There’s an important step that must happen in every FUE hair transplant (well, almost “every” and I’ll get into that in a bit) - shaving your head.
“What?! I have to shave my head for the surgery?!” - used to be a common reaction some years ago when I told patients we would need to shave. Nowadays, not so much. You see, hair transplants have come a very long way both in terms of results and in mainstream adoption/awareness. So, the vast majority of patients that come to me know that they generally must shave their head in order to have the surgery.
But why is that?
There are two parts of the reasoning for it and I’ll get into both of them. Firstly, shaving the donor area is needed because, in order to safely and completely extract follicular units, we must cut around them with a circular scalpel called a punch (It’s basically a very small, very little, and very sharp tube). This punch is usually just a bit wider than the diameter of the follicular unit. We cut the skin around it in order to free it from the surrounding tissue. I’m not going to get into that in this text, but Dr. José Lorenzo published great research about the hair follicle anchoring system (that we must cut to free the graft from the scalp).
So, in order to cut around it with the punch, logic makes it so that the hairs have to go inside the lumen of the punch. There is no way around it (actually there is, but again, later). So we cut that hair very short, and then it becomes super easy to do those cuts.
My personal preference is to have the hairs on the donor area super short, less than 1mm in length. I just leave enough to identify the hair and the angle at which it exits the skin. And that’s the main reason we do it.
And the recipient area?
It isn’t mandatory to shave the recipient area. Although for me it kinda is. I only don’t shave the recipient area in women and in very small cases or touch-ups. Of course, if there’s no hair in the recipient area, there’s nothing to shave, but I do like to shave the borders in order to seamlessly integrate the transplanted hair with the native hair. But why do I do it?
Because it greatly benefits my view of the area. It allows for a much more general idea of what’s happening “under the hood” so to speak. Any good engineer will tell you a great build starts with great foundations, so I like to have a very good view of the “foundations”. It also allows for better planning, better graft distributions, and reduces the risk of damaging the native hair as long hair doesn’t have the same evident angulation as short hair. It falls to whatever side it is combed to. And when you’re implanting grafts right next to those hairs, you want to be sure you’re not damaging them, causing unrecoverable shock loss. Shaving the recipient area greatly minimizes this risk.
Shaving the head of a patient who was at 5 months post-op of his first procedure to reconstruct the frontal third.
So, those are the main reasons. However, there are a few other aspects in which shaving benefits the surgery. It makes the surgery easier and quicker as you don’t have to struggle with hairs that obstruct your view or stick to the skin and crumple up with other hairs. Bloody hair is not really easy to work with, so not having to deal with that is a plus. Post-operative hygiene and care is also largely facilitated. Washing your scalp and keeping it clean, applying any needed ointments, etc, is way easier when your hair is very short. It also improves comfort and reduces any itching. It’s just that much better.
I did say that it’s not always needed to shave. There is something called long-hair FUE. It’s basically a technique that uses a punch that has a groove that allows to do the aforementioned cuts without having to introduce the hairs through the punch, thus making long hair extractions possible. In my opinion, it’s an interesting exercise but it lacks the many benefits of shaving. I think it can be an interesting technique for very small procedures, but not very useful for the majority of cases.
One thing I do sometimes in small cases and in women is to shave little parts of the donor area, creating a flap with the hair that is immediately above. This hair covers the donor area nicely, camouflaging the fact that something has been done. The shaved hair then grows back to its original length and it then looks as if nothing happened.
These are compromises we make for very select cases. But the gold standard and the absolute best course of action will always be the same: shaving.