FUE Hair Transplants
Exclusively offering both the NeoGraft Automated FUE and the Artas Robotic FUE hair transplant procedures
FUE Hair Transplantation

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What is FUE Hair Transplantation?

FUE hair transplantation is an acronym that stands for Follicular Unit Extraction and transplantation.  The word follicular unit comes from the embryological way that hair actually grows.  The natural pattern of hair on your scalp is in what are called follicular units.  A follicular unit is the genetically determined way that a hair shaft grows in relation to its bulb or root.  Approximately 57% of all the scalp hair has two hairs associated with the single bulb or root system.  21% of scalp hairs have three hair shafts associated with the bulb and root system and only 15% have a single hair associated with a bulb or a root.  4% – 5% of all scalp hair have four hairs associated with a bulb.  Thus, if one harvests using an FUE technique, or Follicular Unit Extraction method, one can harvest singlets, doublets, triplets and quadruplets. Harvesting the  FUE itself ensures that genetically related hair families stay and grow together leading a potentially more natural, wavy, growth pattern when transplanted.

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FUE TorontoThe most advanced and modern way for Toronto FUE hair transplantation patients to undergo this procedure is to harvest the hair from the preferred donor site at the back of the scalp, called the occipital fringe or donor region, with a Follicular Unit Extraction technique that is automated and robotic. Robotic FUE harvest technologies, called Artas® Hair Transplant and Autmoated FUE hair transplant technologies, called NeoGraft® Hair Transplant, are the fastest, most accurate and efficacious way to harvest hair without a linear scar. Thus, FUE hair transplantation is quite different than the commonly chosen alternative, the older and more traditional strip graft technique.

Figure 1. A high power magnification of the scalp at the back a scalp, from the “preferred donor” site.  The scalp is made up of special embryologic groups of hairs shafts that share the same bulb or root and these “families” are called Follicular Units.  Extracting these embryologic groups, is called Follicular Unit Extraction.

FUE Hair Transplant Diagram

Figure 2.  The preferred donor site, or fringe is the hair with normal 5 alpha reductase activity and can be transferred to the balding top of the scalp and survive and grow normally.

A strip graft involves using a scalpel to cut out and remove a large piece of scalp, that extends from ear to ear from the back of your head in the donor fringe.  This piece of scalp is approximately one centimetre wide by 10 to 12 centimetres long.  Once the scalp is cut away, the donor site is then pulled together and stapled.  The strip graft hunk of scalp is then prepared by hair technicians under a microscope by cutting out individual hairs and groups of hairs into non anatomic, non follicular unit orientation.

Strip Graft Scar

Strip grafts leave a nasty scar on the donor site on your scalp. Avoid it with FUE hair transplants

Strip Graft Scar

These Traumatic Effects of a Strip Graft can be Avoided if You Opt for the FUE Hair Transplant

Figure 3. A strip graft donor site (A) with the scalp tissue harvested for technicians to cut down the hair grafts. The strip graft technique can be very traumatic to the hair grafts (B), from excessive manipulation increasing Telogen Effluvium (shock hair) in the donor transplanted grafts. The FUE technique does not involve manipulation of the grafts once harvested, a much gentler process resulting in greater potential graft survival and less Telogen Effluvium (shock hair).

The major disadvantage of the strip graft technique is a large and visible scar at the back of the head.  This scar can sometimes heal well, but any time you wear your hair very short, it is always very obvious and easy to see, as it is white tissue set against the back drop of darker scalp hair.  Thus, strip graft patients need to wear their hair long at the back of their head for the rest of their life. Most strip graft patients are very self conscious on windy and rainy days, or at the beach, coming out of the water that someone will see their scar.

The second major disadvantage of the strip graft technique, other than debilitating visibility, the high probability of not undergoing a second, third or subsequent hair transplantation session.  As patients lose more genetic hair with age and often, eventually require another transplantation, most strip graft patients are very reluctant to have yet a second scar at the back of their head.  Thus, strip graft patients do not undergo subsequent transplantation sessions over the years to maintain a full and natural appearance to their hair, for fear of the excessively scarred donor site.

FUE Pros

Scar at the Back of the Head Following a Strip Graft. The FUE Hair Transplant Leaves no Scars Behind

Figure 4. The back of the scalp in a previous strip graft patient with a wide obvious strip graft scar. Most strip graft scars prevent patients from wearing their hair short due to scar visibility.

The last major disadvantage of the strip graft technique is that most technicians are cutting the strip graft into transplantable grafts often frequently the natural follicular unit pattern and during the cut down process traumatizes the bulbs and the follicles, leading to a less natural appearance of the hair that grows (as the hair does not have that same FUE waviness and relationship of one hair to the other) and, the excessive handling of the hair leads to a higher post-transplantation “shock hair”, a telogen effluvium effect.

