Result Driven Hair Restoration

Hair loss can make you look older than you are, lower your confidence, and keep you wearing hairstyles or hats for coverage instead of style.

At Sharma Skin & Hair Surgery, Dr. Sharma performs follicular unit excision, an advanced form of hair transplantation by hand. With over 10 years performing hair transplant surgery his experience allows him to give patients a realistic expectation of what is truly possible.

Find out why so many patients in Edmonton, Alberta, are going with the FUE method over older techniques of hair restoration.

What is FUE?

F.U.E. stands for Follicular Unit Excision. It is a minimally invasive procedure that involves individual follicular extraction in which follicles are excised within a small circular punch drill that is less than a millimeter in diameter.

Motorized F.U.E. Punch

Some Things just Need to be done by Hand

The punch is the motorized, sharp, peaked end handheld tool used in the procedure. Surrounding the follicle with each insertion it scores the scalp, separating the graft from the surrounding area. The punch is then carefully lifted from the area leaving the graft ready for extraction. The graft is then placed into a preserving solution called HypoThermosol until they are ready to be relocated to the desired area of the body.

What is a Graft?

One “graft” or hair follicle is a tunnel-shaped structure in the epidermis (outer layer) of the skin. Hair starts growing at the bottom of a hair follicle. The root of the hair is made up of protein cells and is nourished by blood from nearby blood vessels. A hair follicle can be a unit of single, double or multiple hair roots.

In the hair transplant world, hair follicles may sometimes be refered to as “grafts”, this is the term for a piece of living tissue that is transplanted surgically. Hair transplants are often measured by the number of grafts required to fill in an area of hair loss.

Learn more about grafts and follicles here.

Who is a Good Candidate for the FUE?

There is a large range of candidates for the hair transplant procedure. Most commonly we will see people who are starting to notice significant hair loss, or those who are fed up with wearing hats constantly to hide a balding area. A patient whose concern is about his or her appearance and wants to improve on it is a good candidate for a hair transplant surgery, but still there are many factors that need to be considered:

Play Video about Jordans-fue-hair-transplant-before-and-after-results-video

DONOR HAIR DENSITY – It is one of the biggest factors that will determine if a patient is a good candidate for a hair transplant. If a patient has a low donor density, the feasibility of doing a hair transplant is decreased. One of the purposes of having a hair transplant is to look good this means we must be careful not to over-harvest the donor site. Doing so may cause these areas to appear thin.

HAIR TEXTURE – Patients with curly hair tend to be a challenge for FUE because the hair roots are at a much higher risk of being cut or transected from the harvesting process. It takes a lot of skill and years of expertise to master the FUE technique for patients with curly hair.

HAIR COLOUR – This is because of the contrast between the hair color and scalp color. The wider the contrast between the two, the more it presents the balding of the scalp. For patients who have similar hair and skin color (dark skin & dark hair or light skin & light hair) the balding is less noticeable than those who have high contrast.

HAIR THICKNESS – much like the hair colour – thickness can also determine the success of a hair transplant. Patients with thick hair would require less grafts to be placed than patients with thinner hair in certain recipient areas.

SCALP LAXITY – If a patient has a low laxity then it would be more challenging for the grafts to be extracted out of the donor area and be planted. This can be a difficult factor to asses at home, making the consultation an imperative step before committing to surgery.

If all the factors are considered – then a patient is likely a good hair transplant candidate. To confirm that any one patient is a good candidate we require a consultation with Dr. Sharma prior to committing to surgery.

Book a consultation with Dr. Sharma

Origins of the Follicular Unit Extraction

In the late 1930’s, the cultivation of World War II, a Japanese doctor named Shoji Okuda operated the first hair transplant. He used small punches, like the current FUE method, to remove segments of hair bearing skin from the sides and back of the head which then were transplanted into the bald scalp, eyebrow or any other body part. When the war broke out, the Dr. Okuda’s work was unfortunately forgotten but was given recognition in the new century (mid- 2000’s).

