DHI vs FUE?

[Heartbeat]

I'm norwoood 5.

Some clinics I'm looking at are offering DHI or FUE. Which is better for someone with alot of balding like me ?

 

[Understanding Hair]

Hi @Heartbeat,

FUE is the procedure, Follicular Unit Extraction, the hair is removed from the donor using some kind of punch instrument. This is the same for any type of FUE procedure. The grafts are checked under magnification and separated into their follicular unit sizes.


This is where the difference can now occur. As "pure" FUE, the doctor will begin to create sites for the grafts to be placed, whereas DHI, or any type of implanter tool can skip the doctor´s role in the graft placement.

Custom-made sites, this is normally performed with a fine blade; the blade can be customed to the width the doctor wants in specific areas. For instance, a finer blade for the immediate hairline where only single hair units is used, compared to a thicker blade for the larger 3 and four hair follicular units. Consequently, the doctor can refine the design of a hairline with bespoke slits how they want the hairs to be placed, this includes the density, depth, angle and orientation they want to create. Creating the entire hairline this way helps with continuity and quality. The technicians will then place the hairs into the recipient sites.

The implanter tool, like a propelling pencil, the hair being loaded into it and punched out. The implanter can be used in conjunction with custom slits, instead of forceps to hold the hair when placing into the pre-made recipient site. However, direct implant instruments are more commonly known to be used independently, by passing the recipient site making process, removing the doctor. Loading the hair into the implanter and creating the slit and implanting the graft in one movement. With implanters prefilled with grafts the placer simply picks up a new implanter and continues the process.

When the implanter is used to create the sites and implant the hair in one movement it is much faster, more efficient for the clinic as it takes the doctor´s surgical quality, skin understanding and time out of the loop.

 

[Understanding Hair]

I'm norwoood 5.

Some clinics I'm looking at are offering DHI or FUE. Which is better for someone with alot of balding like me ?

To reflect more on your hair loss pattern, it´s going to come down to your expectations, and donor hair characteristics. NW5, assuming hair loss from the temples to the crown, with the crown still high. Depending on age, having to consider whether the pattern could advance further.

Some clinics will try to cover the entire area, while more conservative clinics will cap the number of grafts per procedure to help preserve the donor better for any future sessions, best healing and growth. NW5 would require something like 5000 plus grafts, not wise to try and achieve in one session with FUE. Assuming your donor can safely reach that over multiple sessions, trying in one, you´ll likely to find when healed the donor would be moth eaten with various changes in hair density around the back and sides due to the over-harvesting process.

Why not post pictures, and get a few opinions. But FUE is the technique, implanters are a different way to place the hair.

 

[Heartbeat]

Thank you for your replies. Appreciate it ! Hair on the back and sides is only short is because I shave it from there lol
I've never had a hair transplant before.

 

[Understanding Hair]

Hi @Heartbeat,

It appears your hairline is still relatively low and intact, maybe some loss of definition, and while you have hair coverage it´s diffuse and the scalp is obviously visible going back to the crown. You may want to look at meds, even if you have a hair transplant, diffuse hair loss can also be weak hair and adding more hair around the current hair can cause shock loss. Clinics often suggest starting minoxidil for a few months prior to a hair transplant. It can depend on your age and degree of hair you have.

Clinics are going to vary on the approach. If you in your 20´s or even early 30´s some may suggest treatment only, especially if in your 20´s, just to try and protect your existing hair and see if the hair loss keeps progressing. Having a hair transplant now, it may be wise to not lower your hairline, reinforce your current line by adding density in area to rebuild the definition and framing of your face. Then going back over the frontal and mid-scalp. Clinics that cap the graft numbers will not be able to achieve total restoration to the crown. There are two reasons, it´s not a good idea to harvest very large numbers as it can cause a great deal of damage and reduce the yield. Also, don´t try and spread the hair to achieve more coverage, it never looks natural. Read this post for more information - https://www.hairlossexperiences.com...llusion-that-makes-it-work.14527/#post-105459

Good luck!

