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FUE hair transplant is a surgical procedure that involves moving hair follicles from the so-called permanent area of the body (the donor regions) to bald or balding parts (the recipient sites). Most people view hair transplantation as a means to treat male pattern baldness, but specialists also restore eyelashes, eyebrows and beard hair. Doctors may also perform a hair transplant for individuals who have scars from accidents or surgeries.
Hair transplant techniques vary but there are two distinct ways to harvest donor hair:
- Strip Harvesting, or Follicular Unit Transplant (FUT): The surgeon and team remove a strip of skin from the back and sides of the scalp under local anaesthesia and then suture the wound. They then dissect the strip of scalp into small units, grafts, which they then transplant into the thinning areas of the patient’s head. This method leaves the patient with a long linear scar in the donor area, limiting hairstyle choices unless the patient does not care the scar is noticeable. Recovering from a strip procedure is generally about 2 weeks and requires the patient return to the clinic, or other medical facilities, to remove the stitches. Most patients must also tend to the donor site for around three months.
- Follicular Unit Extraction (FUE Procedure): The surgeon and team remove individual follicular units (naturally occurring groupings of 1-4 hairs) using tiny punches between 0.6mm and 1.25mm in diameter, while the patient is under local anaesthesia. They then place these grafts into the scalp’s thinning areas using a micro-blade or needle. The individual removal of follicular units causes less trauma than FUT, significantly decreasing the chances of visible scars or post-surgery pain if a skilled surgeon conducts the procedure. There is no need to return to the clinic to remove stitches. FUE patients generally recover from surgery within 7 days but must monitor and encourage recovery for at least a month.
The Results First Depend on the Surgeon’s and Clinic’s Capability and Skill
Near all clinical evidence, and patient feedback, indicate FUE hair transplant is the best current option for patients. However, the surgeon’s, team’s and clinic’s skill and capability are essential for a quality result. Proficiency in hair transplantation, particularly FUE, requires years of training and experience. Conducting an FUE hair transplantation procedure is labor intensive and requires excellent hand-eye coordination, as the surgeon and team extract and transplant every individual graft. Hair transplantation is a potential source of revenue for clinics, however, leading many untrained surgeons to offer hair transplantation and then either conducting the procedure themselves or, worst yet, relegating it to surgical assistants. Results from these chop shops usually disappoint, if not outright humiliate and upset, patients.
Like most fields, hair transplantation has a number of professional organizations that serve as resources for specialists, beginning surgeons and patients. These organizations’ purposes, and reputability range a great deal. Patients are often misinformed by industry references who receive kickbacks and clinics that do anything from photoshop results photos to promise major bargains.
Selecting an Ideal Clinic Demands Research and Personal Considerations
Patients, therefore, must think critically about the clinic they select. They must make sure to critically assess the surgeon’s training, influences, techniques, additional treatments and industry presence. Near all surgeons of repute have trained with a specialist, or multiple specialists, who have a track record of excellence. All legitimate clinic websites highlight the surgeons’ medical backgrounds, specialities and industry renown as well capabilities, treatments and patients’ results.
The Benefits of FUE, Abridged
- Less intrusive procedure
- Faster and less painful recovery period
- Does not require a scalpel or surgical sutures
- Does not leave a tell-tale linear scar
- Most patients can complete near all work-related tasks the next day
- Typical results allow cropped or shaved haircuts without obvious scarring
- Lasting results show appear all-natural
- Possible even when the scalp is too tight for a strip procedure.
- Ideal for repairing or camouflaging linear scars from previous strip procedures
- Maximizes donor hair for harvesting
- A stand-alone procedure: no need to return for a procedure to hide scarring
- Physicians can “cherry-pick” grafts for optimal yield
- Allows the possibility of harvesting body or facial donor hair
- Very low follicle transaction rates if the surgeon is proficient
- Unprecedented accuracy for excellent cosmetic results
Top Five Reasons to have an FUE Hair Transplant
FUE’s unprecedented advantages obviously make it the ideal choice for most patients. Physicians and researchers active in the hair restoration industry had only one surgical solution to add hair to the top of their scalp. That solution was strip harvesting. Today patients have a better option, follicular unit extraction (FUE). Here are the top five reasons why patients who want to restore their hair loss should consider FUE as a hair transplant solution.
