Hair restoration is advancing fast.
Skill and artistry still matter most. But new procedures and scientific innovations are pushing results even further.
At ForHair, we combine Dr. Cole’s surgical expertise with cutting-edge cellular therapies and scalp micro pigmentation (SMP).
This article covers three real cases that show what’s possible when experience meets innovation.
FUE Repair with CRP and Stem Cell Infusion
FUE Repair with CRP and Stem Cell Infusion
Our first case involves a patient who came to ForHair after a disappointing procedure elsewhere.
His initial surgery involved 1,500 grafts. After 18 months, the results were clearly below average.
This happens too often. More surgeons offer FUE before building the prerequisite experience. Others cut corners to reduce costs.
When he arrived at our clinic, his graft density measured 0 to 30 per square centimeter. Hair density was 30 to 60 hairs per square centimeter.
That’s significantly below par coverage.
The Repair: 2,717 Grafts Using Multiple Punch Sizes
Using Hairmes, a French program that calculates hair coverage versus scalp surface area, we mapped his donor potential.
The calculation showed a hair loss of 78.99 hairs per square centimeter.
Our solution: add 2,717 grafts to both transplant and donor areas. He chose the fully shaven FUE method.
We extracted grafts using three different punch sizes: 0.8 mm, 0.9 mm, and 1.0 mm.
Most physicians use a single punch. We use a variety of sizes to harvest different sized grafts.
This adds variance and improves results.
We harvested two-hair grafts with the 0.8 mm punch, three-hair grafts with the 0.9 mm punch, and larger grafts with the 1.0 mm punch.
Final numbers: 3.24 hairs per graft on average with a 4.9% follicle transection rate.
The composition: 8% two-hair grafts, 64% three-hair grafts, 34% four-hair grafts, and 4% five-hair grafts.
Single-hair grafts are uncommon in repairs unless the donor area is very sparse.
Strip surgeons and most FUE surgeons average 20% single-hair grafts because they accidentally split follicles during harvesting.
That’s a primary reason to avoid unproven surgeons. They require far more grafts to create similar density.
CRP, ACell, and Stem Cell Infusions
After the repair, we treated his recipient area with CRP (Cytokine-Rich Plasma) mixed with 60 mg of ACell.
ForHair’s minimally invasive technique, Cole Isolation Technique (CIT), is particularly suitable for CRP and ACell treatments.
Stem cell remnants from donor areas have a good chance of rejuvenating after minimally invasive harvesting.
We typically see a 30% to 40% renewal rate.
Put simply: 1,300 to 1,600 new strands of hair for every 1,000 single follicle grafts.
With CRP treatment, we typically see 99% of grafts growing at 4.5 months.
We treated his donor area with 30 mg of ACell mixed in hyaluronic acid and follicle stem cells created from 12 of his grafts.
We also injected a stem cell infusion at the top of his head.
ACell injections in the donor area help promote follicle regeneration in 30% to 40% of extraction sites.
Adding follicle stem cells to this mixture may further stimulate regeneration.
These treatments, including CRP, ACell, and follicular stem cell suspensions, represent cutting-edge cellular therapies for hair restoration.
At six months, results showed the combination of cellular therapy and strategic graft selection delivers excellent coverage with fewer grafts.
A Photo is Worth a Thousand Words
At six months, results showed the combination of cellular therapy and strategic graft selection delivers excellent coverage with fewer grafts.
Why Punch Quality Matters
Punches are expensive.
Many surgeons use a single punch on up to four different patients. This is unacceptable.
A punch dulls during use. After 400 to 1,000 grafts, it becomes unacceptably dull.
At that point, follicle transection rates skyrocket.
Surgeons should always change punches during a case to maintain the sharpest cutting edge.
ForHair’s dedication to sharp punches is one reason we get better coverage from fewer grafts.
We never sacrifice results to cut costs.
Every procedure is a once-in-a-lifetime opportunity for a patient. We treat it that way.
Punches should be single-use, disposable items. You can’t sharpen them like a knife.
The diameter of the punch wall is only 0.1 mm. Too thin to restore to original sharpness.
Dr. Cole’s emphasis on quality instruments led to Cole Instruments, offering some of the best utensils for hair restoration.
