The FUE Shave Test, developed by Dr. U, is a groundbreaking diagnostic tool used to distinguish between permanent and non-permanent donor grafts on a patient’s shaved scalp. It does so by examining the actual hair growth pattern on an individual basis, rather than relying mainly on predetermined/fixed anatomic landmarks defining the Safe Donor Area (SDA). Traditionally, surgeons exclusively depended on the SDA for obtaining permanent follicular units unaffected by DHT’s miniaturizing effects. However, Dr. U’s FUE Shave Test takes into account the unique variations in hair density patterns among patients, offering a personalized approach to identifying permanent and non-permanent donor sources. This redefines the concept of the SDA as a dynamic region rather than a fixed one, making more patients eligible for specific graft types, like nape hair, and increasing the potential quantity of grafts.
Rethinking The Conventional Concept of the Safe Donor Area Zone With Dr.U’s FUE Shave Test
In hair transplantation, the Safe Donor Area (SDA) based on fixed/predetermined anatomic landmarks has traditionally been used as a guideline for selecting suitable donor grafts to ensure healthy, long-term hair growth in all patients. Regions outside thus determined SDAs are considered impermanent and not to be used.
This rigid method for determining the SDA has prevented the use of donor hair from the nape, periauricular, and anterior parietal regions. These areas have thinner, slower-growing hair, which is valuable for softer hairlines, temples, and other areas like eyebrows and body hair restoration.
Before FUE, these SDA constraints didn’t matter much with strip surgery since FUT surgery would not cut out donor strips from those areas for aesthetic reasons anyway. But FUE allows the harvesting of nape and periauricular hair without similar levels of scarring and esthetic risks.
Presently; Some FUE hair transplant surgeons have avoided using nape hair due to concerns about follicle longevity, while others use it without assessing patient suitability.
So, it’s necessary to reconsider the SDA’s definition, by creating a method that determines when the SDA is true to the extent that prohibits the use of hair outside of its confines including the NPA, and when it is not. The Shave test described by Dr. U serves this purpose. It identifies the true SDA, including those at risk of developing retrograde alopecia.
Study Findings Which Question the traditional Standard Safe Donor Area Definition – Most Men Will Not Attain Norwood 7 with Retrograde Baldness.
The current traditional SDA model is somewhat theoretical in nature. It assumes that most men will eventually experience severe baldness with retrograde alopecia. Retrograde alopecia is a condition where hair is lost in the nape and around the ears (think Homer Simpson). According to this traditional SDA definition, surgeons must avoid harvesting hair from these NPA zones because these follicles are not expected to last permanently.
However, there is evidence that leads to different conclusions:
- A study conducted by Unger, involving 328 individuals aged 65 or older, found that only 20% of them actually reached Norwood 7 baldness. This suggests that 80% of men may not experience severe baldness.
- Norwood 5 or less level of hair loss patients are less likely to develop retrograde alopecia
- Furthermore, among those who do not reach extreme hair loss stages, not all will develop retrograde alopecia.
To gain clarity on this matter for specific patients, a useful approach is to shave their heads and visually examine the evidence of declining hair density in the nape or other regions beyond the SDA. The “FUE Shave Test”, which involves using a guardless clipper and assessing key hair distribution patterns, helps identify whether patients qualify for NPA graft extractions or not. It identifies patients who are more likely to develop retrograde alopecia that precludes the use of NPA hair.
Importantly, shaving the patient’s head for an FUE hair transplant surgery is a routine part of the procedure and does not pose any additional burden for the patient.
Photographic Examples of Real-Life FUE Shave Test Results on Hair Transplant Patients
In the following Shave Test cases, A, B, C, D, and E, patients ranged in age from 26-55 years. Case E documents the Shave Test results and the surgery performed on the patient.
Case A
Case B
Case C
Case D
Case E
In cases A, B, D, and E, the patients are classified as FUE Shave Test Negative. Upon assessment, the change in density and caliber is precipitous, along a discernable line. Follicles below this demarcation are severely affected by miniaturization processes, resulting in a noticeable decline in both hair growth density and hair thickness. These individuals are not good candidates for nape or periauricular hair FUE, since the donor grafts from these regions are impermanent.