1. Discrete and Convincing Results
FUE hair transplant from a proficient surgeon rarely leads to noticeable scarring. This is a huge difference from previous methods, all that which lead to telltale scarring somewhere on the scalp. FUE, in fact, is the preferred method for near all accident and transplant-related scar repair.
2. Greater Yield Per Graft
FUE hair transpant usually offers an average 33% more hair for each graft. With FUT, the surgery technicians dissect the grafts, predominantly into one and two hair grafts, leading patients to pay twice or three times for the same follicular unit. FUE, meanwhile, enables surgeons to better select the range of grafts and, through precision, offer up to 33% more hair with each graft.
3. Less Follicular Transection than FUT
Follicle injury is less likely with FUE hair transplant if the surgeon is adequate. Strip harvesting results in a much higher follicle injury rate. This is the dirty secret strip surgeons don’t want you to know and is also why they rarely calculate transection rates.
4. Less Intrusive than FUT
FUE’s relative lack of intrusiveness enables patients to avoid problems such as the persistent pain and numbness common in FUT donor areas. Most FUE is so superficial, in fact, that the nerves and blood vessels are not cut. Also, the scalp is not left tight because a wide chunk is not cut out as is performed in strip surgery.
5. Best, Longest Lasting Results Available
FUE hair transplant creates a better result from the same number of grafts. Further, FUE transplants age more elegantly than FUT, which can appear doll-like after it ages. FUE, clinical studies indicate, even often produces a better result from fewer grafts because they have a lower follicle injury rate and more hair per graft. Out of body time (TOB) is also much less with FUE grafts. Typical strip surgery procedures often leave the grafts out for over 5 hours while FUE grafts receive placement, typically, within one hour after harvesting. All of these factors help ensure a better yield.
The Art of FUE Hair Transplantation
Medical art combines medicine, mastery of current surgical skills and techniques, a keen eye and the accurate reproduction of what occurs naturally. Many hair restoration patients assume that a surgeon’s artistic ability is a given, resulting from education and practice of established surgical techniques. Art and surgery, however, are separate skills which must be taken into consideration when evaluating a doctor for your hair restoration; not doing so can be disastrous. Many patients fall victim to doctors with little or no artistic sensibilities.
FUT Surgery in a Nutshell
To illustrate the critical component of artistic hair restoration surgery imagine, for a moment, the quality result that an art restorer would produce following the methodology of a strip hair restoration doctor. After the preliminary preparation, the art restorer carefully removes a strip of paint layer from the canvas. He then utilizes the correct colors of the original paint material to touch up damage on the painting.
With a hair restoration strip surgery, the team removes a strip of skin and dissects it for grafts. Nothing is put back in the donor area and the edges are drawn tight with suture. Even if there was no scar, at all, this procedure causes distortion of hair direction and a loss of the naturally-occurring gradation of hair shaft diameter. Worse yet, strip surgeons today boast of mega sessions of 8,000 grafts, which results in even greater cosmetic problems in the donor area.
As a further illustration, let us consider the types of patients looking to repair a FUT transplant. All will likely keep their hair at a length to conceal the strip scar, if this is possible. Most, however, and especially those with a large FUT scar, will have a rather abrupt termination of natural hair diameter gradation and density in the donor area. Shaving the donor areas down, meanwhile, makes any FUT scar obvious. Near all patient feedback indicates that even a very good strip scar, and there is no way to predict their size, can cause anxiety and embarrassment.
To complicate matters further, FUT scars not only disfigure the natural hair shaft diameter gradation, but also modify hair growth direction to appear unnatural configuration. As I have just illustrated by the previous art restoration example, with strip surgery you solve one problem and, at the same time, create another.
