What is No-shave FUE?
The following is a transcript of Episode 11 of the Hair Restoration With Dr. Daniel A. Danyo podcast.
Dr. Danyo: I get asked a lot why more practices don’t offer a No-shave FUE technique. And the answer is that it’s difficult to do. And FUE, in and of itself, doing a shave case is difficult, and then you add another dimension of extra hair around and decrease visibility, and managing this procedure so that it’s timely and done effectively, that is daunting for a lot of practices, and it makes it impossible, especially to do large cases.
Clark: That’s the voice of Daniel A. Danyo, MD, founder and physician at North Atlanta Hair Restoration. They’re a boutique medical practice solely dedicated to the diagnosis and treatment of male and female hair loss. And you’re listening to “Hair Restoration” with Dr. Daniel A. Danyo. I’m your host, Clark, and all season long, we’re speaking with Dr. Danyo about how he and his team at North Atlanta Hair Restoration are helping his patients transform their everyday lives for the better. In this episode, Dr. Danyo and I discuss the incredible procedure known as No-shave FUE. It’s a cutting-edge process in hair transplant therapy. In fact, it’s one of the most discreet hair restoration techniques available. And as you’ll hear from Dr. Danyo, most patients can resume normal life within just a few days of the procedure, and best yet, without the need of shaving your head. There’s a lot to talk about, so let’s dive right in. Dr. Danyo, it’s great to be back on here with you. How are you?
Dr. Danyo: I’m doing great, Clark. How about you?
Clark: I’m doing well. I’m looking forward to another great conversation with you. I always learn so much, and you always make this so easy to understand, and this topic…
Dr. Danyo: That’s my job.
Clark: Yeah, man. Well, I know it’s something you have great passion in and you have designed this boutique-like service where it’s truly you from the very beginning. So, part of this podcast is just getting to talk with you and getting to hear a little about not only the what and the how, but really hear the why you do this kind of work and help answer some common questions. And as I understand, one of the most common questions you get is around
Dr. Danyo: Yes.
Clark: When I say that, I had that written down here, but that seems a little intimidating. It seems… Like, what does that even mean? Can you just walk me through each part of that and how that’s such a big part of what you’re actually doing as a physician?
Dr. Danyo: Sure. Well, No-shave FUE basically means that we don’t have to shave any part of the head or leave the hair when the patient leaves, especially the donor site in a condition where it just doesn’t look natural. So, I tell patients, “My plan is for you to walk out like you walk in.”
Clark: What does the FUE…? Like, what does that stand for or mean?
Dr. Danyo: So, FUE means follicular unit excision. That’s a harvesting technique. So, what we’re doing is taking individual grafts from the back and side of the head. Occasionally, we’ll do FUE extraction from the beard, chest or abdomen if we need more hair if somebody has just a huge need for coverage. So, it’s basically describing the extraction component versus a surgical strip where hair-bearing scalp is removed in a strip, usually about a centimeter wide, sometimes from ear to ear. And the problem with that is that you end up with a linear scar, which, you know, for many people, limits what kind of haircut they have. It can cause some scarring, even some alopecia around the scar, and kind of thin…
Clark: What is that, like an irritation or something?
Dr. Danyo: No. It’ll thin out the donor area around the scar and make it thinner, especially underneath.
Clark: The scar tissue is just going to be different. I mean, it looks different. It interacts differently, I’m assuming.
Dr. Danyo: Yeah. So the FUE is kind of a newer technique of extracting here where random follicles are taken and you do not have a linear scar.
Clark: Okay. So, as you’re talking to me right now, I just got my arm pulled up. I’m trying to just look closely at one of…just one of the follicles, right?
Dr. Danyo: Yes.
Clark: So, what FUE is, I know it’s a long phrase, but really it’s the technique is what you’re describing is that it’s just sort of…you’re going…
Dr. Danyo: It’s a technique. Yes.
Clark: Each hair at a time, each follicle at a time, is that right?
