FUE Hair Transplant
Read this before you consider
If you are considering hair transplant, please make sure that your doctor gives you full disclosure about the different techniques that are now available. First and foremost, your doctor should tell you that nowadays there is a new technique in hair transplantation called FUE. FUE stands for Follicular Unit Extraction. It is widely regarded as one of the most advanced hair transplant techniques available nowadays. Most clinics in the world now promote FUE as a No Scalpel, No Stitches, and No Linear Scars procedure. Invented and perfected by Dr. Woods, FUE is reported to be minimally invasive and many times less traumatic than traditional strip excision hair restoration technique. With FUE, you can even use your own body hair (chest, legs, arms) as donor and transplant them to thinning areas in your scalp. This technique is now commonly referred to as BHT or body hair transplant.
Unfortunately, right now there are only few truly qualified FUE doctors in the world. The majority of the hair transplant doctors worldwide are still offering traditional STRIP technique whereby a strip of skin is removed from the patient's head using a knife or scalpel. In comparison to FUE, STRIP technique is many times more invasive.
In traditional Strip hair transplant procedures, the donor area is closed using stitches or staples which cause further trauma to the donor site. Return visits are required for suture removal. Patients will be left with a linear scar after healing. The term "Strip" derives from the fact that a strip of flesh and skin is required to be removed from the patient's scalp during the procedure.
High magnification photo of the patient's donor site in the back of his head immediately after the donor hairs extraction. The small wounds which remain do not require stitching and leave no visible linear scars. Donor site heals faster and the procedure is a lot less traumatic for the patient than traditional Strip hair transplant procedures. No stitches necessary.
FUE Frequently Asked Questions FAQ
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The below is compiled based on feedback from our forum members. Every person's experience is different. Do not consider below as medical advice. Consult your own physician before making a decision. Information below may not apply to all patients undergoing FUE or hair transplant procedures.
Do not confuse FUE with FUHT. Some doctors try to mislead their patients by using these two acronyms interchangeably. FUE and FUHT are not necessarily the same thing. FUHT stands for Follicular Unit Hair Transplant. It simply means hair transplant using the natural groupings of hair follicles. FUHT can actually be a traditional Strip procedure.
Follicular Unit Extraction. It is the individual removal of hair follicles in their naturally occurring groupings of 1-4 hairs. A special tool is used to create about a 1mm incision and the hairs are removed with forceps.
There is currently a large debate between these two and this FAQ is not meant to foster this debate, only to present the facts. I see the following as risks of Strip Excision and benefits of FUE. With strip excision a strip of flesh is removed from the permanent ring of hair around the occipital lobe and sides of the head. The most serious problem that occurs is excessive scarring, because the remaining tissue cannot accommodate the tissue that has now been depleted, and over time stretches. To demonstrate. Lean your head forward until your chin is touching your chest. Place your hand firmly on your occipital lobe near the base of your head. Pinch this area of skin. Any where from a few millimeters to an entire inch of skin may be removed from this pliant skin. This loose skin gives us what is known as laxity. Which allows you to comfortably move your head and sleep. Do not trust anyone's opinion other than your own if you have enough laxity to spare for this surgery. Perform the same exercise on the sides of your head, pinching the skin to determine how much "extra" skin you have. Realize a portion of this hair bearing skin will be permanently removed. Another risk is this strip of skin must then be dissected by techs under stereo-microscopes. There is a risk the follicles may be accidentally transected or transection at the donor site may occur. Finally nerve damage may occur as a scalpel is used and a sub dermal excision must be made.
This nerve damage can range from hyper-sensitivity to numbness. Not all patients have these complications and many have enjoyed success with strip excision. Just be aware of their potential. An emerging trend is to have one strip, and add successive density with FUE.
With FUE there is a minimal reduction of laxity because as little extra skin is removed as possible. Only the hair and surrounding tissue is removed. If done properly there is no need for further dissection. There is no linear donor scar, and no area to stitch up post operatively. Repeat procedures can be performed as soon as the next day. Also hair can be taken from a much wider range than the occipital lobe and sides of the head. Hair can be taken from anywhere on the body. Though I highly recommend only having hair removed in areas that can be concealed by clothing or other hair, as a precaution.
Transection is when the lower portion of the hair, the hair bulb which generates new hairs is cut off or damaged during the removal of the follicle. Your transection rate will vary depending on the skill of your doctor and the precision of their tool. An expert physician will have a transection rate around 5%. Other physicians may have anywhere from 20-60%. Sometimes higher. Because donor hair is limited. Transection is a serious issue.
Please read Dr. Woods' comments in this forum discussion about hair transplant donor transection biopsy photo.
A lot depends on the skill of the doctor performing the procedure. Assuming the procedure is performed properly by a skilled doctor, then immediately following the procedure you will have a small 1mm scabs (maybe larger in some cases) where the hairs were removed. Once this scab sheds in about 2-3 weeks, a small red dot is likely to remain. Depending on your healing characteristics and the skills of the doctor, this dot may perfectly match your skin, turn white, or remain somewhat red. Often hairs removed from the head are almost undetectable due to camouflage from the remaining hair. Some scarring is likely to remain anywhere from 6 months to longer or even permanently. Consider this when you are having hair removed and from where it is removed. I strongly suggest not having facial hair removed. Remember FUE is not magic, and some marking or scarring is likely to happen even though they are relatively small compared to scars from traditional strip surgery.