FUT and the Trichophytic Closure
The trichophytic closure has never been wholeheartedly embraced by specialists with a strong motivation to provide the very best aesthetic outcome. Instead of only suturing, the trichophytic closure involves precise trimming of a very small amount of scalp on the upper or lower end of the donor site. Does that solve some of the strip scar issues?
“Trying to create closures are not a solution for strip surgery,” says Dr. Cole. “They are a sales gimmick, in my opinion, and if you’re a guy who’s not comfortable with the probability that you’ll be that unlucky person who gets a strip scar because it’s embarrassing, well then stay away from the trichophytic closure.” Dr. Cole continues, “Part of the issue is when you transect hair follicles you are going to kill them. There’s an example of a hair that was bisected purposefully to create this trophy closure, and the first thing you notice is that this is a scar that is perceptible, you know that he’s saying we see very little hair growing through it. But you do have this one little hair that’s sort of an island in the middle of this scar and if you reach in there and you grab it and you pull on it very gently, y’know, pluck it, just easing it out you say that this hair, it’s not even a lot. It’s dead hair. And so that’s what happens to quite a few of the hairs in the trichophytic closure. You just kill them. And then once you kill them they elongate a little, and then basically, they just hang there in the scar until either somebody pulls them out, like I just did, or your body’s reaction around the graft is to form a pimple, that you pop, and the hair comes out.”
Major Aesthetic Benefits of FUE
At base, FUT not only leads to inferior results but also effects how hair appears in the donor area and its growth angle. Lucky for patients looking to repair their FUT, and those getting their first hair transplantation, tools and associated technologies have moved forward considerably in the last 10 years. FUE, in the right hands, with the finest surgical tools, provides numerous advantages to hair restoration patients.
- The doctor is not limited to using only hair within a small strip; he or she can use the finer hair available in the greatly expanded resource of donor area to create the most natural appearing hairline possible
- Most FUE variants do not cause distortion of hair growth angles or destroy the natural hair shaft diameter gradation that is seen occurring naturally at the back of a virgin scalp, unlike strip surgery
- FUE hair transplant is far less invasive than strip surgery
- ACell, a post-surgical extracellular matrix popular for all types of wound recovery, and blood treatments in conjunction with FUE further decreases the chance of any visible scars or hypopigmentation as well accelerates new hair growth.
Surgeons Use FUE to Repair FUT
The section “FUT Surgery in a Nutshell” mentions the best case scenario good strip scar. Severe strip scars, on the other hand, can be greatly upsetting. Often too large to conceal without mid-length hair, and then even lopsided appearing, severe FUT scars can be a major source of anxiety for patients. Worse yet, consecutive FUT procedures further increase the scar size and visibility. The only option for such scars, or any FUT scar for that matter, is to repair with FUE.
Scar repair via FUE is possible for near all patients suffering from FUT scars. Unfortunately, no surgeon can actually remove the scar. Instead, surgeons must carefully implant hair around, and sometimes on, the scar. As said scar is either at the side or the back of the head, many surgeons opt to use donor hair from the body to preserve available donor follicles. This at least helps obfuscate the scar and normalizes the hair growth pattern. Application of scalp micropigmentation (SMP), an all-natural tattoo that creates the appearance of growing hair follicles, further renders the scar noticeable. Depending on the surgeon’s skill, patients with large FUT scars even comfortably shave their heads.
Varieties of FUE
So far, this primer on FUE has mostly focused on the benefits of FUE, the detractions of FUT and the importance of selecting a reputable clinic and surgeon. However, not all FUE techniques are identical: instruments for the procedure, type of graft extraction and type of placement into the recipient area all matter a great deal. FUE variants may either use the instrument of the procedure or have its own term. Most surgeons, however, merely refer to their technique as “FUE.”
