97%. Other clinics in good standing, meanwhile, average 90%. This is due to a few reasons, including the equipment or devices they are use, the surgeon’s and team’s proficiency, and the patient’s needs.

Forhair most often performs CIT® but offers other transplant options as well. These include FUT, if the best option for them, as well Body Hair Transplants (BHT) for patients who have less donor hair. A patient’s viability for such transplants depend on a number of factors but Forhair also offers hair growth treatments, including a superior variant of PRP, CRP. Featuring five to eight times the growth factors and cytokines as regular PRP, CRP in fact enables Forhair patients to enjoy 99% follicular activation in four and a half months. This is more than twice the average, which is around a year.

Forhair clinics put the patient first, meaning they also emphasize consultations. This is to ensure hair transplantation is right for you. Sign up for one today!  

As with all other elective procedures, Forhair has every patient sign a consent form. This form is not a legal disclaimer. Instead, it is a document that outlines everything that can possibly go wrong, rare as those instances are. Reputable clinics should consider such consent forms a patient right; disreputable clinics, meanwhile, over-rely on sales and will gloss over possible complications.

Legal disclaimers, meanwhile, are documents that protect the designated party from legal proceedings. Patients should avoid clinics that require legal disclaimers, as their role is often to protect the clinic from negligence or awful results. These are not consent forms.

Consent forms are just one way Forhair advocates for patients. Hair transplantation is more established than ever and a growing amount of surgeons are offering procedures. However, with greater expansion, and the development of new techniques such as FUE, there is greater risk of unscrupulous surgeons abusing patients’ confidence.

Hair transplantation is a specialty field that requires years of training and experience. A demanding technique, FUE specifically requires training, experience, and talent. Reputable hair transplantation clinics prioritize informing the patient on both hair restoration and available procedures.

Genuine hair restoration specialists will have differing opinions and preferences regarding hair transplant surgeries, yes. This advocacy, however, should never lead to blurring the facts. This is one reason why strip (FUT) surgeons are specifically suspect: strip procedures have consistently proven an inferior option compared to FUE. Patients should also be cautious of unscrupulous FUE surgeons, however. The increase in demand for FUE has led to surgeons without proper training to offer it, also leading to bad results and complications.  

Patients must do their research when considering a hair transplant clinic. Reputable surgeons will always outline their experience, including surgeons they trained with and their total amount of patients. A competitive field, clinic websites often contain a detailed information about each transplant or treatment option. Questions about consent forms or specifics about Forhair’s practices? Contact us today!

Hair transplantation is a complex procedure and results depend on the surgeon’s skill. Always make sure the surgeon has proper training and experience and that the clinic is reputable. Complications often result from clinics cutting corners or otherwise using subpar techniques or equipment.

An innovator of FUE with global renown, Dr. Cole takes a number of measures to lessen any chance of complications. This includes developing his namesake FUE variant, Cole Isolation Technique (CIT®), as well as specialty instruments trusted by over 500 surgeons. For instance, Dr. Cole uses a unique solution at a specific temperature to keep FUE grafts; this maintains their cellular framework and prevents decay, thereby enhancing results and decreasing the chance of shock loss.

Complications from a hair transplantation can happen for any number of reasons. Clinics, of course, must follow the best practices of any medical provider. A specialty field, hair transplantation also requires pacing and considerations to both ensure the best result and decrease the risk of complications; as like all medicine.

Reputable clinics will always use a step-by-step routine for each patient. This will include a consultation, when they will typically use advanced programs to chart current hair density, and other important steps before the procedure even begins. Reputable clinics, in fact, will often have a full schedule and patients will have to wait several months, at least, to receive their procedure. Disreputable clinics, that both offer worse results and a greater chance of complications, will typically pressure for a procedure within the near future.

Forhair has global repute because of its consistently excellent results. As such, we take complication very seriously and offer free treatments when appropriate. Forhair policies are so stringent, in fact, that the very few patients who receive noticeable scars enjoy scalp micro pigmentation for free. Questions? Learn more by contacting us today!

Reputable hair transplant clinics will always include genuine before and after photos. That mentioned, it is essential prospective patients also research each clinic’s reputation and standing. Patients will often post reviews or feedback online, as well offer references socially.

Surgeons active in hair transplantation also receive training from experts in the procedure and typically reference these surgeons. The amount of patients of a surgeon also indicates their experience. Above all else, prospective patients will want to do research into the latest proven trends and techniques and select the appropriate clinic: there can be a lot of material to absorb and, further, patients should ask select clinics about the details of their procedures and techniques.    

