Common questions and answers about CIT (FUE) hair transplantation vs. other techniques, learn about the procedure and it's advantages.
What Does CIT Mean?
The follicular isolation technique is a process of removing one follicular unit at a time from the donor region. Our technique has evolved from the techniques of Dr. Inaba, Dr. Woods, and Dr. Rassman. A special instrument is used to extract the individual follicular units.
This instrument must cut into the dermis to a point just deep to the arrector pili muscle. Once this structure is cut, the graft can be extracted intact. Grafts ranging from one to 5 hairs each have been extracted. Our technique has allowed the largest single session of graft removal in a single day. We successfully removed 950 intact follicular units in a single day. We also have the largest successive sessions in a two day span on the same patient. Currently, we are able to move almost 2000 grafts in a two day time using our follicular isolation technique.
This process requires a dermal depth analysis so that we can properly judge the depth of the arrector pili muscle. We have found that this depth varies from one region of the donor area to another.
Our process allows for the harvesting of hair from multiple regions of the body. This includes chest, stomach, back, etc. hair. The combination of this technique with standard graft harvesting expands the scalp donor region. The ability to use hair from other regions of the body also adds significantly to the total amount of available donor hair. Dr. Ray Woods has found that chest hair grafted to the scalp eventually begins to grow faster and longer than it did when it was on the chest.
Who does the extracting of the grafts and who does preparing the recipient area and graft placing?
You can read details about our Follicular Extraction procedure on our website. In our procedure the physician does the critical steps in extracting the grafts. Typically, we leave the grafts in their natural environment as long as possible prior to moving them to the recipient area. We feel the body's storage area is superior to man made storage solutions. Once we are ready to place the grafts, we remove them from the donor region. They are then briefly placed in a storage solution or transferred directly to the recipient area. Our storage solutions contain a number of antioxidants designed to minimize the affects of ischemia reperfusion injury (IRI). IRI results from exposure to toxic metabolites that build up in organs or tissue that are removed from their blood supply. Antioxidants decrease the amount of toxic metabolites that our grafts are exposed to.
The recipient sites are prepared by the physician, as well. We feel preparation of the recipient area is critical to the success of your procedure. We do not like needles for the preparation of most of our recipient sites. Needles are not designed for cutting the skin. Needles are designed for injections and removal of blood. We prefer very tiny scalpels that we hand make and can be precisely cut to any size.
What is the gauge of the instrument (needle) that is used to extract/place the grafts?
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 because I want my staff to know where to place grafts of a specific size. I use the needle incisions to direct my staff, like a road map.
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 guage is very small. We know that Dr. Woods likes to use 23 and 25 guage needle sites for his grafts. We know that you will have much greater trauma, slower placement of the grafts, longer time out of 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 an recipient site incision should allow ease of placement and provide for a snug fit so that the grafts our less likely to pop out during the procedure or after the procedure. Since each individual has a specific hair characteristics, 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.
Does location of where procedure will be held has an effect on the final result,ie. is the standard of the service in South Korea or other affiliates the same as the standard of the service in Atlanta?
If Dr. Cole does the surgery, it does not matter if you do the surgery with him in Atlanta or any other location. In either location you will receive the same high quality result. We have invested heavily in the clinic in South Korea to insure the highest standards and quality of care.
Do I have to sign a legal disclaimer?
In our offices we have every patient sign a consent form. This is designed to protect both the patient and the physician. The consent form outlines everything that can go wrong. You have a right to know these things and we have an obligation to inform you of them. You can down load this form from out website. Complications from hair restoration surgery are uncommon, but they do occur. Consent forms are not legal disclaimers. They are a consent to perform a procedure following a full explanation of the procedure, its limits, and its risks. They are not a barrier to protect a physician from legal proceedings that result from negligent care. If a physician performs negligently, he has no protection from the courts.
What's your policy on post-op help in any case of complications?
It is up to the patient to do their due diligence in looking for a physician, who routinely performs high quality medical care. If the patient looks carefully, he will find this physician. If the patient is careless or relies on television advertisements to find his physician, he is following a risky approach that often leaves him disappointed. The hair loss message boards are an excellent source for information about hair loss solutions and the highest quality physicians.
We do quality work and our standards are very high. We take care of our patients and although complications are very rare in our hands we will provide support during the post-op surgery if needed.
Are photos that are on your web site genuine? If i meet your patient will they share their before and after photos?
The photos on our website are genuine. They are of our patients. We have thousands of additional photos, as well, but not all patients want their photos displayed. We have some patients that will be happy to meet with you, while others are not as excited about meeting with you. Those that will meet with you are happy to share their experiences. I see no reason they would not share their photos with you. You must remember that hair loss, its treatment, and cosmetic surgery in general are private matters. Most individuals seeking treatment for their hair loss do not want their information or experience shared. They do not want to risk for their friends or associates to discover their presentation for a surgical solution. Very few patients go public about their hair restoration. Even on the message boards, very few give their real name or full face photos.
Is it true that FUE can't give good density, ie. is it true that better density can be achieved with strip HT?
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) becomes the mainstream, 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- 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 from CIT®. In 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 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 insures 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 hair line, you will require fewer grafts. If you want the lower hair line, you will need more grafts. Hair line 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 life time of our patients. Patients who begin to loose hair in their early 20s will most likely have more excessive hair loss and my 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.
Does your FUE procedure causes shock loss to existing hair? If so, is the loss permanent?
No one wants this. There is no way to absolutely prevent it except to avoid hair restoration surgery. Shock loss by definition is temporary, but it may affect you ultimate coverage potential. Every follicle has a critical number of cycles it will endure prior to undergoing miniaturization that leads first to thinning and later to overt baldness. Hair that undergoes shock goes through one full cycle. If that follicle has reached its critical number, it will not grow back as strong. It will not have the same diameter, length, and pigment. All three will be attenuated. Therefore, we recommend that you avoid this when possible.
The best way to avoid this is to limit the density of grafts that we place. If we limit the density, you will produce fewer traumas. Fewer traumas reduce the risk of shock loss. Other ways to limit the trauma are to reduce the exposure of the recipient area to the toxic metabolites of ischemia reperfusion injury, limit the size of your incision site, and limit the width and length of the instrument you use to make recipient sites.
In short, there are ways to reduce the probability of shock loss, but there is no method that totally eliminates its risk.
Is a FUE - CIT procedure more expensive than the traditional strip procedure?