FUE treatment

Before the treatment - important preoperative instructions

In the run-up to any FUE-based hair transplantation, patients should bear the following restrictions/information/instructions in mind, as the optimal healing process and success are highly dependent on them.
These instructions are available as a pdf file below the page under IMPORTANT INSTRUCTIONS.

Basic information:

  • No alcohol / no smoking in the three days prior to the operation. It is very recommendable to get enough sleep.
  • If you suffer from any disease, a blood test should be done beforehand, either by your local GP or by us. Generally speaking, a pre-operation blood test is not necessary when the patient is young and healthy. Please inform us as early as possible whether your blood needs to be tested.
  • On the day of the operation, you should only have a light breakfast. We will give you breakfast at the clinic.
  • Please wear comfortable clothes on the day of the operation. Do not wear clothes which you need to pull over your head. Wear comfortable shoes.
  • You will be given operation clothing during your stay here in the clinic. This should be worn the whole day.
  • Please do not wear jewellery during your stay here - remove it before coming to the clinic.
  • Please understand the necessity of us always being able to contact you by phone. This is particularly the case on the day of the operation, and you should be available from 07:00 AM onwards in case we might have to contact you for urgent matters.
  • Please do not have your haircut before an FUE operation, as this makes it more difficult for us to determine the status of your hair and the subsequent treatment. Before treatment begins, we will cut your hair to a length of 0.9mm.


Medication:

  • Should you take anticoagulant medication, for example ones such as Marcumar containing coumarin, please contact our doctor.
  • Medication containing acetylsalicylic acid such as aspirin or other pain-relievers should not be taken during the 7 - 10 day period prior to treatment. The same applies to stimulants and narcotics, including antidepressants.
  • Please bring with you your prescription drugs and show them to the doctor. Should you have any worries about the effects of prescription medication on the treatment, please contact your GP or pharmacist.
  • Blood thinning (med. haemodilution) is influenced by the intake of vitamins B and E, which can have negative consequences for the transplantation. Please therefore stop taking supplementary vitamin B and E 7 days before the operation.


Supporting medication:

  • Propecia/Finasteride supports and improves blood circulation in the scalp, which in turn strengthens the hair roots. Taking such medication is therefore no problem.
  • Minoxidil solution can be applied up to 24 hours before treatment. Propylene glycol may cause irritation and dryness of the skin following the operation. This is not just unpleasant, but can also have a negative effect on the transplantation. Please don't use Minoxidil in the first three weeks following the operation. After that, please first consult the doctor treating you.
  • After the operation, swelling will probably occur in the transplant area. This should go away within 5 - 7 days. Arnica D30, a homeopathic remedy, can be a help in mitigating any swelling. Please consult your pharmacist should you want to use this, as Arnica D30 is available in various forms, differing in the way it is administered and in dosage.
The treatment: a step-by-step guide

On the day of the operation

  • On arriving at the clinic, you are welcomed in the lobby and taken to a private room. This room remains available to you throughout your stay in the clinic. Relatives or friends accompanying you can stay here during the operation. The private room is equipped with a television (including satellite programmes), a DVD player and a selection of magazines.
  • You can then choose what you would like to have for lunch.
  • You are then given a disposable operation gown to put on.
  • Dr. Feriduni will then welcome you and will take you through the details of the operation once more. A set of preoperation photos are taken.
  • A medical assistant will then give you a medical hair-wash.
  • You are then taken to the operation room and seated. Vital parameters such as blood pressure, heart rate, oxygen saturation and (when deemed necessary) ECG are checked and venous access established.

Preparing the donor area for extraction

The operation is usually done under sedation, with a patient generally being given Midazolam as a sedative. This has an effect similar to that of valium. The donor area is also numbed by a local anaesthetic prior to extraction. Dr. Feriduni and at least 2 - 3 medical assistants are present throughout the operation. Individual FUs are painlessly extracted using a micro-needle with a diameter between 0.7 and max. 0.95 mm. Extraction is performed intermittently, i.e. hair-root groups are extracted for a period of 1 - 2 hours, immediately after which the implant incisions are made. Implanting takes 1 - 2 hours. This extraction / implantation procedure is then repeated.