Dr. Danyo: It can be between one and four hairs. So, most hairs are grouped together with other follicles. And actually, it’s typically around 10% of follicles are just one single hair.
Clark: So, on an arm, like, well, I can see easily, these mostly looks like it’s just one hair each, but on your head, you’ve got a couple in one spot. Got it. But still, they’re all part of that one root or that one spot.
Dr. Danyo: Yes, or one grouping. So, they’re individual follicles.
Clark: One grouping.
Dr. Danyo: Yes. But they’re grouped together tightly, so, so tightly that they’re actually grouped within about a millimeter sphere. So, we take a millimeter punch and create a circular incision around that grouping, and then we pull it out.
Clark: So, for you to be able to see that and do that, I mean, you are truly like a surgeon in a way, like it’s a surgical technique. It’s very… How are you even able to…? Like, what kind of tools do you use to do that? And does it hurt?
Dr. Danyo: Well, first of all, we’ll talk about the pain aspect. After I do the neuro blocks, which are really not that painful to get, I always tell people it’s like having a slab of concrete on the back and sides of your head because, you know, the actual extraction is not painful at all. It’s completely numb. So, it’s just getting through the first couple of steps of the neuro blocks, and they’re very effective. I mean, it’s literally 100% of the time I can get people numb back there. So, the actual FUE extraction is not painful. And then those grafts are all taken out and collected, and then they’re put in with what we call direct hair implantation. We’ve got another podcast on that, but we’re going to focus mainly on the FUE. So, you know, when I talk to patients… And we get a lot of phone calls about the No-shave FUE because most people, for one, want this to be concealed. They don’t want to come out and say, “Hey, I just got a hair transplant,” but…
Clark: That’s not… Yeah, it’s a total opposite of what people are doing.
Dr. Danyo: Exactly.
Clark: They’re not adding to their Facebook status, “Hey, here I am with Dr. Danyo.”
Dr. Danyo: It’s very occasional. You’ll get somebody that just broadcast it. Especially for the No-shave, I mean, they’re looking for concealment. They want to get through this so they can get back to work sooner, they can get back into social settings sooner. I mean, I’ve even had people not even tell their spouse that they’re getting it done.
Dr. Danyo: Yes.
Clark: I did not realize that. So it’s…
Dr. Danyo: I don’t recommend that.
Clark: …pretty stealthy.
Dr. Danyo: Yeah.
Clark: You don’t recommend it.
Dr. Danyo: Exactly. So…
Clark: But you can go in on a Friday…I mean, you can go in at the end of a workweek, right, and go back on Monday?
Dr. Danyo: Yes. Yes. And there’s some other aspects of doing hair transplants so that people don’t end up with a swollen face, which can blow your cover. And it’s very rare that we have people with swelling. And really postoperatively, there’s not much pain. There’s some soreness, but I haven’t written for pain medications in well over two years and we’re doing FUE transplants on a daily basis. So, we’re talking about hundreds of patients with no need for pain medication. I mean, people take a Tylenol or something like that, but it’s not a really painful event after the procedure.
Clark: So, after talking about No-shave FUE, this truly is…it’s a technique, just like we mentioned a moment ago, and you’re doing these by hand. This is something that takes a while because of the precision. And, you know, you’re saying you’ve not given out pain medicine in over two years and there’s been thousands of procedures you’ve done. How did you get into this? How did you become the expert with this technique?
Dr. Danyo: Well, I would say about eight years ago, I was at a conference and somebody presented a No-shave FUE procedure and described the fact that the back and sides of the head didn’t have to be shaved and the patient could go back to work almost immediately. And I had a number of patients that said, “Well, I just can’t do this and shave my head.” And I had gone through hair transplant and had my head shaved and I didn’t like it at all. And so, kind of my experience and then talking with patients and then being stimulated by this course, I thought, “You know what? This is what I’m going to focus on.” So, when I first started doing it, we started with 200 grafts and it took hours to do because doing FUE without shaving the head means that you’re having to do this with the existing hair blocking your visual site. It becomes a major management issue. And I’ve kind of built out the number to where I’ve actually done over 3,000 No-shave FUE in one day.
