Follicular Unit Extraction - "FUE"

fue5“FUE”  is short for Follicular Unit Extraction. A hair transplant technique that uses a micro cylindrical surgical punch. This instrument surrounds the hair units one by one. The technique requires skill and precise measurement. As each hair is carefully removed from the donor area.

Follicular Unit Extraction leaves no linear scar in the donor. There is no need for stitches and downtime post op is reduced. The extraction points/scars are spread around the sides and back of your head.

A handheld instrument is used more time is required. Even a highly experienced FUE specialist will be limited to approximately 1500 and 2000 in a one-day session.

Larger sessions are possible over two consecutive days. These must be carefully planned.  Even then care has to be given to donor management and healing.

A reason FUE is slow is the punch device is manually controlled. This allows the Doctor to feel the depth and angle of the follicular unit.  Make adjustments to the punching as and when required. In some cases, the depth or direction can alter almost constantly.  As a result, it is important the seating position and hand orientation changes to match the changes in the hairs.

The FUE technique has proven to be a superior option for those with minimal thinning. The Norwood 2, 3 and possibly 4 hair loss stages.

It has helped those who have undergone multiple “older” procedures. Especially when their donor is impaired. In these cases, FUE widens the donor area allowing more hair to be made available.

Larger areas of hair loss such as NW4 and higher can be treated with FUE.  These cases require a higher than average donor hair density. Also, good hair characteristics to ensure sufficient grafts can be safely removed.

FUE Punch Size

A number of punch sizes are used with FUE. Some doctors preferring a larger punch diameter. Others prefer to refine the punch size and use a 0.75-0.8mm diameter punch size.  The smaller punch can remove or at least minimise skin trauma. As well as peripheral damage to surrounding FU and reduce visible scarring. Whilst being able to encompass an intact follicular unit without damage or transection.

Doctor Input

A hair transplant Doctor should have the major role in your hair transplant. From the moment of your consultation to the final graft being placed. They should be personally involved in specific aspects of the medical procedure. Their medical understanding of the skin and hair will ensure the careful extraction and placement of the grafts. Without damage being caused to the removed graft or the surrounding hair and skin. The graft placement and hairline design are crucial for the look and planning of the hair transplant.

The “In Demand” Technique

The FUE technique has grown to be the most desired technique. This is partly due to some dubious marketing. As a result, it has become known as non-scarring, which is untrue. That said, in the correct hands, it is an excellent surgical procedure.

Extraction Pattern

FUE extraction is spread around the donor area. How spread is depending on the extraction pattern. The extracted hairs do not regrow once removed. But the number of hairs remaining and the hair density reduces.  If the amount of hair is reduced too much the area will become patchy. Often anymore than 4500 – 5000 taken over multiple procedures will start to be a problem. But, almost certainly if removed in one procedure will create long-term concerns.

Planning

So, where to get a hair transplant, the answer is simple but requires you to research and take your time until you find the right Doctor and Clinic. The answer is the one that best looks after your hair and your well-being with the emphasis on your well-being opposed to the cost, regardless of whether the cost is high or low-cost. Take advantage of online consultations and question the information you are being given, especially when it appears to contradict other Clinics information.

Importantly, on such an important decision do not allow your heart of hair emotions rule your common sense, and if the deal sounds almost too good to be true, it´s probably because it is.


PROS
  • FUE extraction scarring is spread and leaves no linear scarring
  • Post-operative recovery is faster and easier
  • Able to “cherry pick” FU to suit the area of placement
  • Widens the donor area to expand the number of FU available in conjunction with Strip
  • Gives a new alternative to repair patients to widen the harvesting potential, especially with the advent of BH
CONS
  • Slow to perform so the graft number per operation will be low compared to Strip
  • The potential for increased transection and lower yield in inexperienced hands
  • Overall a lower number of FU can be removed compared to Strip, making it generally unsuitable for higher levels of hair loss, NW5 and above
  • Cost is generally higher per graft than Strip
Learn more about PURE Follicular Unit Extraction – The FUE Technique
and hairline design, graft placement, and shock loss, also Follicular Unit Transplant (FUT) hair transplant technique.
PURE Follicular Unit Extraction

To perform FUE to the highest standard the donor area requires total shaving. With the exception of small procedures such as 100-500 grafts. Smaller areas can be shaved and hidden by surrounding hair. Shaving will allow for a better harvesting pattern. With the FU spread easier over a wider surface area. This will reduce the change in hair density over the donor. Also, avoid over-harvesting leaving patchy low-density areas.

