It’s extremely important to keep in mind that hair restoration is a medical art. Medical art combines medical knowledge, mastery of current surgical skills and techniques, as well as a keen eye, enabling the accurate reproduction of what occurs naturally.
Many prospective hair restoration patients assume that artistic ability is a given, resulting from education and practice of established surgical techniques. Art and surgery are separate skills, and this must be taken into consideration when evaluating a doctor for your hair restoration surgery.
Unfortunately, a large part of Dr. Cole’s practice consists of repairing patients who have fallen victim to doctors with little or no artistic sensibilities.
HAIR TRANSPLANT ART ILLUSTRATION
To illustrate the critical importance of the artistic component of hair restoration surgery, imagine with me for a moment the quality of result an art restorer would produce if he followed the methodology of a strip hair restoration doctor.
After preliminary preparation, the art restorer would carefully remove a strip of paint canvas, including the paint layer. He would then utilize the correct colors of the original paint material to touch up the damaged area of the painting.
With a hair restoration strip surgery, the strip is removed, dissected, and the unused tissue is discarded. Nothing is placed back in the donor area, and the edges are drawn tight and sutured.
Even if there were no scars at all, this procedure causes distortion of hair direction and a loss of the naturally occurring gradation of hair shaft diameter. This gets worse as strip surgeons boast of mega sessions above 8,000 grafts. This requires the removal of a wider strip, which results in even greater cosmetic problems for the donor area.
Our patient, who came to us for strip scar repair surgery on October 4th, 2012, illustrates (see video) how strip surgery disfigured his natural hair shaft diameter gradation and hair direction. His hair in the back abruptly changes from coarse to fine.
His 7mm hair length hides his relatively fine scar and the unnatural change in his donor hair direction. With his head shaved down, these cosmetic problems become obvious.
In light of the contemporary popularity of short hairstyles, even a good strip scar is unacceptable to the vast majority of patients. Strip surgery often does a decent job of providing grafts for balding areas of the scalp, but at its very best, it solves one problem while creating another.
Strip scars can, and often do, widen. Some have placed hope in the trichophytic closure as a means to improve the appearance of strip scars. In Dr. Cole’s opinion, trichophytic closure is a strip salesman’s gimmick.
Trichophytic closure transects hair follicles. Hair that is purposefully bisected to create a trichophytic closure commonly won’t survive. Dead hairs will sometimes stay in place for a time, while others can become ingrown, developing unsightly pimples.
Technology, Surgeon Skills, and Experience
Hair transplant tools and associated technologies have moved forward considerably over the last 10 years. FUE in the right hands with the finest surgical tools provides great and numerous advantages for the patient undergoing hair restoration.
- There is no strip scar.
- The doctor is not limited to using only hair within the relatively small strip.
- The doctor can use the finer hair available in the greatly expanded resource of the donor area to create the most natural appearing hairline possible.
- CIT is a far less invasive procedure than strip surgery.
- The current state of the art hair restoration surgery includes PRP and ACell. Used in conjunction with CIT, PRP, and ACell have demonstrated quicker healing, accelerated new hair growth, donor hair regeneration, and minimized hypopigmentation at the donor sites.
The first example (see video) represents a relatively “good” strip scar. The next example is a severe strip scar. The following example illustrates one doctor’s abysmal lack of artistic ability.
There are only a handful of doctors in the world who have the skills to attempt such a repair. Dr. Cole here in Atlanta is one of them. So far our patient pictured here received 7,976 grafts, mostly from the chest and beard area. Our patient considers himself a work in progress and returns every year for additional grafts while he continues to enjoy a major improvement in his appearance.
What Makes FUE Artistic vs Technical
The difference between adequate and exceptional FUE comes down to artistic vision paired with surgical precision.
Technical skill extracts grafts. Artistic ability creates natural results. Dr. Cole’s 35 years performing over 15,000 procedures reveal patterns most surgeons miss.
Natural Hair Growth Angles
Hair doesn’t grow perpendicular to the scalp. Angles vary by location. Frontal hairline follicles exit at 15-25 degrees. Mid-scalp angles reach 30-40 degrees. Crown follicles approach 45-50 degrees following the natural whorl pattern.
Implanting at wrong angles creates obvious “doll hair” appearance. Each graft requires individual angle assessment. This takes experience most surgeons lack.
Hairline Design Principles
Straight lines don’t exist in nature. Neither should they exist in hairlines. Dr. Cole designs irregular, asymmetric hairlines that mirror natural patterns.
Zone 1 (frontal 5mm) receives only single-hair grafts at acute angles. Zone 2 (next 10mm) transitions to 1-2 hair grafts. Zone 3 (beyond 15mm) uses 2-4 hair grafts for density.
Most clinics ignore these zones. They pack multi-hair grafts at the hairline. The result looks transplanted.
Hair Shaft Caliber Matching
Natural hairlines use finer hair. Dr. Cole selects temporal and nape grafts for frontal placement. These areas naturally contain 20-30% finer diameter hair than the occipital donor region.