Still, patients will want to review before and after photos. These photos, at the least, should leave not alter the patient’s scalp and hair. There are many ways for a disreputable clinic to present results as better than they are in reality. This includes photo editing techniques such as blur, shadow effects, and lighting. Such alterations can make a transplant appear thicker or otherwise a higher quality.     

That mentioned, clinics always are grateful towards patients who volunteer before and after photos. Medicine is a private matter and most patients do not want to share their experiences or information. Clinics with a large amount of patients are more likely to find volunteers. Before and after photos from dishonest clinics, however, can even feature models or altered photos from rival clinics. The more glossed over a photo seems, however, and the more distinct its lighting, the more likely it is a result of alterations.

Patients should also be conscious that hair transplant before and after photos are static. Hairstyle effects the appearance of density, as well the appearance of the transplant’s quality itself. Motion capture and talking to transplant recipients in person always provide a better idea of the transplant’s quality. Please contact us if you have any questions!

We do not know where this concern over density has arisen from although it is most probably comes from the physicians who promote strip harvesting (FUG, FUT). The truth is they are scared to death of CIT® and FUE or they should be. Follicular unit extraction (FUE) is now mainstream and they have no choice except to learn CIT® or FUE. If they do not learn these procedures, they will soon have far fewer patients to work on.

If anything, the potential density and the potential total number of grafts available from CIT® are both greater than from strip harvesting. Typically, in a single pass, we are able to achieve densities that are 25% greater than from strip harvesting. This is because the grafts are smaller so we can place more of them into a smaller surface area. In addition, although the CIT® grafts are smaller, they generally contain more hairs per graft than most physicians’ staff are capable of producing from graft preparation subsequent to strip harvest removal. Finally, our grafts do not have the same high risk to telogen hairs that are seen from graft preparation after strip harvest. All of these factors- the greater potential number of total grafts, higher single pass density, more hairs per graft, and less risk to telogen hairs – essentially assure a much better density from CIT® than one can obtain from strip harvesting.

There are other factors that contribute to the greater potential density of CIT® hair transplant. With strip, harvesting grafts are allowed to soak in a solution of saline or lactic ringers along with hundreds to thousands of other grafts for prolonged periods of time. A case of 2000 grafts will take at least 4 ½ hours to accomplish, but most patients will require 6 hours and even up to 8 hours for a higher quality procedure. Yes, you can do any strip procedure faster, but you will sacrifice quality and you will have a much higher transaction rate with greater damage to the hair follicles. While these grafts are all soaking in the same solution, they are releasing toxic chemicals that are injurious to one another and to the recipient area. Time out of the body and the exposure to other grafts within the same solution is far less with CIT®. Thus, CIT® grafts have a significant reduction in exposure to these toxic metabolites. This essentially ensures a higher yield from CIT®, although we have not performed scientifically conclusive studies yet. We have found that our CIT® methods often result in a much faster re-growth rate than we saw from strip harvesting. Still, it may take 8 months to 1 year before you have full re-growth. From CIT® you will generally have a higher percentage in the growing phase at any given time.

Peak restoration or temple restoration comes in many different varieties. Basically, it depends on the amount of loss you have or the total surface area that needs treatment. It is safe to say that peak or temple restoration requires a minimum of 400 grafts, but could require up to 1200 grafts. The location of the hairline has an affect on this number. If you are comfortable with a higher hairline, you will require fewer grafts. If you want the lower hairline, you will need more grafts. The hairline extension adds surface area to the recipient area at an exponential rate. A 1 mm extension increases the surface area by 3.14 sq. mm, a 2mm extension adds roughly 12.56 sq. mm, and a 3 mm extension adds about 28.26 sq mm. Small changes can require significantly more grafts. To fill in the frontal area, you may want to add another 100 to 300 grafts. If this area is much weaker, we may require more grafts.

Age is very important to the hair restoration procedure. We find that working on individuals with minimal hair loss in their mid-thirties is a safer bet that we can provide full coverage over the lifetime of our patients. Patients who begin to lose hair in their early 20s will most likely have more excessive hair loss and may not be able to achieve full coverage. Of course, there are many factors governing potential coverage. Density, Diameter, Wave, and many additional factors are important. We look forward to seeing your photos and a hair sample is often times a good thing to send, as well, so that we can assess you hair caliber.

Few hair restoration patients undergo shock loss, but it does happen and its frequency can reflect the surgeon. Shock loss’s cause is most likely dependant on each patient’s reaction to the procedure. The level of the procedure’s invasiveness, however, does decide the overall level of trauma. Any physical trauma, especially sustained trauma on the scalp, can lead to shock loss.

