HAIRLOSSHELP: Dr Jones, since you have actually performed several of these FUE procedures we thought that you would be the ideal person to get a second opinion from about some of the claims that were made about FUE.

HAIRLOSSHELP: The claim was made that with FUE instead of having a single, very fine incision which can heal in 7 days and ultimately produce a barely noticeable scar, you have a "punch" that is used to extract the units which results in “hundreds, and literally thousands of small, white scars, the equivalent of looking like you were shot in the back of the head with a shotgun."

Can you comment on the accuracy of this statement.

Dr. JONES: In my experience the small 1mm holes heal up much faster than the strip incision and leave no visible scarring. Patients that I have operated on with strip incisions and FUE procedures all prefer the FUE procedure. In fact I am a recipient of a hair transplant and I will have a FUE procedure next time instead of a strip incision procedure.

HAIRLOSSHELP: With regards to punches being use to “punch” out the follicle and causing transection, I am confused. In Dr Rassman’s peer-reviewed published paper on FUE, he clearly states that the punch only penetrated about 2mm and was only used to score around the follicle, not actually punch it out. Has this been verified in your experience with the FUE method?

Dr. JONES: Yes, that is 100% correct; the punch is used to make a circular incision around the follicles. The follicle is then gently eased out and it just “pops” right out. The follicles are not punched out like they were in the days of the large punch grafts. In essence the punch is being used as a circular scalpel, and not a punch.

HAIRLOSSHELP: Another comment was made that the donor area in FUE is diffusely depleted and you end up with substantial scarring. Has this been your experience?

Dr. JONES: Even on the chest, where scarring is much more of a problem than the head, scarring is not an issue. Many patients are seeking this procedure to repair damage caused by strip incisions where there has been extensive scarring.

HAIRLOSSHELP: A claim was made that only 1-2% of patients have a problem with wide donor scars. Since you have done strip harvesting for 6 years can you comment on what you have seen? Also do you know of any study that showed that only 1 or 2% of patients had issues with wide donor scars?

Dr. JONES: The biggest single concern with current methods of hair transplantation to the patient is the donor scar. It is more common in larger sessions and in the second, third and fourth sessions. I have never seen a study showing the percentage of problems from donor scars. I'm not sure where this 1-2% number comes from. My opinion is that most patients who have had unsatisfactory results with a surgery never go back to the same doctor, and this may be one reason why some doctors think the problem with donor scars is less than it really is.

HAIRLOSSHELP: In terms of healing time, its was stated that "a suture wound is typically going to heal in 7 days, whereas a punch wound is going to take 2 to 3 times that amount of time because it has to fill in totally on its own. The rate of healing is far slower with a punch than with incision." Again, since you have done both, can you tell us what your experience has been with regards to healing?

Dr. JONES: The holes always heal much faster than the incision. You cannot compare a 1mm incision to a 5mm plug incision. In my experience the small circular incisions not only heal a lot faster, but the patient experiences far less discomfort since less tissue has been removed.

HAIRLOSSHELP: In terms of donor site depletion, an interesting comment was made and that it would be difficult to fix someone who has had FUE done and you would be dealing with a profoundly depleted donor area with extensive scarring.

I was surprised by this comment because I have personally seen people who had massive open donor scarring from old-fashioned punch grafting and this was simply excised with a strip incision. If there ever were an issue with donor depletion would it be any more difficult to remove a strip that consisted of FUE incisions over a strip that consisted of large punch graft incisions?

Dr. JONES: I think donor depletion would be diffuse and better hidden compared to a linear wide incision. Another issue is that the statement that wide incisions are easy to repair. This simply isn't true. Ask the dozens of patient that have had multiple failed repair procedures who post on the various web sites.

HAIRLOSSHELP: When we started featuring info about Dr Woods the complaint amongst doctors was that there was no information about the procedure and therefore it was very unethical for it to be presented. However now Dr Rassman published his FUE paper in a peer-reviewed journal and yet the method still seems to be questioned. In that particular interview about FUE, references were made to follicles being punched out when they are not being punched out according to the paper published by Dr Rassman

So how do patients know who to believe if there is such a discrepancy between what is published in a peer-review journal, and what other doctors are saying about it?

Dr. JONES: I always think the best thing is to ask other patients since they are the ones on the receiving end and have no biases.

HAIRLOSSHELP: One good point was made during that interview that using reproducible research that is verifiable by multiple peers is the benchmark of a good solid scientific technique. You have come along after Dr Woods and Dr Rassman in performing this procedure. Do you feel you are able to successfully reproduce their results?

Dr. JONES: So far I am able to reproduce their results. I hope other physicians adopt this technique and we get more information, more data and further this technique and make it available to patients all over the world.

HAIRLOSSHELP: Is it unconscionable to charge doctors a fee to train under you, as Dr Woods want to do? Is this a rare thing in this field? I have heard of transplant doctors charging other doctors to learn their techniques. Is this true or is it urban legend?

Dr. JONES: Most doctor's do charge other doctor's for training, but most are not a secretive as Dr. Woods.

HAIRLOSSHELP: This FUE controversy is very confusing for consumers. So many doctors are opposed to it yet they are the same people who were in favor of scalp reductions several years ago. How do consumers know what is right or wrong when doctors perform a procedure today and then later say it’s no good?

Dr. JONES: Patients have to weigh up all the options and facts and make their decisions based on what they see themselves. Sites like this are a good way to get objective information and allow patients to share experiences.

HAIRLOSSHELP: With all the associations and peer-reviewed journals to "protect" consumers and promote science, how did large punch grafting get done for decades? If punch grafting was that terrible why did they do it in the first place and how did it get to be the "de facto" and accepted standard for over 30 years?

Dr. JONES: That’s a very good question….

HAIRLOSSHELP: How has your practice changed since you started practicing this FUE technique?

Dr. JONES: I definitely spend a lot more time per patient now than I ever did with strip incisions. This may be a reason why it’s not very popular amongst some doctors.

HAIRLOSSHELP: Are you still going to be doing strip procedures?

Dr. JONES: Not unless a patient wants it. I feel this is a better way to go and I am changing over my whole practice to the FUE technique.

HAIRLOSSHELP: Well congratulations and we will follow your progress with great interest.

Dr. Jones extracts a follicle with jewellers forceps during an FUE procedure.

The follicle has not been punched out, but rather is being pulled out.