The major advantages of automated and robotic, NeoGraft Hair Restoration and Artas FUE hair restoration and transplantation are:

1) the absence of a linear scar at the back of the scalp.  This leads to the second major advantage,

2) patients who undergo this hair restoration and transplantation using automated and robotic NeoGraft and Artas techniques can come back years after their first session and have no fear of undergoing a second or third transplantation session as they lose genetic hair and require more transplanted hair, because we are able to harvest repeated times at the back of the donor site on the occipital back and side fringes without leaving linear scars.

3) The third advantage of this extraction and transplantation process using automated NeoGraft and Artas techniques is that the donor site is not visible, allowing the patient to wear extremely short hair at the back and sides of their head if they so desire.

4) The fourth advantage of FUE hair extraction and transplantation is the near-absence of any significant pain or discomfort at the back of the head, unlike strip graft techniques, where it is quite common to have prolonged pain and numbness in the area of the scar.

5) The fifth advantage of the NeoGraft and Artas automated and robotic hair extraction and transplantation techniques are the more natural-appearing recipient site or area where the hair is transplanted.  The more natural appearance comes from the method developed at SpaMedica where the follicular unit is almost always left intact and planted at the recipient site exactly the way it grows at the back, using a “stick and place technique”.  This leads to more natural, wavy-looking hair with two, three and four-hair follicular units having their hair shafts interrelated, growing together in a wavy pattern, which leads to a very natural, non-transplanted look.

FUE Toronto

FUE Hair Transplant in Stages of Recovery Shown on SpaMedica Toronto Patient

Figure 5. A. Donor site immediately after harvest.B. FUE donor site after 3 days. C. The donor site at 10 days after harvest. D FUE donor site at 3 weeks after harvest.

FUE Hair Restoration

FUE Donor Site Fully Healed After FUE Hair Transplant Leaves No Scars Behind

Figure 6. The appearance of the donor site of a previous patient coming for another Automated and Robotic FUE transplantation several years after their first session. Notice, even with the scalp shave, the previous scars are not easily visible. All  patients can wear their hair as short as a #1 blade shave and not have linear scars.

How is FUE hair transplantation and hair restoration performed?

Dr. Mulholland and SpaMedica have been at the forefront of automated and robotic NeoGraft and Artas hair transplantation for many years. Dr. Mulholland purchased his first automated FUE hair extraction and hair restoration system in 1997 – a system called the Calvitron, which was an early predecessor of the current NeoGraft and Artas devices. Since that time, with advances and developments in automation and robotic technology, the current FUE technique deploys two cutting-edge technologies, affording graft survival and most natural-looking hair.  The first technique deploys the robotic and automated Artas hair transplantation system.  Toronto FUE hair transplantation patients benefit from this high-tech robotic hair restoration harvest using the Artas Robot. The Artas Robot uses very precise computer generated programs and algorithms to ensure the most accurate and precise harvests of individual follicular units. After being programmed by Dr. Mulholland and his very experienced hair technicians, the Robot is able to send a tiny rotatory punch in the scalp and core out and extract the desired follicular units. The Artas Robot’s parameters are set to precisely match the angle and depths of your follicular Units.

For the Artas Robotic hair restoration procedure, patients must shave the scalp region fairly short, somewhat less than a number one blade, and the size of this patch of shaved hair, where the FUEs are harvested from, depends on the number of follicular units and hairs the patient needs.  For women suffering from Female-pattern hair loss who undergo Artas or NeoGraft the hair at the back of the head that is just above the shaven patch, so it can fall back down over the shaven patch and completely camouflage the donor site while the hair stubble surrounding the follicular unit extraction site grows out to hide the donor punch holes, which are barely visible to the naked eye by 4-7 days.  Using very sophisticated computer-driven algorithms, the robot extracts all the larger four, three and large two-hair follicular units, using the robotic, rotatory extraction technology. The robotic system and the on-board computer also plan the density of the extraction very evenly, so that no area of the occipital and temporal donor sites at the back and side of your scalp is over-harvested or thin looking.

Artas FUE Toronto

Artas Robotic FUE Hair Transplant Machine in Toronto

Figure 7. The SpaMedica Artas Robotic Hair Transplantation system

The NeoGraft Automated FUE Hair Transplant MachineIn the same session, Toronto hair restoration patients will benefit from another high tech FUE hair transplantation technology called NeoGraft. Dr. Mulholland and the SpaMedica senior hair technicians will deploy the NeoGraft automated FUE hair transplantation system immediately after the Artas robot.  NeoGraft also uses an automated rotatory punch and FUE extraction system.  The NeoGraft has slightly more human control than the Artas robot, and allows the the use of extremely small .8 and .9-millimetre diameter punches for the harvest of the very small single-hair and double-hair follicular units that are very important to create the most natural frontal hair lines.  By using a combination of the Artas robotic FUE hair transplantation system and the NeoGraft automated FUE transplantation system, the SpaMedica hair restoration program affords you a donor site, with the least possible degree of transections, smallest amount of linear scarring at the back of the head and highest possible graft “take rate” available on the market. Figure 8. The SpaMedica Automated Neograft machine.