Seasoned hair restoration professionals are wary of shock loss. A temporary problem, shock loss can create complications with future growth. Hair follicles’ longevity depends on the amount of growth cycles they undergo. With balding and thinning, hair strands first begin to miniaturize, or lose its diameter, length, and pigment, and then, after further cycles, become vellus hair. If the follicle is on its last legs then shock loss can effect coverage. Hair transplant results, however, should have the same aesthetic placement and overall quality.   

There are numerous ways to minimize shock loss. FUE is less invasive than strip surgeries, or FUT, and therefore less likely to cause shock loss overall. However, there are numerous FUE variants and these range in intrusiveness.

Cole Isolation Technique (CIT®), Dr. Cole’s namesake variant, is among the least invasive FUE options in the world. As such, CIT® patients are less likely to undergo shock loss at all. For this same reason, CIT® is less likely to scar. FUE has the least chance of scarring of all hair transplant methods. However, scarring depends on both the variant’s intrusiveness and the skill of the surgeon.

Along with being an innovator of FUE, Dr. Cole is a globally renowned hair restoration surgeon whose own transection rate is below 3%. As such, Dr. Cole uses a number of precautions to further limit trauma. These include limiting the size of incision sites, calculating the area between transplants, and using an instrument with a small width and length.

Questions or concerns about shock loss? Please contact us and we’ll be happy to talk!

The most recent method for hair transplantation, Follicular Unit Extraction (FUE) involves extracting individual follicular grafts and then transplanting them to the donor area. So long as the surgeon is adequate, FUE’s results will almost alw0ays be superior to that of Follicular Unit Transplantation (FUT), an older type of hair transplant technique that always leaves a visible scar and often leads to lousy results; over 40% of Forhair’s patients seek us to repair transplants by other clinics.    

Cole Isolation Technique (CIT®), meanwhile, is Dr. Cole’s namesake FUE variant. A pioneer of the technique, Dr. Cole developed CIT® with the hope of facilitating donor recharging: the regrowth of follicles extracted as grafts. His belief, which was proven correct, is that if the extraction did not penetrate too deep then it would actually leave stem cell remnants. In fact, the application of ACell, an extracellular matrix used for post-op recuperation, enables an average of 30% to 40% of donor follicles to regenerate: this means 300 to 400 new donor hair for every 1,000 single extractions. CIT® is the only hair transplant technique, currently, that enables such recharging: all other hair transplants only transfer hair from one location to another.

CIT® offers numerous benefits aside from donor recharging. Minimal intrusion also decreases the amount of trauma to the scalp, thereby improving recuperation time and lessening the chances of swelling or other side effects. Another prime benefit of CIT® is a substantially decreased chance of scarring. FUE can leave scars that resemble moth-eaten cloth. The minimal intrusion of CIT®, however, helps ensure that patients rarely deal with any noticeable scars. Should patients have any noticeable scars, and this is quite rare, then Forhair will offer Scalp Micro Pigmentation (SMP) for free. An all-natural tattoo that lasts for five to seven years that Forhair regularly uses for scar repair, SMP creates the appearance of hair that is actively growing.  

CIT® is among the best options for hair transplantation. Learn more by visiting our CIT® page or by contacting us.

Yes. CIT is more time and labor-intensive for the physician, making it a more expensive procedure overall. However, with CIT, Dr. Cole averages 2.9 hairs per graft versus the 2.0 most strip physicians yield. This means that you are getting almost 1 hair per graft more with CIT than you would with a strip procedure (or 30% more hair for the number of grafts you are paying for).

You can read more in this article:  fue vs strip surgery

Follicular Unit Extraction (FUE) offers a substantial amount of benefits over Follicular Unit Transplant (FUT). The latter is an older method that is more inconsistent and, in fact, can cause substantial problems for the patient as the transplant ages. FUE, meanwhile, is the latest available method available to patients.

FUT involves extracting a donor strip for follicular grafts, typically from the back of the head, and then segmenting them into grafts for transplantation into donor areas. Patients must carefully tend to the extraction site for months after the procedure, one reason fewer patients are opting for FUT. The donor strip is not typically that large but will still leave a noticeable scar that short haircuts cannot always obscure. Further, FUT transplants can age, leading the plugs to become more noticeable and have an appearance similar to doll hair.

FUE, on the other hand, involves individual extractions of follicles. Patients do not have to worry about a large, orbital scar on their head nor months of caring for an extraction site. Depending on the procedure and surgeon, though, FUE can lead to scars similar to moth holes in a garment and may not yield the best results.

