Dear Dr Reddy, though you claim no linear scarring with H+ technique, i have read a few patients complaining of a golf ball like appearance on the donor area. Could you kindly throw some light on this?

Dear Mr TA, thanks for your question. I have to agree with you on the fact that, I have myself seen a few patients with FUE ending up with patchy areas of visible scalp on the donor area. I would assume this is secondary to over enthusiastic extraction on part of the surgeon, whereby a lot of the grafts are extraction from one zone.
A lot of effort goes into the preparation of an extraction zone and I suspect this could be the reason why some surgeons prefer to stick to a small zone. Also the fact that it is easier to extract from certain areas of the donor areas than others, it is quite possible that this might influence a surgeon in the thought process of extraction.
With the H+ technique, we have totally moved away from focussing on one single zone and working the entire permanent zone. To second this, we have stringent protocols for extraction (Kindly attach a lead to protocols for extraction).
I have always believed in the fact that that the surgeon should aim to get maximum yield with minimal or no transection.

Though a very intrresting question, not a lot of work has been done with regardsto answering the question. Follicular units naturally occur as 1,2,3,4 and sometimes upto 7 hair grafts. In the traditional strip surgery the surgeon has access to different sized grafts availabe from the extracted strip & place accordingly.

With the H+ technique, the surgeon can pick and choose the size of FU'S required to get the desired results. The success of the H+ or any FUE technique is directly dependent on the quality of grafts extracted. This has been backed by studies by Beehner and Bernstein who clearly suggests that in the follicular unit, the whole is greater than the sum or its parts.

From my experience, I have clearly observed that follicular units that are intact have significantly better outcomes than split ones. Hence we have been able to achieve very natural looking results with the H+ technique.