The Artas and NeoGraft automated and robotic FUE hair transplantation procedures are performed under local anesthesia with oral sedation and the local anesthesia removes any sensation of pain or discomfort. Most patients, who undergo their procedures at SpaMedica, describe the Artas and NeoGraft automated and robotic procedure as far less pain and discomfort than a dental procedure. The first portion of the day involves the harvest.  The Artas robotic FUE harvest system and NeoGraft automated rotatory FUE systems are deployed to remove the necessary number of follicular units required for your transplantation.  It is important to note that at SpaMedica you pay for the number of follicular units (AND NOT HAIRS) and each follicular unit contains, on average, two to three hair shafts.  Thus, a 2,000-to-3,000 follicular unit hair graft transplantation case would commonly contain between 4,000 and 6,500 transplanted hairs.

FUE Neograft

Neograft FUE Harvesting Rotatory Punch and Hand Piece

Figure 9. The Automated Neograft FUE harvesting rotatory punch and hand piece. The device “cores” out the grafts traumatically (with excellent technicians) and collects the grafts and keeps them moist, automatically.

Male Pattern Baldness Cure

Undergoing FUE graft Harvest With the Robotic and Automated Rotatory Punch in Toronto

Figure 10. A SpaMedica  patient undergoing graft harvest with the rotatory punch.

FUE Harvest

Harvested FUEs at SpaMedica Toronto

Figure 11.  Automated and Robotic FUE grafts harvested at SpaMedica exhibit EXCELLENT quality with pristine, traumatized matrix around the bulb (not too skinny and not too fat, but just right). You can see single, double, triple and a quadruple FUE hair units.

Who is a candidate?

Norwood Classification

Norwood Classification of Male Pattern Hair Loss in Toronto

Good candidates for FUE hair restoration are those individuals that desire no linear scar at the back of their scalp and have either genetic hair loss or a post-traumatic hair loss. The most common underlying reason for Toronto hair transplantation patients presenting to SpaMedica for FUE hair restoration is genetic hair loss.  Male Pattern genetic hair loss results from a weak enzyme called 5-alpha reductase being present in the bulbs of the hair shafts at the front, middle and crown on top of your scalp.  This is a genetic condition in that you inherited this poorly-functioning enzyme from genetic code acquired from your mother and your father (often a combination).  The more male family members in your family tree with thinning hair, the more likely you will have progressively thinning and receding hair. Male-pattern hair loss results from less-effective 5-alpha reductase at the top of the scalp.  5-alpha reductase is required to break down circulating testosterone into usable metabolites that facilitate natural, healthy hair bulbs and hair shafts.  When the 5-alpha reductase cannot break down testosterone completely, an intermediary product called dihydrotestosterone, or DHT, builds up in the local scalp tissue around the bulb. Figure 12. The Norwood Classification of Male Pattern Hair Loss.

Long-term exposure to DHT affects the cellular metabolism in the bulb, resulting in its reduced ability and, finally, inability to produce a hair shaft.  The hairs fall out gradually, leading to Male-pattern hair loss, or MPHL.  There are multiple patterns for male-pattern hair loss.  Some patients begin with generalized thinning.  Others get temporal recessions first.  Yet others develop thinning in their crown.  Eventually, however, as more advanced Male-pattern hair loss occurs, the temporal recessions and thinning at the front will connect with thinning in the middle of the scalp and the crown for an advanced Male-pattern hair loss appearance.

One can classify Male-pattern hair loss into six classes, Norwood 1-6.  Norwood 1 patients generally have a little temporal thinning and temporal recession.  Norwood 2 through 4 patients have variable temporal recession and crown thinning.  Norwood 4 through 6 patients start connecting the temporal and frontal thinning and recession with an expanding thinning of the crown until Norwood 6 Male-pattern hair loss arises, which results in complete baldness at the front, middle and back of the top of the scalp.

Patients who fall under one of the stages of Male-pattern hair loss from Norwood 1-6 are candidates for SpaMedica’s follicular unit extraction and transplantation procedures using Artas and NeoGraft automated and robotic hair restoration techniques. Generally, early stage Male-pattern hair loss involves follicular unit transplantation to the frontal and temporal regions.  Mid-life hair restoration usually involves follicular unit extraction and transplantation to the crown and mid-scalp, although each patient has their own unique Male-pattern hair loss thinning pattern that is addressed and treated in a customized fashion by Dr Mulholland and his team.