A pioneer of FUE, Dr. Cole and Forhair offer some of the best results the world over. His namesake FUE variant, Cole Isolation Technique (CIT®), is among the least invasive techniques in the world and offers a number of benefits over most versions of FUE. Selecting CIT® from Dr. Cole means enjoying:

• Minimal to zero visible scarring
• 30% to 40% donor regeneration with application of ACell
• A much shorter recovery time than FUT
• A transection rate of under 3%: most surgeon’s transection rates range from 5% to 10% or 20%
• Precise placement of grafts, leading to better aesthetic results

One of the most important elements of choosing a FUE technique is recognizing that some variants are more effective and some are less effective. Many surgeons are resorting to automated or robotic options that typically have a higher transection rate and, typically, offer less impressive aesthetic results. Read here to learn more about the differences between FUT and FUE.

The only way to know for sure is to have a consultation with a hair restoration surgeon. Generally, those who are very young (in their teens or early twenties) are not good candidates because it is difficult to predict how far their hair loss will progress. Other factors that a physician may consider in deciding whether you are a good candidate include donor supply, the extent of your current hair loss, family history of hair loss, personal hair characteristics and whether or not you have realistic expectations.

Follicular Unit Transplant (FUT) is well known for offering a large graft count. However, the quality of a hair transplant depends on far more than just the amount of grafts. Surgeons must consider placement, longevity, overall aesthetics, and much more. The best hair transplant surgeons, in fact, know how to distribute grafts to maximize their effectiveness. This is actually essential to prefer donor grafts for patients that may opt for future hair transplants.

While FUT offers a large graft count, however, the donor area is limited to the strip of skin surgeons extract to create grafts for transplanting into recipient areas. Similarly, every future FUT procedure will also require a similar extraction. Patients should also be aware that the extractions from FUT will always leave a noticeable scar, that the scar’s size is impossible to predict, and that the scar can become more noticeable with age.  

Follicular Unit Extraction (FUE), meanwhile, is a more recent technique that involves extracting individual or very small groups of follicles as this leads to substantially less, if any, scarring and better aesthetic results. Harvesting grafts, therefore, can require substantially more time unless in the hands of a master; Dr. Cole finds that most his procedures equal the time of a FUT procedure in terms of graft placement and extraction.

Of course, graft count and efficiency also depend on the technique itself. Dr. Cole’s namesake FUE variant, Cole Isolation Technique (CIT®), is available in three different versions: fully shaved, patch shaved, and no-shave. Each has its own limits for the maximum amount of grafts they enjoy and this ranges from 3,000 grafts to 5,000 or even more.  

FUE also has the added benefit of allowing surgeons to gather grafts from a range of donor areas. They most often focus on the sides of the head but, depending on the case, specialists may also harvest from multiple regions of the head and/or the body. Learn more by reading about CIT® and BHT.

The overall amount of grafts patients can receive per hair transplant sessions depends on both the surgeon and the hair transplant technique they use. Many other factors govern the size of a hair transplant session, including the patient’s amount of viable donor hair, the clinic’s scheduling, and the patients’ willingness to stay still for a long session.

Follicular Unit Transplants (FUT), or strip-style transplants, have a reputation for allowing large sessions. The truth, however, is that such procedures require less time and therefore allow the surgeons to implant a larger amount of grafts in a shorter amount of time. However, FUT also has a number of disadvantages. These include a large, orbital scar at the extraction site, a longer recovery time, and a much greater chance that the transplants will show with age.

Follicular Unit Extraction (FUE), the most recent type of transplant available, brings a number of greater benefits to the patient. These include a faster recovery time, far less scarring, and, in the hands of a skilled surgeon, far superior results. FUE, however, does typically require much more time to conduct.

A pioneer of FUE who has innovated his own techniques and surgical devices, Dr. Cole is exceptionally quick at conducting his namesake FUE variant, Cole Isolation Technique (CIT®). Most sessions reflect the speed of FUT, though it depends on the patient and type of CIT®.

Shaven CIT®: Patients’ heads are shaven for the procedure and Dr. Cole can do up to 5,000 grafts per procedure, though this depends on scheduling and availability

Patch-shaven CIT®: Patients’ donor patches are shaven, allowing patients to hide the donor area with at least mid-length hair, and Dr. Cole can do up to 3,000 grafts per procedure.

No-shave CIT®: Dr. Cole individually cuts each donor follicle’s hair strand, extracts it, and then transplants it, and can do up to 2,500 grafts per day and typically requires two days per procedure.

