The 4th Generation Hair Transplant

The first generation of the hair transplant technique involved the 4mm punch grafts from post-WWII to the early 1990s.  The second generation of hair transplant technique involving the multiple strips with dissection grafts became predominant in the late 1990s. The multiple strips with mini grafts were improved to the single strip with microscope dissection in the early 2000s.  The graft size further reduced from mini graft to micrograft, and finally, single follicular units. This allowed for the hair transplant to be performed in the mega section and the dense packing predominant in the late 2000s. 

Starting around 2010, the third generation of hair transplant technique involving the extra small 0.8-1mm punch grafts (FUE-follicular unit extraction) became the prevailing trend.  Historically speaking, the approach changed from 4mm punch to stripping and then to 1mm punch.  A few years later, NHT uncovered the significant disadvantages of the FUE, i.e. the donor hair sites could not be used efficiently. The punched hair might not be permanent, in addition to the other drawbacks.    

NHT has been using the new generation of hair transplant techniques since the late 2010s.  This new generation of hair transplant techniques are based on the traditional FUT method with new techniques, new concepts, and new approaches.  The new way conceals the linear scar drawback of the traditional FUT method in the donor hair area. 

Please click the link below to review the pros and cons between the two methods; NHTs FUT (follicular unit transplantation) and the FUE (follicular unit extraction), along with several comparison images from these two methods. 


The New Generation of Hair Transplant Technologies

The new generation of hair transplant technologies have the following features:

  1. Blunt Donor Strip Harvesting -to minimize hair transection 
  2. Invisible Linear Scar
  3. Hair Density Concept Approach
  4. Better Surgery Fee Approach
  5. Painless Hair Transplant 
  6. Video Consultation
  7. Minimum Number of Surgery Approach
  8. Mixing Graft Sizes 

1. NHT Blunt Donor Strip Harvesting – to minimize hair transection

Refer to the following Skin Anatomy for the discussion in the next section. 

Skin Anatomy

NHT Blunt Donor Strip Harvesting is base on The Back of Blade and Hooks Technique, which includes the following three significant steps:

  1. Make a shallow incision with the sharp tip of a blade for the epidermis separation
  2. Apply the skin hooks for dermis traction and easy tear-off 
  3. Use the blunt end of the blade tip to separate the dermis layer of the skin

The epidermis is the outside layer of the skin. It is the toughest of the layers for skin protection, while the dermis layer has much looser tissues where hair follicles exist.

NHT surgeon makes a shallow incision with the sharp tip of a blade to separate the most rigid epidermis layer. 

NHT technician then uses two skin hooks to pull the epidermis skin layer in the opposite direction.  Simultaneously, the NHT surgeon uses the blade tip’s blunt end and applies pressure to tear off the dermis layer.  NHT surgeon then has a clear vision of the dermis layer to prevent the hair follicle’s transection and damage to the blood vessels and nerves.  If the hair follicle is contacting the blade tip, the blade’s blunt side will push the hair follicle away.  This prevents the hair from being transected.

 Minimize Hair Transection 

  • Stereo Microscopes Graft Dissection

Years ago, most transection of follicle happened during donor hair strip dissection into small pieces of grafts. NHT adapts the best binocular stereo microscopes, which allow NHT technicians to see the hair grafts directly in a three-dimensional view, resulting in the reduction of the stress and tiredness of their eyes. The transection in this step is almost down to zero.  

  • Back of Blade and Hook Donor Harvesting 

Donor strip harvesting is the next most transection reason. NHT’s Back of Blade and Hooks Technique further reduces the hair follicle damage during the strip harvesting step.

Using this method, every strip is almost perfect — even for curly hairs. Additionally, the depth of cutting is to separate the epidermis layer only. It is never too deep to damage the blood vessels and nerves. Since using this method, NHT hasn’t used cautery to burn bleeders or to cause nerve pain after surgery for years.  NHT surgeons have clear views of the epidermis and the dermis layers. 

2. Invisible Linear Scar 

The most significant difference between FUT and FUE is the shape of the scar. The FUT results in only one linear scar, while the FUE method results in thousands of small punch scars. Using the Trichophytic Closure Technique,  the linear scar of FUT is much smaller and almost invisible.   But Medicine isn’t precisely as mathematics. We use the same technique and approach but do not always get the same perfect result. Usually, no one can detect the scar unless the hair was cut extremely short. To deal with extra short hair, tattoos or SMP (Scalp Micropigmentation) will be able to conceal the scar nicely.

The difference between SMP and tattoo is the depth of pigment placement. 

The tattoo sticks deeper into the skin and needs only one procedure to stay, and is almost permanent. The black tattoo pigment color may fade and become bluish after several years.  Therefore, the tattoo color fades and becomes bluish. Even though the scar line becomes bluish,  it is still not apparent under the hairs.  If necessary, the patient can always have another tattoo to cover up the previous faded one. See the attached photos. 

On the other hand, the pigment of SMP sticks shallower, and it requires three to four procedures to make the pigment stay.  In one to two years, the color disappears, and the patient needs to repeat SMP procedures to cover up the scar.   

NHT believes that it is good enough to use tattoos to cover up the scar line. And tattoos’ cost is more affordable.

Click the link to see photos—invisible scar.

3. Hair Density Concept Approach

NHT uses the density approach instead of a number of grafts approach as the density is directly related to a hair transplant’s final goal. 