Depending on your pre-existing density in the donor area of the head. There may be a thinning effect. If too much hair is removed from a single area a patchy look will result. The amount of hair that would have to be removed before this occurs depends on individual characteristics. In the typical FUE procedure this is not a concern. However I suggest having hair removed from as wide an area as possible. You must realize any area that hair is removed from will have to be shaved. Infection and or ingrown hairs, occurring from hairs that are transected and continue to grow is another concern. Finally peripheral hairs may be transected and permanently damaged, resulting in loss of more hairs than actually harvested. I strongly suggest using Minoxidil 5% with Retin-A-a one month post operatively to aid in the recovery of any transected or damaged hairs in the area of extraction.
In my opinion no. Even though using very small gauge needles hair can be densely packed. I believe the hairs of someone with a true full head of hair is closer together than even this can be provide. However with FUE you can come closer than ever to this goal, due to the wider range of available donor hairs. The entire body.
Of course what is good, will vary from person to person. But in my opinion for the person with average density. 1800 grafts will be needed to avoid a look that is too thin or spread out from the hairline just before the crown. For the crown another 800 for a dusting effect. The crown takes more grafts to achieve coverage due to it's curved shape. If you have hair loss behind the crown about the same amount per inch will be needed to achieve coverage as on the top of the head. Some individuals chose to first get a strip excision to build density and fill-in with FUE, also covering their donor scar with FUE. covering donor scars with FUE is not always successful and it should not be assumed this can absolutely be done.
This will depend on the skill of your doctor. The use of high magnification and high gauge needles will help. Also individual placement of recipient grafts will also aid diffuse thinners. With any hair transplant future hair loss should always be considered. I recommend placing at least some hair in areas that are diffuse but at some time are likely to shed. And placing more hair in areas where there is complete loss. This way in the event you lose all your hair, you won't have patches of hair where you were once bald, and no hair, where you once had hair. Shock loss is always a risk, but tends to be minimized with FUE due to it's less invasive nature.
According to studies by Dr.Ray Woods, the pioneer of FUE, over time, hair from the donor area tends to take on the characteristics of the recipient area, including length.
FUE is very labor intensive and highly specialized. Any doctor offering a mega-session in FUE should be approached with caution. Each hair must be individually removed. With strip, all that is needed is an excision of anywhere from 500-3000 grafts and dissection by techs. A typical strip surgery takes about 3-4 hours. A typical FUE procedure takes from 8-12. The doctor must be compensated for their extra labor. Also though you may save money with other methods, you run the risk of paying with your health. Money tends to regenerate, one's health does not. That said what are the costs? Dr.Woods currently is the best and original FUE provider, however his rates have changed since I went to him, so you will have to contact him for rates. As FUE gains popularity I'm sure rates will begin to vary. However I'd expect to pay at least twice as much as you would for a typical strip surgery.
I hate to say this but the anesthetic was worse for FUE. The reason for this is, for me personally I had hair taken from all over my body. Well that's great, but the price I had to pay was injections all over the place.. So it can be painful and takes at least two weeks for the soreness to go away. Why am I willing to put up with this? Because once that pain is over, I'm done, no lasting tightness or increased nerve damaged from scarring.
After the FUE procedure patients tend to be alert and not in pain. Some mild pain killers will be prescribed in the event there is any pain. Typically one can return to work the very next day. The scabs and redness however will persist as long as two weeks. Anywhere from 1 week to a month the majority of hairs will first grow rapidly but then shed, as is common with all transplants. Around 2-4 months the hair will again grow. Also around this time some hair lost from shock will again grow.
Sleeping the first few nights will probably be uncomfortable due to swelling and injection sites for anesthesia. When multiple FUE procedures are performed in a row swelling can get quite intense in the face, as saline from the anesthetic is not rapidly absorbed in the body. This swelling subsides 1-2 days after the last FUE procedure is finished, and primarily occurs from frontal work. The first few nights after your FUE procedures you must likely will want to take pain killers to help sleeping. Within 3 days I didn't need them to sleep comfortably.
As far as your head starting to look normal again about 2 weeks. Weight lifting sports etc. I would suggest waiting 3 weeks, but ask your doctor. Showering with direct contact 2 weeks. Hair dying 1 month. Over the course of the next month, the donor sites will get smaller and smaller
Leave scabs alone, allow scabs to dry and shed on their own. This should complete in about two weeks. After two weeks you may apply direct shower pressure and gently ease off scabs that are otherwise about to come off. Scabs ready to shed will come off easily and with no scratching or pulling.
An interesting debate broke out in our community forum as to who was the inventor of FUE hair transplant. Click FUE inventor debate to follow the discussions.