The grafts per square centimeter that patients receive depends on its location, the patient’s available donor amount, and areas that are thinning as well their amount. How a surgeon layers the number of grafts by each centimeter depends on their technique. Almost always, however, they will first assess which areas require the most grafts and then make a decision from there.

Most studies indicate that the average, natural average density per square cm is 80 to 100 FU. However, thinning only begins to appear noticeable at 40 FU. Any hair transplant surgeon’s objective, therefore, is to increase recipient areas’ density to at least slightly above this level.

There are also risks involved in placing too many grafts per square centimeter. Some studies indicate the even exceeding 30 FU grafts per square centimeter can significantly decrease the overall yield. However, surgeons use different techniques and must consider each patient differently. Dr. Cole’s namesake FUE variant, Cole Isolation Technique (CIT®), enables him to transplant up to 45 grafts per square centimeter.

Among the least intrusive hair transplant options available, CIT® causes less trauma to the scalp than most FUE variants. It also brings a number of other benefits too, not the least being the only FUE option with an average of 30% to 40% donor regeneration with the application of ACell. Put simply, this means for every 1000 single CIT® extractions patients regenerate 300 to 400 donor follicles. Along with maintaining the overall appearance of density, such regeneration also allows patients to undergo future hair transplants if necessary.

One reason Dr. Cole typically prefers never exceeding 45 grafts per square centimeter is finite donor supply. A pioneer in hair transplant surgery, Dr. Cole’s overall skill at planning for a patient’s aging and future hair loss is one reason his results are so spectacular. Learn more by contacting us today!

Scarring from hair transplantation was common and pronounced until the advent of Follicular Unit Extraction (FUE) variants that minimize it, of which Cole Isolation Technique (CIT®) is one. In fact, CIT® is actually among the least intrusive methods available, adding a number of unprecedented benefits.

After results, of course, scarring is probably the first concern that patients voice. They are also right to ask about scarring. FUE, conceptually, is far superior to the second most recent option, Follicular Unit Transplantation (FUT) because the latter’s visible lateral scar and inferior precision in graft placement.

However, the effectiveness of FUE depends on both the surgeon and clinic. Less experienced or incompetent FUE surgeons will almost always leave a pattern of scarring that patients like to moth hole patterns in garments, not to mention have less success implanting the actual grafts themselves.

A pioneer of FUE since before the 2000s, Dr. Cole is among the most experienced and renowned hair transplant surgeons worldwide. This is due to the top-caliber results his patients enjoy, of course, but also his emphasis on research and innovation. Cole Isolation Technique (CIT®), Dr. Cole’s namesake FUE variant, is among the least intrusive hair transplant options in the world. This emphasis on the slightest amount of invasion possible offers a number of unique benefits that only CIT® recipients enjoy. Minimal to no visible scarring is one such advantage.     

Scarring from CIT® by Dr. Cole is very rare to nonexistent due to a number of factors. First, and as already mentioned, Dr. Cole’s acumen means he is very familiar with good practices that minimize scarring. This is perhaps the most critical part of choosing a surgeon: demonstrable skill. Further, Dr. Cole has both researched and clinically tested a number of instruments and post-procedure haircare to further minimize scarring. In the very rare case that patients have noticeable scarring, however, Forhair offers Scalp Micro Pigmentation, a technique excellent for masking scars, for free. Learn more by visiting our CIT® webpage or contacting us!

Follicular Unit Extraction (FUE) is the newest hair transplant technique to gain prevalence. At first available through pioneering physicians, of which Dr. Cole was one, FUE initially was far less consistent than it is nowadays. Surgeons were still adopting the technique and many preferred Follicular Unit Transplant (FUT), an older technique that leads to a major scar, only because it was more proven.

One of the common defenses of FUT surgeons in the early 2000s is that FUE still left scarring. Diffuse and far less invasive than FUT, FUE scarring still has the potential of leaving a scar pattern similar to moth holes in a garment. However, such scarring depends on both the surgeon’s skill and the technique. As FUE gained prevalence and demand more and more surgeons adopted the method, with those who popularized it, including Dr. Cole, both contributing important research and establishing finer or more efficient techniques.

There are now numerous FUE variants to select. Cole Isolation Technique (CIT®), Dr. Cole’s namesake FUE variant, is among the least likely to leave noticeable scars. This is due to the variant’s unprecedented lack of intrusiveness, which adds a number of unique benefits that only Forhair clinics offer.

Minimal to no noticeable scarring: As mentioned, the minimal intrusion of CIT® radically decreases the chance of scarring. 

Donor regeneration: CIT® is the only hair transplantation technique that leaves stem cell remnants that, with the application of ACell, have the chance to regenerate.

