FUE Hair Transplant Surgery

 

FUE is a term used to describe a surgical hair transplant procedure, Follicular Unit Extraction; the method of extraction makes the major difference between the other recognised hair transplant technique; FUT. On the right candidate the FUE technique can be an excellent option and can open the safe donor zone outside the traditional strip or FUT zone for harvesting; expanding the donor area has a number of advantages

Follicular Unit Extraction Punch Tool

Follicular Unit Extraction Punch Tool

Candidates that have undergone previous surgery and then donor has been impaired with scarring FUE can extract around the scarring and over a wider surface area to increase the total number of grafts available. If scarring is too wide or an irregular shape to excise via FUT then grafts can be removed randomly from other areas of the donor and then placed into the scar tissue; not removing the scar but helping to camouflage the area

FUE can expand the donor zone because of the method each follicular unit is removed or extracted; a cylindrical instrument around 1mm in diameter surrounds the hair shaft and then makes a punch into the scalp

Understanding the direction of the hair as it exits the skin is vital, as is depth control of the punch; as it is impossible to see with the eye FUE is a blind extraction technique; a great understanding of anatomy is required. The direction of the hair as it exits the scalp can differ from how the follicle is directed under the skin; if this is not understood it can lead transecting the follicular unit, best case scenario is the FU is split and the healthy hair count reduced, worst case scenario the FU is worthless due to being divided

The angle of the hair will alter dependent on the area of the scalp it is position in, the sides and back of the head; when punching the FU´s the positioning of the hand needs to change to compensate for the change in direction

The depth the FU sits in the scalp can also alter, some more shallow or deeper than other; in general most individuals there is a small variant in depth around the head but in some cases the depth can alter dramatically, even in the same areas, making depth control of the punch harder to be consistent

Regardless of manual or motorised punch tools these are basic fundamentals that have to be taken into account; with due care any damage caused during the extraction process can be kept to a minimum, with around a 5% transection rate; if the transection rate gets too high then a decision has to be made whether the process should be continued

To extract the FU´s it is considered better that the hair in the donor area is shaved to make it easier to detect the hair shaft direction and encompass the punch around the graft; on very small procedures it may be possible to partial shave an area that can be hidden by the surrounding hair, but any procedure requiring a decent graft count requires shaving

Although FUE grafts are removed individually they still a need for the FU´s to be cleaned and sometimes trimmed and this should be performed under magnification. This is to ensure the quality of the follicular units and that all are fit to be used

Due to the punch size being small the grafts generally will be leaner than FUT grafts, less fatty tissue surrounding the FU. Any graft requires care when being handled but FUE grafts a little more; to not hold the bulb as it is easily crushed

FUE surgery will leave small cylindrical scarring around the donor, some hardly visible even under close inspection; other can be more visible, looking a little chicken-pox scarring. An educated harvesting pattern must be adhered to and not remove adjacent FU´s or create a man-mad pattern of extraction as this can highlight the scarring with shorter hair, long hair it cannot be seen

When researching hair transplant it is important the technique utilised is best suited to your hair loss pattern now and in the future as the 2 different techniques have advantages and disadvantages to them

 

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How Many Hair Transplant Grafts Have I Got?

How Many Grafts Have I Got?
Hair loss is progressive and can continue for many years, starting generally from the hair line until it reaches the crown; the hair loss stages are categorised from minimal loss (NW2) to NW7 advanced hair loss. As hair loss over the top of the scalp progresses it can start to reduce the size of the donor area around the sides and back of the scalp as the sides and crown drop.

The donor area is a safe zone where the hair follicles are genetically programmed to not succumb to hair loss. But it is important as hair loss progresses that a conservative approach is taken to the size of the donor safe zone. Dependent on the technique used will determine how the follicular units are removed and how many FU´s can be harvested in one or multiple procedures.

An average donor hair density is around 75 FUcm² and can rise to over 100 FUcm² on a very good donor area. The hair density is an important factor in how many grafts you can use; obviously the higher density the more grafts available.

FUE extracts the follicular units one by one and over a wider surface area than FUT; the donor should be shaved and the safe zone assessed, checking for miniaturisation especially around the borders of the donor and recipient areas. As the FUE donor surface area has no signified boundary care needs to be taken not to stretch the boundary to try and reach high graft numbers and start to extract in a potential unsafe zone in later years.

FUT harvests the grafts from a single, relatively thin hair bearing strip where the follicles are at the highest density. The strip is then divided to remove the individual follicular units, 1, 2, 3 and 4 hair units. FUT relies much more on skin laxity rather than needing to harvest over a wide surface area; and because of the high concentration of FU´s in the area on an average candidate 4000 grafts can be removed in one procedure. On a good candidate anything from 6-7000 grafts can be harvested in one day with FUT. FUE generally in one procedure around 3000 can be achieved, partly due to the slow harvesting and to not over harvest.