Dr. Danyo: Yes. So…
Clark: Wait. Hold on. Say that one more time.
Dr. Danyo: We did 3,000 No-shave FUE in 1 sitting, in 1 day.
Clark: Wow. So, that is a lot.
Dr. Danyo: Yeah. And the typical…
Clark: How long does that take?
Dr. Danyo: It took a while. It took probably over 10 hours, but it still moved along fast. And really, even a shaved 3,000-graft FUE takes about that time. So, as I kind of…
Clark: So it’s comparable.
Dr. Danyo: Yes.
Clark: Wow. I didn’t know that.
Dr. Danyo: So, what I used to do is I used to manually trim, you know, random hairs with these small surgical scissors, and it would take me about 15 minutes to trim 500 follicles, so like an hour to trim 2,000, which is our average case. And I just found my hand was just getting more and more tired.
Clark: Oh, my goodness. Yes.
Dr. Danyo: And you’re already an hour into the case, and then you’re starting the case kind of fatigued. So, with the advent of oscillated, trumpeted punches and just a technique that I started doing and that I’ve completely adopted over the last, I’d say 18 to 24 months, what I do is I use the trumpet, which has a bevel facing outward where the sharp edge is, and I can cut the hair and then go in and core the graft. So, it takes away the tedious hour of trimming these grafts and just cutting and coring. And so, the nice thing is…I mean, the grafts that we move are short, but the rest of the hair is left long. So, most people have about 10,000 follicles in the back and sides of their head, and it takes grafting about 50% of that until there’s really significant visual thinning of the donor site. So, 2,000 grafts with no other hairs cut means that when you leave, your donor site is totally concealed. And my patients are amazed that it can be done.
Clark: That kind of feels so good. And I know so much of this, the reason why you do this, as we’ve talked about in the podcast before, is that feeling of satisfaction that someone gets when they’re able to get the confidence back and to be able to conceal it as well.
Dr. Danyo: Yes. And it just takes repetition, intensity, duration. It’s almost like working out, the principles of getting strong or getting ready for a race or become a professional, it’s the constant repetition. I do a No-shave FUE case…70% of my male patients and 100% of my female patients are No-shave. And it’s something when I talk to other doctors about my practice, they don’t believe it. I’ve had my technicians go to courses and they tell them the numbers that we’re doing in No-shave and they don’t believe it, but…
Clark: You’re an animal. You’re a beast.
Dr. Danyo: Well, it’s all about the repetition, the frequency, and the intensity to where I’ve made this very complex thing that other practices and doctors might attempt like 1,000 or 1,500, but not consistently doing 2,000 or 2,500 shaveless or even up to 3,000. And it’s just that we’ve gotten really good, very fast. So, you know, when I cut and core the hair, that follicle is then loosened, and then my technicians go behind me and then pull the grafts. And it takes a lot of patience on their parts and a lot of cooperation working with them to be rapidly coring these hairs, you know, creating that circular incision around the follicle, and then having them find the grafts and then pull them and then store them. So, it’s a full team effort.
Clark: It’s almost like a streamlined conveyor belt where you’ve just figured out all the corners of this and you’re able…and when you’re able to do that, it creates a better experience. Now, what’s also interesting I think about what you do is you’re the one who’s actually doing the procedure.
Dr. Danyo: Yes.
Clark: You’re not shoving that on to someone else or a trainee or a technician. Like, you’re actually doing all this, which might, in one sense, make you think, “Well, that’s going to take you longer,” but maybe because it’s streamlined and it’s just you, you’re able to be more focused and more streamlined.
Dr. Danyo: So, you know, we usually start at 7:00 in the morning and have patients come at like 6:45 in the morning to get pictures and consent forms. And so, we usually get rolling about 7:15, but after I do the neuro blocks, I am coring and grafting, you know, immediately. And even with the No-shave technique, I’m able to graft even up to 750, 900 grafts an hour, and that’s coring and pulling. And, I mean, obviously, some cases, whether it’s related to hair types, length of the hair, some people bleed a little bit more, or the grafts are a little bit more tethered and a little bit more tedious to extract, and then also pull, that affects our speed. But, you know, this is something that we have perfected and we do it quickly. So, we’re generally done grafting No-shave FUE, 2,000 grafts by about 10:30 or 11:00.
