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The Scarless Hair Transplant Myth

Dr. Bernardino Arocha of Arocha Hair Restoration (https://arochahairrestoration.com) has stepped forward to debunk the claims of those performing follicular unit extraction (FUE) procedures that they leave less scarring than strip extraction. Not only do FUE procedures typically result in widespread scarring throughout the back of a patient’s scalp, the total scarring is many times greater than the scar from a strip procedure performed by a skilled, experienced hair transplant surgeon.

Concerned about the false claims he was seeing, Dr. Arocha did a comparison between the total scarring of an FUE procedure and the total scarring of a strip extraction.

Dr. Arocha’s calculation assumes a 1 mm diameter punch, which is the most common size used. The radius of that punch is .5 mm.

Pi (π) is important in the calculation, since the scar from the punch is circular. The area of the scar for each FUE punch can be found using the equation π x r squared. In this case the radius is .5, so the calculation becomes π x .5 squared or 3.14 x .25 mm.

As a result, we know the total scar area for each FUE punch totals approximately .785 sq. mm.

To find the total scarred area of an FUE procedure, multiply .785 times the number of punches. For a 3,500 follicle procedure, the total scarred area would be 3,500 x .785.

Therefore, the total is 2,747.5 sq. mm. or approximately 27.5 sq. cm.

Dr. Arocha compared that to the scar from a strip procedure that yields the same number of follicles. He would usually extract a 20 cm (2,000 mm) strip across the back of the scalp and work to minimize the scarring using a two layer closing. The deep layer minimizes surface tension. The superficial layer gently brings the surface margins together, allowing the healing of the wound with minimal tension. The third step, is the beveling of the lower wound edge, which causes the hair to grow through the scar, making it only faintly visible.

The total scar area can be calculated by multiplying the length of the scar (20 cm) by height of the scar (.1 cm to .2 cm).

Therefore, the total scar area from the strip method is just two to four sq. cm. compared to the total scar area from the FUE method of 27.5 sq. cm.

FUE is a technique used to harvest hair follicles using a small round punch. The wound from the punch is only about one millimeter, but it is left to heal without primary closing, which results in thousands of small white scars.

“I often see advertising that suggests FUE procedures offer a scarless result, which is an outrageously false claim that needs to be corrected,” said Dr. Arocha. “Done properly, a scar can be almost invisible, but it is impossible to do surgery and have a scarless result. Virtually every week I see hair transplant patients who are disfigured with scarring over a large portion of their scalp from FUE procedures that they thought would be scarless.”