The FUE method
FUE (follicular unit extraction) is currently the most modern and most gentle method of hair transplant.
Very special to note is the fact that in this technique hair follicles are taken in the form of follicular units purposely taken one by one using very fine instruments with utmost precision.
The table below serves as a short synopsis of the special characteristics of FUE. Following this table, you will find a thorough description of each point.
|Scar||approx. 0.6 – 0.8 mm small light points, which as a rule can hardly be seen or are invisible even by precise scrutiny.|
|Extraction: operation, healing process, post-operative complications:|
|- nerve lesions, blood vessel injury||extremely impossible|
|- numbness, pain in the scar area||no|
|- wound healing period||several days|
|- wound infections||very seldom, mostly of very small size|
|(for example, body building)||wait for at least 7 days|
|destruction of healthy hair follicles||Few|
|possibility of controlling the number of grafts to be extracted:||very exact|
|gathering of additional grafts:||no problem|
|handling of surplus grafts:||no problem|
|possibility of controlling the kind of grafts to be extracted:||exact (exclusively FU’s)|
|possibility of patient to control the number of extracted grafts:||exactly up to last graft|
|use of body grafts when there is deficiency in normal donor hair from the scalp:||no problem|
|HT’s for the correction or reconstruction of other regions of the body||ideal|
|(hairless scars, eyebrows, beard, pubic hair, etc):|
|renewed transplantation of hair on strip scars:||ideal|
|flexibility in selecting site of graft extraction||completely flexible|
|maximum number of all grafts transplantable from the donor area (inclusive body grafts)||mostly higher number than in strip surgery|
|consequences after several successive HT’s on the donor region||it results in thinning out of equal distribution; the nape-hair limit remains the same.|
|time intervals between future repetitions of HT’s||at once possible|
|amount of work involved||involves more work (the doctor almost entirely performs the whole procedure)|
|time involved / maximum number of transplantable grafts per working day||several hundreds|
|costs||about 3.50 – 12.00 Euro/ Graft|
|necessity of a preliminary shaving of the donor area:||yes|
|after the operation:|
|- short-term swelling||yes|
|- temporary falling of the transplanted grafts||yes, within 5 days and 5 weeks approximately|
|- rest period of the transplanted grafts||2 – 6 months|
|- when the end result is reached||approximately beginning from the 8th month|
|- grafts which take roots||mostly over 90%,in body- grafts approx. 60%|
The follicular units are taken purposely one by one with the use of fine extraction tools. In our institute, we use extraction needles specially made for us, which have mostly a diameter from 0.7 mm (22 Gauge; Gauge = scale unit, used in medicine to measure the outer diameter of hypodermic needles. The larger the gauge number, the narrower the diameter) to 0.9 mm (20 Gauge). To extract very fine hairs in single grafts, a 0.6 mm (23 Gauge)-needle can sometimes be used. To extract very thick or curved hairs in triple or quadruple- grafts a 1.0 mm is often the best choice.
The resulting “scars” have very small diameters. After they heal, it is often almost impossible for the naked eye to identify them at all.
If the head is to be shaved later on, you will detect only tiny light spots. This is not surprising because the hairs were extracted at these spots and leave tiny gaps.
Example of an exactly-aimed and precise extraction of follicular units performed during a FUE.
2. Extraction: operation, healing process, post- operative complications:
The FUE method is in itself a kind of microsurgery. The tiny holes to be seen at the place of graft extraction have a diameter range of 0.6 – 0.8 mm. FUE is almost bloodless (only a few drops of blood). The small “wounds” retract already within the first hours. On top of these “wounds”, you will encounter a fine point-like crust appearing on it. They completely heal within several days without any complication whatsoever. In this method, no sutures are involved nor drawing of surgical materials is necessary. In most cases, it is even possible to touch with your hand the back of the head a day after the operation without feeling any pain in the wound area. It is possible that a light itch at the back of the head can be felt up to the seventh day after the hair transplant procedure.