Faster, better recovery: Minimal intrusiveness decreases the chance of adverse, temporary symptoms and typically demands less time to recuperate.

Many CIT® patients say donor regeneration is the most significant advantage they enjoy. Hair transplants make foster the appearance of better hair coverage but, at base, it is a procedure that relocates hair follicles from one scalp location to another. CIT® with ACell, on the other hand, enables 30% to 40% donor regeneration: 300 to 400 new strands of donor hair for every 1000 single extractions. Adding to overall hair density accomplishes two things: the ability to extract more hair than previously feasible and, with the replenishment of donor hair, the greater option to undergo future CIT® transplants in the future.

CIT®, in fact, so consistently leaves little to no noticeable scars that Forhair promises Scalp Micro Pigmentation, an all-natural scalp tattoo that appears like actively growing hair follicles, to any patient that has scars as a result of a Forhair CIT® procedure. Learn more about this unique FUE variant by visiting our CIT® website page or otherwise contacting us.

Over 40% of patients request we change transplant work from other clinics, and for good reason. Hair transplant clinics range a great deal in the quality they offer. A premier clinic with a global reputation for excellence, it makes sense that patients who first tried a more convenient or affordable option, and who found the result disappointing, would then arrange for a transplant repair at a clinic like Forhair.

Not all hair transplant repair procedures are a result of bad clinics, however. Sometimes patients are merely looking to correct older transplants for whatever reason, particularly variants of Follicular Unit Transplant (FUT). An older technique than the more popular Follicular Unit Extraction (FUE), FUT always leaves a noticeable lateral scar and, with age, plugs can become noticeable and have a “doll-like” appearance.

A number of surgeons offer hair transplant repair. FUE, in particular, is useful for it, as the ability to extract individual follicles make ideal for redistributing plugs. However, such hair transplant repair depends on both the type of FUE and the skill of the surgeon.

Patients looking to handle a bad transplant opt for Forhair for a number of reasons. First, Dr. Cole’s proven track record and experience speak for themselves. Second, and as important, his namesake FUE variant, Cole Isolation Technique (CIT®), is among the least intrusive and most precise options available today. There are several reasons why CIT® specifically offers superior results in the case of hair transplant repair.

• Minimal or no visible scarring
• Unprecedented ability to for 30% to 40% of donor follicles to regenerate
• More precise, advantageous for plug redistribution

FUT scars can also lead to complication. First off, they are always noticeable with shorter haircuts. Second, and more importantly, such scars can expand with age. There are few ways a surgeon can simply eliminate such scars. Instead, they must obfuscate them. Dr. Cole and his team particularly excel at creating effective, unique solutions that effectively prevents any noticeability of the scar. Such cases typically involve combining CIT® with Scalp Micropigmentation, a natural tattoo that appears like growing hair follicles and lasts up to five years. 

The duration of a hair transplant procedure depends on the hair transplant technique and surgeon. Follicular Unit Transplant (FUT), an older technique, has a reputation for being faster but it always leaves a lateral scar and requires more recuperation time. Follicular Unit Extraction (FUE), meanwhile, is the newest technique in popular practice, leaves far less noticeable scars, if any, but has a reputation for necessitating more time for the same amount of transplants.

The procedure’s length, however, depends on more than just the technique. One of the first pioneers of FUE and an innovator in the field, the combination of Dr. Cole’s custom-made instruments and expertise enable him to complete shaven CIT® procedures in the same amount of time it typically takes to complete a FUT procedure. This is exceedingly rare, however, and most FUE procedures do require more time than FUT procedures.

The length of a procedure, or the number of procedures, will always depend on the transplant’s size. Any worthwhile hair transplant surgeon is concerned about fatigue, as it can affect results, and therefore limit themselves to a certain amount of grafts each day. Further, some techniques work best with a limited amount of grafts. Dr. Cole, for instance, typically does not do more than 3000 grafts for the shaven-patch version of CIT®: any more would require such large shaven patches the entire procedure might as well be shaved.  

Further, sometimes CIT® transplants can be so large they require multiple days to complete. Luckily, they are among the least intrusive transplants in the world. Large-scale transplants do cause more trauma to the scalp, increasing the chance of side effects, but the minimal invasiveness of CIT® decreases the chance of swelling or shock loss in comparison to regular FUE. Patients can expect any session over eight hours to require procedures on at least two days. Questions? Contact us today!

That FUE grafts have a bad survival rate is a rumor left over from the early 2000s. Instead of the technique itself being at fault, the survival rate of FUE grafts depends on a number of factors. Though viable since at least the early 2000’s, proficiency at FUE takes time to build and the technique did not gain prevalence, or become standardized, until a few years later, leading to less consistent results in FUE’s early stage of adoption.