Nearly 2 decades after the then unknown conception of hair transplant in Japan, a dermatologist in New York started doing experiments regarding moving hairs to bald spots of the scalp. Dr. Norman Orentreich began using large diameter punches to transplant dozens of hair follicles to balding regions. His work was praised by his colleagues and an industry was born. He coined the term “ the principle of donor dominance” where the healthy hair follicles continue to grow and thrive even when implanted in an unhealthy scalp. The results were promising but there was an issue in terms of the esthetic result. Due to the large punch drill being used (size 4mm in diameter) the results look like “doll’s hair” as they were “plugged” in the transplanted area.

Then came the 80’s as improvement of hair restoration practice continued. A group of doctors started doing mini-grafting – a technique using smaller grafts cut from a strip of tissue rather than punched out directly from the back of the scalp . Other physicians began using micro-grafts to add density or restore the frontal hairline. The technique had slowly surpassed the practice of the plug technique and became a common procedure of hair restoration. Further procedures were introduced – scalp reductions and flap but likewise presented unnatural results.

Pioneered by Dr. Bobby Limmer in the 1990’s, he then performed a hair transplantation technique called “Follicular Unit Transplantation”. He took a strip of skin from the donor area then dissected it into follicular units. It was known as the “Limmer method”. The method reduced the amount of scarring of the back of the scalp to one linear scar. The results were ground-breaking and aesthetically appealing thus making it perfect for hair restoration.

Across the sea, Dr. Masumi Inaba, a Japanese dermatologist, developed a technique to extract single hair follicles from the skin and became the innovator of Modern Follicular Unit Extraction. In the new millennium, Doctors. William Rassman and Robert Bernstein further improved the method and made it the “Gold Standard” in hair transplant. They coined the term – “Follicular Unit Extraction” but recently changed into “Follicular Unit Excision”.

While certain robotics systems such as the Neograft and ARTAS Robot System have entered the hair transplant world, their results and abilities have not met the high standards of an FUE transplant performed by a trained medical surgeon like Dr. Anil Sharma. The world is still watching and observing how these systems would provide better yielding results. We await what the future will bring with the likes of the AI robotic systems and hair cloning to the hair restoration industry.

Before & After Photos

Comb Through our Results

Take a moment to review the results of Dr. Sharma’s previous patients. You can browse our Before and After Gallery, or review patient testimonials from other people who chose Dr. Sharma as their Edmonton hair transplant surgeon. All of these results were achieved at our clinic here in Edmonton.

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Follicular Unit Excision (F.U.E.):

The F.U.E. process is different in that the head must be shaved so the hair follicles can be harvested individually. Since a smaller area is harvested, a minimally-invasive surgical tool can be used to avoid the appearance of scars. This tool is a small punch that keeps the hair follicle in the scalp tissue, leaving a small dot behind. The benefit is that no scalpel is needed for the procedure. The F.U.E. method is quickly becoming the most popular choice for men requiring hair transplant surgery. The low downtime, light scaring and success rate are hard to beat.

Follicular Unit Transplant (F.U.T.):

Commonly known as “strip” transplant surgery. This method of hair transplant surgery involves taking a strip of scalp from the donor area. A scalpel is used to cut this narrow piece of skin and hair follicles. Then, the wound is carefully closed with stitches using a three-layer closure to minimize scarring. If a small scar is present after the treatment, it is usually unnoticeable for most patients because it can be hidden with a small amount of hair growth. The harvested hair strip is placed under a microscope and divided into graft units that can be placed to recreate the hairline.

What advantages does FUE have over FUT?

While neither surgical technique is superior for every case, the F.U.E. hair transplant has certain benefits over the F.U.T. version:

1. No Linear Scar – There is no linear scar as the donor harvesting on the back is diffused over a large area. FUE produces create small minute pinpoint scars that are hard to see even with very short hair. These tiny scars often appear as small flecks that are obscured by hair worn at a one-quarter of an inch or longer.

