FUE Questions

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FUE Q&A

What is Follicular Unit Transplantation?

Follicular Unit Transplantation, a technique pioneered at NHI, is the transplantation of very small, individual, naturally occurring groups of hair called follicular units. Follicular units are comprised of one, two, three and sometimes four hairs each. These units are placed in thinning/balding areas following carefully studied natural hair growth patterns. The results are incredibly natural in appearance. See here for much more detail: Learn More

What is Follicular Unit Extraction?

Follicular Unit Extraction is a technique used for harvesting individual follicular units during hair transplant surgery.  Each naturally occurring group of follicles, or hair grafts, can contain up to four individual hairs.   The hair transplant surgeon uses a special manual surgical punch to remove the grafts from the donor area of the scalp.  Robot-assisted surgery can also be used to perform an FUE procedure.Learn More

What is the primary difference between FUE and FUT?

During an FUT procedure, the hair transplant surgeon will cut a strip of skin from the donor area in the back of the patient’s head.  The strip is dissected into individual follicular units and prepared for transplantation.  The open wound left from the removal of the strip is sutured together and ultimately results in a linear scar once the donor area is healed.  Visibility of the scar is dependent upon the skill of the surgeon, the patient’s ability to heal and the length of hair worn over the donor area. During an FUE procedure, the hair transplant surgeon will remove individual follicular units from the donor area using a special surgical punch.  This approach leaves small punctate scars on the scalp once the donor area is healed.  These scars are the size of a small ballpoint pen.  The surgeon will remove the follicular units in a random pattern throughout the donor area thus leaving the patient with an even distribution of punctate scars.  This uniform distribution technique eliminates the potential for the donor area to end up looking moth-eaten.  The patient can confidently wear his hair long or very short over the donor area since the FUE scars are not noticeable to the naked eye.

How do doctors get qualified to perform FUE?

There is no formal training or certification available for manual FUE. Many doctors train with other experienced surgeons and then return to their own clinics and continue to learn by trial and error. In surgery, there is no substitute to human learning. The key is to learn from a hair transplant surgeon who has a long history of successful hair transplantation and who has a highly skilled surgical team with proven quality control mechanisms in place.

Do I have to shave my hair from the donor area before my FUE procedure?

The donor area should be cut in buzz cut style in order to maximize the number of grafts extracted during a single FUE session. For patients with long hair, FUE can be performed by shaving multiple layers of three to four millimeters separated by flaps of longer hair that can cover the donor area. It is important to note that performing FUE in this manner may require additional FUE sessions. Long Haired FUE is an option invented and regularly performed at NHI. Ask your doctor about Long Haired FUE during your initial hair transplant consultation.

Do all hair transplant surgeons use the same tools when performing FUE?

Different doctors use different tools. The diversity of instruments among doctors is so varied that many surgeons develop their own specialized tools. For example, some doctors use a sharp surgical punch while others use a dull one or even a combination of both. Some FUE surgical instruments resemble a dental drill that rotates at a specific speed and others vibrate like a cast cutter used to remove a plaster cast from a broken arm.

All of these tools produce similar results that suggest that no specific tool or technique works for every surgeon. Regardless of the types of surgical tools used to perform FUE, the most important factor is the survival of the hair graft once it is removed from the donor area. Ask your hair transplant surgeon what type of FUE instrument he uses when you meet with him at your initial hair transplant consultation.

Is it better to pre-make recipient sites or to use the stick and place method?

We prefer to pre-make recipient sites for the following important reasons: Control of transplant design By making all the sites himself, the physician has complete control over the aesthetics of the surgery i.e. the angle of distribution of each follicular unit and the overall design of the transplant. If the physician is highly skilled, this is an extremely important advantage. Less popping When sites are pre-made there is less popping, since the act of making the sites (in stick and place) puts pressure on the surrounding skin causing adjacent grafts to pop. Popping can be a significant cause of graft warming and desiccation, which can decrease graft survival. Because there is less popping, grafts can be placed closer together, increasing the density. Easier sorting of Follicular Units When all of the sites are pre-made it is easier to sort follicular units so that you can use the larger units to create central density and the 1-hair units for the frontal edge of the hairline. In stick and place, sorting is much more difficult since the grafts are placed as they are cut. Pre-made sites can be made the day before the surgery. Less bleeding The body’s natural coagulation has a chance to work so that there is less bleeding and better visibility during the surgery. In our opinion, the purported advantages of stick and place (i.e., less chance of piggy-backing and missed sites) do not out weigh the many advantages of pre-making sites. In addition, these small advantages can be compensated for by appropriate techniques.

