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       FUE Hair Transplant


The Origin of FUE

The use of direct extraction to harvest follicular units was initially conceived by Dr. Woods in Australia as the “Woods Technique,” but he did not disclose the details of his procedure. The technique was first described in the medical literature by Drs. Rassman and Bernstein in their 2002 publication “Follicular Unit Extraction: Minimally Invasive Surgery for Hair Transplantation.” This paper provided the anatomic basis for the procedure, gave it its current name, and described the FOX test used to identify patient variability in harvesting, an issue which continues to be a significant challenge for doctors today.
A major refinement in the procedure was advanced by Dr. Jim Harris by adding an additional step of blunt dissection to the technique, as this substantially reduced transection (damage) to follicles. FUE continues to evolve as more physicians learn about this procedure, gain experience with it in their practices and offer improvements to the technique.


Indications for FUE

Because FUE does not leave a linear scar, it may be appropriate for patients who want to wear their hair very short. It is also an advantage for those involved in very strenuous activities, such as professional athletes, who must resume these activities very soon after their procedure.

The technique is also useful for those who have healed poorly from traditional strip harvesting or who have a very tight scalp. FUE also allows the surgeon to potentially remove hair from parts of the body other than the donor scalp, such as the beard or trunk, although there are many limitations with this process.

Possibly the most straight-forward application of this technique is to camouflage a linear donor scar from a prior hair transplant procedure. In this technique, a small amount of hair is extracted from the area around a linear donor scar and then placed directly into it.

Some patients desire FUE simply because they heard that FUE is less invasive than FUT or is non-surgical. The reality is that both procedures involve surgery and in both cases the depth of the incisions (i.e. into the fat layer right below the hair follicles) is the same. The difference is in the type of incision made. In FUE there are multiple round incisions scattered diffusely through the donor area and in FUT there is one single, long incision in the middle of the donor area. FUE should be chosen if the multiple round incisions are preferred and not because the technique is “non-surgical.”

This process is repeated until the hair transplant surgeon has harvested enough follicular units for the planned hair restoration. This process can take one or more hours and in large sessions, may be accomplished over two consecutive days. The donor wounds, approximately 1-mm in size, completely heal over the course of seven to ten days, leaving tiny white scars buried in the hair in the back and sides of the scalp.

This method of donor harvesting, removing follicular units one-by-one directly from the scalp, is what differentiates the FUE procedure from a traditional Follicular Unit Transplant (FUT), where the donor hair is removed from the scalp in one thin, long strip and then subsequently dissected into individual follicular units using a microscope.

Before the grafts are harvested, tiny “recipient sites” are made in the balding area of the scalp using a fine needle-point instrument. The follicular units are then placed into the recipient sites where they will grow into healthy hair-producing follicles. The creation of recipient sites and the placing of follicular unit grafts are essentially the same in both FUE and FUT procedures. The difference lies in the appearance of the donor area and in the quality and quantity of grafts obtained with each technique.

Follicular Unit Extraction is an instrument dependent procedure; therefore, the type of tool used for this procedure significantly affects its outcome. In fact, the development of increasingly better extraction instruments has closely paralleled advances in the procedure.

In 2012, Saundarya CIty  – Center for Hair Restoration began offering Follicular Unit Extraction (FUE) hair transplant, for the extraction of follicular unit grafts. We are now performing all of our FUE hair restoration procedures using this technology.

All procedures performed at Saundarya City-Center for Hair Restoration are based on Dr. Chaware’s pioneering Follicular Unit Extraction (FUE) techniques. The essence of these procedures is that the hair is transplanted into the balding area as individual follicular units (naturally occurring groups of 1-4 hairs), so that it will look totally natural and be undetectable as a hair transplant.

In FUE, the follicular units are removed directly from the back and sides of the scalp using new  techniques to minimize injury to follicles.

All of our hair restoration procedures are performed under local anesthesia.

Hair transplant sessions that use thousands of follicular unit grafts may take a whole day or even two consecutive days; however, medications are given to relax you and the time goes by quickly.

For part of the procedure, you will be offered a movie selection and cable T.V. Most patients choose to listen to music, watch a movie, or just chat with the doctor and staff.

The misconception that most people have of hair transplantation is associated with the out-dated plug techniques in which patients leave the office with their heads wrapped in bandages and have significant bleeding and pain.

In modern follicular unit hair transplants, patients leave the office with only a hat and headband and are able to shower and shampoo their hair the day after the hair restoration surgery.


The Procedure

When you arrive for your hair transplant, the staff begins by going over the activities for the day.
The surgical consent form that had been sent to you is reviewed and other paperwork is completed.
The physician reviews the goals that have been established and answers any questions that you might have.
The doctor will carefully re-draw the hairline that was marked and photographed during your consultation and will add other markings to further delineate the extent of the procedure.
You will have a chance to examine and discuss them before proceeding. The physician will then take high quality photographs that will become part of your permanent medical record.

Sedatives are given to relax you before the start of the hair restoration procedure, but you can remain fully alert if you like. You will be offered a movie selection and cable T.V. Most patients choose to listen to music, watch a movie, chat, or just relax.

The length of your hair transplant procedure will depend upon how may follicular unit grafts are transplanted. Smaller sessions generally take one day. Larger FUE sessions will be performed on consecutive days.

We do this very technical job in a friendly, relaxed atmosphere, so that your experience is pleasant and so that the time goes by quickly.
You will be able to take a series of breaks, to the restroom, to eat, or to just move around and stretch. Many of our patients tell us that all the attention they received throughout their hair loss surgery made the experience truly enjoyable.
Our full-time staff has years of experience assisting Dr. Suresh Chaware with these procedures. In addition to expertise in performing the procedures, the staff is adept at ensuring the comfort of our patients.