Before going further, it is important to differentiate between transection and graft survival rates. Transection is when a follicle is irrevocably damaged during the extraction or transplantation phase. Graft survival rate, meanwhile, is how many grafts survive after recuperation.

Since FUE has become more mainstream, however, it has proven to be just as effective as FUT. For this to be the case, however, depends on the surgeon, clinic, and patient all. Hair transplantation may happen at the clinic but proper recuperation is vital for graft survival, almost as much so as the surgeon’s proficiency and clinic’s practices.

The growing demand for FUE has led to any number of surgeons offering the technique. However, not all surgeons have sought the necessary training or are practiced enough in the technique: as mentioned, building mastery in FUE can require years. Surgeons who offer FUE but lack competence will either botch the procedure themselves, or, worse yet, assign it technicians with practical experience but little medical knowledge. Such procedures can have a graft survival rate of 50% or less. If FUE is conducted by a surgeon who is actually competent, however, the story is different.

Cole Isolation Technique (CIT®), Dr. Cole’s namesake FUE variant, has a transection rate of under 3% when conducted by Dr. Cole. Masters at FUE generally have a transection rate of around 10% or less. Other FUE surgeons who range in competence, meanwhile, can have transection rates that range from 20% to 80%.

Follicular Unit Extraction (FUE), currently, is the most desirable hair transplant technique for most patients. It raised in prevalence starting the early 2000s, with Dr. Cole being one its first pioneers, as an alternative to Follicular Unit Extraction (FUT), a transplant technique that leaves more scarring and demands a longer recovery time. As FUE developed and gained prevalence, however, it developed several variants that orient towards differences in technique or instruments.

A complex procedure, FUE involves extracting one or a small cluster of follicular grafts and then individually transplanting them to the recipient area. How the hair transplant surgeon accomplishes this is up to their discretion. Some prefer manual punches while others prefer mechanical or automated. Similarly, some prefer to extract every follicle individually while others blend different groupings for time efficiency. Several types rely on specialized devices.

• Neograft is an automated system that, unfortunately, is notorious for subpar results as surgical techs often run the device and administer the transplant.
• ARTAS is a robotic system that some surgeons use to save time during the extraction phase but also increases the chance of scars and transection rates.
• Body Hair Transplant (BHT) is an emerging transplant type that that uses FUE techniques to extract hair from the scalp and body hair donor region.

Cole Isolation Technique (CIT®), Dr. Cole’s namesake FUE variant, are both comparatively quicker and bring top-caliber results. There are a few reasons why CIT® is the superior choice, but the main difference between it and generic FUE is intrusiveness. CIT® is among the least invasive hair transplant options available, leading to a few major benefits. We list the primary advantages below.

• Almost always no visible scarringFar more precise in extractions and graft placement
• The only hair transplant variant capable of donor recharging
• Quicker recuperation times with less chance of swelling   

Read more about CIT® by visiting its webpage!

Hair transplantation has advanced a great deal, including variants that allow patients to not shave their head for the procedure. This is actually quite unusual; most procedures in the 90s required shaving.

The introduction and prevalence of Follicular Unit Extraction (FUT), however, enabled hair transplant surgeons to keep near all hair by only necessitating that the patient’s donor area is shaved. If the hair over the donor area was over an inch and half or so it can easily cover the extraction site as it heals. FUT, however, also has plenty of drawbacks, including the inevitability of a noticeable scar and long recuperation time, and this is exactly why there was a minor commotion when Follicular Unit Extraction (FUE) began having no-shave variants.

FUE initially required that all patients shave their heads. This was to aid in the extraction of follicular grafts, as surgeons lacked the instruments or techniques to effectively remove follicles or transplant them into recipient areas with some degree of hair. Innovation, though, has led to several options since then and Cole Isolation Technique (CIT®), Dr. Cole’s namesake FUE variant, now has several no-shave options.

No-shave FUE, or CIT®, exists in several forms. The type a patient selects typically pertains to the number of transplants the require and their hairstyle. CIT®, of course, also has a shaved version and it confers one major strength over other options: transplant size, as Dr. Cole can clear a larger amount of transplants in less time due to accessibility. This is not to say, however, that no-shave CIT® also doesn’t also lead to excellent results. Patients can select from two types of the variant.

• Patch-shave CIT® involves selective shaving of donor areas to ease extraction, though there is no shaving of recipient areas
• No-shave CIT® involves Dr. Cole and his team selecting individual donor follicles and cutting the hair strand upon each extraction.