2. Decreased donor area healing time – The down time for patient’s having FUT is usually around 10-14 days. For FUE – it is just 5-7 days and usually does not entail sutures and stitches like the FUT.

3. Less post-operation discomfort – Pain is minimal with the F.U.E. surgical technique. Most patients after surgery report mild pain at both the donor site & recipient area. We more often hear about itchiness and discomfort throughout the first 2 or 3 months as the newly transplanted hairs begin to grow.

4. Useful for those with a greater risk of donor scarring – FUE is a superior option for patients that have a history of Keloid scarring. The punch used in the harvesting phase is sized 0.8-1.0 mm in diameter thus when healing occurs the scarring is minimal.

5. Useful for repairing donor scars that cannot be excised – For patients who have previously had F.U.T surgery, the F.U.E. technique is a great solution for scar revision as grafts can be placed near the scar tissue providing coverage of the area.

6. Repeatable for future transplants – Because the FUE does not require us to remove a portion of the scalp it is much more repeatable. Patients who have undergone multiple FUT’s may find that the donor area is too tight to perform the procedure again should revisions be necessary.

Where is the Donor Site

The primary area for follicle harvesting is the back of the scalp. The section of hairs at the back and sides of the head are different from the ones on the front due to their resistance to the cause of male pattern hair loss. The hairs at the donor site are not affected by the cause of male pattern hair loss – DHT (Dihydrotestosterone) a hormone which can miniaturize the hair follicles as well as shorten the growth cycle making it look brittle, thin, and fall out faster.

For patients undergoing FUE, the donor area must be completely shaved down for surgery. The reason behind this is to provide Dr. Sharma with the best visibility and access to the area during the harvesting portion of the procedure. This minimizes the transection rate to give the greatest yield of viable grafts. (Transection of grafts is when the hairs root is cut or damaged during the harvesting phase.)

Learn more about grafts and our harvesting techniques here.

Anesthetic

Hair transplants are performed over a single day and under local anesthesia with the occasional use of mild sedation (varies with patient). To lessen the perception of pain, a solution is added to reduce the acidity of the local anesthetic during drug injection via subcutaneous or intradermal infiltration. Dr. Sharma also utilizes a tumescent anesthesia to assist in controlling the bleeding and lifting the scalp to aid graft harvesting.

Post hair transplant, patients would usually feel a heavy sensation around their head as if they are wearing a helmet. This feeling is from the anesthetic effect and lasts between 4-6 hours from the time of the injection. Patients must be careful to not bump their head (i.e. going inside the car) for one week post-surgery. If mild sedation was provided in the morning, the effect has usually worn out by the time they are discharged. Patients may even drive home following surgery once the nurses have performed a Glasgow score verbal and motor response check which determines that the patient is able to be discharged safely.

Following the hair transplant, pain is very mild depending on the areas that have been worked on. A pain relief medication is given in addition to the anesthetic in providing a painless procedure and post-surgical experience.

Manual F.U.E. Transplant VS Robot Graft Excision

The modern era of medicine has developed systems that would assist surgeons in doing hair transplant. One of the popular systems of today’s practice is the ARTAS Robotic system. The ARTAS is a US FDA approved piece of equipment that is manually controlled to harvest follicular units. Currently there is a dilemma in the industry regarding which is better – Manual FUE or Robotic systems like ARTAS? The significant difference between the two is that the Manual FUE is wholly done by hand of the surgeon while the ARTAS system is only physician assisted.

The manual F.U.E. offers a lot of advantages – it can manage different kinds of hair colours and textures (curly and wavy) unlike with ARTAS which only does dark straight hair. Also, the manual technique uses a 0.8mm-1.0 mm punch drill while the ARTAS cuts with a bigger punch drill. There might be no variance in terms of the number of follicular units harvested, but the most important thing to be considered when choosing between the two is the number of successfully relocated grafts. When completed by hand the surgeon gets to feel the stature of the skin and the resistance of each follicle thus preventing the risk of transection. Performing surgery by hand also allows the surgeon to insert the tool to the minimum required depth, this is important as going deeper might complicate wound healing.