This includes the serrated tip punch, manufactured from the highest quality hardened steel.
CRP vs. PRP: A Side-by-Side Comparison
Our second case offered a unique opportunity to compare CRP and PRP directly.
The patient granted permission to use different cellular treatments on each side of his head.
Right side: CRP with 30 mg of ACell.
Left side: standard PRP with calcium gluconate activator and 30 mg of ACell.
The Transplant Procedure
After injection, we transplanted 2,200 grafts.
Using Hairmes, we mapped his donor area: 16,520 follicular units.
That’s fortunate. The average donor bank is 15,200 follicular units.
We used five different punch sizes ranging from 0.8 mm to 1.0 mm, increasing in 0.05 mm increments.
These grafts achieved more than 95% success rate.
The Results: CRP Outperforms PRP
This case gets interesting post-procedure.
After three months, about 80% of grafts were growing on the CRP side.
The PRP side showed much lower response.
This observation led us to study graft regrowth rates for CRP versus PRP versus placebo.
Our subsequent studies confirmed these findings.
On average, CRP initiates over 80% of grafts to grow at 3.5 months. By 4.5 months, 99% of grafts grow.
This makes sense. CRP has 6 to 8 times the concentration of growth factors as PRP, according to ELISA testing.
Without PRP or CRP, hair transplants typically show 10% of grafts growing each month post-procedure.
Standard PRP only slightly improves this rate.
CRP exponentially increases results and may also improve overall yield. More research continues.
The patient was happy with his right side (CRP treated) but felt he needed a small touch-up procedure on the left (PRP treated) side.
FUT Scar Repair with FUE and SMP
Our third case showcases the general risks of Follicular Unit Transplantation (FUT).
FUT was the go-to method before FUE spread in the early 2000s. It has major drawbacks that FUE bypasses.
A noticeable linear scar. Often, noticeable plugs that resemble doll hair.
This patient’s FUT procedure left him with both problems.
With long hair, he could conceal the scar. Nothing hides bad graft work.
The Goal: A Normal Appearance
His hope was simple: look normal, even if that meant showing some hair loss.
The strip scar was so wide we couldn’t guarantee he could comfortably wear a buzz cut.
Fortunately, he had only one strip harvest.
Multiple harvests can warp hair growth angles. Sometimes that makes normal appearance impossible.
We developed a creative plan combining FUE and SMP.
Scar Camouflage with FUE Grafts
Scar hair transplant repair was the first stage.
Our objective: make it look as normal as possible without compromising other donor areas.
We harvested 447 grafts in two procedures from random locations across the viable donor area.
This irregular pattern makes extraction sites harder to see. There’s no regular pattern to spot.
We call it the “parking lot at the busiest mall the day before Christmas” pattern.
The spots are there, but you really have to look to find them.
The frontal FUT grafts required removal. They were large, prominent, and had visible pits.
In less severe cases, we can redistribute FUT grafts to create a more natural hairline.
These plugs were too tight to repair. Redistributing them risked frontal scars without much improvement.
Scalp Micro Pigmentation for Final Coverage
Stage two was scalp micro pigmentation (SMP).
SMP is a specialized tattoo that replicates the appearance of real hair follicles.
It can add the appearance of thickness to bald or thinning spots. In this case, it created the look of a buzz cut.
Stages three and four? More SMP sessions.
Covering an FUT scar with SMP requires applying it to the scar and surrounding area.
FUT procedures pull neighboring skin over the extraction site.
Think of it like putting dots on a deflated balloon, then inflating it. The dots spread apart.
FUT scars stretch the skin and reduce hair density around them.
This wide scar was a particular challenge.
We had to mimic the density of other areas in the donor region.
A lot of planning and creativity went into formulating the right SMP blend.
The result: a convincing appearance of uniform hair density in and around the scar.
Results: A Normal Appearance with a Buzz Cut
The 447 grafts and three SMP sessions produced excellent results.
This patient can now buzz his hair.
Before we developed this combination of SMP plus FUE, FUT patients would have found this impossible.
Each pass of SMP or grafting improves an FUT scar’s appearance even more.
View more transformation examples in our before and after photo gallery.