 

[Heartbeat]

Hi @Heartbeat,

It appears your hairline is still relatively low and intact, maybe some loss of definition, and while you have hair coverage it´s diffuse and the scalp is obviously visible going back to the crown. You may want to look at meds, even if you have a hair transplant, diffuse hair loss can also be weak hair and adding more hair around the current hair can cause shock loss. Clinics often suggest starting minoxidil for a few months prior to a hair transplant. It can depend on your age and degree of hair you have.

Clinics are going to vary on the approach. If you in your 20´s or even early 30´s some may suggest treatment only, especially if in your 20´s, just to try and protect your existing hair and see if the hair loss keeps progressing. Having a hair transplant now, it may be wise to not lower your hairline, reinforce your current line by adding density in area to rebuild the definition and framing of your face. Then going back over the frontal and mid-scalp. Clinics that cap the graft numbers will not be able to achieve total restoration to the crown. There are two reasons, it´s not a good idea to harvest very large numbers as it can cause a great deal of damage and reduce the yield. Also, don´t try and spread the hair to achieve more coverage, it never looks natural. Read this post for more information - https://www.hairlossexperiences.com...llusion-that-makes-it-work.14527/#post-105459

Good luck!

Oh thank you for your comprehensive help.

I'm 43 and I think my hair have been like this for a few years now.

Clinic told me not to start finasteride yet until after a HT. You reckon I should start taking minoxidil now then ? I'm thinking of transplant in June time.

The clinics I'm talking to are in turkey and say there's no cap.

I'll have a read of that thread when I get home. I'm just at BBQ lol

 

[Understanding Hair]

43 is a good age for a hair transplant with your pattern.

Finasteride helps with the cause of male pattern hair loss, as does minoxidil but mx is a stimulant so likely to resist the shock loss risk more effectively. But does need to be stopped prior to the hair transplant and then started after. However, it may do nothing if the clinic are aggressive in how they perform a hair transplant. Clinics that are prepared to put high numbers in front of care and quality, just be careful, I would also suggest reading this also -

https://www.hairlossexperiences.com/threads/fue-donor-shock-loss-–-it-doesn´t-have-to-be-considered-normal.14511/

https://www.hairlossexperiences.com/threads/fue-procedure-size-smaller-vs-large.14219/

There are many risks going for big numbers in one session, it may seem the best option to get it all done in one go, but you research a little and you will find many people it didn´t work out for, be it permanent shock loss, poor yield, over harvested donor, and simply due to the protocols and standards, a poor looking result.

Bon appetite!

 

[Heartbeat]

Oh what great threads and advice!

That shock loss looks bad. I'm going to try find a place to buy some minoxidil and get on it ASAP before surgery. And u know u said it might not be enough. But its w orth a try.

For larger HT grafts like 3k above. Is DHI not a good choice? I heard if your norwood 5 it's better to do an FUE as it covers more area etc.

 

[Understanding Hair]

I appreciate implanter marketing, but it´s important to understand that FUE is the name of all hair transplants that remove the hair from the donor with a punch tool. The graft placement can differ, custom made recipient sites or a direct implanter. Although it does let you know the clinic´s practice of graft placement.

It is my opinion, recipient sites, made by the doctor, are more refined. It´s unlikely to find a clinic offering five thousand grafts making recipient sites, as it goes against the clinic principle to reach high numbers cost-effectively. You are more likely to find clinics that cap the numbers, making recipient sites, then place the graft, with an implanter or forceps. This takes longer, requires more care, skill, and concentration, rather than directly punching the hair into the skin.

Hair placement is unrelated to the surface covered; more grafts equal more coverage. However, the exceptionally high numbers, the risk for everything increases with FUE, poor yield, over harvesting, shock loss. Clinics willing to do extremely high graft numbers in a session are likely to have laxer standards and protocols. Otherwise, they couldn´t reach the numbers.