Preparing the incisions

The area where the implant incisions for the individual FUs are made is also locally anaesthetised, allowing the incisions to be made painlessly.

The transplantation

The incisions in the recipient area are made using tiny slit needles, also known as blades. These custom-made blades can be perfectly adapted to the respective size of the patient's FUs. Customized blades are usually 0.6 - 1.0 mm wide. Nearly all incisions are made before implantation (Premade Incision Technique). This part of the operation takes about 2 hours. Dependent on the duration and scope of the treatment, a break is now taken. This can be used for relaxation or having lunch.
Again dependent on the method used and its duration, implantation may follow immediately afterwards. This takes 1 - 2 hours and is performed by medical assistants and Dr. Feriduni. Any major FUE involving the transplantation of a large number of hairs continues after the break with the next bout of extraction and implantation. This iFUE technique (intermittent FU extraction), in which the extracted FUs are implanted immediately afterwards, can be repeated up to three times.

Stick and place – the fine-tuning phase

The following part of the treatment is extremely important, and involves the use of the so-called Stick-and-Place technique. This is used to optimise the result, making the transplant look as natural as possible. This fine-tuning, which involves making additional incisions and directly implanting single FUs in certain areas, is of major importance for the end result, and in particular the shaping of the hairline.

End of treatment

A FUE operation ends with a further medical hair-wash and Dr. Feriduni then checks the result, discussing the operation with the patient.
The patient is then given written instructions on what needs to be done over the next 24. We provide our patients with a so-called after-care kit, containing a post-surgery mousse shampoo, post-surgery serum, post-surgery oil and hair spray treatment. 

An inflatable cushion for the neck is also given to the patient as well as a bandana for covering as far as possible all visible signs of the treatment. The patient will receive an emergency telephone number, under which he can contact the surgeon and the head assistant on a 24-hour basis. After a final check-up by Dr. Feriduni, the patient is taken to his hotel by taxi. In most cases the operation lasts the whole day, generally ending sometime between 16:00 and 19:00.
The patient generally returns the next day for a postoperative check-up, he/she then has the opportunity to discuss any issues that might be relevant for the next few weeks. A medical assistant also washes the hair again. There are no stitches needing to be pulled.

After the treatment

After an FUE transplantation, patients need to follow certain instructions. These are also available in the section IMPORTANT INSTRUCTIONS below.

A short overview of the instructions:

  • In the first nights after an operation, patients should sleep on their backs with their upper body slightly raised. This minimizes danger to the transplanted area.
  • The main thing is to avoid pressure to the head. This means that patients should avoid bending down, not hold their heads in a downward position, not shout loudly or cough too much. All these movements can cause blood pressure in the head to rise, leading to possible bleeding in the transplantation area in the first few days after an FUE operation.
  • Sports and other physical activities should be avoided for a period of 2 weeks.
  • The hygiene rules, which you will have received from Dr. Feriduni and his team, must be followed in detail over the next two weeks.
  • In the first 2 weeks after an FUE transplant, patients should not wear a helmet, hat or wig. In most cases, a bandana may be worn.
  • For a period of 4 weeks after the transplantation, patients are advised not to go to a sauna or solarium.


The following points also need to be followed after the transplantation:

  • A check-up is performed on the day after the FUE transplantation. This should be repeated about 2 weeks later.
  • Swelling will probably occur on the day after the transplantation. This should disappear within a week.
  • A fine scab will form on the transplantation area after the operation. This generally disappears within 7 - 10 days.
  • The stitches in the donor area, along with any remaining scabs in the transplanted area, will - insofar as they have not already disappeared (this generally occurs within 7 - 10 days) - be removed by the medical team after 14 days.
  • There is a possibility - due to operation stress - that a number of hairs will fall out in the post-operation phase. This generally temporary occurrence is known as "shock loss", and may last just a few weeks or possibly months. In certain cases, donor hairs and neighbouring hairs may fall out after a hair transplant (for instance when dense packing has been performed). This should not worry patients, as the hairs generally regrow once the shock loss period has ended.
Process of growth

As with normal hair, the growth pattern of transplanted FUs varies from one person to the next - some hair grows faster, other slower. There are so-called fast growers and slow growers, with some patients already clearly seeing results after just 6 months, and others having to wait more than a year.