We take great precautions to protect both our patients and ourselves from blood-born agents during the hair restoration procedure. Our patients and staff are routinely tested for HIV and hepatitis for everyone’s safety and protection. Instruments are either sterilized in an autoclave or are disposable.
Video of FUE Hair Transplant Procedure (R-FUE)
FUE Part 1: Donor Area Preparation
Hair Transplant Procedure Part 1: Donor Area Preparation
FUE Part 2:  Manual Recipient Site Creation


Local Anesthesia

After sedatives are given orally and intra-muscularly, we use a combination of the local anesthetic Lidocaine (Xylocaine). High frequency vibration is applied to the skin as the anesthetic is given to decrease the sensation of the injections (this is referred to as vibratory anesthesia). The anesthetic is administered only around the perimeter of the scalp (called a ring block) to make the entire scalp numb. Once the scalp is numb, the remainder of the hair restoration surgery is painless. If more anesthesia is required, usually around 5-6 hours into the procedure, it will be given before the initial medication wears off.

Since the scalp is very vascular, there is a commonly held belief that a permanent hair transplant is a bloody procedure. However, at Bernstein Medical, this is not the case as we have developed techniques that both minimize bleeding and minimize the amount of medications that are needed (see Limiting Epinephrine) while at the same time making the hair surgery a more comfortable one for you.


Donor Tissue

In Follicular Unit Extraction (FUE), the donor tissue is removed from a broad area of the back and sides of the scalp. The location of the donor area is chosen to have long-term stability. The hair in the area to be removed is clipped short, to a length of approximately 1-mm. This will include the entire back and sides of the scalp in large sessions and a long, thin band in smaller procedures.

In  FUE, the patient sits leaning forward, with his/her forehead on a special headrest. As the surgeon moves around the donor area, scanning select follicles, one-by-one, it begins to separate the follicular units from the surrounding tissue. Once the selected follicular units are removed from a specified area, they are placed in a holding solution,  Ringer’s lactate. This solution closely mimics the body’s own fluids and thus maximizes the survival of grafts while they are being held outside the body.

Once the grafts are extracted, the donor area is covered with antibiotic ointment and a dressing that will be removed the following morning.

Microscopic Dissection

In Follicular Unit Extraction, the extracted grafts are placed under a microscope to assess their integrity and to sort them according the number of hairs they contain. In cases where a particular size follicular unit is needed, such as for the frontal hairline, larger units may be microscopically dissected into smaller 1-hair grafts (if the number of naturally occurring groups are not sufficient). In eyebrow restoration, for example, where all single-hair grafts are needed, this is particularly important.

Creating the Recipient Sites

Recipient sites are made by the hair transplant surgeon using a fine instrument the size of 21- and 19- gauge hypodermic needles. For most procedures, we use lateral (perpendicular slits) for the recipient sites. The creation of the recipient sites determines much of the aesthetic look of the transplant – it sets the angle at which the new hair grows and determines the distribution and density of the grafts. Recipient site creation is a critical aspect of hair restoration surgery that requires considerable experience and surgical skill and a keen aesthetic sense.

When making sites, Dr. Bernstein is able to work in and around your existing hair so that it does not need to be cut. This is particularly helpful so that you can use your hair to camouflage the transplanted area during the immediate post-op period.


Graft Insertion

Once all of the recipient sites are made, the surgical team begins to place the follicular unit grafts into these pre-made sites. One-hair follicular units are used in the frontal hair line to give a soft, natural appearance and 3- and 4-hair grafts are used in the central forelock area to achieve maximum fullness. Placing is the most time-consuming part of the hair loss surgery. Graft placement is an exacting process and during this period you will be asked to keep your head relatively still. Watching movies, TV or sleeping, will make the time go by quickly and, of course, you make take breaks as needed to go to the restroom, stretch or eat.

At the End of the Procedure

When placing is complete, the position of all of the grafts will be double-checked. The post-op instructions will be explained and a printed copy will be given to you to take home. This will include the doctor’s cell phone number. A tennis bandage is placed around the head to cover the donor area and a baseball cap or bandana is worn home. No bandages or dressings are required on the transplanted area and all dressings can be removed the following morning. Throughout the procedure and afterwards, Dr. Bernstein and our highly-trained staff will answer your questions and take care to help you feel comfortable.

Comparing FUE & FUT

Follicular Unit Extraction (FUE) and Follicular Unit Transplantation (FUT) are frequently compared as if they are two totally different, even competing, hair transplant procedures. Despite this common misconception, the difference between FUE and FUT is the method by which follicular units are removed from the donor area in the back and sides of the scalp. The remainder of the hair transplant procedure is essentially the same.

However, the harvesting method does have important implications for the hair restoration procedure as it will affect the total number of high quality grafts that can be harvested from the donor area and ultimately, the fullness achieved from the hair transplant. In general, the harvesting method of FUT via strip is superior to that of FUE for two main reasons. The first reason is that the FUT procedure allows the surgeon to produce the highest quality grafts by isolating the follicle units with minimal trauma (this disadvantage is minimized with Robotic FUE). The second is that FUT enables the surgeon to best utilize the most permanent part of the donor area. To more fully understand these concepts, click: Graft Quality and Utilizing Donor Hair.

Because the differences between FUE and FUT are significant, the pros and cons of FUE should be considered when deciding which procedure is best for you. Pros and Cons of FUE.