 

[Heartbeat]

I appreciate implanter marketing, but it´s important to understand that FUE is the name of all hair transplants that remove the hair from the donor with a punch tool. The graft placement can differ, custom made recipient sites or a direct implanter. Although it does let you know the clinic´s practice of graft placement.

It is my opinion, recipient sites, made by the doctor, are more refined. It´s unlikely to find a clinic offering five thousand grafts making recipient sites, as it goes against the clinic principle to reach high numbers cost-effectively. You are more likely to find clinics that cap the numbers, making recipient sites, then place the graft, with an implanter or forceps. This takes longer, requires more care, skill, and concentration, rather than directly punching the hair into the skin.

Hair placement is unrelated to the surface covered; more grafts equal more coverage. However, the exceptionally high numbers, the risk for everything increases with FUE, poor yield, over harvesting, shock loss. Clinics willing to do extremely high graft numbers in a session are likely to have laxer standards and protocols. Otherwise, they couldn´t reach the numbers.

Oh I see thank you for clarifying that. Looks like most turkey clinics offering HT for around 2k for unlimited grafts depending on how much they can extract ( regardless of how good for you or bad for you) will most likely use direct implanting without it being customised

 

[Understanding Hair]

Oh I see thank you for clarifying that. Looks like most turkey clinics offering HT for around 2k for unlimited grafts depending on how much they can extract ( regardless of how good for you or bad for you) will most likely use direct implanting without it being customised

Yes, it´s fast, much of the time the doctor doesn´t get involved with the procedure, except sign off on the consultation, all medically un-registered staff doing multiples of ten people per day. While it´s not always the case, here you get what you pay for. You have to decide if you are worth more or risk the damage caused.

 

[Heartbeat]

Yes, it´s fast, much of the time the doctor doesn´t get involved with the procedure, except sign off on the consultation, all medically un-registered staff doing multiples of ten people per day. While it´s not always the case, here you get what you pay for. You have to decide if you are worth more or risk the damage caused.

A clinic got back to me.. I did ask what's their graft placement method.

He replied.

'The difference between the two techniques is that with the DHI technique, there is no need to open a canal; the grafts are implanted directly with a special pen. In contrast, with FUE, we first need to create channels and then implant the grafts. That is the only difference between them.'

So their charging me £1190 for 'FUE' and £1350 for 'DHI' .. uncapped . But they reckon about 3k to 4k. I know you spoke about shock loss etc. But from the 2 isn't it better just to go for thr DHI if I'm eager for it ?

 

[Understanding Hair]

A clinic got back to me.. I did ask what's their graft placement method.

He replied.

'The difference between the two techniques is that with the DHI technique, there is no need to open a canal; the grafts are implanted directly with a special pen. In contrast, with FUE, we first need to create channels and then implant the grafts. That is the only difference between them.'

So their charging me £1190 for 'FUE' and £1350 for 'DHI' .. uncapped . But they reckon about 3k to 4k. I know you spoke about shock loss etc. But from the 2 isn't it better just to go for thr DHI if I'm eager for it ?

You have the information why custom recipient sites are superior, along with more information. It´s your decision, your expectations and priorities. No one can tell you what to do, just present the facts.

 

[mania]

Hair follicles are extracted and implanted using both FUE (Follicular Unit Extraction) and DHI (Direct Hair Implantation) hair transplant procedures; however, the implantation process is different. While DHI uses a specialized instrument known as a Choi implant pen to simultaneously construct a channel and put the follicle, FUE uses a tiny, circular punch to extract follicles.

 

[L64]

DHI is best suited when you need high densities. But when you're a Norwood 5, i'd prefer conventional FUE via premade slits.

 

[Understanding Hair]

DHI is best suited when you need high densities. But when you're a Norwood 5, i'd prefer conventional FUE via premade slits.