At SpaMedica, on your consultation day, you will not be greeted by a non-medical hair transplantation sales person, but Dr. Mulholland himself and his hair transplantation team. Under Dr. Mulholland’s personal guidance you will undergo a complete hair restoration history and physical, with a complete strategy for your FUE hair restoration procedure using automated and robotic hair transplantation techniques laid out and discussed with you. Dr. Mulholland will provide you with his industry leading experience to outline a complete hair transplantation plan for the immediate and subsequent hair transplantation procedure you may need over time. At SpaMedica, Dr. Mulholland and his team will ensure that you are given a hair restoration plan that provides the frontal hairline, mid and posterior density that you desire now, but will also leave you enough Follicular Unit Extraction donor site options for future hair restoration sessions that you may require, depending upon the extent and severity of your Male-pattern hair loss genetic trait.

What about Female Hair Transplantation and Restoration?

Female-pattern hair loss generally involves generalized genetic loss in the front and middle parts of the scalp and is not associated with genetically determined and deficient enzyme system in the bulb.  Female-pattern hair loss generally does not progress to full-scalp baldness, but, rather a generalized and embarrassing thinness.  Follicular Unit Extraction hair restoration and transplantation techniques for females are very successful, using the NeoGraft and Artas automated and robotic techniques.  Female FUE hair transplantation patients who come to SpaMedica have the advantage of having long hair at the back of their scalp and the hair above the patch of scalp that must be shaved can be lifted out of harms way. A patch of scalp is then shaved and the Artas robotic and NeoGraft automated FU extraction systems deployed to extract the necessary number of follicular units to densify the front and middle parts of the scalp.  At the end of the procedure, the long hair at the back will cover the donor site until the shaved patch grows out.

Female Hair Pattern Classification

Classification of Female Pattern Hair Loss

Figure 13. The classification of Female pattern hair loss, characterized by progressive thinning on the top of the scalp, but rarely completely bald.

Both men and women are good candidates for the automated and robotic FUE hair transplantation procedures when they have been adequately selected and prepared for the recovery at the donor and recipient site. Patients with long hair at the donor site at the back of their scalp, can hide the shaved patch at the donor site immediately; whereas individuals with shorter hair need to plan on approximately one week off work until the stubble at the back of the FUE donor site grows long enough to hide the little rotatory robotic punch holes that quickly become invisible.

Good candidates for male and female FUE hair transplantation need to be prepared for the recipient site as well.  Individuals with short hair at the top of their head, or recipient site, need to wait till the scabs from the hair restoration have fallen off, which can take 7-10 days.  Individuals with longer hair at the front and top of the head can leave it long. SpaMedica’s expert hair transplant team can insert the graft between your existing recipient hair and the existing genetic hair that is left long can hide the initial stubble and scabs from the recipient transplantations.

Hair Restoration Toronto

Freshly Grafted Temporal Recipient Site on Day 3

Figure 14.  Freshly grafted temporal recipient site on day 3. The patient has enough temporal hair that the scabs and stubble from the transplant can be hidden

The best candidates for automated and robotic FUE techniques are realistic about the amount of hair and density that can be achieved.  Generally, with Dr. Mulholland’s expertise and experience, a natural hairline with excellent density and very natural-appearing scalp hair is achieved in all patients with the appropriate number of sessions and number of follicular unit extractions and transplantations.

Are there any contraindications to this hair restoration and transplantation?

A few of the absolute contraindications to Follicular Unit Extraction hair transplantation would include auto-immune or inflammatory conditions that led to the hair loss as well as patients who are unrealistic or individuals who may be pregnant at the time of the procedure or have open sores, lesions or cancerous growths in either the donor site or the recipient site.

Are there any alternatives to Follicular Unit Extraction hair transplantation?

Light Therapy Machine

NeoLTS High Fluence, Low Level Light Therapy Machine

There are other surgical options to Follicular Unit Extraction hair transplantation.  As discussed, the strip graft procedure is still commonly performed, but the strip graft and other surgical techniques have more aesthetic and functional disadvantages compared to the FUE method.  There are some non-surgical techniques that can be deployed, including topical minoxidil, topical growth factors and nutrients, as well as high-fluence, low-level light therapy and nutrient shampoos. The SpaMedica non-surgical hair restoration program can be a popular place to start treatment for some patients, particularly young women and men, who often benefit from the SpaMedica combination program of laser therapy, topical growth factors, high dose, safe and effective 15% minoxidil serum and medicated shampoo. This non surgical hair restoration program uses a combination approach to non-surgical hair restoration as part of the SpaMedica post operative FUE hair transplantation program and begins approximately two weeks following your hair transplantation. Figure 15. SpaMedica’s NeoLTS high fluence, low level light machine.

Shown above are the SpaMedica NeoLTS high fluence, low level light therapy. A patient undergoing this “high tech” painless laser stimulation of the scalp which increases the number of hairs growing in Anagen and enhances the bulbs ability to “fight off” the affects of Dihydrotestosterone, or DHT. The high fluence, low level light therapy includes light in both the red and green spectrum for better results.