Strip surgery can’t do this. The strip contains whatever hair exists in that section. FUE allows selective harvesting across the entire donor zone.
Who’s Actually a Good FUE Candidate
Not everyone should get FUE. Not everyone should get a transplant at all.
Good Candidates
Norwood 3-5 with a stable pattern for 2+ years. Adequate donor density (70+ follicular units per cm² in donor zone). Realistic expectations about achievable density. Age 30+ preferred, 25+ acceptable if pattern established.
Family history matters. Father, brothers, and uncles with Norwood 6-7 progression means a conservative design is essential. Can’t give you a teenage hairline if you’ll be extensively bald at 50.
Poor Candidates
Norwood 6-7 extensive baldness with limited donor supply. Active inflammatory scalp conditions. Unrealistic expectations about density or coverage. Body dysmorphia or psychological concerns requiring addressing first.
Age under 25 unless in exceptional circumstances. Pattern still evolving. What looks stable at 23 progresses to Norwood 6 by 30. Then you’re stuck with an unnatural low hairline and depleted donor.
Borderline Cases
Diffuse thinners without a clear pattern. May respond better to medical management with finasteride or minoxidil first. A hair transplant can still help, but requires a different approach.
Women with female pattern hair loss. CIT works, but the candidacy assessment is more complex. Hormonal factors, miniaturization pattern, and realistic density goals all need evaluation.
Real Success Rates and Realistic Outcomes
Industry markets 95% graft survival as standard. Reality is more nuanced.
CIT Graft Survival Data
Dr. Cole’s technique achieves 97% graft survival consistently. This exceeds the industry average of 85-90% for strip procedures and 80-85% for basic FUE.
Why the difference? Smaller punches (0.8-1.0mm for CIT vs 1.0-1.2mm for standard FUE) mean less trauma. Grafts spend less than 90 minutes outside the body vs 2-4 hours with strip dissection.
The transection rate (damaged grafts during extraction) stays below 3% with CIT. Industry average runs 8-15%.
Density Expectations
Native density runs 70-100 follicular units per cm². Single transplant session achieves 40-50 FU/cm² maximum in the recipient area.
You won’t match your original density. You’ll get 50-60% of original density if everything goes perfectly. That’s enough to look full in most cases.
Clinics promising “full density” or “100% native appearance” lie. Physics and biology limit what’s possible.
Timeline to Final Results
Month 1-2: Most transplanted hair sheds. This is normal. Follicles enter the rest phase.
Month 3-4: First fine regrowth emerges. Coverage minimal. Many patients are discouraged here. This is expected.
Month 6: Approximately 60% visible coverage. Hair is still fine, gaining thickness.
Month 10-12: 85-90% final coverage. Hair continues gaining caliber.
Month 18: Full maturation complete. Final assessment possible. Some patients add density at this point if desired.
Faster timelines promised by some clinics don’t match biological reality. Follicles need time to establish a blood supply and resume the growth cycle.
Risks and Complications Nobody Discusses
Every surgery has risks. FUE done poorly creates specific problems.
Overharvesting Donor Area
Safe extraction limit: 25-30% of donor follicles maximum over lifetime. Dr. Cole recommends keeping the first session to 20-25% to preserve options for the future.
Aggressive clinics extract 50-60%. Leaves a visible moth-eaten appearance in the donor zone. No hair left for future procedures when loss progresses.
Once overharvested, the only option is body hair transplant from the chest or beard. Body hair has different characteristics and lower survival rates (70-80%).
Poor Growth Angles Creating Unnatural Appearance
Hair implanted perpendicular sticks straight up. Impossible to style. Looks obviously transplanted, even with good growth.
Fixing this requires removing perpendicular grafts and re-implanting. Essentially starting over. Wastes donor supply and patient money.
Pitting and Cobblestoning
Occurs when the punch size is too large (1.2mm+) or the technique is too aggressive. Leaves small pits or raised bumps in the donor area.
Usually fades over 12-18 months, but sometimes permanent. More visible in short hairstyles. A strip scar might be preferable to severe pitting.
The CIT (Cole FUE) smaller punch size (0.8-1.0mm) minimizes this risk. Can’t eliminate completely, but reduces incidence significantly.
Infection and Poor Healing
Rare with proper sterile technique. Occurs in less than 1% of CIT procedures at ForHair. Industry average closer to 3-5%.
Symptoms include persistent redness, pus, increasing pain, or fever. Requires immediate antibiotic treatment. It can result in graft loss if not addressed quickly.
Post-procedure care is critical. We provide 24/7 contact for concerns during the first 14 days.
Shock Loss of Existing Hair
Native hair around the transplant sometimes enters shock and sheds temporarily. Typically regrows within 3-6 months, but not guaranteed.
Occurs in 10-15% of patients to some degree. More common in patients with miniaturized hair, already barely holding on.
Can’t predict who experiences shock loss. Finasteride started pre-procedure may reduce risk, but it has not been proven definitively.
What FUE Actually Costs and Why
National average FUE: $5-12 per graft. Why such a wide range?
