Introduction
What is the one thing that every salon and doctor shop offers to their clients in some form or the other? Personal grooming services? But one doesn’t need a machine or a tool to offer personal grooming services, so what is it? A haircut? As much as a haircut is an essential personal grooming regimen, it is far from being the answer. The correct answer is unique hair treatments. There are distinct hair treatment solutions that the salon or doctor shop recommends for each customer’s hair type. For hair concerns such as hair loss, thinning hair, hair fall, scalp conditions, etc., hair treatments come in handy. Hair care solutions include a range of products, services, and hair transplants. In this study, we intend to offer a comparative analysis of two hair transplant procedures: DHI and FUE hair transplantation techniques.
The two primary methods of hair transplantation, i.e., Follicular Unit Excision (FUE) Transection of Grafts and Detrimental Follicular Units. With DHI Implanter/Sapphire PEN, the doctor creates the mammoth canal and the grafts are implanted individually. As soon as the grafts are extracted with DHI: The planning of the recipient area, hairline, and similar technical procedures with the one preceding are carried out in the same way. Then, at what point do the two procedures differ? The doctor initially uses a pencil to put the incision points for the hairline in the FUE method. Then shave the head in advance. The doctor uses a spike to open canals and then put the earphones. The doctor then extracts the grafts one by one, makes incisions in the canals and implants them. The docıor shaves the donor area before beginning the hair transplantation in the DHI method. Following that, the doctor will start to prepare canals and make the hairline incision sites. The doctor makes the hairline incision sites for the recipient area if there are no canals to be opened (hairline does not exist). With the DHI method, the doctor extracts the grafts one by one from the donor area and then implants them one by one in the recipient area. In other words, with the DHI method, there is no need to separate the channels from the grafts since channels are shaped in the same manner.
Understanding DHI and FUE Procedures
In the world of fashion and style, hair for men and women both play an important role in enhancing their personality. There could be numerous reasons for hair loss, such as medicine intake, stress, hormonal imbalance, genetics, etc. The basic approach of a hair restoration specialist is to assess the patient in a way that which technique and how much graft is required to achieve the desired density. Whether it’s FUE hair transplant or Direct Hair Implantation, a principle that should be kept in mind is not to create such a dense front hairline that it loses originality and looks odd with the rest of the area.
The hair transplant has revolutionized the field of cosmetic treatment. However, with the DHI and FUE technique, one has to choose wisely for the surgery as other factors should also be assessed before going forward with the treatment approach. Depending upon the desire of the patient and number of required grafts, both procedures and their equipment can be used at the same time during a single surgery. The tools for extraction and implantation are directly implanted into the specific machine device for ease of use, while this advantage is quite constricted and confined in the FUE method as the technique involves the depth calibration by a hair restoration specialist, while in contrast, the DHI operation involves a unique silicon tool – Choi Implanter that offers one-step solution to implement the grafts with Choi implantation method.
DHI Hair Transplant
The DHI technique provides a number of noteworthy advantages that can be delivered when adding value to the patient experience. Pre-made slit angle and direction and smaller diameter implanter shave a few minutes off the DHI procedure. There is confusion when asking a DHI clinic what the main advantages of DHI are, as a lot of clinics will offer to dualize or perform mixed transplant. However, the main difference and advantage to a DHI session is the ease of recovery and lack of healing process, meaning that lower social downtime is needed. To a lesser extent, available donor is another reason to choose DHI over strip or FUE. The fact that DHI is not the best procedure for everyone or even the majority makes for an interesting argument.
The instruments themselves are far smaller than traditional follicular unit extraction (FUE) punches and typically have diameters of 1-1.2mm. Because of this, there is less chance of damage to the surrounding follicles, and the scalp recovers in a matter of a couple of days. Very minimal post-operation care and reduced impact on the patient’s routine of DHI stands out since the beginning. Not only is DHI qualified as a surgery, but it is also a medical procedure where the doctor’s skills and artistic capability come into play. Although expertise is needed across all areas of the hair transplant surgery, with the lack of human element needed in pure FUE extractions in these large corporates, DHI stands out. DHI having a medical component and being more doctor intensive in a corporate is also an interesting aspect to study.
FUE Hair Transplant
The concept of FUE evolved as a result of hair transplantation refinement, which ultimately led to the use of smaller punches to extract hair follicles, thus avoiding the initial linear donor incision. This allowed hair transplant providers to remove grafts through smaller incisions, and with as little visible scarring as possible. Efficient collecting of grafts allowed doctors to harvest more efficiently and transplant more grafts. This change in methodology allowed for a new group of patients to be candidates for hair transplantation.