Light Therapy Hair Transplant

Patient Receiving NeoLTS High Fluence, Low Level Light Therapy at SpaMedica Toronto

Some individuals, particularly female patients, elect to start with SpaMedica’s non-surgical hair restoration program consisting of a home program of topical minoxidil, topical nutrient shampoo and six months of high-fluence, low-level light therapy, performed  once or twice per week in the SpaMedica Yorkville clinic. This non-surgical hair restoration program is often quite successful in bringing back more diffuse densification for early female-pattern hair loss and also quite successful in male-pattern hair loss at bringing more hair into the anagen, or growth, phase from the sleeping phase, particularly in the male crown.

Figure 16. The SpaMedica NeoLTS high fluence, low level light therapy. A patient undergoing this “high tech” painless laser stimulation of the scalp, which increases the number of hairs growing in Anagen and enhances the bulbs ability to “fight off” the affects of Dihydrotestosterone, or DHT. The high fluence, low level light therapy includes light in both the red and green spectrum for better results.

However, it is important to note that if you have male-pattern hair loss or female-pattern hair loss, there is very little that non-surgical procedures can do to stop the progression of your genetic condition or thinning hair.  Propecia, also called Proscar® or Fenesteride, is an androgen-blocking, oral medication that can significantly slow male-pattern hair loss, but care should be taken in having this prescribed, as some patients may be at risk for a higher incidence of aggressive prostate cancer.

What kind of anesthetic is used during the hair transplantation procedure?

At SpaMedica, Dr. Mulholland and his hair restoration team have perfected a technique where only local anesthesia and tumescent anesthesia is used to both harvest and implant your follicular unit-extracted hair grafts. Toronto hair transplantation patients begin their procedure by working with Dr. Mulholland early in the morning to draw in the desired hair line. The rest of the day does not proceed until both Dr. Mulholland and you are happy with the hair line design and pattern. Then Dr. Mulholland himself will inject local anesthesia to block selective nerves at the donor site at the back of your scalp.  Tumescent anesthesia (swelling up the scalp with fluid) is used to dramatically swell and distend the transplantation hair at the back of your head for presentation to the Artas robotic and NeoGraft automated systems. It also lifts and separates your recipient hairs on the top of your head, so that the hair can be transplanted atraumatically amongst your normal genetic hair. So as not to traumatize your normal genetic hair bulbs, which greatly minimizes the risk of temporary or permanent recipient hair “shock loss”, also called Telogen effluvium or “TE”.

FUE Anesthesia

A SpaMedica FUE Patient Undergoing the Tumescent Technique for Local Anesthesia Injection at the Back of the Donor Site

Figure 17. A SpaMedica FUE patient undergoing the tumescent technique for local anesthesia injection at the back of the donor site

Is the restoration and transplantation procedure painful?

The SpaMedica FUE hair transplantation procedure using the NeoGraft automated and Artas robotic FUE extraction hair transplantation systems is completely painless, once the local anesthesia is injected.  The injection of local anesthesia naturally comes with some mild to modest discomfort, but a non-steroidal anti-inflammatory and oral relaxation medication is given prior to the procedure (one of the reasons you come early) will induce and  facilitate a relaxed state for the FUE hair transplantation and will also minimize inflammation and discomfort.

How long does the procedure take?

FUE hair transplantation patients can expect to spend the entire day at SpaMedica’s Toronto hair restoration centre undergoing their hair transplant procedure. We recommend you bring your own iPod and ear buds for auditory entertainment or avail yourself of the SpaMedica playlist.


A SpaMedica FUE Hair Transplantation Patient Lying Comfortably in a Message Bed Undergoing Automated and Robotic FUE Harvesting

The procedure is divided into two parts.  The first part of the day involves extraction from the back of your scalp, an area called the occiput and the temporal regions.  This part of the procedure takes approximately four hours, depending on the number of  grafts that are required to establish and restore the hairline and hair density to your desired levels. During this procedure, you are comfortably semi-reclined in a massage chair, similar to the type of chair you might see at an airport massage centre.  Following the Artas robotic harvest of your 4, 3 and large 2-hair follicular units, you then lie completely flat on your stomach on a massage bed with your face resting comfortably inside the doughnut while the NeoGraft automated FUE hair transplant system is used to harvest the more delicate small single-hair follicular units and double-hair follicular units that are going to be used for your frontal hairline restoration. Figure 18. A  patient lying comfortably in a message bed undergoing FUE harvesting.

Once the donor site follicular units and grafts have been harvested, you get a lunch break.  Following the lunch break, the second part of the day, or the actual transplantation and insertion of your follicular units occurs.  Again, at SpaMedica, Dr. Mulholland and his hair transplantation team have perfected an automated implantation, or “no touch” system for implantation of the delicate single and double hairs used to densify the frontal hairline.

Small FUE hair grafts being aspirated

Figure 19.  Small  hair grafts being aspirated up into the automated hair implanter which can then be implanted in a “no touch” a traumatic fashion.