It takes many years of training, experience, dexterity, skill, and precision for surgical excellence. All the more reason to select a skilled and experienced surgeon for your hair transplant procedure.

Every Surgery Comes With A Certain Amount of Risk

Complications & Risks of the FUE procedure:

There are no risk-free surgeries. The following is the list of possible complications that may happen when a patient undergoes any hair transplant surgery regardless of the technique.

1. SWELLING – The scalp will be swollen post procedure due to injection of fluids which controls the bleeding in the area of transplant. It is normal and would subside in a couple of days. Due to gravity, the swelling might go down to the forehead and under eye area between Day 2 to 4 post transplant.
2. BLEEDING – Minimal bleeding might occur in the donor area immediately post transplant as it is still raw and in the process of healing. Constant pressure applied on the site will help control this. Stitches or sutures may be used to stop the bleeding if it persists.
3. PAIN – Mild pain may be experienced post FUE. A pain relief medication is prescribed to alleviate any temporary pain during the recovery period (5-7 days).
4. NUMBNESS – A tingling sensation or numbness is to be expected at both the donor and recipient sites and slowly disappears in the following weeks. This more commonly happens at the donor area where the grafts were harvested.
5. INFECTION – While we take every step possible to prevent this, infection can happen due multiple factors. Patients are covered with antibiotics which keeps the risk of it is very low. Some things to watch out for are fever, tenderness and pus forming around the transplanted area or donor area.
6. THINNING OF THE EXISTING HAIR – Post FUE patients may undergo a phase where their existing hairs at the transplanted area are shedding – it is completely normal. It is caused from a process called Telogen Effluvium. The hairs will then grow back in 3-6 months.
7. REDNESS OF THE SCALP – It is very common to have redness around the scalp post hair transplant. The redness may take for weeks to months depending on various factors such as skin ethnicity.

Recovery following surgery comes with a bit of work. At Sharma Skin & Hair Surgery, we ask patients to follow a very strict post-care routine which involves the use of a custom solution. This solution contains Hypothermosol and Saline and must be applied to the scalp at regular intervals following surgery. The point of this spray is to promote growth and speed up recovery times. The saline is a natural disinfectant which further helps to reduce the chances of infection at the recipient site.

Hair Transplant Recovery Timeline

Manual Excision

Hair restoration using the F.U.E. has become the most popular technique in for hair transplant surgery throughout the world. Patients would like to keep their hair short at the sides and back of the head – and F.U.E. hair transplants allow them to do that. This minimally invasive excision method helps to restore your hairline without esthetically effecting the donor areas. Changes in punch technology have made it easier to extract follicular unit hair grafts more quickly and safely. As the follicles are harvested, Dr. Sharma is careful to position the tool with precision so that it is aligned with the hair growth direction.

Regardless of the way the hair grafts are harvested, “stereoscopic dissecting” microscopes are used to ensure each hair unit is prepared for transplant. Dr. Sharma is a highly trained surgeon, with years of experience to ensure these grafts remain viable for placement.

Incisions & Graft Insertion

A critical part of the surgery is the phase where we place the grafts to the designated recipient area. First, the area is anesthetized to make sure there would be no pain throughout incision process. Sometimes, the scalp is infiltrated with sterile saline to stretch out and to lessen the bleeding. The incisions are made using a sterile blade with the depth depending on the individuals hair graft length. The angles and directions of the slits are important as it must match the surrounding grafts and relative area of the scalp. The angle that the grafts are placed ultimately determines how the hair will grow. The hair follicles are then placed in a gentle and precise manner that does not incur any damage to the hair roots. Each incision is carefully placed into the tiny incisions made during the previous step and set at very specific distances to make sure that each one has sufficient blood supply. This phase is where esthetics must be carefully considered as the angle and depth of each incision will determine the appearance of the final result.