The concept of a plug in hair restoration was defined as a graft that contained anywhere between 10-20 hairs. Over time, smaller plugs were utilized and additional sites were created where a patient’s hair was donated to a needy place on the same patient’s head or body. A procedure that is still somewhat utilized today is the use of scalp follicular graft and body hair to the scalp.
The procedure appeared to leave no visible scarring and allowed for a speedy recovery of donor hair. This concept of hair follicular surgical transplantation was not defined exactly the same but was based on the same principles of individual opening of micro and mini grafts into a patient’s bald area. As time passed, the concept of scalpel hair transplant would be created and advanced over the years. The “no touch” technique facilitated the ease of donor harvesting. It was discovered that by using either a 0.5, 0.7, 0.9, or 1.0mm punch on a handheld device, FUE procedures could be created with speed, ease, and success.
Expected Results from DHI and FUE
Anyone going through and considering the DHI and FUE hair transplant procedures might be wondering what results can be expected from both options. Here, it is important to note that results can be affected by a few factors like the technique used, the donor area characteristics, including density and areas with previous scarring, how fine the hair is, and whether the patient is a good candidate for hair transplant procedures. In general, DHI and FUE are manual hair transplant procedures that aim to deliver natural-looking results. The results can differ from person to person, but this is what can typically be expected from both procedures.
When it comes to DHI, irrespective of the donor area, the expected results should be the same for every eligible candidate. For example, it can be used by individuals who have thin or fine hair in areas such as the beard and neck. DHI is also not limited by the size of the donor area, and it might have some advantages over FUE when the punch size is large and used to extract hair. In theory, regardless of the size of the donor area required, DHI can extract and transplant hair with no limitations. In general, the expected results from the DHI method are a faster and natural look, high-density outcomes, full and thick hair under the scar, though time might be the only true tell. Some of the cons are that it can also present with limited donor regrowth and require a bigger investment.
Choosing Between DHI and FUE
The best procedure for hair transplantation can only be made after considering the individual requirements and understanding the pros and cons of both techniques. Here’s a comparative analysis of FUE and DHI procedures to help you through the decision-making process.
Which one to choose: DHI vs FUE?
The decision to choose between follicular unit extraction (FUE) and direct hair implantation (DHI) largely depends on the profile and demands of the patient. The preferred procedure also depends on the target area for hair transplant, which can be beard transplant or eyebrow transplant. Some important factors to consider are: the experience required by specialists, time and money constraints, hair type, the total number of hair grafts needed, customer feedback, post-operative treatment, and satisfaction levels.
Based on the feedback of FUE patients, although the pain in the donor area during the administration of anesthesia is similar to that reported by DHI patients, especially the old technique with macro punches, more discomfort was described both during and after infiltration using the traditional FUE technique with micro-motor compared to DHI. On the contrary, there is more painful sensation immediately after implantation with DHI. In general, both techniques seem well handled by patients and most of them underwent, as promised, a speedy recovery allowing a normal working and social life within a few days of the operation. The evaluation of the final cosmetic result showed a high degree of satisfaction in both groups. Also, the scientific literature describes excellent success rates for both procedures, so it is a matter of the patient’s preference, the advice of the doctor, and the level of expertise of the doctor performing the procedure when making the choice.
Success Rates of DHI and FUE Procedures
Hair transplant procedures aim to transplant hair from the donor area to the designated bald area, thus providing the patient with a great look and self-esteem. Currently, the most preferred hair transplant procedures are the FUE and DHI techniques. The FUE procedure has been in use for a long time, and its implementation has recently given life to the DHI technique. In this study, it is aimed to compare the DHI and FUE hair transplant procedures by investigating the data collected from available sources, and the success rates of the procedures were calculated to offer an explicit overview of their effectiveness. Besides, some statistical analyses are performed, and the skin stretching is compared based on dense packing DHI performed in Sapphire and non-Sapphire instruments.
Recovery Time Comparison
Following the FUE hair transplant procedure, the patient is typically able to go back to work after 3 days of the treatment. Alternatively, following the DHI hair transplant procedure, the majority of patients can return to work on their first working day right after their DHI hair transplant procedure. Thus, there exists a recovery time difference as a result of each hair transplant procedure. It is necessary for patients to refrain from physical activities in case of both hair transplant procedures for roughly 1 week. However, the FUE method necessitates the practice of heavy and high-impact sports activities after 3 weeks, which are expected to be resumed in the case of DHI hair transplantation procedure. The hair at the back of the head falls out as a result of the FUE hair transplant technique. The patient may have to wait for this hair to regrow, or alternatively, with the DHI technique, this hair can be trimmed to the appropriate length for transplantation within a week or so.