It is possible to have more than one hair transplant procedure, either with FUE or FUT, generally the 2nd procedure will not yield the same amount as the first as the donor density has been reduced with FUE or laxity changed with FUT
Donor healing will play an important part after the first procedure how many grafts can be removed in the future.

With good laxity a 2nd procedure could yield a further 3000 grafts with FUT, FUE probably much lower because of the reduction in hair density from 100% prior to any surgery to around 70-75% after the 1st procedure. An average hair transplant candidate with FUT can reach around 7-8000 grafts over multiple procedures, over multiple procedures with FUE this figure will generally be lower, unless harvesting exceeds 50% of the donor hair.

Planning is vital from the very first procedure to ensure long term the donor is kept in the best cosmetic condition and the maximum number of grafts can be removed if/when hair loss progresses

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Repairing A Previous Hair Transplant

Hair transplants have moved on greatly in the last decade and results can be undetectable from natural hair growth. Alas in the past and sometimes today poor surgery has been performed that needs to be repaired.

Repair surgery can be complicated and a drawn out procedure, requiring multiple future operations to get back to as normal situation as possible, patience is required and prioritising areas to repair first. Hair transplant repair can be either the recipient area or the donor area, or both. Poorly placed grafts in the recipient area and bad donor management can leave the scalp overtly scarred, miniaturised hair due to trauma.

Older methods used plugs or mini-grafts opposed to follicular units. These are larger bundles of hair maybe up to 20 hairs placed in an unnatural pattern of growth. When visible, especially along the hair line looks unnatural.

Poor slit placement can leave ridging and pitting on the skin; pitting is a crater effect where the hair enters the skin, ridging leaves a raised hump of hard skin on the surface of the head. Old pluggy grafts can often to hidden by placing around them to camouflage, if directly on the hair line it may be required to remove the graft or place directly in front to create a new hair line, design allowing.

The donor area, previous scarring can be englobed or removed with FUT to leave a smaller finer scar, laxity permitting. When the new strip is removed hair can also be harvested for use in the recipient. FUE can then harvest over a wider area if more grafts are required in the recipient, also if previous scarring has poor laxity grafts can be placed directly into the scar tissue to help camouflage the area.

With hair transplant repairs it is usual for a lower density to be placed to maximise the growth yield, especially if the hair is being placed in to scar tissue when the cardio-vascular is impaired. Also, due to the nature of a repair all areas are impaired, the remaining donor is reduced and damaged and priorities need to be made in where to place the hair in the recipient to give maximum benefit. It is important to research thoroughly before undergoing a repair, every hair counts

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What´s the difference between hairs, follicular units and grafts?

A hair transplant relies on the fact we can remove hair from the back and sides of the head and place them over the top of the scalp to give coverage and the illusion of high density to mimic nature.

Hairs are single shafts growing from a follicle embedded in the skin, the hairs grows, rests and falls out before it regrows again and goes through the same process time and time again. A follicular unit can be a single hair also, but a follicular unit can also be up to 4 hairs. An FU is a group of hairs that grow in tight bunches from 1 to 4 hairs normally.

The follicular units are spread around the scalp. There is a higher concentration of smaller FU´s around the sides of the head, with the larger follicular units, 3 and 4 hair units situated around the occipital bone, or the back of the head. So hairs to FU`s, you can have 5000 FU´s but the number of hairs could be anything from 5000 if all single hair units to 20,000 hairs if all 4 hair follicular units. This can make a huge difference to the quality of the hair transplant. Most hair transplant clinics use the phrase follicular units when saying how large the hair transplant procedure was. They will also give you the hair to FU count so you can compare the number of hairs; averaging to around 2.2 hairs per FU.

The definition of a graft is a piece of living tissue that is transplanted surgically. The term graft applies to the follicular unit in a hair transplant procedure. The term graft and follicular unit can imply the same. As the term graft technically only means a piece of tissue it is important to determine what the clinic refers to it as. Many clinics will say you have had “x” amount of grafts placed, and this can mean FU´s, but it important to understand the meaning prior to making your decision.

When quoted for a hair transplant it is common you are told you pay per graft placed, confirm this means pay for every intact FU placed and ask for the hair to FU count. As before there should be an approximate average hair count of 2.2 hair per FU/graft, if this is significantly lower it can impair the quality of the hair transplant and mean paying significantly more on average to the number of hairs.

Always research before making any decision on having a hair transplant

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What´s The Largest Hair Transplant?

