FUE Hair Transplantation

FUE or follicular unit extraction (or follicular unit excision) is a relatively advanced hair transplant technique as compared to FUT. Since its invention, this procedure has gained constantly rising popularity. Unlike FUT, FUE does not leave a long linear scar at the donor site. Uniqueness of this technique is individual excisions of follicular units directly from donor site unlike FUT technique. The FUE method of hair transplant is the most sought after procedure. It is said that if done properly it is much safer and provides a much natural result.

A FUE technique comprehends safer methods for hair follicle harvesting from the donor area, under local anesthesia, which is most commonly from the scalp. In the FUE technique, through a peripheral incision, the entire thin skin (tissue) surrounding the follicular unit (graft) containing the hair follicle, intradermal fat, dermis and epidermis is removed.

When the donor grafts are limited and can’t fulfill the requirement, the FUE technique enables a surgeon to extract grafts from other parts of the body to meet the requirement. The graft extraction is accomplished by the use of a circular punch of less than 1 mm diameter. The extraction leaves a circular wound or incision, which heals and leaves only a tiny circular scar. It is always advised for a patient to choose an experienced doctor as only an experienced team can extract the FUE grafts without much transection.

Follicular Unit Extraction (FUE) Procedure in Detail

FUE involve many steps to accomplish the procedure successfully. Let’s discuss the same one by one.

1. Planning of Procedure

The essence of a good result depends on well-calculative planning and execution of the same. During the planning the bald area is examined and donor hair follicles are assessed for their density, thickness, and caliber. Where the donor source is limited, to fulfill the requirement the hair grafts at beard or body parts are also evaluated. Once the proper assessment is done the candidate is considered for the procedure. Choosing a right candidate is also a part of planning. When the grafts are insufficient and not healthy, it is advised that one should not go for hair transplant.
At first, for FUE technique transplant shaving of hair the donor area of the scalp is required. A mature and realistic hairline is designed depending on the availability of the donor and requirement of the recipient site.

2. Preparation for the Procedure

There are 3 most important things that are emphasized during preparation for the procedure.

1. Sterile Environment : At first the most important thing is to sterile the operation theater, it should be free from contaminants. Both the patient and the medical team must follow strict hygiene protocols to prevent infection and post procedure complicities.
2. Position of patient : The position of the surgeon as well as the patient should be very comfortable for easy and safe extraction. In the OT chair or modified dental chair, frequent changes in prone and lateral positions will provide maximum support to the patient.
3. Administer Anesthesia : Local anesthesia is applied to the recipient area. It ensures that the patient will remain comfortable throughout the procedure. It is very important to provide safe, comfortable and pain-free anesthesia. The technique of giving local anesthesia should not be painful. Use of fine bore needle on the area before infiltration, sedation, slow infiltration speed, prilocaine gel, ice pack, nerve block and field block are some of the steps that reduce pain while giving anesthesia.

3. Grafts Harvesting (Extraction) in FUE Technique

In FUE involves extraction of the follicular unit directly from the donor area intact using punches with a diameter ranging from 0.7 mm to 0.9 mm. Generally, 0.9 mm diameter punches are used for scalp and 0.7–0.8 mm for body hair follicle harvesting. Harvesting of follicular unit involves two steps of the process, Circular incision and Extraction. This is carried out meticulously using a sharp and tiny cylindrical punch. Before incising the surface of the skin around each hair follicle and carefully teasing out with the help of fine forceps. A tiny punch of less than 1 mm diameter can successfully excise the unit.

This procedure is carried out either manually or with a motorized surgical tool.

Motorized FUE using sharp punches in the setting of good magnification, tumescence, and lighting provides faster extraction rates with minimum transection. Constant hydration of grafts, reduction of their “out of body time”, and the “No root touch” method of implantation enhances their survival rate.

Hair is firmly attached to its surrounding tissues. This tethering influences the grafts harvesting as it varies patient to patient, so the result. Doctor needs to take care of this while harvesting. For better and easier extraction, the doctor needs to cuts most of the lateral attachments.

Doctor has to take special care of nature of grafts and skin in FUE donor harvesting as the structure and behavior changes due to unevenness of the different donor sources like head, beard, chest etc. FUE is a time-consuming surgery that requires focus and experience.

The doctor faces difficulty while operating on a person with white hair. Donor white (grey) or light-colored hair is more difficult to harvest because they blend in with the skin and lack visibility. Extra care has to be taken to properly utilize these donor grafts. Patients with grey hair are instructed to dye their hair a few days prior to the procedure to increase the visibility. Temporarily colored hair gives an improved contrast against the skin of the scalp. Just prior to surgery, methylene blue may be injected in very low concentrations into the donor area to aid in the identification of gray hair during harvesting.

Furthermore, it is regarded as a technique that leaves no scar in the donor area, though leaves multiple 'dot-marks' in the donor area that are minor in size than those left by the strip method (FUT).

Use of Body Graft for Advance Grade Baldness

The body grafts are used to treat advance grade of baldness where the donor area grafts (back of head, side head) are not enough to fulfill the entire requirement. It is also termed as body hair transplant. Advances in FUE like improvements in equipment and also better understanding of body grafts have made possible the treatment of grade-7 alopecia a reality. In body hair transplant the grafts are extracted from body parts like the beard, chest, armpit etc. Advance grade baldness requires more than 3500 grafts. In such cases multiple sessions can be planned. But an experienced doctor with trained team expert in using latest sophisticated instruments and sharp punches can harvest such large number of follicles units in one session of hair transplant. Such long sessions are called mega sessions.

4.Insertion Process of Grafts

The next most important step is to insert the extracted FUE grafts. Precise insertion at a precise depth and angle is the main key to a good and successful FUE hair transplant. There are several important points that need to be addressed during this phase.

• Slits or Punch Holes Creation: Slits or holes are made at the recipient site to place the graft. The method of making it may vary. Some surgeons prefer to make a small slits with a scalpel, while others use a special needle or blade. The choice of method largely depends on the patient's specific needs, suitability according to the characteristics of the hair. While creating splits randomized pattern is followed to achieve a more natural and even result.
• Role of Proper Angulation and Depth: While making slits at recipient site, it is ensured that slits are at the correct angle and depth. It is essential to consider the angle to mimic the natural hair growth pattern. It requires expertise and precision.
• Graft Handling: The grafts are handled with great care to avoid damage to the follicles. The grafts are placed in a holding solution or kept moist (hydrated) during the insertion to prevent it from drying out. Fine-tip
• Density and Distribution: Attention is paid to the density and distribution of the graft. Uniform distribution and density are the keys to the aesthetic outcome of hair transplant. Clustering them too close is avoided; this can lead to poor growth, unnatural appearance and diffused hair loss even after hair growth.

5. Post FUE Hair Transplant Care

After all grafts are inserted proper bandage is done just to reduce swelling at forehead. Doctor provides post-operative care instructions to the patient. These instructions include the details on how to clean, protect, and maintain the transplanted area.

6. Follow-Up

Schedule follow-up appointments to assess the progress of the transplant and address any concerns or complications.

FUE procedure directly involve surgeon at every step. It is time-consuming procedure which requires time and practice for a doctor to become expert in the technique. With the experience, use of better quality of instrument the shortcomings of FUE like chances of transection can be reduced. It is crucial for patient that the both the surgeon and the supporting staff should be experienced and skillful. Patients should also be well informed about the procedure and post-operative care to achieve the best possible results.