The SpaMedica FUE hair transplantation technique deploys what is called a “stick-and-place” procedure and methodology that has been perfected at SpaMedica using automated FUE, resulting in the densest, most natural-looking hair that you can achieve.  In the stick-and-place technique, a small hypodermic needle creates a small slit between your recipient hair, or along the balding frontal hairline, and as the needle is removed, the graft is inserted.  This transplantation process takes approximately 2-4.5 hours, depending on the number of grafts that need to be placed.

Follicle Extraction

Implanter Inserting a Single Hair Follicular Unit in Toronto

Figure 20. The Automated implanter inserting the FUE graft with a gentle “no touch” technique, optimizing the probability of a high graft survival and low Telogen Effluvium rate in the more delicate single and double hair shaft follicular units.

Thus, when planning a hair restoration day at SpaMedica, using the Artas robotic and NeoGraft automated FUE extraction and automated implantation techniques, one should plan for an 8-10 hour day, depending on the number of grafts needed and placed.

How long is the recovery following the transplantation?

The initial recovery following hair transplantation involves the first two to three days. During these two to three days, a soft dressing is used to cover the very tiny 0.9 to 1.2-millimetre donor site extraction holes at the back of the scalp.  This dressing is in the form of a wrap that goes around the front of the forehead, securing the bandage over the back.  It is important to note again, there is no cutting, scalp or sutures used during this procedure. The transplanted hairs at the top of the head are left open to the air. During this period of the recovery, you return the following day to have your wrap removed and a new dressing applied.  One or two days following that, the dressing is removed once again and this time it is left off (usually by day 3).  At this point, you’ll be shown how to gently wash and shampoo both the donor site and recipient site.  By the third day, you can start to wear a baseball hat; however, it is important that this baseball hat only contacts in the back of the scalp and just above your eyebrows, but there is no fabric touching the actual transplanted hairs.  The transplanted follicular units, if traumatized or touched by the fabric of a baseball cap, could become dislodged, fall out or die.

The second part of the recovery occurs between days 3-12.  During this next 7-10 days, the stubble at the back of your scalp, where the follicular units were harvested, grows out to the point where you can no longer see the tiny 0.9 and 1.2- millimeter holes at the back of your head.  At this point, if you have relatively long hair at the front and sides of your scalp where the hair restoration was performed, you will not need to wear a baseball cap, as the moderately long hair you have at the front, temporal and mid-scalp will hide the transplanted hairs.  However, if you have short hair at the front and side, you may need to wait two weeks following the transplantation until all the scabs have fallen off until you’re able to return to work.

FUE Wrap

Dressing and Wrap Used to Protect the Donor Site After FUE Hair Transplant

Figure 21. Dressing and wrap used to protect the donor site and cover the 1000’s of tiny 1mm donor holes while they are healing. This dressing is changed the next day and removed on day 3.

Most patients are able to return to work in 7-12 days, depending upon the nature of their job. Thus, if you are a male and you wear your hair fairly short, it is important to schedule a vacation of ten to twelve days following your transplantation session till you return back to work.  If you are a male with male-pattern hair loss that wears their hair relatively long at the front and temporal areas of their scalp, or a female with long but thinning hair at the front and very long hair at the back, generally one can return to work within 7 days.

FUE After Picture

The appearance of the donor site at the back of the head on day 3 after fue hair transplant

Figure 22. The appearance of the donor site at the back of the head on day 3.  By day 3 it is very difficult to even see the little donor site holes in most patient. The swollen lines are just wear the edges of the telfa gauze was lying and these go away in 2-3 days. Patients are able to wear a baseball cap or hat on day three as long as the fabric does not touch the freshly transplanted hair.

ARTAS® and NeoGraft® Hair Transplantation Post Op Care Timeline

Day 1 – Day of the procedures        8-10 hours

Day 2 – Back for a dressing change at the back. Replaced with a new dressing

Day 3 – Head wrap dressing is removed for good.

Day 7 – Start the high-fluence low level laser therapy for your scalp. Possible return to work.

6 Weeks – Start on Morphagen, a high concentration Minoxidil and a topica nutrient serum is applied nightly.  Most back to work

Once you have returned to work after two weeks, hair transplantation patients will experience 2 phase growth of FUE transplanted hair. It is important to note, that all patients are instructed to be patient and wait approximately 12-14 months until the full density and thickness of the hair restoration can be judged.

