Unshaven hair transplants are procedures performed either without shaving hair at all or with a limited shaving that allows for camouflage by the remaining hair. These methods may be preferred in women and men who have long hair or have social reasons for not wanting to shave during a hair transplant procedure.
However, frequently there is a mismatch between patients’ perception of an unshaven hair transplant and the actual treatment offered by hair transplant clinics, therefore we would like to explain each procedure that are all referred as an unshaven hair transplant.
Traditionally, hair is shaven during a hair transplant procedure. Hair is shaven not because patients love shaving, but because it is a technical necessity to ensure optimal efficiency and success of the procedure. The first thing a patient must know when asking for an unshaven procedure is that there are certain concessions to be made in return for having the luxury of not shaving during a hair transplant procedure. When unshaven hair transplants are marketed by clinics, a false perception is created as if a new technique has been discovered enabling us to have an unshaven hair transplant and with no disadvantages associated. Having that in mind, it becomes crucial for each patient to understand the unshaven options available to him/her and learn about the disadvantages associated with these options. In some cases an unshaven hair transplant option may be available with little to no disadvantages associated, while in other cases the disadvantages associated may be too great to justify choosing these options.
When discussing whether to shave or not to shave during a hair transplant, donor area shaving and recipient area shaving should be mentioned separately;
1- Donor Area Not Shaved: When talking about donor area shaving for the graft harvesting phase, there is a huge difference between FUT and FUE. FUT does not require shaving the donor area and even when the donor strip area is shaven, this strip is later removed during the procedure so there is no shaven donor area left behind. On the other hand, it is a technical necessity to shave the donor area is FUE. The punch graft removal method is impossible when there is a long piece of hair attached to the follicular unit. The rotation and penetration maneuver can’t be done without cutting through the long hair and the unshaven hair blocks the vision of the entrance point of the hair into the skin which is crucial in the correct alignment of the surgical punch and the follicular unit. An attempt to do FUE without first shaving the donor area would end up not only cutting through these hairs and eventually shaving them all off but also lead to a huge amount of donor damage and wasted hairs due to impaired vision of hair follicle entrance points. In an attempt to avoid or limit shaving the donor area during FUE procedures there have been 3 main methods introduced.
A. Shaving one or two macro-strips: A window-like area could be shaven within the donor area if the hair is long enough like in long-haired women. 30 to 50% of the donor area could be utilized using this method. Alternatively, two strips each with a hight of 2 to 3 cm could be shaven in a zebra-crossing-like fashion. 30 to 50% of the donor area could be used with this method. This method could be used in medium length hair which would not allow for camouflaging a single larger window shave. The harvesting needs to be concentrated at the shaven sights with these methods which means that there will be a density gradient between the shaven and unshaven sights. This density gradient could potentially be visible if in the future the hair was to be shaven or trimmed very short. Being able to use only 30 to 50% of the donor capacity is the main limitation. This method is our recommended option for patients who want to limit donor area shaving.
B. Shaving many micro-strips: Many 1 to 2 mm micro-strips could be shaven within the donor area. In theory 30 to 50% of the donor area could be used with this method, however, the hairs surrounding the excision sites would still impair the visualization of the donor area as well as keep tangling with the surgical punch and decrease the performance of the procedure, increase the donor damage and wastage of valuable donor hairs. We don’t recommend this technique.
C. Using an indented or dull punch: Recently, special instruments have been introduced in order to allow for FUE without shaving. However, our observation is that due to the impaired visualization of the donor area, the tangling of hairs with the instruments, the increase of donor damage and wastage of hairs, the slowing down of the procedure these options are not to be recommended for the majority of cases.
2. Recipient Area Not Shaved: The recipient area is shaven during a hair transplant procedure to enable a better visualization of the area. Although this is not a technical necessity, trying to make recipient incisions and transplant within unshaven hairs involves some significant disadvantages. Missing some of the empty spots and therefore adding less density, damaging existing hairs by not being able to avoid the roots of these follicles, making angle and directional mistakes, causing multiple attempts to place grafts and damage these grafts, hairs sticking with the placed grafts, hairs being pushed into recipient incisions, causing fatigue of the placers, difficulties in washing and managing the recipient site post-surgery are the main problems. Especially when there are diffusely thinning hairs, these problems are augmented. An exception could be patients with a totally bald recipient area and previously transplanted hairs; in these cases most of the recipient area is devoid of miniaturized hairs and the transplanted hairs are thick and clearly distinguishable from the rest of the area, transplanting without shaving the recipient area becomes not as difficult as transplanting between naturally thinning hair.
In any case, hair restoration surgery is an uphill battle against baldness, which involves very sophisticated and labour intensive surgical maneuvers. Quality, performance and time are the most important parameters needing to be controlled and every effort should be made to optimize these parameters in order to increase the chances of success. Unshaven hair transplants are valuable options for patients whose hair style or life style would not deem a total hair shave to be convenient, however, knowing in detail the actual method offered and the disadvantages associated is crucial for the fulfillment of the expectations.