Hair restoration is sought out by men and women of different ages to look and feel more youthful, healthy, and confident. A hair transplant is one form of hair restoration that delivers permanent results. Hair transplants can be performed using different methods for removing hairs. One of these methods is called follicular unit extraction, or FUE.
What is follicular unit extraction (FUE)?
Follicular unit extraction (FUE), also known as follicular transfer, is a method for removing hairs from one part of the body in order to transfer them to another. Typically, back of the head hairs are removed and moved to the front. However, other combinations including body hair are possible. The ultimate purpose is to leave the least amount of trauma at the donor site, where the hairs are taken from. FUE achieves this goal by removing hairs one at a time and respecting the natural clusters that they grow in.
Who is a good candidate for FUE?
There are a few characteristics that make someone a good candidate for FUE, including:
- Adequate donor hair – usually from the back of the head
- Short hairstyle – one of the advantages of follicular unit extraction (FUE) is the lack of a linear scar which is great for patients looking to wear a short hairstyle
- Medically stable for prone position – usually several hours of laying on your stomach is required for FUE so the patient must be medically stable for this type of positioning
How is this procedure done?
The concept for FUE is to use a tool to remove a follicular unit graft without traumatizing the follicle. The tool must punch through the skin, keeping the hair shaft in the middle of it, and include some of the deeper subcutaneous tissue as a cuff around the hair while preserving the deeper hair follicle bulb. There are a few tools that can be employed in order to harvest (punch out) honor hairs using the follicular unit extraction (FUE) method, such as:
- Manual: A sharp or blunt tipped manual punch is a cylindrical instrument that is rotated in the hand and through the skin around the hair shaft.
- Motorized: This is the most common method currently used for FUE and includes a few types of machines including ones made by Ellis, Devroye (WAW), Neograft, SmartGraft , and Trivellini (Mamba). The Ellis is a sharp punch system with a rotational mode only. The Devroye WAW follicular unit extraction (FUE) system has only an oscillating mode. The Neograft and SmartGraft systems are rotation mode only and come with a suction-based system. The Trivellini mamba system is digitally advanced and has three different modes (rotation, oscillation, vibration) which can be custom set per the doctors preference to adjust to the hair and skin quality of the patient. Using suction is possible with Trivellini as well. Dr. Linkov prefers the Trivellini FUE system for its versatility and adaptability and usually uses the vibration setting to avoid traumatizing the hair follicle. The Trivellini FUE system is the newest and most advanced FUE system on the market and comes with blunt-tipped flared punches that further reduce injury risk to the follicle.
- Robotic: The Artas robot has some automated features for extracting hairs, creating recipient sites, and placing the hairs (with the Artas iX). While a great marketing tool and helpful for reducing human fatigue with longer procedures, there are a number of disadvantages, which include:
- Cost – Since the robot costs about $300,000, the procedures are often more expensive to patients as the practice works to recoup the expense.
- Hair color – The robot requires darker hair in order to do the extractions. Patients with white or red hair need to dye their hair for the robot to work.
- Harvest location – The robot will only work where a flat grid can be applied, which limits the possibilities of harvest location.
- Time/Labor – The procedure is generally not any faster with the robot compared to motorized punch systems and still requires a team of technicians to complete the procedure.
There are several options for preparing the donor area for follicular unit extraction (FUE) harvest, such as:
- Shave: The entire area to be harvested is shaved with an electric clipper down to about a number 1
- Partial shave: The lower back of the head is shaved down as stated above, the rest of the potential donor area is kept longer and trimmed carefully as needed for any further harvesting
- No shave: Only careful trimming is used with a scissor to leave enough surrounding long hairs to cover the harvested area and to make it less noticeable during recovery that you had a procedure. The cost usually increases for a no shave technique since it requires more time and effort.
The size of the FUE punch is typically 0.8mm-1mm depending on hair quality and provider experience.
Once the hair grafts are punched, they are extracted using delicate fine forceps and kept in a solution on ice until they are ready to be transplanted to their new location.
Who performs the follicular unit extraction?
The actual process of FUE is sometimes done by a hair technician and other times by the surgeon or an advanced practitioner such as a nurse practitioner or physician assistant. Technically, follicular transfer is considered a surgical procedure and it may be unlawful for hair technicians without an advanced degree to do the extractions in some states.
What is the recovery from FUE?
Immediately after the FUE procedure, antibiotic ointment is placed over the area, and should be applied twice daily at home for the first 5-7 days. Minimal bleeding may occur for the first few days. Some discomfort is common but rarely is there significant pain for the first few days. Temporary sensation changes are possible. Each small punch site will develop a crust which falls out after 3-5 days. It is okay to get the area wet with soap and water the day after the procedure. A haircut in the area of the FUE is possible as early as 4-5 days after the procedure.
What are the risks and complications from follicular unit extraction FUE?
The following are possible risks/complications after FUE:
- Overharvest with patchy hair loss
- Shock loss
Does a follicular unit extraction (FUE) leave scars?
With the FUE method of hair extraction, small circular scars are left but they are barely noticeable even with a shaved head. The key is not to overharvest, to leave enough hairs in between the FUE sites so that they provide sufficient coverage.
Is follicular unit extraction FUE painful?
Typically an oral sedative (Ambien) and an anxiolytic (Valium) are given at the start of the follicular transfer procedure to relax the patient and make it more tolerable to be on the stomach for up to several hours. Follicular unit extraction (FUE) hair transplant involves first numbing the area with a solution of lidocaine with epinephrine as well as a longer lasting anesthetic called bupivacaine. Once this is done the harvesting is not a painful process. You may feel some pressure but there is no sharp pain. There is minimal discomfort during the recovery process.
What are the contraindications for follicular unit extraction?
The contraindications to FUE include:
- Medical conditions that are not compatible with local anesthesia containing epinephrine
- Autoimmune alopecia areata, in which the body will continue to try and destroy the hair follicles
- Lack of adequate donor hair
What are the alternatives to follicular unit extraction?
The primary alternative to FUE is called the strip method, or FUT (follicular unit transplantation). FUT involves cutting out a strip of tissue to the depth of the hair follicles. The resultant wound is closed with suture. The hairs are then processed by technicians outside of the body to prepare for transplantation. The advantage of FUT is the speed of removal and potential for a greater number of hairs. The disadvantages are a lengthier and more uncomfortable recovery as well as the linear scar that forms.
Does follicular unit extraction (FUE) hair transplant work?
Yes. In experienced hands, the rate of transection (cutting through the hair follicle and destroying it) during FUE is very low (4-6%). The small punch sizes used today lend well to a speedy recovery with minimal discomfort at the donor area.
Are patients satisfied after FUE?
Yes. FUE is the most modern method of hair extraction for a hair transplant. Patients enjoy the less invasive nature of follicular unit extraction (FUE) hair transplant compared to a strip procedure which results in less downtime and less visible scarring.
What is the cost of follicular unit extraction (FUE)?
The cost of FUE usually depends on the number of grafts extracted, though it can also run a flat rate in some clinics. For per graft cost, the going rate in NYC is $5-8 per graft for standard scalp hair restoration. Cost may be higher for more specialized procedures, such as eyebrow transplant or body hair transplant.
Who is the best follicular unit extraction (FUE) hair transplant surgeon in NYC?
There are few surgeons in the United States that know how to perform their own follicular unit extraction (FUE) hair transplant procedures, as most rely on hair technicians for the majority of the work. Dr.Linkov personally performs the FUE hair transplant in NYC to ensure the best results in a clean and safe environment.