In that twelve to fourteen months following your FUE transplantation, you will notice a two-phase growth pattern.  The first-phase growth occurs with those transplanted hair shafts that do not undergo a “shock hair” effect and just start growing almost immediately.  One of the very unique advantages of the Artas and NeoGraft robotic and automated FUE extraction systems is that they are very gentle on the hair bulb (unlike inaccurate comments on other websites, these two FUE hair translation procedures are much less traumatic than strip graft techniques, where there is excessive handling of each graft that must be “cut away” from the harvested chuck of scalp). At SpaMedica, we do not manipulate the follicular units once they are harvested and, as such, very little trauma occurs to the bulb. Thus, Toronto FUE hair transplantation patients can expect that approximately 50% of their transplanted hair shafts, on average, will start growing within 3-4 weeks following the transplant and will become quite long within the first six months.  For the other 50% of the transplanted follicular unit grafts, the hair shaft will often fall out along with the scab in the first 14 days.  However, do not fear that the graft has died, because the hair bulb has survived and is still inside the scalp alive and well.  Second-phase growth then occurs at 4-6 months where you feel another diffuse layer of stubble starting to grow.  The second-phase growth takes another six months to get long, thick and dense.  Thus, it is at 12-14 months, that the final result of your SpaMedica FUE hair transplantation can be judged.

Why choose SpaMedica?

At SpaMedica, you will receive the benefits of Dr. Mulholland’s vast experience in automated and robotic FUE hair restoration procedures.  Dr. Mulholland is Canada’s, and one of North America’s, most experienced and foremost authorities on Artas and NeoGraft robotic and automated hair restoration procedures. In fact, over several years, Dr. Mulholland taught the art and science of automated FUE hair transplantation to hundreds of physicians across the United States. More importantly, Dr. Mulholland is also a renowned plastic surgeon with a keen eye for natural and esthetically-pleasing hairline designs.  Whether you are a male with male-pattern hair loss or a female with female-pattern hair loss, Dr. Mulholland will be able to design a hair transplantation program that balances your unique donor site and recipient needs.  Many of Dr. Mulholland’s competitors will say that Dr. Mulholland does other plastic surgeries and therefore will not be as qualified.  To this Dr. Mulholland would say, quite the opposite, in that no one has more experience over the years at automated and robotic NeoGraft and Artas hair transplantation than Dr. Mulholland and, his vast aesthetic experience and knowledge in the art of facial aesthetics and proportion make him most suited to design the hairline that best matches your unique facial features. Most hair transplant providers have medical directors that are not aesthetic plastic surgeons, with aesthetically trained eyes, principle and skills, but rather family practitioners or general non-specialty trained doctors that picked up the strip grafting technique to avoid managed care. At SpaMedica, Dr. Mulholland has two full-time hair technicians, with over 30 years of hair transplantation experience between them and over 1 million grafts successfully placed.   At SpaMedica the hair restoration team is totally devoted to ONLY FUE HAIR TRANPSLANTATION 5 days a week.  By deploying the Artas robotic and NeoGraft automated extraction systems, SpaMedica can boast some of the lowest transection rate in the business.  This transection rate, which is the percentage of times the robotic or rotatory automated punch transects a hair shaft prior to a bulb, is less than 4%.  At SpaMedica, with a transection rate of less than 4%, we also combine that with a post-graft implantation success rate of over 85%.  That is, over 85% of all transplanted Follicular Unit Extraction grafts will survive and grow.  The results of an FUE hair transplant are not measured solely by transaction rates or graft survival rates, but also by the hairline design, the aesthetic result and a HAPPY PATIENT.  This is one of the biggest benefits you will receive at SpaMedica, which is Dr. Mulholland’s experience and unique ability to design natural-appearing hairlines and customized hair restoration programs for both male and female hair loss patients.

What kind of results can I expect?

At SpaMedica, you can expect the highest possible graft transplantation survival rates, the lowest possible transection rates and the lowest incidence of telogen effluvium.  Telogen effluvium, or TE, is shock hair.  There are two types of shock hair.  Shock hair of the transplanted grafts – that is, transplanted hair that has been over-manipulated or cut down following a strip graft – damage to the bulb has ensued, the shafts fall out and you don’t see any hair growth for four to six months. The TE rate of transplanted FUE grafts at SpaMedica is very low.  Approximately 50% of all hair shafts start growing immediately.  The other 50% that undergo telogen effluvium start growing at six months.

The second type of telogen effluvium, or TE, occurs in the recipient site.  At SpaMedica, we have perfected the tumescent infiltration technique that lifts and separates the recipient hairs, allowing a very careful and precise “stick-and-place” and automated insertion techniques that minimize trauma to the local recipient hair.  Occasionally, telogen effluvium will occur to the recipient “genetic” hairs in the areas of the transplantation that have very advanced dihydrotestosterone (DHT) effects and these hairs may fall out and never return.  In general, however, shock hair of the recipient site grows back within 4-6 months.  It is extremely rare for TE to occur in the recipient site and for all the TE, or shock hair, not to grow back. If you have a large degree of thinning, pre-terminal hair, SpaMedica often recommends embarking on a six-week course of strong, 15% minoxidil, nutrient shampoo and high-fluence, low-level light therapy prior to initiating your transplantation to ensure a more robust recipient site and hairs that are not as susceptible to telogen effluvium.

