FUE Hair Transplant

FUE is an abbreviation for Follicular Unit Extraction. FUE hair transplantation has become more popular than FUT because of its many advantages. The possibility of transplanting hair from areas other than the back of the head, such as the beard, chest, has made the FUE method popular and in high demand.

What is a FUE Hair Transplant?

FUE Hair Transplantation is the process of extracting the hair grafts between the two ears, which are genetically resistant to hair loss, or the hairs in other parts of the body as follicular units one by one and transferring them to the balding area. Defined in 2002 by Dr. Rassman, this method has made rapid progress, especially with the use of micro-motors, and has become an indispensable method by dethroning the other – FUT hair transplantation method. FUE is known as the newest hair transplantation technique.

We have performed surgeries with 10.000 grafts transplanted using the FUE method. The volume of the grafts depends on the volume of the donor area. In contrast, a maximum of 3,000-4,000 grafts can be transplanted with FUT. Very rarely FUT and FUE can be performed in combination (FUT surgery follows 1-2 days after FUE). 10,000 grafts can be transplanted in patients with Norwood 6-7.

Overview and Advantages of FUE

In the FUT method, the scalp between 1.5-2 cm x 20-30 cm is cut and removed from the donor area, then the two skin ends are sewn together. In FUE hair transplantation, hair follicles are taken one by one in a homogeneous way. There are no incisions and stitches. People have rapidly moved away from the process of cutting a piece of scalp and then suturing the skin after FUE. Therefore, FUE has almost completely eliminated the FUT method.

With FUT, the area between the two ears can be used as the donor area, in FUE, almost all hairs of the body can be used.   FUE has developed very rapidly, especially with the transfer of beard and chest hair to the balding area. Therefore, the total number of grafts that can be transplanted has become much higher. In addition, the fact that there are no stitches compared to the FUT method and that there is no linear scarring due to the flap piece taken in the FUT method has placed FUE in the first place in the ranking of the best hair transplantation method today. In patients with short hair, the FUT scar is prominent. In FUE, on the other hand, the scars are dotted and these scars can be easily camouflaged even in short hair.

One of the benefits of FUE is the difference in postoperative pain. After the FUT procedure, moderate pain lasts 3-4 days. Because the scalp is cut and sutured, it is a small invasive surgical procedure. There is also numbness in the nape of the neck for 3-4 months after the operation. In some cases, numbness continued for 6 months to 1 year. In FUE, most of the complaints disappear after 48 hours. Comparing to the FUT method numbness are much less in FUE. Another article will examine the differences between FUT and FUE in detail.

What are the Stages of the FUE Technique?

The only difference between the FUE hair transplant and FUT is a way of hair graft extraction.

We can summarize the stages of an FUE Hair Transplant operation as follows. Information about the period before and after hair transplantation is explained in detail in their respective topics.

1. Local Anesthesia. Local anesthesia is not specific to FUE. It is also performed in FUT method. We will examine the issue of local anesthesia in hair transplantation in detail in another article.
2. Removal of Hair Roots. This is our main topic. We will examine this in detail below.
3. Hair Transplantation (Transplanting the Grafts to the Hairless Area). Grafts implantation has no connection to the FUE. Hair implantation with the FUE and FUT techniques is similar.

How is FUE Performed?

The patient is placed face down on the hair transplant chair or placed in a sitting position.  In this position the hair on the back of the head and occipital region can be easily removed. The patient is placed in the lateral decubitus position while the side area hair is removed. Lateral decubitus is the way the patient lies on his/her side. In this way, graft harvesting is made easier. In the lying position, the removal of the grafts is relatively faster, but bleeding may be slightly higher depending on the position. In the sitting position, harvesting is slower but bleeding is less common.

Magnifiers called loupes must be used during graft harvesting. 2.5x -4x magnification ratios of loupes are usually sufficient. The graft incision rate will increase significantly when harvesting without using a loupe. Hair follicles are extracted one by one with the help of fine punches without cutting and stitching. These extracted hair follicles are placed one by one in pine containers called petri dishes and kept in cooling containers until the transplantation stage of the hair follicles. It is beneficial to keep the hair follicles in a cold environment at 0-4 degrees Celsius until the transplantation stage.

FUE Donor Area

In FUE hair transplantation method, it is necessary to shave the hair. In the classical FUE method, the donor area is shaved so that the hair is 1 mm long. This hair shaving is called zero (0) number. This is the general practice. Up to 5000-7000 grafts can be taken from this shaved area depending on the need and donor capacity.

It is most appropriate to take the graft from the so-called safe area. Safe area has strong roots and is rich with anagen. Safe area roots are strong and rich in anagen phase. In addition, the roots above the ear and under the occiput (posterior projection of the skull bone) can also be taken with caution. The roots here are relatively thinner and more suitable for frontal hairline design. Since the roots in the area below the vertex have a high potential for shedding in the future, it is not correct to harvest from these areas. The hair in the parietal region above the ear also has the potential to fall out in the future. Even if it is taken from this area, it is beneficial to take low density grafts. This is more important at a young age.