When making the frontal hairline, it is important that high density is achieved to give the appearance of hair fullness. The forward hairline is the first area people would notice in terms of hair loss thus achieving density to the receding / thinning area is critical for attaining an esthetic and natural result. The follicular units placed in the area are mostly singles (follicles with only a single root) to make sure the front does not look like doll’s hair more popularly known as “hair plugs”. With the proper technique and number of grafts people may not even notice you have had a hair transplant.

How Do You Know a Graft Will Grow?

Once we have succesfully excised a graft from the scalp, we review the quality of the root under a microscope. Some grafts have excess tissue which can make the implantation phase difficult. This required a process that trims off the extra tissues or fats by cutting the follicular units into individual grafts that are to be placed in the recipient area. During this phase, the technicians carefully inspect and handle each graft with care under the microscope and choose only healthy grafts for implantation. These grafts are constantly hydrated with sterile saline and Hypothermosol, and kept at a controlled temperature to increase the viability. The technicians are well trained and under supervision of the surgeon to ensure the highest quality throughout the process. At Sharma Skin & Hair Surgery, we have a small team dedicated to hair transplant surgeries, each member is hand-picked by Dr. Sharma and year of experience together gives us the ability to deliver consistent and high quality results.

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Long-Term Strategy for Hair Transplants

Not only does Dr. Sharma consider the immediate results of hair transplant, but he also designs a plan that considers how hair loss patterns will affect the long-term appearance. For example, there are times when multiple treatments are needed as the hair continues to recede later in life. The transplanted hair follicles must be placed strategically to ensure a natural appearance in 2, 5, and 10 years.

Every person has is a limited amount of donor hair available. The long-term plan should ensure that adequate donor supply is present if additional treatments are needed in the future.

Safety, Precision, and Effective

We want to give you an idea of what your day at our clinic will look like. It’s very natural to feel nervous about your upcoming surgery and we hope that this page will help to put your mind at ease. At Sharma Skin & Hair Surgery we perform roughly 2-3 hair transplants a week this ensures our staff are well-rested and can delivery quality work. Due to this, our wait times can be several months long.

Our small team have become experts at completing the hair transplant procedure as safely and effectively as possible.

How Long Before My Hair Grows Back Completely?

It depends on which procedure we are doing and which area you are referring to. For the F.U.E. procedure your hair will grow back to normal at the donor site (back of the head) within 2-4 weeks.

The recipient area (where we are transplanting to) normally takes around 3-6 months to start coming in evenly. With about 70% growth by the one-year mark. It takes a total of 18 months to see the full maturity of your transplanted grafts.

Common Questions About Hair Transplants

Here are answers to some of the most common questions about hair transplant procedures:

What causes hair loss?

Dihydrotestosterone (DHT) is a hormone that affects hair follicles on the scalp. Hormonal changes can cause the follicles to become shorter in length and smaller in diameter, until eventually the follicle disappears completely. Male hair loss is hereditary, but certain medical conditions or medications can also cause hair loss.

What are the side effects of hair transplant?

Your scalp will be swollen, tight, and achy for the first few days after treatment. It is common to experience temporary scabbing during the healing process.

Are hair transplant results instantaneous?

Many patients are surprised to learn that the transplanted hair usually falls out within a few weeks after the surgery. Be patient; the truth is that you don’t walk out of the clinic with a full head of hair. Hair goes through phases, and the transplanted hair will be visible after a few months since it needs to go through all three cycles: anagen, catagen, and telogen.

Will hair transplants cause scarring?

FUE transplants are preferred over FUT to minimize scarring. With FUE, the donor area will have red pinpricks where the follicles are removed. These small marks heal over a few days and leave micro scars. These are extremely small, discoloured flecks, that are easily hidden once the surrounding hair begins to grow back.

Are hair transplants permanent?

The transplanted hair follicles tend to be permanent, but that doesn’t mean that you won’t lose more hair in the future. Hereditary hair loss is a continual process, which is why the transplant plan is designed based on your unique pattern of baldness. Continued hair loss can be minimized by using certain products and medications, and sometimes another transplant treatment is required in the future.

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