Price Factors
Surgeon experience and skill level matter most. Dr. Cole’s 35 years and 97% graft survival justify premium pricing over recent graduates.
Geographic location affects hair transplant costs. Manhattan runs 30-40% more than Atlanta for comparable procedures. Overhead drives this difference.
Technique specifics influence pricing. No-shave FUE (C2G) costs more due to additional time and difficulty. Standard CIT runs $8-12 per graft at ForHair.
What’s Included in Our Pricing
Every graft is extracted and implanted by or under the direct supervision of Dr. Cole. No technicians performing surgery unsupervised.
All pre-procedure consultations. Post-procedure follow-ups at 1 week, 3 months, 6 months, and 12 months. PRP treatment is included with procedures over 2,000 grafts.
24/7 on-call access during the first two weeks. All prescription medications. Detailed post-procedure care kit with specialized shampoo and healing products.
The Repair Surgery Reality
There are only a handful of doctors in the world who have the skills to attempt such a repair. Dr. Cole here in Atlanta is one of them.
So far, our patient pictured here received 7,976 grafts, mostly from the chest and beard area. Our patient considers himself a work in progress and returns every year for additional grafts while he continues to enjoy a major improvement in his appearance.
Repair surgery represents 40% of ForHair’s practice. Most common issues: overharvested donor areas, unnatural hairlines placed too low, poor growth angles creating “pluggy” appearance, and visible linear scars from strip surgery.
Repairs require more grafts than the original procedure would have needed. Why? Covering old scars, redistributing poorly placed grafts, and filling in areas that should have been covered originally.
Cost of repairs typically $15,000-50,000 or more. Far exceeds the cost of doing it right the first time.
How to Avoid Needing Repair
Choose a surgeon based on results, not price. Lowest cost almost always means corners cut somewhere—usually donor area overextraction or inexperienced technicians performing actual surgery.
Verify the surgeon performs or directly supervises all critical steps. Many clinics advertise a famous doctor’s name, but technicians do 80% of the work.
Review before/after photos with detailed information: graft counts, timeline, patient age, Norwood stage. Photos without context are meaningless.
Ask pointed questions: What’s your transection rate? What percentage needs repair work? How many grafts are safe to extract in my case? The doctor should provide specific numbers, not vague assurances.
Frequently Asked Questions
How long does FUE procedure take?
Depends on graft count. 1,500 grafts takes 4-6 hours. 3,000 grafts requires 6-8 hours. 5,000+ grafts may require two consecutive days.
Rushing increases transection risk and poor graft placement. We don’t hurry. Quality over speed.
What’s recovery like day-by-day?
Days 1-3: Mild discomfort, take prescribed pain medication. Sleep elevated to minimize swelling. No exercise.
Days 4-7: Swelling peaks then decreases. Begin gentle shampooing. Scabs start forming over grafts.
Days 8-14: Scabs loosen and fall off naturally. Don’t pick them. Light exercise OK after day 10.
Months 1-3: Transplanted hair sheds (expected). Return to all normal activities, including vigorous exercise.
Most patients return to desk work within 3-5 days, some even after 1 day, depending on the healing, but we recommend taking some days off. Manual labor or heavy lifting should wait 14 days minimum.
Can people tell I had a transplant?
During the first 7-10 days: visible redness and small scabs where grafts are placed. Wearing a hat helps, but it is obvious to close observers. * We do have cases of remarkable healing after only 1 week with our protocol.
After 2 weeks: redness fading, no scabs. The recipient area looks slightly pink but is easily concealed with longer existing hair.
Month 3+: After shed and during regrowth phase, may look thinner than pre-procedure. This is temporary.
Month 12+: If done well, nobody can tell without extremely close examination. Dr. Cole’s results look natural because the hairline design and angles match natural patterns.
Does it hurt?
Local anesthesia numbs both the donor and the recipient areas. Injection of anesthesia causes brief stinging (5-10 seconds). After that, the procedure is painless.
Some patients feel slight tugging sensation during extraction. Not painful, just awareness of activity. Many patients watch movies or nap during the procedure.
Post-procedure: mild discomfort similar to sunburn. Pain medication provided. Most describe it as 3-4 out of 10 pain level, easily manageable.
What if I continue losing hair after transplant?
Transplanted hair is permanent. Came from a donor zone genetically resistant to DHT. Won’t fall out.
Surrounding native hair can continue thinning. This is why conservative, age-appropriate hairline design matters. The hairline you get at 30 needs to still look natural at 60 when the surrounding hair thins.
Medical management with finasteride or minoxidil is recommended to preserve native hair. Can add more transplanted hair in the future if needed, and donor supply is adequate.
How many grafts do I actually need?
Depends on the area of baldness, desired density, hair characteristics, and donor supply. Can’t give an accurate number without examination.
Online calculators often overestimate. We see patients quoted 5,000 grafts elsewhere when realistic need is 2,500-3,000.
Dr. Cole provides an honest assessment during consultation. Won’t promise unrealistic results. If you can’t achieve your goal with the available donor supply, he tells you that upfront.