Very seldomly small wound infections can occur, like in every needle stitches. Prophylactic antibiotics can minimize additionally this rare complication. Ingrown hairs are very seldom and unbend mostly itself.
3. Active sports
Without any problem, you can engage in all kinds of sport activities after a few days. After a lapse of approximately 3 weeks, extreme sports activities are again possible.
4. Destruction of healthy hair follicles
The follicular units of the donor region are extracted individually and precisely with the use of very fine extraction needles. During the development and refinement of our instruments, we have considered two following factors:
- The extraction instrument must be as big as necessary, in order to guarantee the taking out of a healthy follicular unit capable of living after extraction (when much smaller instruments are used, some parts of a follicle may get cut).
- The extraction instrument must be as small as possible, so that the neighbouring follicle remains untouched.
Our extraction instruments fulfil both requirements. This facilitates a sure extraction of donor follicles. Therefore the transsection- rate is very low.
Moreover, the FU’s gathered for the purpose of FUE already possess the suitable size needed for transplantation and they need no further preparation. In this case, a further destruction of the follicle can then be avoided.
5. Possibility of controlling the number of grafts to be extracted
Since the grafts can be extracted one after the other, the extraction of the desired number of grafts needed for transplantation is made feasible.
6. Gathering of additional grafts
Should the need arise to have additional grafts, it is no problem at all to further extract more grafts spontaneously at any time.
7. Handling of surplus grafts
Any surplus graft can be replanted back into the small extraction holes of the donor area without any problem. Thus, no grafts are wasted unnecessarily nor thrown away. These grafts grow further in their original natural sites taking the same growth direction. They contribute to the hair density of the donor area and can be used later as donor grafts for future hair transplants.
8. Possibility of controlling the kind of grafts to be extracted:
For aesthetic reasons, single grafts are usually needed for the reconstruction of the hairline. And it is for the same reason that double or triple grafts are predominantly used to attain the thickest possible density in the upper part of the scalp. It facilitates reaching the goal of gathering the exact kind of graft needed and calculate in advance the exact constellation of single, double or triple follicular units needed for the transplantation.
In the FUE technique, the tiniest nature-given hair follicular units are exclusively implanted. This guarantees a natural look of the result.
9. Possibility of patient to control the number of extracted grafts:
The patient has full control over the number of gathered grafts. The FU’s are extracted one by one giving the patient the possibility to count during the process and compare this amount later on with the number of implanted grafts.
10. Use of body grafts when there is deficiency in normal donor hair from the scalp:
The use of body grafts in FUE is no problem at all and this has been regularly practiced worldwide since 2000. In this process, chest hair is mostly used by virtue of its length, character and structure. Transplant of leg hair and other kinds of hair is also possible. Body grafts are used preferably in the upper part of the head, especially the vertex. Body grafts are above all suitable to make a hairy area denser.
This applies also to the donor regions in question: Due to the fine extraction technique used in FUE, the areas remain practically scar-free. Body- grafts have a lesser rate of grafts which take roots in the donor: approx. 60 %.
Extraction of several thousands of body grafts from the chest area with the FUE- method (3 days after the operation). On account of several strip- HT’s, the patient has no longer enough number of donor hair on his scalp.
11. HT’s for the correction or reconstruction of other regions of the body
Without any problem, hairless areas (for example, one resulting from accidents or burns; inborn asymmetries) can be reconstructed and be covered with natural hair growth.
It does not matter whether it is hair of the scalp, eyebrows, beard hair, pubic hair, etc.
In scarred tissue the grafts don’t take roots as good as in scar- free tissue. Like in body- grafts, approx. 60 % can be reached. Nevertheless you can get a very good visual improvement even with this rate in scarred tissue.
12. Renewed transplantation of hair on strip scars:
FUE is very suitable for the renewed transplantation of hair on scars caused by earlier strip hair transplants. Through this method, these scars are converted to look less obvious in everyday life.