A doctor makes tiny recipient slits with the tip of a fine blade, all created in one progressive movement, controlling the depth, angle, and orientation depending on the area treated, and hair and skin characteristics. Changing blades size depending on the size of follicular unit, with technicians needing to be well trained, with great accuracy and hand eye coordination to then place the hair into the tiny slit. Compared to an implanter injecting hair into the skin, it needs a new implanter for every hair, reducing accuracy and control. There is no comparison as to density and accuracy in using an implanter over custom made recipient sites, except speed and ease of use in performing the procedure, removing the doctor from the equation.

The implanters used are commonly 0.8 mm, 0.9 mm, 1.0 mm, and 1.2 mm, inner diameter. On the whole larger than good FUE doctor using anything from a 0.6 to 0.85mm punch to remove a hair unit. While slightly smaller implanters are available, it defeats the purpose of use, as the reason is to make the process faster and easier for technicians, especially when 2 or 3 technicians are on a head at the same time, maximising speed, and an allowance of inaccuracy. A change depending on dealing with a high NW makes no sense, sounds like a marketing spin, which hopes no one really questions the why.

 

[L64]

The implanters used are commonly 0.8 mm, 0.9 mm, 1.0 mm, and 1.2 mm, inner diameter.

The tip which goes into the scalp surely is finer. There are so many reputable surgeons relying on implanter pens.

 

[Understanding Hair]

The tip which goes into the scalp surely is finer. There are so many reputable surgeons relying on implanter pens.

Tools, medical instruments are categorised by size of the key part of the tool. For instance, a nut, will be a specific size/diameter and need a specific size/diameter spanner or socket to release it. This makes everything uniform. You don´t categorise the nut, spanner or socket by the handle length or width or make. The measurement indicates the diameter of the "tip" of the implanter, like the measurement of the FUE punch indicates the diameter of the punch that enters the skin.

Clinics occasionally use the implanter along with custom made recipient sites. This allows the doctor to create the sites as they wish, angle, orientation, meaning the techs can only place the graft how the doctor makes the slit. Using the implanter to punch the hole and place the graft in one motion is quite different, but it is faster.

 

[L64]

Tools, medical instruments are categorised by size of the key part of the tool. For instance, a nut, will be a specific size/diameter and need a specific size/diameter spanner or socket to release it. This makes everything uniform. You don´t categorise the nut, spanner or socket by the handle length or width or make. The measurement indicates the diameter of the "tip" of the implanter, like the measurement of the FUE punch indicates the diameter of the punch that enters the skin.

Clinics occasionally use the implanter along with custom made recipient sites. This allows the doctor to create the sites as they wish, angle, orientation, meaning the techs can only place the graft how the doctor makes the slit. Using the implanter to punch the hole and place the graft in one motion is quite different, but it is faster.

If you look at this picture you will see that the scalp in the recipient doesn't get penetrated with a larger diameter than the punch in the donor when using implanter pens:

 

[Understanding Hair]

Surgical hair transplant instruments are all small today, they use millimetres (mm) or micrometres (μm) for calibration precisely because they are small. Surgeons use instruments with varying diameters, or size, depending on their standards, ability, and needs.

(taken from a current suppliers website)

The sole use of an implanter takes the doctor skills out of the loop with the punch and place action. This makes the process easier, requires less focus, is less precise, requires less diligence and takes much less time. The entire premise of using the implanter is because it is much faster and easier to use, of course, less skills also equals less wages paid. For the clinic, this allows them to do larger or multiples of sessions daily, weekly, monthly.

Opposed to a more refined approach, not high volume, with attention to micro details, such as hair depth, angle, orientation, density, hair distribution. However, this requires a greater need for competency and skill, diligence, and patience, as much slower to perform. This comes at a price.

For one, precision, quality and refinement is of paramount importance. For another, less refinement, with speed, and ease of use being the primary factors. There is a place for both.