In the first few days after an FUE transplant, thin scabs develop over the small incisions in the donor area. These disappear as healing progresses. Parallel to these scabs, most of the transplanted hair falls out in the second or third week after transplantation. Patients should not start worrying about this, as this is a completely natural process. The reduced intake of oxygen and nutrients weakens the transplanted roots, leading to the hairs attached to them falling out. As the hair roots are only weakened and not destroyed, new and strong hairs start developing after 3 - 6 months, once the roots have regained their strength. In certain cases, for instance when dense packing has been performed, there is a possibility of not just the donor hairs falling out, but also neighbouring hairs. These will also grow again once this hair loss period has ended. This so-called shock loss is a short-term phenomenon occurring in certain patients, probably triggered by operation stress.

The new hair roots start producing new hairs immediately after being transplanted. In the first three months, these are very thin, akin to flax. Afterwards the hairs get thicker and stronger and after about a year the end result is very visible. All transplanted follicles generally produce new hairs, although there are certain exceptions. These are fairly seldom.

Dense Packing and the One-Session Philosophy

Natural hair density on a person's head is usually 60 - 120 hair root groups per square cm, though density varies in different parts of the scalp. It follows that hair density plays an important role in any hair transplantation. The hair density achieved through hair transplantation is decisive in achieving an aesthetic natural-looking result. So-called Dense Packing involves implanting FUs in a certain density in a certain recipient area.

A personal decision: low, medium or maximum density

  • The surgeon plays around with hair density, implanting donor hairs as sensibly as possible and doing his best to achieve a result looking as natural as possible. This attempt to mirror natural hair as far as possible is very patient-dependent, taking three factors into account:
  • The possibilities available under the circumstances and the availability of donor hair.
  • Future age-related hair loss - the recipient area should remain looking pleasing and natural in the long term.
  • The overall concept determined beforehand.

It is understandable that any patient will have his own wishes and objectives. However there are not always sufficient donor hairs to fulfil patient hopes. Using the right technique, an experienced hair surgeon will be able to create the optical illusion of high density with just a few hairs, using donor hairs as efficiently as possible.
A higher number of transplanted grafts does not necessarily mean greater naturalness, as hair density is not something that can be measured. Much more, it is subject to how it is seen. It is quite possible for a patient with excellent donor hair and a seemingly low density of about 40 hair root groups per cm² to achieve a result looking more natural than a patient with a much higher density and/or with worse donor hair.

Customized blades

The implantation of extracted hair root groups is done via incisions made in the recipient area. These incisions can be made sagitally (top-down/parallel) or laterally (sideways/ perpendicular). The needle and slit techniques can be done in various ways: lasers are no longer used, as they cause too much tissue damage, with implanted FUs having difficulty taking root. Ready-made needles, scalpels or special blades are now commonly used. Custom-built blades, adaptable to the respective requirements, may also be used. The finer the instruments used are, the more accurately FUs can be implanted, as well as in higher numbers.

Both methods - needle and slit techniques - offer very good results, as they cannot just be used flexibly and adapted to the respective situation, but also cause minimum damage to tissue, thereby considerably increasing the percentage of transplanted hairs taking root and growing. Customized blades can be produced locally in the clinic in different sizes (also intermediate ones) with relatively little effort. They are much sharper than needles, meaning that they are a lot more precise and only cause very small wounds. This has a positive effect on the healing process. In a transplantation involving 3000 FUs for instance, 3000 times less damage is caused. Further advantages are to be found when the wounds heal, as the use of blades generally causes less bleeding, quicker healing and minimum damage to the skin, with little or no scarring. Scalp rashes are also less prevalent.

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