FUE (Follicular Unit Extraction) is a hair transplant where hair follicles are harvested one by one in the back of the head and then placed in the front, temples or top of the head.
The method is sometimes called the Golden Standard in hair transplantation since it is an exclusive and quite expensive method. With FUE the surgeon can lower the temples, lower the hairline and fill in empty spaces with hair. Typically many reoperations and corrections are made with FUE.
It is often said that FUE is a minimally invasive technique and that the follicular units are harvested from “micro-cuts” of about 0.5-1 mm in diameter. The surgery should be done by using high magnification and it is done with instruments that vary in diameter.
The use follicular units was originally introduced by Dr. Woods in Australia under the name “Woods Technique,” but Dr. Woods did not show any details of its new technology and a little later wrote Rassman and Bernstein a scientific paper about the method. Subsequently, other surgeons developed the method further and is now a legal standard solution even if it is a smaller proportion of the world’s surgeons who choose to do FUE.
Hair follicles usually grow with 1-7 hairs but the majority of follicles contain just one hair, two hairs and three hairs. FUE implants usually consist of 1-3 grafts. For example, one usually place the ones in the front row of the hairline, while two hairs are placed further back to thereby imitating the way hair looks . If you place the 2′s in the front hairline makes the hair transplantation will look unnatural and the team sort out the various follicles before they are placed. It is common that splits up the hair follicles so that, such as, get more one hairs if necessary.
FUE is a gentle surgical technique for the patient because the surgeon will extract all follicles individually and they do not remove large areas of skin from the head. FUE procedure can be performed under local anesthesia without hospitalization. The operation takes depends on the area treated between one and up to 10 hours. It is not uncommon for major surgery (mega session) going for up to 8 hours.
The advantages of FUE is also the wellbeing of the patient because the surgeon to use local anesthetic similar to the one you get at the dentist. After surgery, you can go home with a light protective dressing orto cap over his head and after an operation do you look like a pincushion on the back of the head but after a few weeks.
Benefits of FUE
FUE has many benefits: the risk of scarring is small, infections or other complications are minimal and more hair follicles can be theoretically removed. A patient suffering from hair loss have a limited number of hair follicles and it comes to conserve these resources.
Of course, these FUE most about how to remove the hair follicles but it is likely that a clinic that uses micro tools to remove the hair follicles also uses micro tools for placing the same hair follicle. How to place the hair follicle is of great importance for the outcome. The surgical team must place each graft in the right angle in harmony with the existing hair – which contributes to a more natural result.
Disadvantages and risks of FUE
There are also a lot of disadvantages with FUE. The disadvantages are mainly the price that was high explained that it is time consuming.
Leaves no big scar on the donor area and gives very natural results
For more hair loss is often required multiple operations because they can harvest a maximum of 3000 follicles (about 6600 hairs) from each FUE surgery. If you do major surgery is wound surface huge because you multiply the diameter of the tool with the number of hair follicles to be charged. I have done calculations on it that shows that even the size of the instrument is relevant to the wound surface at major surgery.
There are also doctors from FUE opponents that states that the survival rate with FUE is lower than the strip. But the investigation may result depending on factors such as how the team cope with hair follicles. There are many indications that there are other factors that influence survival rate such time as the hair follicles are in the open and fluid as they are kept in before they are placed. There is also strong evidence that FUE grafts will take a bit longer before they grow up than those made with strip – I’ve talked to a few patients who claimed that the hair at the strip operations have started to grow earlier.
Automated or manual FUE
FUE can both be performed both manually and mechanically, ie with motorized tools. The first motorized FUE tools that came a few years ago was not very good results and there are some horror stories online from patients who have suffered from such clinics. The newer motorized FUE tools are available in various diameters down to 0.7 mm and works better and companies Restorationrobotics develops software to extract FUE implants in view of the hair follicle angle looks like.
Another company involved in robotic assisted hair transplants is Artas system and they are using a system that is FDA cleared.
How to cut out each hair follicle so that the so-called transections rate is low is of great importance. What is important is the angle from which the hair follicles taken out and that anyone who takes out the hair follicles to adapt the tools after the patient’s hair follicles. The size of follicles can vary in both size and how the root looks like. For example, people with curly hair often more curved hair follicles than those with straight hair.
Other uses for FUE
- Scar reduction
- Eyebrows, beard transplants
- Re-operation and to give a natural look at a previous hair transplant.
Follicular Unit Extraction: Minimally Invasive Surgery for Hair Transplantation.
Rassman and Bernstein