Why FUT Is Outdated
Avoiding FUT altogether is any patient’s best option.
FUT has not been the gold standard for over a decade. Modern FUE techniques have replaced it.
Some surgeons still advocate for FUT. Many receive finder’s fees for referrals.
FUT has no advantage over FUE.
Our studies prove that strip surgery kills hair due to traction alopecia.
No one can predict the width of an FUT scar. Surgeons often promise pencil-thin scars.
Thin scars happen occasionally. Many perfect FUT procedures still leave wide scars.
Young men are most susceptible to shady sales tactics. Panic sets in when hair loss becomes obvious.
They often resort to cheap procedures with unproven doctors.
Both FUT and FUE require years of training. FUE takes even longer to perfect.
Choosing the wrong surgeon risks disappointment worse than hair loss itself.
The Bottom Line
Skill and artistry remain essential to successful FUE procedures.
But new innovations are dramatically improving results.
Cellular treatments are proving to be the next great step in hair restoration.
CRP and ACell foster faster, thicker growth. They encourage follicular regeneration in donor areas.
Follicular stem cell suspensions show even more promise.
Research indicates these suspensions can invigorate dormant follicles to grow terminal hair again.
Scientists theorize that further research may even generate follicles where none existed.
SMP is proving invaluable for FUT scar repairs.
Patients who once hid scars with longer hair can now wear a buzz cut.
Each case is unique. Dr. Cole’s ability to combine SMP and FUE continues helping FUT recipients wear their hair however they want.
Frequently Asked Questions
What is CRP and how is it different from PRP?
CRP (Cytokine-Rich Plasma) is Dr. Cole’s advanced version of PRP (Platelet-Rich Plasma).
CRP contains 6 to 8 times more growth factors than standard PRP, according to ELISA testing.
This higher concentration means faster graft growth. With CRP, 99% of grafts typically grow by 4.5 months versus about 10% per month without treatment.
How does ACell help with hair transplants?
ACell is an extracellular matrix that promotes tissue regeneration.
When applied to donor areas, it helps 30% to 40% of extraction sites regenerate new follicles.
Combined with CRP, it accelerates healing and extends the duration of growth factor benefits.
Can SMP fix an FUT scar?
Yes. Scalp micro pigmentation can effectively camouflage FUT (strip) scars.
SMP replicates the appearance of hair follicles. When combined with FUE grafts placed into the scar, patients can often wear their hair very short.
Multiple SMP sessions may be needed depending on scar width.
Why do you use multiple punch sizes during FUE?
Different follicular units contain different numbers of hairs.
Using multiple punch sizes (0.8 mm, 0.9 mm, 1.0 mm) allows us to match the punch to the graft size.
This reduces transection rates and improves overall graft survival. Most surgeons use just one punch size, which compromises results.
How long do stem cell and CRP treatments last?
CRP results typically begin to diminish around 9 months.
Adding ACell extends this duration. We recommend follow-up CRP sessions before the 12-month mark for optimal maintenance.
Stem cell infusions provide longer-lasting benefits, though individual results vary.
What makes ForHair’s approach different?
Dr. Cole pioneered the Cole Isolation Technique (CIT), a minimally invasive FUE method that leaves stem cell remnants in donor areas.
We combine this surgical expertise with advanced cellular therapies like CRP and stem cell infusions. We also use only single-use, sharp punches and multiple punch sizes. These details result in higher graft survival and better coverage from fewer grafts
References
1. Gentile P, Garcovich S. Advances in Regenerative Stem Cell Therapy in Androgenic Alopecia and Hair Loss: Wnt Pathway, Growth-Factor, and Mesenchymal Stem Cell Signaling Impact Analysis on Cell Growth and Hair Follicle Development. Cells. 2019;8(5):466. PubMed
2. Gupta AK, Carviel J. A Mechanistic Model of Platelet-Rich Plasma Treatment for Androgenetic Alopecia. Dermatol Surg. 2016;42(12):1335-1339. PubMed
3. Rose PT. Hair Restoration Surgery: Challenges and Solutions. Clin Cosmet Investig Dermatol. 2015;8:361-370. PubMed
4. International Society of Hair Restoration Surgery (ISHRS). Practice Census Results. 2022. ISHRS.org
