Proper Selection is Essential for Hair Restoration in Black Men and Women

Hair Restoration in Black Men and Women: Proper Selection is Essential

In general, there are three ways to remove hair from the back of the scalp in the course of a hair transplant:

1. Follicular unit extraction (FUE) 

2. Robotic follicular unit extraction (R-FUE or ARTAS)

3. Follicular unit strip harvesting (FUSS)

Each method can give great results and there are advantages and disadvantages of each. Men who plan to shave their scalp in the future prefer the FUE method because a linear scar is not seen.  

What is the best method of donor removal in Black Men and Women?

For most black women in my practice, strip method is superior. The grafts are easily removed and in the properly selected patient, the area heals very nicely. Shaving of the back of the scalp is not required and we have access to 500-2500 healthy grafts.

For most black men in my practice, a preference for FUE is seen. However, not all black men are good candidates for FUE. There are several factors that influence whether someone is a good candidate for FUE.  One of these is the shape and curl of the patient's hair follicles.  It is much easier to extract hairs by FUE in men with straighter hair than men with curly hair.  The curlier the hair, the more difficult it is to predict the path that the hair follows under the scalp and the more likley these hairs are to be damaged by FUE.  We call this damaged 'transection.' Curlier hair is much more likely to be transected during FUE.

If I'm ever not sure if a patient is a good candidate for FUE, I will do a small test session and extract a few grafts and then examine the grafts under the microscope for evidence of 'transection.' If I can't be sure that I'll have nice grafts, I won't do an FUE procedure.  It doesn't happen very often, but certainly there are a small proportion of black men who are not good candidates for FUE by either manual FUE or ARTAS.