Indications for FUE | Contraindications | FUE Harvest | Processing & Implantation
Follicular Unit Extraction (FUE) simply describes one particular way of harvesting hair (and Follicular Units) for hair transplant. Just like the standard Strip Hair Transplant (FUT), it is also a surgical procedure.
FUE for Follicle Renewal
FUE is a donor technique where a round cutting instrument etches the skin and then gently separates and extracts each individual follicular unit away from the surrounding skin. A miniscule cavity is left behind which heals over 5-7 days. Ultimately, a small dot-like scar appears and is concealed by the surrounding hair of the donor area. The process is duplicated repeatedly until enough hair follicles are available for implantation. Some of the follicles may then be further processed microscopically prior to implantation into thinning areas. Both techniques, Strip and FUE are based on the principle known as Donor Dominance whereby hair taken from a particular part of the scalp or body maintains its inherent characteristics regardless of to where it is relocated. Because the hair from the back of the scalp and the hair just above the ears is resistant to hair loss, they are considered “Dominant” and may be used elsewhere in the scalp.
Indications for FUE
FUE was initially marketed around the year 2003 as a type of “Non Incision” hair transplant for people who were unwilling to undergo the standard strip harvest for hair transplant (despite the fact that each FUE is also an incision). The technique was based on a long standing method which was practiced for a number of years in Sydney, Australia by Dr Ray Woods. Because some individuals are reluctant to undergo a standard donor type of incision as well as the subsequent suturing, the “Woods Technique” or Follicular Extraction began to catch on. Refinement of the technique accelerated within the surgical community utilizing smaller instruments and higher magnification. Without the resulting linear scar, FUE is a nice alternative for those individuals interested in keeping short hair as the dot-like scars may more easily concealed than a linear scar. There are other advantages as well such as having the capacity to harvest follicular units from other parts of the body, such as the chest, beard and pubic areas.
Because tissue properties are different for every individual, follicle trauma and damage (transection) rates may limit the procedure. FUE also requires shaving most, if not all of the back and sides of the scalp and this is unacceptable to many people. Finally, an FUE procedure, regardless of technique used, is a more highly labor intensive technique and is significantly more costly that the traditional strip procedure.
Dr John Frank, MD is accustomed to using a variety of instruments for FUE. The most basic (although very effective) is using a circular, handheld sharp biopsy punch. They come in different sizes, but the most common size for FUE is .8 and 1.0 mm which is very small and requires high powered microscopic operating loupes as well as brilliant lighting. There are also a number of different rotating punches as well, and the one we like to use is the rotating Safe Scribe which is a dull punch. Other instruments out there include the NeoGraft as well as the Artas Robot however we have not found any benefit to using them.
Processing and Implantation
Regardless of the technique, each follicular unit follicle is typically dissected and refined prior to implantation. The grafts are handled gently using microscopic forceps and they are kept cool and moist. They are then carefully inserted into tiny slit like openings in the balding areas of the scalp. Once the grafts are inserted, they begin to adhere to the surrounding skin (dermis) and begin a healing process followed by eventual regrowth. The new, slowly growing hair usually shows up in about 4-6 months, but ultimately may not be complete for upwards of one year.