Clark: Wow, and go get lunch.
Dr. Danyo: Yeah. And then we do direct hair implantation. I don’t do surgical slit. So, right after getting those grafts out, I mean, we’re placing. We’re not doing slits, having the grafts sit out and then having technicians stuff the grafts later on. So, you know, that streamlines the procedure as well to where we can consistently do… And again, this is on people where we don’t have complications of increased bleeding or tethering in the grass or, you know, those kinds of difficulties, but I can generally be done with the case by about 2:30 or 3:00. And that’s key because by about 4:00, the neuro block starts wearing off, there’s a lot more discomfort for me, and the staff, and the patient. So, just getting them out, getting them in, it just makes the experience just so much better.
Clark: Do you have them lay down? Are they sitting or do they change? Because you’re probably…you’re moving all around them to get all the different angles, right?
Dr. Danyo: Yeah. So, I’m right-handed, so I generally have them laying on their left side first with the right side up. I’ll numb the right side of the head, and then I just start right in front of the ear, out from there, and just start coming back through the donor site, usually to about…I don’t know. I’ll do about a third to maybe a little bit more, and then we have people lay on their stomach. I’ll push the block over to the left. We’ll do the center part, and then we have people finishing up on the right shoulder to get the left side. So, even if I do 500 grafts, I use the entire donor site. Because the neuro blocks are easy, we get a huge distribution when they’re blocked, so the whole back of the head is numb when the nerves are blocked. And that way, the density stays consistent throughout. There are a lot of places that if you’re doing 500, well, we’re just going to do it in the middle, but you’re over extracting in the middle and the other areas have full density. So, it’s important to do the entire donor site when you’re doing more than 500 grafts at a time.
Clark: Wow. All right. How about next, well, we’ve got a few minutes left, is there a story or two that just helps illustrate how you work and some of the results?
Dr. Danyo: Sure. Well, I can think of a patient named Carol that she’s a nurse and she had undergone a strip procedure before, so she’s got pretty significant hair loss. She had been through…
Clark: So, what does that mean, strip procedure?
Dr. Danyo: The FUT, where they…
Clark: FUT strip procedure?
Dr. Danyo: Yes. So, she had a linear scar in the back of her scalp because they excised the scalp and then did the hair transplant from that strip. And she had a really tough time after that. For one, she had a lot of pain and a lot of swelling in her face, and she actually could not work for a week…
Clark: Oh, my goodness.
Dr. Danyo: …after that procedure. But she needed…
Clark: That was someone else that did that.
Dr. Danyo: Yeah. That was somebody else. Yes. She came to me because she wanted some more grafts. She actually had a really good result but still needed some more fill-in, and I felt that she, to finish things off, needed another 750 grafts. And it was almost like a dog with her tail between her legs when she came in for a consult. She was very hesitant, but I educated her. I kind of reaffirmed how we do things, that I’ll be doing all the neuro blocks, all the extractions, and placing all the hair. So, she really had a sense that it was a very safe environment. We went through pictures of people that had undergone a No-shave FUE procedure before. In the donor site, you could not tell that anything was done immediately after the procedure. Her work schedule, she had actually, at the time of the procedure, she came in and she said, “I’m working tomorrow, so do your best.”
Clark: Whoa. Yeah.
Dr. Danyo: So, I did 750 grafts. And when she left, she said, “I felt like I was at the salon,” and you really could not tell a difference because when people leave, we clean the hair, we blow dry everything.
Clark: Oh, really? I did not know that.
Dr. Danyo: Oh, yeah. So, she looked about the same as when she walked in, and she went to work. Again, because of the refinement we do, it’s very rare, in the technique, it’s very rare that people get swelling in the face, but she actually went to work and did like an eight-hour shift and said nobody knew anything.
