What Is FUE Hair Transplant?
As individuals age, the natural three-phase cycle of hair growth and regrowth tends to shorten until follicles eventually no longer grow hair. Some start to lose hair very young, whereas others may encounter balding much later in life. Hair transplants offer a solution to restore hair by implanting donor grafts that can still grow hair in balding areas. Over the years, various methods have emerged, and each evolution in hair transplant surgery aimed to improve the naturalness of results and minimize the drawbacks associated with earlier techniques. FUE, the most recent and widely adopted method, has become the standard of care for many patients seeking hair transplants due to its effectiveness and reduced visibility of scarring.
FUE or Follicular Unit Extraction is a specific method through which grafts are harvested individually from the donor area, typically the back and sides of the scalp, where hairs are resistant to falling out during the patient’s lifetime. Even though FUE defines only the extraction method, the general technique is referred to as FUE hair transplant since the other two stages (incision and implantation) do not vary much between different techniques.
What Does FUE Hair Transplant Mean?
A FUE hair transplant is different from the previous technique, also known as strip procedure or FUT (Follicular Unit Transplantation), because in FUT, a strip of scalp is surgically removed from the donor area, and the follicular units are prepared outside the body. After the closure of the scalp, a linear scar will be present in the donor area. The follicular units are removed individually with FUE, so there isn’t an incision and a linear scar. Instead, many punctiform scars, smaller than 1mm in diameter, allow patients to use their hair short. It’s important to say that FUE isn’t a scar-free technique, only that there isn’t a linear scar, so shaving the head may reveal small white dots.
To understand the transplant process, it’s essential to define follicles or follicular units, often called grafts. These units are the essential transplanted components of hair follicles that naturally produce hair. A follicle is a group of one to four terminal hairs on the scalp containing sebaceous glands, nerves, vessels, and the erector pili muscle (responsible for creating goosebumps.) This is very important for the success of the transplant because this is the natural way that hair grows.
Hair transplants from this area are successful because the hair from the donor site is resistant to DHT (Dihydrotestosterone – a byproduct of testosterone). DHT is the primary cause of male pattern hair loss. When hair is transplanted from the back and sides to the hair loss area on the front or top of the scalp, the hair follicles maintain their original characteristics and will continue to grow.
How Does FUE Hair Transplant Work?
As previously mentioned, the FUE hair transplant comprises three stages: harvesting, incision, and implantation. Depending on the graft count, an FUE operation usually takes 6-8 hours. Each stage plays a crucial role in the overall success of the transplant and the naturalness of the final results. Additional factors contributing to a successful result are anterior hairline design, direction of implantation, use of appropriate follicular units in each location, etc.
A detailed medical history is essential to grasp the patient’s overall health, pre-existing conditions, and potential risks for the planned procedure. Subsequently, a comprehensive examination should be conducted, and the patient’s expectations should be discussed. Understanding the patient’s expectations is essential for building a solid doctor-patient relationship. It helps manage expectations and ensures that the patient’s goals align with what can realistically be achieved through the planned operation. Once a consensus is reached on the operation plan, the following steps can be taken.
The process begins with shaving both the donor and recipient regions. The donor site is then sterilized using a disinfectant such as alcohol or iodine. Local anesthetic medications, both short and long-acting, are injected into the donor site using needles to ensure prolonged numbness. A local anesthetic ointment or a jet gun (a needle-free instrument applying medication under the skin with high pressure) may be used before needle injections to minimize discomfort. Once complete numbness is achieved in the donor region, a tumescent solution is injected under the scalp to reduce bleeding during the operation and facilitate healthy graft extraction without breakage. Some surgeons may include adrenaline in the tumescent solution to further reduce bleeding and corticosteroid medications to mitigate post-operative swelling.
- The extraction phase in FUE (Follicular Unit Extraction) hair transplant involves the technician extracting individual follicular units using a motorized micro punch. This technique eliminates the outdated “plug” look associated with older instruments. Unlike the older punches with a diameter of 0.5 cm or more, FUE punches are typically less than 1 mm in diameter, just enough to incise the skin around each follicular unit. This advancement has replaced the old technique, where each punch could remove 15 to 20 hairs together, resulting in the undesirable “doll hair” appearance that is now considered a thing of the past. The harvested grafts are collected using micro forceps with delicate tips to prevent tissue damage. Harvesting grafts in an FUE hair transplant proceeds rapidly and efficiently, minimizing the graft storage period and ensuring patient comfort. The extracted grafts are organized based on their hair count (single, double, triple, multiple, etc.) and aligned on surgical pads. They are temporarily stored in a cool, sterile solution until the implantation stage.
- The next crucial step is the incision stage. One of the most critical factors for a successful and natural hair transplant result is the recipient incisions (or channels). While various materials such as sapphire blades, sharp implanters, needles, or slits can be used for creating incisions, many surgeons prefer sapphire blades for their precision and durability. Sapphire FUE hair transplant involves opening incisions (or channels) in the recipient area explicitly using special sapphire blades to create delicate and precise cuts. This ultra-sharp blade prevents tissue damage and promotes faster healing with minimal scarring. If sharp implanters are used for implanting grafts, the technique would be DHI (Direct Hair Implantation).
Incisions should be made in varying lengths and thicknesses based on the features of the extracted hair. Each incision’s angle, depth, and spacing are critical determinants of how the transplanted hair will grow. The channels should be opened in the same direction as the natural growth direction; typically, on the frontal region, the incisions are made at an angle of 30-35 degrees. As the procedure progresses towards the crown, the angle of the incisions gradually increases. In the crown area, incisions are artfully performed in a whirl shape, reflecting a meticulous approach to achieving a natural hair growth pattern. Incision depth is another critical consideration. Depending on the shape of the grafts, the required depth can change. Someone with a curlier graft may require a shallower incision to host the follicular unit, while a thinner and longer graft will require more depth.
In addition to the considerations mentioned above, it is essential to emphasize the importance of adequate bleeding control during the incision stage of a hair transplant procedure. Adequate bleeding control contributes to the procedure’s safety and provides a more apparent surgical field, allowing for precise and controlled incisions. Simultaneously, while focusing on bleeding control, it is imperative to open channels to avoid any disruption or damage to the blood circulation in the recipient area. This is vital for maintaining the integrity of the recipient area and promoting optimal conditions for successful graft placement.
Following the completion of the incision phase in a hair transplant procedure, the extracted grafts are meticulously implanted in the same order as they were initially removed. The implantation process involves carefully inserting hair follicles into the premade channels, utilizing specialized forceps. The distribution of ultra-micro-grafts should be carefully managed for an aesthetically pleasing and natural-looking hairline. Single-hair grafts are preferably placed on the front edge, while grafts containing more than two hairs are strategically positioned in the middle and toward the back. This thoughtful placement ensures a harmonious and natural distribution of hair, enhancing the overall outcome of the hair transplant procedure.
Additionally, careful attention should be given to placing the surface of the grafts slightly higher than the surrounding skin in the transplant area. After the completion of graft implantation, final checks are conducted to ensure proper placement and overall satisfaction with the distribution. After cleaning the recipient and donor areas with sterile saline spray, the donor region is covered with a medical dressing, whereas the recipient area is left open. Now, the patient is ready to be brought back to the hotel or home for rest after giving the first-day instructions