As an alternative for these patient cases, it is recommended to use neck or body hair instead. Since neck hair falls under the category of body hair, it is not susceptible to the miniaturizing effects of DHT. This is evident in the post-extraction photos of case C
.
Extractions for the patients’ main donor count supply would be restricted to the traditional SDA zone.
In patients C and F, the reduction in the caliber and density of hair is gradual and not precipitous. For this reason, a demarcation line is not apparent. The reduction in hair caliber and density occurs very gradually transitioning from the mid-occiptal zone to the neck hairline. This scenario is designated FUE Shave Test Positive. In this case, the mape and periauricular (NPA) hairs are permanent and can be harvested for hair transplantation. This is depicted in case D showing the use of NPA hairs for FUE.
PROVEN IN A STUDY
In a study, using the FUE Shave Test process, Dr. U’s team qualified 128 subjects for the use of nape and periauricular (NPA) hair in hairline restoration procedures. In these 128 FUE Shave Test Positive patients, thinner caliber NPA hairs were placed only along the vanguard hairline edges to create very soft and realistic-looking detail. The gradual introduction of hairs from traditional SDA zones helped to create a natural-looking progression involving thicker hairs.
The following diagram shows Dr.U’s proposed schema for graft insertion into the recipient area.
This set of patient before and after images depicts the type of softness that can be achieved using this approach.
Dr. U and his team continued to follow these subjects for about five years following their hairline restoration procedure to determine any evidence of hair loss in the use of nape and periauricular hair as a novel type of graft. 73% reported no loss, whereas 26% did report hair loss. Upon closer inquiry, it was found that most of these individuals experienced hair loss in regions that included SDA hair. Although, it has commonly been assumed that nape hair is more likely to either fall out or not last, real-life comparisons to SDA hair reveal that the longevity of Safe Donor Area hair may not always be as permanent as initially supposed.
OUTCOME EXAMPLE:
The FUE shave test positive patient in case F did not report hair loss progression until 9 years after his surgery. His vanguard hairline, comprised entirely of nape and periauricular hair was not affected. The hair loss he experienced was due to the shifting of his pre-existing hairline to a new position which is clearly visible.
The patient is shown here 9 years later (above pic) with progressive hair loss as his nape hair grafts continue to hold strong, establishing that FUE-shave-test-positive patients would not develop retrograde alopecia and their NPA hair is as permanent as hair in the mid-occipital zones.
Long-term follow-ups show the same trend in the patients who participated in these evaluations. Based on data and scoring, Dr.U and his team found that the FUE Shave Test does function as a very reliable screening technique. Otavio uses the comb with the same concept in mind.
The presented studies and findings elucidate the point that the SDA should be regarded as a dynamic concept, not one that is arbitrary and fixed. Details of this research can be found in this 2015 publication of the Aesthetic Surgery Journal, Use of Nape and Periauricular Hair by Follicular Unit Extraction to Create Soft Hairlines and Temples: My Experience with 128 Patients.
How Nape Hair Contributes to More Natural-Looking Hairline Transplant Results and Outcomes for the Temples, Eyebrows, and Eyelashes
The thinner caliber of nape hair is useful for replicating the soft outer contours of the hairline and temples as well as providing a more true-to-life thickness that is seen in eyelashes and eyebrows.
Thus far, the majority of hair transplant practitioners have been relying on harvesting donor grafts from the safe donor area (SDA), located on the mid to lower half of the back of the patient’s scalp. The hair follicles in this region are more resistant to the miniaturizing effects of DHT and can therefore be transplanted as reliable grafts that could produce long-term, stable growth. However, these hairs tend to be very thick. When placed in scalp and facial areas that are known for having thinner hair, SDA hairs can create an awkward-looking appearance.