At SpaMedica, with its very advanced and industry-leading Artas and NeoGraft robotic and automated FUE hair transplantation program, Toronto Hair restoration patients, can be assured you’re going to get one of the most experienced and respected plastic surgeon in Canada, hair graft success, the lowest transection rate and the most natural-looking hairline designs available.

What are SpaMedica patients saying about their experience?

SpaMedica’s Toronto hair restoration and transplantation patients are generally extremely happy with the results of their Artas and NeoGraft robotic and automated hair transplantation procedures. Patients are well-selected and realistic, achieving over 85% FUE graft survival rate, less than 4% transection rate and a very natural hair design that they are able to customize with the help of Dr. Mulholland.  For more on what our patients say, see our Facebook page, PlasticSurgeryTalk social media site or Google + and Google review page for hair transplantation.

How long will the results of your transplantation last?

Because the FUE hair restoration grafts are extracted from the preferred site at the back and sides of your scalp, and these are areas of your scalp that you are genetically programmed to never lose hair, the results of your FUE hair restoration are permanent and life-long.  However, depending on the extent of your genetic traits inherited from your parents, you may undergo subsequent male-pattern hair loss and female-pattern hair loss in your recipient site of the un-transplanted genetic hair after the transplantation, as your hair continues to thin according to your familial predisposition.  There may be a period of time lasting many years where you’d be very happy with your genetic hair in combination with your SpaMedica FUE hair transplant procedure.  However, if you continue to lose genetic hair at the top of your head, you may require subsequent hair transplants.

Thus, when you meet with Dr. Mulholland during your consultation, he will outline a program of potential hair restoration treatments that may be performed over 10-20 years that you may require from ongoing genetic hair loss.  Because you will not have linear scars on your donor site following the Artas and NeoGraft techniques, you can come back over and over to harvest new follicular units and transplant them as you get thinner and thinner with age.  Thus, in the SpaMedica FUE hair restoration program, you may design and create the hair pattern that best suits you and be able to sustain and support that hair design with repeated automated or robotic hair restoration and transplantation techniques over the course of your life.

How many times can I repeat the Artas and NeoGraft hair transplant procedures and how soon can I do this?

Patient many come back multiple times for more FUE hair transplants as need.  In general, up 10-15% of the donor site can be harvested at the back of the head in a single session, which usually means 3000-4000 follicular units.  Over time, up to 50-60% of the donor follicular units at the back and sides of the scalp can be harvested and transplanted without the hair at the back of your head looking thin.  This translates into 10-12,000 FUE grafts can be harvested and made available over time, to ensure your transplanted hair looks natural and thick. One can safely go back into the same donor site at the back of the scalp after three months. One must wait 12-14 months to go into the same recipient site (to avoid inadvertent trauma to un-expressed transplanted bulbs), but other recipient sites can be implanted 3 months after the one before.


There is no specific maintenance required following your FUE hair transplant. Over 85% of the  grafts will survive and less than 4% of the FUE extractions are transected.  By 12-14 months, you’ll get a nice hair growth and the hair that has been transplanted will grow permanently, as it has been extracted from the preferred sites at the back and side of your scalp that are guaranteed never to fall out.  However, you may require more hair as some of your genetic hair on the top of your head thins and falls out.  This is not maintenance, but simply re-densification therapy depending on your genetic needs.  At SpaMedica, Dr. Mulholland understands that multiple sessions may or may not be required over the course of your life and he will always design the type of hairline and densification approach that could be sustained and maintained throughout your life.


The cost of your hair restoration and transplantation depends on the number of Follicular Unit Extraction grafts that are required for harvest and implantation.  In general, because SpaMedica has developed the fastest, safest, most efficient and accurate Artas and NeoGraft robotic and automated FUE transplantation centre in Canada and possibly North America – we’re able to offer very affordable prices.  

3000 FUE – From $7999 + HST
2000 FUE – From $6999 + HST
1000 FUE – From $5999 + HST
500 FUE – From $4999 + HST

 At SpaMedica, the cost also includes the post-operative, high-fluence, low-level light therapy and nutrient shampoo.

About Us

You will receive the benefits of nearly 20 year experience of Dr. Mulholland in designing the right hairline and densification approach for you, as well as the lowest-possible transection rate, highest-possible graft survival rate reported in the industry.


Patients should simply fill out the appointment request form or “ask a question” form and upload up to 3 photos for Dr. Mulholland to review.

To schedule a consultation with Dr. Mulholland and his hair restoration team, simply call 877-695-2835 or fill out our online consultation request form and a SpaMedica representative will promptly respond to your request.  Call now to schedule a consultation and create the natural, thick, dense hairline and hair pattern that you desire.


Cosmetic Surgery and Laser Skin Care Spa:
66 Avenue Road Suite 4
Toronto, Ontario M5R 3N8
Tel: 1-877-695-2835