In general, the frontal area needs 50% to 70% hair density, and the crown area requires 80% to 90% hair density to look natural in the human eye.   It should be noted that each graft may contain from one hair to four hairs.  There is a 400% difference between one-hair and four-hair grafts. For example,  1000 grafts might include from 1000 to 4000 hairs, and one doesn’t have any idea how many grafts are needed to achieve a natural-looking. The graft number approach doesn’t directly correlate to the final natural-looking goal. 

As a rule of thumb, in one surgery, NHT recommends 35% density for the frontal area, while 45% density in the small hairline area for better density.  NHT recommends performing the hair transplant in two surgery sessions for those with a large bald spot.  NHT finds out that some patients feel happy after only one 35% surgery session if they have some degree of the original hairs in the transplant areas.

The transplant area is always irregular and very difficult to measure, we have designed an easy way to figure out the size of this area.   Based on the transplant area and density, one can calculate the donor size requirement as follows:

Transplant area  x  density = donor area

For more details, please click the link

For the images of different transplant densities, please click the link . There are good references to foresee the hair transplant results. 

Some people have thicker hairs, while others have thinner hairs. Everyone has their own hair thickness and hair quality.  NHT takes the approach assuming the donor hair density of each patient is 100% by itself.  The same 100% hair density contains different numbers of hair and hair quality in different people.  The final goal of 50 to 70% of density will have different numbers and quality of hair.  NHT’s mission is to provide a balanced and harmonious look to his own hair.  It can not be all thick hairs for all patients.

4. Better Surgery Fee Approach

For the old FUT surgery, all transplant clinics charge by the number of grafts, but the problem with this approach is that the patient never knows how many grafts can be produced from the strip. The Strip dissection is by the size of the follicular unit, not by equal size. The donor’s density is different at every person and even the same person to varying head portions. In traditional FUT surgery, Converting from donor size into numbers of grafts precisely is impossible. If the number of grafts is within 90% of the estimate, it would already be a reasonable estimate. Usually, the difference is much more significant than 10%. Charging the surgery fee based on it is not an ideal method. We charge based on the size of the donor area instead of the number of grafts. You will not know how many grafts you will receive before the surgery, but you know precisely the density you will receive. And the density is directly related to the final goal of the surgery. 

As long as the same coverage area and density, the donor size is always the same for different hair transplant clinics. Using this knowledge, you can compare the price at other hair transplant offices on the same basis. 

5. Painless Hair Transplant  

The most painful part of the surgery happens during local Anesthesia shots. It will take 

at least 20 to 40 shots. The pain comes from the local Anesthesia medication. Even the smallest 30G needle used will not be helped. 

If the anesthesia isn’t given right, the procedure would be excruciating and terrifying. We will make these shots pain very minimal and will make you feel relaxed and in a peaceful state of mind even without you falling asleep completely. You can still go to the restroom, watch Netflix, and enjoy light snacks. 

We perform the NHT Anesthesia Technique. Ninety-nine percent of our patients consider pain scale the hair transplant experience almost as easy as a hair cut.Survey of pain during the procedure. 

6 . Video Consultation 

Going to an in-office consultation can take at least half a day, and you might only meet a consultant, not a physician.  We have developed a program which will save you time and money. The program starts with an online consultation form so we can gain some basic information about you. Then we will email you a ZOOM CONSULTATION LIST to tell you what kind of information you will get from the video consultation. Next,  we will email you a google new patient information form to know you better to give you a better proposal. After finishing all paperwork then there will be a video consultation with our physician. After the online/ video consultation, the only thing we don’t know is the accurate size of coverage and the hairline design desired. That part can be done the morning of surgery. This way, you only need to make one trip to our office. 

7. Minimum Number of Surgery Approach

For most people, hair loss is lifetime progress. Hair transplant surgery -only relocate permanent hair. The surgery’s advantage is that transplanted hair will keep growing as long as the donor’s hair exists.  What it can not do is prevent future hair loss (the hair you were born with). So learning how to prevent hair loss is extremely important.

If no hair loss prevention is taken, the patient will have to come back for more surgeries every few years. It’s a great benefit for hair transplant clinics as they will have repeated patients and don’t have to spend a lot of money getting new patients. 

But at NHT, we take a different approach based on your gender, age, hair loss condition, your existing hair’s quality, and the leftover donor size. If we decide that hair loss prevention is essential to you, we will offer you medication treatment. Sometimes our patients receive medication treatment only even before the surgery.  Some people on medication don’t need the surgery after taking it. It is a tough decision for us. We make money from surgery, not medical treatment. With medication treatment, our clinic has very few repeat patients because after their final goal is achieved by surgery, no further hair loss, they can always keep the same appearance. They don’t need more surgery. 

8. Mixing Graft Sizes 

With FUT, we can use different sizes of the graft to fit your unique needs. On the other hand, FUE is only able to offer one size of the graft.  

For example, curly hair and grey hair are not candidates for the follicular unit FUT and FUE method. 

Curly hair is not only curly on the outside, but even the hair stem within the tissue is curly, so it’s difficult to avoid damage to these grafts. The more the grafts are cut, the more damage is done. Grey color hair poses a different problem because it is tough to see—even under the microscope. Gray hair is the same color as the tissue. Just like writing with white ink on white paper, no matter how much you enlarge a white hair donor strip, it will still be challenging to see.

In this situation, we can cut 3 to 4 hairs grafts instead of only 1 to 2 hair follicular unit(s).

Depending on the transplant area, we will use different sizes of the grafts. As our principle at the hairline, we use only one or two-hair grafts to make it look natural, but use three or four-hair grafts to increase the density for the top of the area. (Fatty graft has better yield than slim graft)