Types of FUE Techniques
Patients should always ask the surgeon what type of FUE technique they use. A surgeon’s skill, experience, and procedure team matter a great deal. However, technique also can have a huge impact. FUE variants, in fact, range in everything from intrusiveness to follicular transection rates to precision. There are four primary types of FUE:
- Robotic: Expensive and only applicable to some patients, robotic FUE graft collection such as ARTAS actually has a higher transection rate and is likelier to scar
- Automatic: Instruments like Neograft that automatically collect grafts but require manual direction, also more prone to have transection rates and to scar
- Mechanical: The operator uses a mechanical instrument to collect grafts; such instruments range in quality and often require additional training to properly use
- Manual: Follicular grafts are individually removed by a surgeon using a regular hair transplant punch, which can range a great deal in quality and sharpness
Put simply, a transplant’s result depends on both the surgeon and technique. Regardless of the technique, FUE hair transplantations also vary a lot in the details. Surgeons must select the punch size, decide on each graft’s amount of follicles, etc. Most build into their own routine, changing intricacies to suit their strengths and styles.
New FUE Options: Patch-shave and No-shave
Along with the type of FUE technique, patients must choose if their FUE involves shaving. Traditionally, patients must shave their head to ensure the surgeon can clearly see both the donor and recipient areas. As instruments and techniques matured, though, new options developed:
- Patch-shave FUE only shaves the donor area for extraction
- No-shave FUE requires cutting each follicle’s hair strand before extraction
Both patch-shave and no-shave FUE offer major benefits. The donor and recipient areas of FUE can be quite noticeable: small bumps in the extraction and recipient sites can last a few weeks or more and discoloration is also quite common. No-shave and patch-shave FUE enable professionals and other people who must maintain appearances to better obfuscate any post-procedure effects, better allowing them to handle meetings and other social situations. Further, hair covering the donor and recipient areas helps prevent UV from effecting the transplants.
8 Reasons to Choose No-shave FUE over FUT
No-shave FUE brings a number of benefits to patients, unlike FUT, while still enabling them to remain discreet about the procedure. Here we list the top ten reasons why patients would want to pick this new option over regular, shaven FUE.
1. Unshaven (Non-Shaven) Head
For many hair transplant patients out there, the primary reason for choosing the strip method over Follicular Unit Extraction (FUE) is that they do not have to shave their donor region. Now, with the non-shaven FUE method, patients are given the opportunity to have the best of both worlds. Patients can enjoy all the benefits of FUE with a full head of hair.
2. Post-procedure Recovery is Easier to Hide
Patients can return to work or their regular routine without anyone knowing they underwent surgery. This can be especially important for anyone who would like to maintain complete discretion regarding their FUE transplant.
3. Improves Outlook During Post-procedure Recovery
Hair transplantation, done right, leads to marvellous results and FUE has the shortest recovery time of any current method. However, the recuperation period can be demoralizing for some. Discoloration, though temporary, can last a few months. Transplant hair, meanwhile, can require up to a year to fully activate without additional treatments such as ACell and blood serums. No-shave FUE enables patients to more comfortably mask their transplantation during this initial phase.
4. Easier Recovery
FUE is quite easy to recover from but patients still must take precautions, including wearing a hat to protect the scalp from UV. No-shave FUE patients have a far easier time covering the donor and recipient areas with their own hair, if it is long enough.
5. Minimally Invasive
The instruments for no-shave FUE requires depth control by the physician, leading to less intrusion overall. This both leads to an easier recovery, even easier than most FUE variants, and decreases the chances of scarring.
6. Lower Transection Rate
Properly conducted, no-shave FUE has a very low transection rate; as low as 3%. This is significantly lower than FUT transection rates, leading to a more convincing, and discrete, result that near all patients find preferable in comparison to strip.
7. Better Post-procedure Hair Styling Options
Some patients may need to adjust their hairstyles after a no-shave FUE procedure. The donor area is typically unnoticeable even with a few inches’ growth. The recipient area, though, is typically the hairline. Patients with long enough hair have plenty of options in how to conceal the new hair. Doing may require some creativity and accustomation to a new style, but any adjustments are easily reversible after recuperation completes and the transplants activate
8. Allows Greater Leeway for Unique Results
No-shave FUE can require up to 30 instruments or more. Along with being necessary, such instruments greatly enhance precision. This enables the surgeon to better tailor each procedure for patients’ specific hair transplant needs. Of course, the quality of said instruments matters an incredible amount as well. Clinics looking to cut costs by using subpar equipment, no-shave or shaven FUE, never offer the same quality results as clinics that stress the importance of better equipment.