The largest hair transplant procedures can be performed in a single procedure or over multiple procedures. FUT on the right candidate can exceed 7000 grafts in a single day procedure, obviously if required. The number of grafts required is largely determined by the surface area that needs to be treated; a high hair loss pattern from the hair line to the crown can require in excess of 8000 grafts.

The FUT or Strip Surgery technique can remove a large number of grafts efficiently; allowing treating high Norwood Scale hair loss suffers in a one day procedure with sometimes total coverage. A second FUT procedure can be performed at a later date to increase the density in the areas the first procedure could not complete. Over 2 procedures FUT could complete full restoration on many candidates, and leave more in the donor.

FUE takes longer as each follicular unit has to be punched individually, high numbers can be achieved but it takes multiple procedures and requires generally a higher starting donor density to achieve the same as FUT.

With a Master Plan the best technique can be assessed and agreed with the candidate to achieve their goals in minimum time scale. FUT maybe 12 months for some, whereas FUE can take years.

2. Before & Grown Out, 4039 Grafts via FUT. Hattingen Hair, Switzerland 6. Before & 15 Months After (slightly wet hair) 3994 FUT. Hattingen Hair Transplantation, Switzerland 4172 Grafts via FUT. Before & Grown Out Result. Hattingen Hair Transplantation, Switzerland 2. Before & Grown Out 3462 FUT. Hattingen Hair Transplantation, Switzerland

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Hair Transplant Donor Management

What is more important in respect of the hair transplant procedure, the recipient area or the donor area? Many will obviously say the recipient because that is where the hair is placed to give someone their hair back. This is obviously true, but the donor area is very important to the result, short and long term, without good donor management a hair transplant will not be successful.

The donor area is around the sides and back of the head, dependent on the technique used the donor safe zone will alter in surface area, FUE technique requiring a wider surface area to harvest from and reach large numbers. Whether FUT or FUE the skin characteristics will change after every procedure and both will leave a degree of scarring. The first hair transplant procedure is working with a “virgin scalp” and important for the long term.

It is easy to think short term, about the first procedure, but effective donor management allow for educated harvesting and long term a better looking donor area and the ability to maximise the graft numbers. Dependent on the hair loss pattern can determine the best technique to initially use, also determining the future pattern of hair loss if possible.

Because FUE requires a wide surface area to harvest from this can complicate the safe zone if hair loss progresses, so treating a low NW hair loss or a younger candidate can be difficult. If hair is removed from outside the safe zone over time these hairs will fall out and compromise the hair transplant result; if too much hair has already been removed from the donor it will make it impossible to repair.

Educated donor management can make the difference between successful hair restoration programme and an unhappy person in the future. Always research thoroughly before deciding on a hair transplant procedure.

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Best Hair Transplant Technique?

The best hair transplant technique is the technique that best suits your needs, it is not determined by which technique is in fashion or most popular, but by design that caters for your needs the best.

FUT or Follicular Unit Transplantation has been the established technique for many years; more recently FUE or Follicular Unit Extraction has also established itself as a credible hair transplant technique. Each technique has its pros and cons with the main difference between the two techniques being the manner in which the hair/follicular units and harvested from the donor area, around the back and sides of the scalp.

Choosing the correct hair transplant can be difficult with many conflicting opinions given when you begin your research; it is important to listen to opinion and base your decision on facts that are provided.

FUT will leave a fine linear scar around the donor, hidden by the surrounding hair; FUE will leave small cylindrical scarring over a wider area of the donor area, again hidden by the surrounding hair. FUE reduces the density or amount of hair on the surface area of the donor, so each procedure lowers the amount of hair remaining, this can limit the number of FU´s available compared to FUT unless the starting density is very high. FUT relies more on scalp laxity as a hair bearing strip is harvested and sutured, so the density remaining is hardly changed, just the skin laxity slightly altered.

On high Norwood candidates there is a demand for a high number of grafts/FU´s to make the result look natural; FUT can harvest in a one day procedure on the right candidate around 5-7000 grafts. FUE in general requires multiple procedures to achieve a high number of grafts due to each FU needing to be extracted individually; also a procedure may have to be over multiple days to achieve around 3000 grafts.

FUE can also benefit repair patients, those who have undergone previous poor procedures or just multiple FUT before. As FUE has a wider harvesting potential it can increase the potential number of graft in total. FUT and FUE can be combined in a hybrid procedure, on an average hair transplant candidate this can allow 6000 plus grafts can be achieved, on a good candidate potentially 8000 plus.

Always research and take your time when researching, collect different opinions and assess the facts when looking to which technique is best for you short and long term

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