Both patch-shave and no-shave CIT® bring major strengths to patients concerned about recovery or their immediate presentation after work. Learn more about CIT® by visiting its webpage!  

The size of punches Dr. Cole uses in a procedure depend on the patient. A highly specialized cosmetic surgery, near all hair transplant surgeons use specialized tools. Follicular Unit Extraction (FUT) does not require individual extractions and therefore does not use a punch. Follicular Unit Extraction (FUE), however, does use punches to extract either one follicle or a cluster of them.  

One of the first pioneers of Follicular Unit Extraction (FUE), Dr. Cole has found that many hair transplant surgeons’ early work was stymied by the lack of instruments to the trade. He innovated a few specialized punches for his own use and, after seeing the difference they make, released them under the brand Cole Instruments. He has continued to invent a number of instruments and updates since then, and now uses over 30 different instruments during his procedures, according to the patient’s needs.

Punch size in hair transplant surgery is always dependent on a few factors. First, in actuality, is the size of the procedure and location of the recipient areas. Dr. Cole will use larger punch sizes and extract clusters of hairs, sometimes up to five, for certain portions of a transplant; almost always areas that in no way impact the hairline. Precision matters, however, and the patient should expect that Dr. Cole will implant either very small clusters or individual hair at the hairline and neighboring areas for authenticity’s sake. This system both decreases the time of the procedure, Dr. Cole’s times conducting his namesake FUE variant Cole Isolation Technique (CIT®) matches the rate of FUT at this point, and leads to stellar results.

Far as actual punch sizes, Dr. Cole typically ranges from 0.8 mm to 1 mm, depending on the extraction. Some surgeons will decrease the size to 0.6 mm in an effort to prevent scars. However, the depth of penetration is what actually causes most scars -wider punches merely increase the chance of it because of the penetration’s width. CIT® may use slightly larger punches but it is also one of the least invasive FUE variants in the world and is well known for leaving minimal, if any, noticeable scars. The benefits of CIT® are actually quite numerous and include donor regeneration, a first in hair transplantation, and far greater control in graft placement. Visit our CIT® page to learn more about their unique FUE variant.

Many elements are important for a successful hair transplantation. One of the most overlooked is storage mediums: how grafts are kept outside the body. The truth is that there is no set standard for how grafts are stored and this can a great amount of damage to the graft.

All human tissue begins degrading after it is taken out of the body. The major reason is lack of oxidation and nourishment: tissue grafts outside the body begin ischemia, or begin cellular deterioration due to via lack of blood flow. The end result is cellular death, or when the graft’s cells die and the tissue becomes damaged, complicating the transplant itself and decreasing its chance of survival. For this reason, hospitals and clinics involved in any graft collection must consider two elements of storage.

Temperature can greatly effect ischemia by slowing down the metabolism: the human brain’s ischemic tolerance at 37 degrees Celsius is six minutes but at 17 degrees Celsius it is nearly 60 minutes. The same applies to all bodily grafts, though ischemic tolerance depends on the body part.

Holding mediums is also tremendously important. These suspend the grafts and offer any number of benefits, depending on the type, but the ultimate goal is to halt any deterioration of the follicular grafts.

Hospitals and clinics range tremendously in the holding mediums they use and their temperature. Generic storage mediums include normal saline, phosphate buffered saline, and Platelet Rich Plasma (PRP). While adequate, there is a number of more advanced solutions that also make decent holding solutions due to their composition, nutrient content, or ability to oxidize the graft.

A premier clinic with a global reputation for excellence, Forhair makes the point to use one of the best holding mediums available. Our variant uses liposomal, a storage medium known for its ability to transfer nutrients, drugs, and oxygen and transfuses it with adenosine triphosphate (ATP), a compound clinically proven to oxygenate the skin, encouraging blood flow and nutrition, and therefore also better preserving follicular grafts. Few clinics use such a high-quality holding solution but our research indicates it helps decrease the chance of follicular transection, or when follicular transplants do not grow after a procedure.

Temperature is less challenging to achieve but it also requires special equipment. Dr. Cole has designed an Electric Chilling Device that pumps cooling propylene glycol to maintain grafts at a constant temperature. The ideal temperature is still up to speculation, as little clinical research has gone into finding the optimal temperature for hair follicles. Kidney transplants, however, show that 10 degrees Celsius is better than 5 degrees Celsius, which in turn is better than 0.5 degrees Celsius. As mentioned, though, going too warm can damage the follicle. Learn more about how we store grafts by contacting us today!