Hair Transplant Cost
Recent advancements in hair transplantation allow for greater value than ever before. Better yet, such value does not impede on quality. This is due to better instruments and consistently improving techniques. The end result is that specialists are more precise and, typically, faster at graft harvesting. Patients must still prepare themselves for spending a good amount of money, as hair transplantation is still a specialized medical procedure that requires significant training, skill and speciality equipment but per-graft prices are decreasing, enabling patients to receive larger procedures for less. Other factors driving the price down is greater competitiveness among clinics and greater transparency.
Hair transplant surgeons typically charge for procedures by the graft. Hair transplant cost often ranges from $3 to $12 a graft, with $4 or $5 being average for strip procedures and $8 being common for FUE. The size of surgical sessions vary a great deal: from several hundred to well over 4,000, depending on the needs and expectations of the patient. Although hair restoration procedures an expensive option, it is currently the only permanent solution available for hair loss.
FUE may seem costlier than FUT, but such an assessment does not evaluate overall long-term costs. As this primer already mentions, FUT provenly lasts a shorter time and the surgery often becomes evident, with characteristic “doll-like” plugs and warped hair growth around the donor areas while the obvious scar may require correction, such as through SMP. FUE, meanwhile, never causes such headaches if conducted by a specialist with adequate skill and experience. Patients who select FUE, in all, enjoy longer-lasting, far more discrete results.
The Benefit of Added Treatments
FUE is demonstrably patients’ best current hair transplant option. Additional treatments further enhance the numerous benefits that FUE provides. These serums and other measures are often effective as standalone options to encourage hair density, and even more effective in conjunction, but do demand regular treatments to maintain.
In application to hair restoration, hair loss treatments are truly worthwhile. Patients enjoy significantly less scars, faster transplant activation, and much faster growing, thicker hair. FUE may offer the lowest transection rates available, but grafts can also die during recuperation. The added nourishment from hair loss treatments, and an overall faster recuperation, helps maintain each grafts’ integrity as it establishes itself in the recipient areas. Ongoing use of said treatments, meanwhile, helps patients maintain their overall hair density and hairline.
There are several hair loss treatments available, all of which complement each other. However, patients should understand that few of these treatments are standardized. Clinics and other medical services typically mix their own serums using a variety of equipment. Resultantly, the effects of treatments, even the same type, range clinic to clinic. Patients looking for consistent results must make sure to ask questions regarding how the clinic processes treatments, the brand and type of equipment they use and observable, measured results of the patients who have received said treatments at the said clinic.
Types of Hair Loss Treatments
Several types of hair loss treatments have risen in prominence in the past decade. Research is ongoing, of course, and promising new treatments are now entering the market. We outline three of the most promising below.
As this primer already mentions, ACell is an extracellular matrix to aid recovery from a number of medical procedures. In the case of a hair transplant procedure, physicians inject it into the patient’s scalp before or after the procedure as according to their protocols.
ACell demonstrably enhances post-transplant recuperation, decreasing the chance of scars and hastening overall recovery. Faster healing skin means faster healing grafts, decreasing the time they have a chance to dislodge from the scalp or otherwise die. ACell is also proven to help decrease any signs of transplantation, so much so that even experienced specialists are pressed to notice if a patient has undergone a transplant recently.
FUE procedures that emphasize minimal intrusion particularly benefit from ACell. Depending on the depth of extraction, donor follicles can leave stem cell remnants. Application of ACell, clinical research shows, can nourish these stem cell remnants and lead to the growth of a new follicle that replaces the donor follicle. Such an effect is unprecedented; hair transplantation, for the time being, entails relocating follicles from one spot of the scalp to another. The growth of new follicles, at all, is a new phenomenon that, at the least, helps maintain patients’ donor follicle count for future transplantations.
