“FUE” or to use the full name, Follicular Unit Extraction, is the movement of genetic groups of hair known as follicular units (FU); “bunches” of hair usually 1 to 4 hairs. A micro cylindrical surgical punch surrounds the FU and with a great deal of skill and precise measurement of skin and hair angles the FU is encompassed within the punch.
What Makes The FUE Technique So Good And So Difficult To Get The Best Results?
To perform FUE to the highest standard the donor area requires total shaving, except possibly for small procedures such as 100-500 grafts when smaller areas could be shaved and hidden by surrounding hair. Shaving allows for the hair density to be correctly measured, any miniaturisation catered for and an even and balanced pattern of extraction to not over-harvested.
When Size Really Matters
FU´s must be removed individually, this requires a great deal of concentration to ensure the punch only encompasses the follicular unit/hair graft.
The size of the punch has to be large enough to not damage the hair graft being removed but also small enough to not overlap or damage the adjacent follicular units.
Taking average hair characteristics and hair density into consideration a punch diameter can vary around 0.75 to 0.85mm in diameter being the optimum size to use, able to remove safely a larger 4 hair FU grouping.
Larger punch sizes can be used, for example, a 1mm diameter, that makes performing FUE easier and faster. But an experienced doctor who has taken time to master FUE over the years and understand the anatomy of the skin will be using a smaller punch size. It enables the doctor to provide the patient with better results short and long term, the potential to leave a more pristine donor and over multiple procedures to harvest more hair safely.
Where Is The Hair Removed From
One benefit to FUE is no linear scar is created because the hair is removed around the back and sides of the head in a relatively random pattern. As long as the extraction pattern is spread the scarring should be dispersed and in most cases hidden between the remaining hairs.
The donor area can be measured for the density and hair count, as well as the total safe surface area the hair can be removed from, without potentially using genetically weak hair that can fall out later.
The current hair loss pattern is taken into consideration but also future hair loss as this may make the donor safe zone shrink in size.
When Is Enough, Enough – Taking Too Much And Over-Harvesting
Remember, the scalp surface area never changes, it remains the same, BUT the number of hairs in the area reduces, the more hairs removed the lower the hair density becomes.
Can the demand for hair be met by the donor hair? Can we take 50% and leave the other half there?
Taking too much hair will leave patchy “hairless” areas, more visible scars and impair the donor area potentially for any further hair restoration.
Taking half the hair from the sides and back on the average person means removing around 5-6000 follicular units, or around 12,000 hairs. Although it is possible unless the individual has exceptional hair characteristics the damage will be obvious, it is likely some of the hair will be damaged when and not grow, the remaining hair will be damaged and become weaker in the donor and the hair has an unnatural patchy pattern of hair growth.
Large FUE sessions are not advisable to be undertaken; FUE maybe minimally invasive in respect of one small punch entering the skin, but multiplied by 4000 and it then becomes a different type of surgical procedure. Although the scalp is vascular the more open wounds created in both the donor and recipient areas the harder it will be for the body to heal each wound effectively. This could result in more scarring in the donor area and impaired yield in the recipient.
Who Needs to Perform FUE – Punching
Follicular Unit Extraction is a surgical procedure. It may be minimally invasive but that does not reduce the expert knowledge and technical ability required to perform this hair transplant technique to the highest standard.
As simple as this procedure can be made to look there are multiple technical aspects that require skill and understanding to ensure the hair is removed intact, undamaged, the remaining hair quality is maintained and there are maximum hair growth and minimum obvious scarring.
The Doctor is responsible for mapping out the safe donor area, calculating the hair density and punching the follicular units one-by-one from the area. This can be slow but precise to ensure the quality of the grafts and the donor area. Having unskilled non-medical persons punching the grafts, on some occasions two at the same time is obviously faster and more efficient for the Clinic but detrimental to the quality of the work and your result.
FUE has and will always be technically a very difficult technique partly due to it being a “blind extraction”; as it is not possible to see below the surface of the skin which angle the hair follicle is situated.
Each extraction can vary slightly in technique dependent on the area of the scalp and the angle the FU exits the scalp changes and the depth of the FU. It is important the doctor can understand the need to alter their position whilst punching otherwise there will be a greater scarring potential and increased transection.
Getting The Best FUE Hair Transplant
Choose your Doctor well and ensure during your hair loss consultation assessment you can ask questions and ensure you qualify the answers.
The FUE technique has proven to be a superior option for those with minimal thinning, those maybe Norwood 2, 3 and 4 hair loss stages; also it has opened a new door to those who have undergone multiple “older” procedures and their donor is impaired. In these cases, FUE widens the donor area allowing for a wider safe hair zone to be used.
Larger areas of thinning say NW4 and higher can be treated with FUE but the person has to have a much better than average donor hair density and good hair characteristics to ensure sufficient FU numbers can be safely extracted and leave options for the future.
If it takes time to perform FUE and maintain high yield then so be it as long as the growth and quality of result stands that is what is important.
The best FUE hair transplant technique and results may not be the latest developments and changes to the technique as they may be more focused on speed than quality. Understanding how technical an FUE hair transplant actually is can ensure you achieve the best possible result from your first hair transplant to when you suffer further hair loss and need another.