Follicular Unit Extraction is the ultimately modern technique of hair restoration surgery wherein donor hair is harvested by plucking follicular units individually, one by one, directly from the back of the scalp under a long, strenuous process with a number of instrumentation designed purposively. FUE hair transplantation procedure also makes eyebrow hair transplantation possible, which is done using 1-hair follicles.
FUE hair transplantation has become the most attractive sensation since its emergence, most significantly for it doesn’t require the strip excision involved with the traditional FUT technique and the resulting linear scars, the scars left by FUE procedure heals within as less as a week with very less downtime. And the only difference between the FUT and FUE techniques is the way the donor hair is harvested and the scar it leaves. The rest of the procedure, of planting the hair grafts to the recipient area and other steps are the same.
FUE hair transplant also allows body hair to be included as donor hair including that of arms, legs, chest, beard etc. as these hairs also reserve the characteristic of donor dominance.
While the basic procedure of FUE hair transplantation is to extract individual follicular units from donor zones of the back of the neck or other hair bearing areas of the body there are several techniques that is maintained to yield the best results. FUE can be done using manual instruments or automated and motorised instruments to harvest the donor hair.
FUE is too, done under local anaesthesia to be injected all over the scalp, the patient can watch a movie on portable devices, chat with the surgeon or choose to sleep on while the surgery is done.
In the FUE technique the donor area is considered the whole back of the scalp that is close cropped or shaved to identify the hair follicular units which is impossible to judge with longer hair. Each hair follicular unit is plucked out from the scalp using a sharp punch to first score or make a hole around each follicular unit and then using a blunt punch to work its way down till the erector pilli muscle in order to loosen the follicular unit from the scalp with a little amount of fatty tissue of the scalp making a whole hair graft. A blunt tipped forceps is used to hold and gently scoop out the hair graft coordinating with the dull punch to separate the hair graft from the scalp. Once harvested the hair grafts are immediately placed to a holding solution that imitates body fluids. This process is repeated a thousand times to achieve the targeted hair grafts.
As the basic or 2-step principle of extracting hair grafts by loosening the dermal attachment around a follicular unit with a punch and plucking an intact hair graft out with little bit of dermal tissue to support for moisture and dignity with a forceps, it is often met with transection or damage to the hair grafts by being cut by the very instruments. Hence, between the 2-steps of scoring the scalp and harvesting the hair graft, a third step is introduced called isolation of the grafts. Follicular Isolation technique limits the penetration of the punch while scoring the dermal tissue and avoiding the instrument to damage hair follicles, since unlike open dissection as in FUT, the surgeon cannot see beyond the surface of the scalp and can only depend on estimation to pull out an intact hair graft without it being transected with the very instruments. Hence, FIT technique is utilised wherein a second dull punch slid to broaden the hole around the follicular unit while the forceps holds out or isolates the hair graft and twisting it gently enough instead of scooping it out with another punch. This step is proven to be more efficient in yielding a greater number of intact healthy hair grafts that can sustain normal growth after the transplantation.
The same thing of done with automated instruments, which can count the numbers of inclusion; can check on the depth of the penetration of the punch, and rotate the punch automatically. While all these utilities can prove helpful during a surgery, there is a question of graft transection or damage due to mechanical trauma for which most surgeons stick with manual FUE, however, this is a matter of personal choice. Best results can be obtained with any chosen instrument as long as the surgeon is comfortable.
Body hair transplant is only possible with FUE technique. Hair bearing areas like legs, arms, chest etc. also have donor dominance which makes it applicable for using as donor hair. Body hair grows in 1hair follicles and not follicular units which are harvested with the expanding needle technique using 0.8mm hypodermic needles and magnified vision.
The instrumentation for FUE hair transplant covers a large diversity that is applicable through manual or automated techniques. However, the efficiency of obtainable results depends solely on the hair transplant surgeon their choice of instrumentation that they are most comfortable in. FUE instruments are all depended to the surgeon’s credibility and operation that same results can be obtained by all the techniques.
A single session of 7-10 hours can successfully harvest up to 1,800 hair grafts and might require more sessions to achieve the desired results of a large hair transplant. This procedure is ideal for patients who have a tight scalp to get a FUT or are simply scared of the idea of cutting off scalp skin.
This procedure requires a greater donor zone than the FUT and makes the back of the scalp thinner of it’s density in order to redistribute it all over the scalp.
FUE hair transplant is ideal for diffusive hair loss most common in female pattern hair loss, wherein selecting the donor zone is more or less a challenge and the FUE hair transplant proves efficient in harvesting permanent donor hair the follicular units than a typical permanent zone.
Patient’s who like to wear their short, or lead an active life like that of a professional athlete or celebrity, this procedure FUE hair transplant proves most significant as it comes with minimal downtime and tiny specs of scars can disappear in days to 3weeks depending the size of the surgery.
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