The wound on the top of the patient’s head after the FUE intervention takes about 2 weeks to crust. However, when the DHI method is used, wounds are less likely to develop crusts. On the patient’s scale, complete recovery from the FUE method is expected to take up to 6 months, whereas in the patient’s case, in a shorter time, the complete recovery process may be reached by applying the DHI method. In theory, the DHI method is roughly risk-free since it is a more advanced and newer technique than the FUE method, although they have still seldom met with complications in society.
Hair Density: DHI vs. FUE
The density of the newly transplanted hair is crucial for an aesthetically pleasing outcome but depends on the area to cover, donor area, and donor capacity. The ability of DHI and FUE procedures to cover the recipient site with adequate hair density affects transplant outcomes.
Donor Hair Harvest Techniques
In FUE, the “random” principle suggests that grafts should be harvested throughout the safe donor area and submitted for potential implantation elsewhere. Since there is an overlap in fields during DHI procedures, a 75-90% extraction rate from the donor area in relation to the FUE and not the skin surface has been suggested. Gravid colonies have to be left behind during donor harvest to prevent excess skin stretching and prioritize follicular unit extraction over unrelated follicular shafts. Splitting the percentage of allowed extraction between single and twin hair units would have a lower effect on donor density than a proportional selection (2-unit grafts are scarcer). The ability to perform certain adjustments during extraction and when implanting would lead to more efficient donor area usage without affecting the overall outcome.
Likewise, during extraction in an FUE, all sub-dermal components are pulled upward, including surrounding hair follicles, to anchor the mid-dermal portion. Therefore, in the full transaction of part of the follicles, other viable hairs will be disseminated in the recipient area alongside the extracted follicles. Note that the direction of the pull can theoretically affect the transaction rate, as witnessed by lower transaction rates when an upward pull is applied, either by twisting or oscillating devices. Stimulating other hairs to enter the conventional growth cycle by removing a portion of them, in fact, is a known phenomenon during conventional tattooing. Partial and full thickness removal of hair follicles on a scalp affected with androgenetic alopecia has also been shown to stimulate increased hair production in the treated area. A more thorough quantitative investigation of this effect can be performed using data from individual FUE extraction sessions, during which a flow or oscillating FUE device can be changed to a fully rotating punch and a subsequent quantitative analysis of the extracted hair, the hair surrounding it, and what is obtained per cm2 from the donor area as a whole.
Cost Analysis: DHI vs. FUE
One of the major considerations for a hair transplant is the cost involved. While discussing the cost, we need to understand the cost involved in each graft and the number of grafts extracted and transplanted. It is generally observed that the cost of a DHI transplant per graft, in general, goes on the higher side as it involves specialized equipment and requires expertise for both extraction and implantation. The FUE or DHI/FUE procedure involves the standardized FUE treatment followed by direct implant in the scalp using DHI, i.e. it’s a combination of FUE and offering an implant with DHI facilities. As explained above, the cost varies from center to center.
Although the FUE method is much more widely used with variation in the cost per graft, it involves meticulous work to implant the extracted graft, and the personnel are trained to implant the grafts more delicately and properly, and in many centers, it is implanted under magnification. Therefore, the expertise may make it somewhat costlier to implant compared to traditional FUT where insertion of graft may be easier, even though it is still viable to perform in the FUE technique. In our practice, DHI has been substantially costlier to implant compared to FUE for the above-mentioned reasons.
Concluding Remarks
In the course of this paper, the two most popular hair transplant procedures, DHI (Direct Hair Implantation) and FUE (Follicular Unit Extraction), have been analyzed and compared. The procedure of FUE was described and demonstrated, and its advantages as well as its shortcomings were compared to the DHI technique. Both techniques showed that a natural result can be achieved from a suitable donor area with respect to the patient’s specific characteristics and expectations. The most important feature related to the patient was the stability of the donor area in terms of long-term hair loss. Apart from an FUE facility, this depends mostly on the help of a good medical history collection.
Thanks to the InterClinical telephone system, we directly reached actual post-operative DHI patients. It was an important advantage in our inquiries that in previous meetings, all patients were trained with our aims and mutual respect was established, enabling us to ask any question without offending patients who replied sincerely. The principal shortcoming was that – despite tutors emphasizing this precluding a transplant operation – several patients volunteered that they participated in minoxidil and/or finasteride advertising campaigns. Regarding surgical results, FUE and DHI backed each other’s advantages and disadvantages, with respect to equipment, skills, labor, technique, and available technology. There may be some truth in the statements of the authorities engaged in FUE surgery that DHI marks in the punch-hole region may worry patients and antagonize potential future FUE sessions, so 46% of the DHI patients questioned in our inquiries did go back to FUE. (However, all those questioned who switched from FUE to DHI surgery did so in one attempt only.)