Dr. Danyo: And this is a story I hear over and over again, especially people that have had hair transplant at other places, whether they had a shaved FUE or had a previous strip, that the No-shave FUE was just very easy. I think another key point on the pain side, when you shave the head and then you have all these little, small wounds and then you lay back to go to sleep on this bristle, you know, around the wounds that are created by the FUE, that creates pain in and of itself and having long hair to cushion it really helps out with the pain.
Dr. Danyo: So, it was a completely different experience for her.
Clark: Sounds a lot better.
Dr. Danyo: Yes.
Clark: Any other stories that come to mind as we still have a moment left?
Dr. Danyo: Sure. So, today, actually, I worked on a guy that he would be totally bald. He actually went through two previous strip procedures, and I did a No-shave FUE procedure on him last year. And today, I did another No-shave procedure where he had a very large scar as a result of the strip procedures. That was probably about, in some areas, a centimeter wide of just blank skin to where he…
Clark: Oh, no.
Dr. Danyo: Yeah. He couldn’t wear his hair short. And so, I put about 300 grafts into that scar, and then we just did a little fill-in in the parts, and he wanted a little bit more up into his crown, so we did 1,250 grafts. And I asked him, you know, how was the recovery from the first procedure? And he said, “Night and day difference.” I mean, it’s not even a question as far as the technique and the post-op. And the first No-shave procedure that I did on him was 2,000 grafts, and he had the same experience of getting back into work quickly and into the social scene quickly. So, you know, I’m sure he’ll have the same experience with the second procedure.
Clark: It’s encouraging to know that if… Both these stories, a common theme is they had an experience somewhere else, they came to you, there were some scars, and you’re actually not only able to help them with what they need, but also can maybe do some…maybe repairing is not the right word, but you’re able to help conceal what someone else has done.
Dr. Danyo: Well, I think repair is the right term because, you know, I don’t offer FUT because of the scar. And oftentimes, there’s hardly any evidence of the scar, but frequently, there’s a very visible, almost debilitating scar, and people have to wear their hair like to a number four cut. They can’t go below that, maybe a three. So, it limits their haircut, or if they go swimming it can be visible, and they just don’t even want to get into the pool. And having a scar in the back of your head, you know, people will say, “Did you have hair transplant?” or, “Did you have brain surgery?” or something like that.
Clark: That’s the worst. Yeah.
Dr. Danyo: Yeah. And not to mention the healing from an FUT can be brutal because it’s a surgical scar, and doing FUE, especially No-shave, we just don’t have pain issues like I talked about. I just haven’t written pain medications for somebody who had pain from one of my procedures in well over two years.
Clark: Thank you for sharing both of those examples and just more context around what you do and how it goes. It might seem a little intimidating using some of these phrases and terminology, but it’s actually all pretty straightforward, and I know you make it really easy. So, I, as always, appreciate you taking the time to share a little about your why and your experiences through all this.
Dr. Danyo: Well, I appreciate it. Thank you, Clark.
Clark: Thanks for listening to Hair Restoration with Dr. Daniel A. Danyo. You can book your consultation today with Dr. Danyo by simply calling 678-845-7521 or online at nahairrestoration.com and be sure to subscribe, rate and review this podcast wherever you listen to your audio content.
Dr. Daniel A. Danyo is the founder and medical director of North Atlanta Hair Restoration, specializing in treating hair loss in both men and women. He is one of only 300 people in the world certified by the American Board of Hair Restoration Surgery.
He is a member of the American Board of Hair Restoration Surgery, International Alliance of Hair Restoration Surgeons, American Hair Loss Association, and The International Society of Hair Restoration Surgery.
He is also an early adopter and pioneer of Shave-less FUE, one of the most discreet surgical procedures available for hair restoration. Dr. Danyo performs every procedure himself, from start to finish. He individually extracts and places every graft on every patient. Learn more about Dr. Danyo on his Meet Dr. Danyo page.