Do large grafts produce a better, denser result than smaller grafts?

Can a portrait painter create a better portrait with a house painter’s equipment i.e. by using a roller rather than a brush? The use of an artist’s brush is analogous to the use of very small grafts. High-quality hair transplants require fine instruments and delicate, small grafts. These grafts must be distributed in a way that balances the facial features, hair characteristics, and goals of the individual patient. Large grafts simply can’t offer sufficient flexibility to allow this “customizing” and their unnaturally high density doesn’t take into account the progressive nature of hair loss, placing the patient at great risk of having an unnatural appearance in the future. You can see for yourself what large plugs create. I don’t believe anyone today wants them. Learn More

Is removing large amounts of donor hair unsafe?

This is a statement commonly made by doctors who lack sufficient experience, or technique, in performing large sessions. The amount of hair needed for the average large session is well within the safe limits of what can be moved, provided that the procedure is done properly. It is the experience and judgment of the surgeon that will insure that the amount of hair that is harvested from the donor area is safe and appropriate. This is discussed in the following section: Learn More

Is it true that the blood supply of the scalp cannot support a large session?

No. People who make such comments don’t understand the oxygenation process in the transplanted grafts or the anatomy of the scalp’s circulatory system. The issue is one of oxygenation, not blood supply. By their very size, large grafts over 2 mm, will result in oxygen deprivation to the hair located in their center. This has been proven over and over again by observing the phenomenon called donuting (the loss of hair follicles in the center of larger grafts). In contrast, oxygen diffuses easily into grafts 1 mm or less in size. The blood supply of the scalp is among the richest in the entire body, enabling it to support the growth of large numbers of grafts, provided that they are kept very small. The Follicular Transplantation procedure performed at the New Hair Institute insures that these implants are kept to their optimum size. With this said, there can be problems if a doctor doesn’ know what they are doing as reported cases of gangrene (scalp necrosis) has been reported when a doctor used the wrong anesthetics or needles that were too large to make recipient sites.

Do scalp reductions save hair for future loss?

No! Hair is a limited resource. It is used up regardless of how it is moved and scalp reductions are just another method of moving hair around. Scalp reductions move hair to the crown at the expense of the front of the scalp, the cosmetically more important area. As a result of the reduction, the hair in the sides and back of the scalp is reduced in both density and looseness (This is why the procedure is appropriately called a “reduction”). The hair on the sides and back of the head thins considerably through the process and this, together with the tighter scalp, makes it more difficult to move the hair to the cosmetically important areas such as the frontal hairline and front part of the scalp. After a scalp reduction, the surgeon may never be able to harvest enough hair to complete the transplant. In addition, the scalp reduction can cause problems such a scarring, a thin scalp, altered hair direction, and a host of other unwanted effects. No wonder that the use of this procedure has dropped so dramatically in recent years! Learn More

Are lasers state-of-the-art technology?

No! Lasers are used by some hair transplant doctors to make the recipient sites. The laser works by using a beam of very high energy to burn a hole in the skin. But, regardless of how precise the laser, it still works by destroying tissue i.e. by making a hole. The beauty of Follicular Unit Transplantation is that the tiny follicular unit grafts can fit into very small sites that are made with a needle poke rather than by an instrument that removes healthy tissue. In Follicular Unit Transplantation, the blood vessel rich tissue that it is to receive the grafts does not need to be destroyed, so the growth is maximized.

With new surgical techniques, is it possible to restore a full head of hair?

No! All hair transplantation procedures move hair around to make you look better, but none create more hair. However, if performed properly and on the right person, it can make an incredible improvement in your appearance. The actual amount of hair you need may be as little as 25% if your original hair density. Those people with less severe balding can get a far higher density and come closer to their original look as long as the supply of donor hair is enough to meet the demands of the recipient balding area. This is something that you must speak with one of the doctors about.

If I am unhappy with a transplant performed by another doctor, can I have repair work done at NHI?

Of course, it is always better to do things right the first time. Unfortunately, many individuals have had hair restorations with less than satisfactory results. NHI has been able to develop strategies that can effectively camouflage many of the mistakes caused by less sophisticated procedures. Individuals have come to NHI from all parts of the world for repairs. To determine if you are a candidate for repairs, you should arrange a private consultation with a NHI physician.