Platelet rich plasma (PRP), as also already mentioned, is a blood serum. Research shows that it can have a dramatic effect on the patients’ hair health and growth. Those unviable for hair transplantation often undergo PRP treatments for its beneficial effects. Unfortunately, such treatments must be routine to maintain the effect. PRP in conjunction with ACell, studies show, both seems to enhance the PRP’s effect and duration, allowing patients to undergo less treatments per year.
In combination with hair transplantation, PRP has a similar effect. The reason for PRP’s effectiveness is its cellular content, such as cytokines and growth factors. These proteins help activate and nourish follicles, thereby encouraging faster and thicker growth. PRP demonstrably has the potential to hasten the post-transplant recovery process, leading to faster graft activation and growth. Such effects, though, depends on the PRP’s potency.
A treatment that involves processing the patient’s own blood into a serum, clinical studies indicate that PRP quality ranges a drastic amount. Almost always, said quality is due to its processing. Clinics must pick from a variety of brands that sell PRP kits, the PRP’s activator, and any additional processing techniques before injection.
Research shows that numerous factors effect a PRP serum’s potency. These include the density and amount of nutrients and their activation. Some proteins remain dormant unless their alpha granules open, one reason a growing amount of clinics are opting to sonicate their PRP; doing so can increase potency by five to eight times in comparison with un-sonicated PRP.
Differences in hair transplant patients’ recovery time is a great benchmark for assessing a PRP serum’s potency. Quality PRP has a profound improvement on follicular activation and growth. Many patients who receive it, such as sonicated PRP, enjoy total follicular activation and growth in than half the time as transplant patients who do not receive PRP: less than six months rather than a year. Such fast results are wholly dependent on PRP quality: patients who receive less potent PRP will not enjoy such fast results. In fact, research indicates that bad quality PRP often has little to no impact on follicular activation.
Stem Cell Treatments
The latest research shows serums consisting of the patient’s follicular stem cells can have a dramatically positive effect on hair health, growth and density. Stem cell treatments are still an emerging option but, if results are any indication, will increase in availability.
Quite similar to PRP, stem cell treatments involve taking small biopsies from the patient’s scalp, separating stem cell-bearing tissue from regular tissue, processing it, and then injecting the serum into the patient’s bald and thin spots. Follicles in the areas of effect show faster, thicker growth than PRP. Of even greater note, stem cell treatments are showing signs of being the first treatment to activate dormant follicles. This is unprecedented in the entire field of hair restoration and one reason so many specialists are researching its capabilities.
Already impressive, stem cell therapies will likely further improve as research continues. Specialists are experimenting with the best stem-cell bearing areas, processing, and effects in conjunction with other treatments like ACell. Patients considering stem cell treatments for hair loss should be sure to stay current on developments, as clinics offering stem cell treatments will adopt new processing techniques on an individual basis. As with PRP, make sure to ask each clinic about its specific processing methods and effects for former or current patients.
Post-procedure Care for FUE Transplants
As mentioned, patients’ recovery from an FUE procedure is quick in comparison with other transplant methods. However, they still must take numerous precautions in the immediate post-procedure period to ensure quality results. All reputable clinics offer detailed instructions on how to best facilitate recovery. Below outlines several aspects of recovery that are particularly essential.
Immediately after an FUE procedure, the patient receives semi-permeable dressings to absorb any bodily fluids. It is important patients change these dressings until their instruction indicate otherwise. Patients must also stay at an elevated position for less than a week, even needing to sleep at an incline. Shampooing must be avoided for at least one or two days, and then only patients should only use the types of shampoos their instructions recommend. Patients must also avoid strenuous activities and prevent any direct sunlight from hitting their scalp until the instructions declare otherwise.
Almost all of the transplanted hairs will fall out after around 10 days post-procedure; this is called “shock loss” and almost never effects non-transplant follicles. As patients heal they will want to monitor and moisten their scalp to facilitate the removal of any scabs that develop, but only when post-procedure instructions indicate this is okay.