When attempting to restore the hairline and temples, it is important to consider the natural patterns, characteristics, and tendencies of hair growth in these regions. Upon regular observation, one will notice that the outer edge is soft and feathery, gradually progressing to thicker hairs towards the back of the head. Such standards, as subtle as they may seem, should ideally be regarded as reference points for any hair transplant procedure as the ultimate goal is to recreate the most realistic-looking outcomes possible. Not only would the patient’s undertaking of surgery be virtually undetectable to others, but more importantly, such results would also help them move forward emotionally with their life almost as though they had reacquired the natural head of hair that they would have had without hair loss having been a factor. The renewed confidence resulting from this would undoubtedly exert a positive effect on the social, professional, and personal aspects of their lives.
When it comes to the eyelashes and eyebrows, hair in these facial areas is considerably thinner compared to regular head hair. As in the case of hairline and temple restoration, the fineness offered by nape hair provides a far more accurate graft choice for eyelash and eyebrow transplantation.
Patient hair transplant results are lifelong. On a basic level, it may suffice to simply achieve the goal of restoring hair growth or rendering better density and hair length (as in the case of eyelash and eyebrow restoration). But an even better choice would be to strive for the most natural-looking standards that could possibly be attained. With the means available to achieve these types of results, it would be advantageous to utilize these resources for the sake of helping patients attain the absolute best aesthetics possible for their hair transplant outcomes.
Dr. Umar’s FUE Shave Test For Young Men Who Want a Hair Transplant Earlier In Life
Since Dr.U’s Shave Test ascertains whether or not a male patient is on the path to becoming severely bald by revealing signs of dwindling hair density in the nape and periauricular zone, this diagnostic assessment can also be useful for long-term planning in young men who wish to undergo hair transplantation.
Take, for example, a young man who undergoes a conventional hair transplant (i.e. using only scalp donor hair), and their hair loss progresses past the surgically created growth region. Their results will be futile. This problem can be fixed by using an additional set of head hair to fill in these emerging areas of emptiness. But these quantities are limited. If the individual is already destined for severe baldness, they will not be able to provide enough grafts from their head. They will eventually run out of grafts and be left with an irreconcilable bald region on the back of the head.
According to Dr. Umar, the number of stable head hair grafts that remain at the Norwood 6-7 stages will not be sufficient for significantly improving their coverage.
This is why many providers will completely refrain from performing hair transplant surgery on younger hair patients in their twenties.
If it has been determined that a young man, still in his late teens or twenties, will inevitably reach the point of severe baldness, the long-term, future use of body hair may be considered for an expanded donor supply, preventing the risk of running out of grafts as their hair loss continues to progress. Of course, sufficient quantities of these grafts must be available. Secondly, the specialized features such as those which comprise Dr.UGraft ™ technology would also be mandatory requirements, not just for the purpose of safely harvesting body hair at a large scale, but also for rendering non-visible wound healing results on exposed skin areas such as the face, neck, chest, abdomen, arms, legs etc.
If you are in the Los Angeles area and would like to undergo Dr.U’s Shave test for nape hair transplantation, send us your information along with photos through our complimentary online consultation form.
Frequently Asked Questions About Dr. Umar’s FUE Shave Test
Can women take the FUE Shave Test?
Genetic androgenic hair loss in most women will commonly manifest as global thinning with a very different patterning compared to males. However, in a very small percentage of cases, females may exhibit the same pattern of hair loss as men. Although women do not have a safe donor area, the FUE Shave Test may still highlight regions of the scalp affected by declining hair density, due to the miniaturization of follicular unit grafts within these regions.
What if my Shave Test results indicate that I will become severely bald and cannot use nape hair for my hairline transplant surgery, what options would I have?
First, it would be important for you to have an ample supply of body hair as a reserve of extra grafts that would counteract the formation of an empty region of baldness behind the transplanted zone. Secondly, with the ability of Dr.UGraft ™ technology to safely extract hair from anywhere on the body, another type of thin caliber hair, such as grafts from the legs or neck may be considered for the outer hairline edge.
Is it possible that my FUE Shave Test results can change later in life?
In most cases the outcome of the FUE Shave test will remain consistent and not change in one’s later years. It is possible that indications of severe baldness may reveal itself in future years. But if the first Shave Test shows a depleting nape area zone, this pattern will not reverse.
Further Reading