In addition, a decreasing number of grafts should be taken from the areas near the end of the drawing area. The line should end with a transparent transition, not a sharp line. In terms of natural appearance, it is preferred that the hair follicles in the front line are thinner. Front line transplantation with multiple grafts creates an unnatural appearance. The diameter of the fue punches plays an important role in the number of grafts that can be taken

 A high number of grafts cannot be harvested with thick diameter punches and the transection rate is higher. In addition, the scar left by thick FUE punches on the head will be larger. We prefer 0.7, 0.8 and 0.9 mm diameter punches in our applications. However, patients usually do not like the idea of a haircut. If the possibilities allow, it is possible to perform hair transplantation without cutting the hair. We have explained this method in detail in our unshaven hair transplantation article.

Three Important Rules in the FUE Hair Transplant

1. FUE Punch Length and Depth Control
2. FUE Punch Entry Angle
3. Number of Grafts and Donor Capacity

1- FUE Punch Size and Depth Control

The most important issue to be considered in graft extraction, whether manual or micro motorized method, is the depth of the punch under the skin. If the punch length is too long, it causes the hair follicles, which we call dissection, to be broken and damaged. This means unnecessary graft loss. Graft length may vary from person to person. After a few trials, the ideal punch length is understood and it is necessary to fix it to this length. If the punch length remains short, it becomes difficult to remove the grafts and graft breaks may occur.

2- FUE Punch Entry Angle

Another consideration is that the punch must enter the skin at the correct angle. The correct angle can be found after a trial. With the wrong angle of entry, graft incision called transection is inevitable. In the hair of the nape of the neck, there is a slight difference between the above-skin and subcutaneous angles. An experienced FUE hair transplant doctor can easily grasp this angle difference after a few test attempts at the beginning of the operation and direct the course of the operation accordingly. Transection rate (incision rate) means the ratio of the number of grafts taken to the damaged hair follicle. Acceptable transection rate in the world is between 2-10%. We limit the transection rate between 1 and 2% in our applications. This is a percentage related to the correct application of the general principles of FUE and manual dexterity.

FUE Hair Transplant Tools

In FUE hair transplant operation, two methods are used in hair follicles extraction. In both methods, they are removed with the help of various diameters tools called punches. These punches can be sharp, round punches, fish mouth, serrated and U punches used by Dr. Umar. The diameter of the punches may vary according to the thickness of the grafts. There are many companies producing punches in the market. Their diameters vary between 0.6 – 1.5 mm. We do not find it right to use punches with very wide tips. In general, punches with diameters of 0-7, 0.75, 0.8 and 0.9 mm are suitable for graft extraction. If harvesting is performed with very wide tipped punches, the shock loss rate in the donor area will increase. In addition, the length of the punches used is as important as their diameter. Punches with a length of 3 mm, 3.5 mm or 4 mm should be selected according to the length of the hair follicles.

a) Manual FUE

b) FUE Micro Motor

c) Robotic Hair Transplant

After FUE Hair Transplant (Donor Area)

After FUE hair transplantation, the donor area will be recovered soon enough. If the number of grafts taken is not high and the way of extraction is done homogeneously, after about 10 days the surgical procedure performed in the donor area will not be obvious. In the pictures below, you can see the post-operative images of the hair and beard areas.

Before FUE hair transplant / 1st day after FUE

What FUE Hair Transplant Advantages and Disadvantages?

• We do not find it reasonable to take more than 2000-2500 grafts in one session in a FUE. If it is necessary to take a higher number of grafts, operation can be divided into 2-3 consecutive days.
• Taking into consideration the graft survival period, one session should not exceed more than 5-6 hours in average.
• In women the FUE has replaced the old FUT technique. No-shave method is a great advantage for women.
• FUE is the best eyebrow transplant method.
• FUE, especially with the pen technique, has become an indispensable method of beard transplantation. Since the hair follicles are visually removed one by one, the strong hairs in the anagen phase (Growth Phase) are collected.
• The claim that there are no scars after the FUE hair transplant is wrong. Every surgical intervention on the skin leaves more or less scars. But since the other hair in the donor area grows, these scars are not visible. However, in case of excessive or uneven graft harvesting and short hair, these scars may be visible and may be visually disturbing. The scar increases in proportion to the number of grafts taken and the punch diameter.
• There is no connection between the FUE and pen implanter hair transplant methods. FUE is a type of hair extraction, pen implanter is a hair implantation method. The pen is a new method in our country, thus there is a misunderstanding as if the pen method is only applied in FUE.

FUE Hair Transplant Results

You can check our FUE hair transplant reviews in hair transplant before and after section on YouTube, Facebook, and Instagram. Pay attention to natural look and expected hair density as the main criteria. You can also refer to diverse forums for more information about the FUE. To get more details about Dr. Hakan Doganay’s results please contact us directly.

FUE Hair Transplant Price in Turkey

To get the FUE hair transplant cost please mail us or contact by phone 0090 533 247 1990 (available on WhatsApp).

Frequently Asked Questions

References

1. Does the use of implanters affect the quality of FUE grafts?  Hair Transplant Forum International May 2017, 27 (3) 96-99; DOI: https://doi.org/10.33589/27.3.0096  https://www.ishrs-htforum.org/content/27/3/96