FUE Hair Transplant Procedure
The extraction of the follicular unit is a new modification of the traditional follicular unit transplant. In both methods, the planting of follicular units in the recipient region is the same and thus both provide transplant growth without “plugginess.”
The difference can be seen in the method of harvesting the hair from the donor region. Instead of extracting the hair strip, sewing the region together, and then dissecting the follicular units under the microscope, the follicular units in the FUE process are separated from the scalp separately, one by one. There is also no need to repair a wound, so there is no need for microscopes.
The follicular units are separated by inserting a 1 mm punch around a single follicular unit and cutting a small circle through the skin around the follicular unit. The follicular device is then grasped and gently separated from the loose connective tissue that covers it under the skin.
No further planning is required once it is removed. It’s about to be inserted. The little hole left behind is left to be filled by itself over a period of one to two weeks. This cycle is repeated hundreds of times until the desired number of follicular units are obtained. Rather of having a white, circular scar as in the typical follicular unit transplantation, the patient is left in multiple 1 mm round white scars.
Proponents contend that the advantage is less visible scarring and no tightness of the scalp (because no tissue has been assembled and sutured as in normal follicular unit transplantation).
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Disadvantages of FUE
There are some significant drawbacks to follicular unit extraction. Some of the worst is that not every patient with scalp is responsive to the extraction of a follicular organ. For these cases, the follicular structure appears to tear when being pulled out of the skin. Damaged follicular units are not going to develop as well, if at all. A test procedure is also prescribed to verify if the follicular units of the patient remain intact during extraction.
Another big issue is that it is difficult to organize broad sessions. The extractions are sluggish and tiring. Patients wishing to have large sessions may be expected to return several days rather than a single day as during regular follicular unit transplantation.
Potential for long-term growth is a theoretical concern. During extraction, the follicular units are gently separated from the underlying tissues. The deepest part of the connective tissue below the follicles appears to be absent from these graftings. Failure to do so will lead to a weakening of the follicular unit over time.
Because this is a modern procedure, hair transplant surgeons cannot be sure of long-term outcomes. At the end of the day, patients need to realize that they will get injuries in the donor region either way. The detachment of the follicular unit leads to hundreds or thousands of thin, circular scars in the back of the scalp. It is unclear if this is superior to a linear scar.
It will especially affect:
- Patients with minimal donor material remaining due to tightness of the scalp
- Patients who prefer to heal with large scars after stitching
- Patients with loss of eyebrow or moustache hair needing follicular units of a specific size
- Patients in the army who need to keep their hair very short in the donor region.
Our Opinion
It is HTL‘s opinion that the traditional follicular unit transplantation used to be useful, but the DHI technique and the FUE technique are much superior at a comparable cost, so in effect, patients are getting better care, better outcomes at the same price.