Shaving The Donor Hair

Shaving allows the Doctor to precisely measure the hair angles. Especially the follicular unit (FU) angle as it exits the scalp. The hair density changes around the head. The extraction % changes dependent on hair density. As a result, without shaving this is almost impossible to calculate. This is especially true with larger hair transplant procedures. FU angulations, skin variations, healing can all be helped.

Diameter Changes In MM´s

Larger punches can be faster and easier to use. Generally, they require less precision and can take more hair in one punch. But this is not Pure FUE.

We are dealing with micro numbers with variants in mm´s. With differences when comparing the use of a smaller .75 mm FUE punch to that of a 1.0 mm. But, the area of extraction is 85% smaller. With a .8 mm punch, the area of extraction is 60% smaller. with around a 0.85mm punch diameter being able to remove the majority of follicular units.

Performing a hair transplant to the highest standard takes an experienced FUE doctor. Dedicated to taking the time to master the technique and understand the anatomy of the skin. It enables the doctor to provide the patient with better results short and long-term. Being able to leave a more pristine donor. Especially over multiple procedures when harvesting the maximum number of follicular units safely.

The FUE Donor Safe Zone

By splitting the safe zone into areas it is possible to calculate the safe number of grafts available. Whether the donor is viable for FUE and how many grafts can be extracted now and in the future.

FUE needs to start with a high donor hair density. One aspect of FUE is no linear scar. Potentially allowing hairstyles to be worn shorter. But this can only apply if the donor is not over-harvested. If the case, although no linear scar, there are obvious signs of scarring and patchy hair growth. The number of hairs in the area is reduced. The more hairs removed the thinner the hair density becomes.

Hair Loss Patterns

The safe donor area depends on the pattern of hair loss. Maybe around the sideburn area are very strong with no signs of receding. If weak the area has to be discounted for harvesting any grafts. This will reduce the surface area available to harvest. There are other danger areas of possible hair thinning around the head. Two areas especially are the nape of the neck and around the ears. A conservative approach should be taken, assess the safe zone and then reduce it slightly to play safe.

PURE FUE Harvesting Protocol

A harvesting protocol is vital when planning a hair transplant. The donor hair density will change. With the more removed the thinner the area will become.

How much can be removed, 20, 30, 50, 60%. Safely the figure is around 35% over multiple procedures. Under good conditions with an average to higher starting donor density. Hair characteristics will also play a role in how much can be safely removed. Some characteristics hide better the loss of the hair. If too much is removed it leaves obvious “hairless” areas. Possibly more visible scarring. As a result, it will impair the donor for future hair transplants.

More can obviously be removed. The hair in the area generally grows in a downwards direction. Because of this, with a little hair length, the loss is less obvious. Even so, there will still be visibly thin patchy areas.

PURE FUE Punch Control

FUE being a blind extraction method. Meaning it is not possible to see below the skin surface. This is the difficulty when the punch enters the skin. As to what damage can be done.

Each extraction may need to vary slightly. This can be dependent on the area and the angle of the hairs. The need to change position is not something that can be avoided regardless of the instruments used.

Pressure control is also important to achieve minimum transaction. Considering the effects to the surrounding hair units.

The Punch Method

There are various punch methods employed to perform the FUE hair transplant technique. Dependent on the hand control of the user the pressure, friction on the skin can be minimal to high.

The finger to the punch pressure helps gauge the skin characteristics. It is possible to minimise transaction to as little as 1-2% in some cases. Even in demanding cases rarely increases to above 5%. This is made possible by the minimal transference of resistance.

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