The Miracle Hair Transplant Technique – Follicular Unit Extraction

The Miracle Hair Transplant Technique – Follicular Unit Extraction

We recently started the discussion on the changes in the FUE hair transplant technique on UK based hair loss forum

The debate has attracted interest from well-known and respected individuals associated with hair loss and hair restoration.

FUE is now a long-established hair transplant technique but over time there has been a growing tendency by some to want to dumb down the fact FUE is a surgical procedure and or aspects and consequences of the procedure assuming to play down the medical aspects or make it appear more appealing and simpler to perform.

Three random quotes from three websites just pulled off a search engine

  1. “The hair line is natural-looking (no linear scar).”
  2. “FUE –Follicular Unit Extraction (FUE) is a NO Stitch, NO Scar technique”
  3. “FUE is a minimally invasive procedure that leaves almost no scarring.”

The problem with these quotes?

  1. There is no correlation between the hairline looking natural and not having a linear scar
  2. It maybe no stitch but it is not a “no scar technique”
  3. “almost no scarring” is incorrect, every punch made will leave a scar

FUE uses a cylindrical instrument to punch around the outside of a follicular unit (FU), it is then extracted normally with forceps to leave a small open wound initially. The wound heals superficially with a scab like any cut on the body would as part of the healing process. Over time the wounds heal and the skin pigment settles, this can vary depending on the application of the punch and the natural skin healing characteristics.

A scar is a mark left on the skin after a wound has healed, every wound will leave a scar, every punch made into the skin will leave a scar, the size of the scar can depend on the punch and technique and skin characteristics.

How visible will the scarring be?

Hair length can be a large factor of course because with a little hair length the coverage hides the scalp and so hides any scarring. The shorter the hair is cut the more likely the scarring will be visible

The skin healing and the harvesting pattern can play a role in how visible or obvious the scarring is, along with the number of follicular units removed. The tighter the extraction pattern is going to remove more FU in a smaller area leaving larger or closer situated hair-less areas, scars. Therefore, the more grafts the more scarring, the tighter the extraction pattern and the chance of it being more visible.  1500 grafts can be spread around the donor from side to side and pro rata with an educated pattern of extraction only make a small change to the overall average hair density around the donor. Double the extraction, 3000 FU, and the pattern becomes tighter and harder to manage not over-harvesting areas.

This does not take into consideration any miniaturisation of hair in the donor or any transection caused when punching or extracting the FU´s.

The skin and hair characteristics, lighter skin complexion against darker hair colour, the contrast is going to be higher than light skin complexion and blonde hair colour so making the punch marks blend more with the surrounding skin.

When punching a random but educated pattern needs to be adhered to, not to remove adjacent FU to leave larger areas of no hair, not to transect surrounding FU´s and not to overharvest some areas simply because the starting hair density is high, so overharvesting as it is easier to remove the larger units and split them down later to create more grafts.

One of the largest issues with FUE was always that FUT in good hands and the right candidate could reach 4000 odd grafts in a one-day procedure whereas FUE, especially in the early days would struggle to reach 500 but later around 1500 and 3000 over a two-day procedure.

Because the extraction process is so different between the two techniques it takes a very different point of view on what can be taken and how. With FUE the skin surface area does not change but the hair density in the donor zone does. Basically, the more that is taken the less is left.

Trying to create a random but thought out extraction pattern is not easy as our brain is wired to patterns. Large FUE sessions, like 4000 grafts put a lot of pressure on the person punching to spread the punches enough not to take adjacent hair units and leave a random pattern at the same time. Something that as the need for high numbers increases makes it impossible to maintain a random pattern and allowing for missing adjacent hair units to avoid larger gaps between each punch.

High or average hair density donor areas it almost doesn´t matter as the pattern of extraction still needs to be monitored to maintain a balance around the donor area. It´s not wise to take a larger number from an area with a high hair density to match the areas of lower hair density as it doesn´t work like that. Once healed there is an obvious demarcation line between the area harvested and the virgin scalp area.

By spreading the numbers over multiple procedures cares for the scalp and improves the number of grafts available over time as well as making it easier to respect a harvesting pattern to not remove too many in any specific area.


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