In the meantime, this kind of repair work is practiced regularly worldwide. Although the growth rate of grafts in scar tissues is not as good as in the scalp, an outstanding result can be already reached with a relatively less number of grafts. If necessary, this procedure can be repeated without any problem. In this sense, the FUE is the only possibility to cover strip scars in repeated sessions.
13. Flexibility in selecting site of graft extraction
In this regard, FUE offers various choices: The follicular units can be extracted without any problem from any conceivable location of scalp grown with hair. Patients, who have many scars resulting from several strip hair transplants performed before (thus having no donor follicles anymore in usual locations), can avail of the hair diagonally situated at the back part of the ear or other body sides (body grafts) any problem.
In the case of this patient, many hair transplants using the strip method have been performed before. With FUE technique it is now possible to gather as much as hair follicles from areas like the one immediately behind the ears or near the nape. With the gathered hair follicles, a repair work was done. In reference to the area of graft extraction, the FUE technique is in this regard absolutely adaptable. Each small red point seen in the picture represents the spot where a follicular unit has been purposely extracted. This photo shows us the condition immediately after an extraction. The small extraction spots seem to look bigger as they ought to be in view of the small drops of blood emanating from these points.
14. Maximum number of all grafts transplantable from the donor area (inclusive body grafts)
In this regard, FUE offers more positive points. From the cosmetic point of view, up to around 1/3 of donor hair can be transplanted (wherein an even distribution of the extraction sites is observed). In addition to this, the supply of body hair (for example, chest hair) should also be considered.
It therefore can be assumed, that the maximum number of transplantable grafts in a given patient with FUE is mostly markedly higher than in the case of strip surgery. Of course, no exact numbers can be mentioned in this case. It greatly depends on the individual condition of each patient. What is meant here is the dimension of the donor area, thickness of hair, existence of suitable body hair, etc).
15. Consequences after several successive HT’s on the donor region
When an equally distributed extraction from the donor area has been performed, it is expected that an equal decrease in hair density or thickness is expected. However, the nape hair limit remains untouched.
16. Time intervals between future repetitions of HT’s
Since the skin is usually not under tension and the fact that the place of graft extraction can be duly selected by the person performing the hair transplant, it is possible to perform further FUE’s all at once.
Important: In case grafts have to be transplanted into an area that has been already treated before (for example, in case of making a treated area denser), it is pertinent to wait at least 8 months after the last transplant has taken place. By this time, it is expected that all transplanted grafts have already grown in the meantime. Otherwise there exists the risk of grafts to be implanted mistakingly on the same spot where earlier grafts are situated in their rest period. This would mean overlooking them and eventually lead to its destruction as they are usually not to be seen at this stage.
Should a different place need a treatment, a further HT can be naturally performed all at once.
17. Amount of work involved
The fact that FUE hair transplant is a microsurgical kind of graft extraction requiring extreme care, it obviously involves a great amount of work.
18. Time involved / maximum number of transplantable grafts per working day
Considering the great amount of work invested in a FUE hair transplant, it is of course time-consuming. At the most, approx. 1000 grafts can be transplanted per working day.
This means that a patient needing 2,500 FUE grafts to be transplanted requires at least 2 and a half days of treatment.
The prices lie between 100 Rupees and 150 Rupees per graft.
20. Necessity of a preliminary shaving of the donor area:
In order to facilitate the extraction of follicular units – depending on the number of grafts wished – it is necessary that a less or more extended area of the donor region be shaven to a length of as much as 2-3 mm. This means that depending on the area shaven, it would either require several weeks or months before the desired length of hair is finally reached. Nevertheless, when only small amount of grafts are required for the hair transplant, we try our best to shave only a small area (at the same time, sticking to the geometrical principle of an elliptical strip) as symmetrical as possible, so that this area can then be completely covered by hair later on without the area of extraction being noticed at all.
21. After the operation:
No difference to strip- surgery (see there!). Exception: all concerning body- grafts, because in strip- surgery no body- grafts will be used.