Over the course of the last few years, the number of grafts transplanted in any one treatment session has steadily increased. This means that the donor strip needs to be bigger in order to provide the requisite number of grafts. These often time-consuming treatment sessions led to a major improvement in results. However it took a long time to acknowledge that the removal of a larger donor strip also caused greater scarring. One of the reasons for the development of Follicular Unit Extraction or FUE for short was the dissatisfaction of patients and surgeons with the previous extraction and transplantation methods. This went hand-in-hand with the wish to reduce scarring in the donor area, as this sometimes causes problems when removing strips. FUE as an alternative extraction method provided the opportunity of removing individual grafts using a micro-punch. Early FUE versions did however cause difficulties, as the removal of individual FUs took up too much time, thereby pushing up costs. This in turn resulted in considerably less grafts being removable at once than under the strip method. As with strip removal, many hair follicles were destroyed in early graft extractions. The FUE method leaves no linear scars. However scars consisting of many small white dots remained visible, thereby delaying the triumph of FUE. At the same time, innovations in the field of FUT reduced acceptance for FUE. The minimization of the linear scar after removal of the donor strip via the trichophytic closure method was one particular factor somewhat detracting from the new FUE technique.
Over the past few years major progress has been made in the field of FUE, with the technique becoming increasingly fine-tuned. Smaller punches are now being used, thereby minimising scarring. Incisions are more precise - and understanding for the structure of the extracted follicles has grown, meaning that less are damaged and results are increasingly positive.
Follicular Unit Extraction has now become a successful treatment method for transplanting high numbers of FUs (i.e. high numbers of grafts) without any great scarring. FUE and FUT differ in their respective pros and cons. Which method is to be used depends on its suitability for individual patients and is weighed up carefully by Dr. Feriduni.
The main advantage of Follicular Unit Extraction is that linear scars in the donor area are avoided. When done properly, a hair transplant done using the FUE method should not be recognisable at all. This is an advantage especially for those patients wanting to wear their hair short - even shorter than 1 cm. Scarring can occur with FUE, visible as small white dots on the scalp. Whether scars actually appear is dependent on a number of factors such as skin characteristics, the choice of punch, the depth of the incision, the number of FUs removed per square cm and other factors which can be checked individually in the run-up to the operation. FUE is nearly always recommendable for patients only requiring a small amount of hair to be transplanted. In cases where age-related future hair loss is not fully foreseeable, FUE can also be very advantageous.
Certain patients prefer to shave their heads, as they are not really worried by a tonsure or hair loss developing over the course of time. In such cases, FUE carried out in one or two short treatment sessions offers the chance of stopping hair loss and enables patients to wear their hair very short or even shave their heads down to just a few millimetres.
Patients who have already been through strip-method treatment, meaning that any renewed removal of a strip from the back of the head (as the donor area) would pose a major problem, can often be successfully treated using the FUE method, as this method allows further grafts to be taken. A further possibility involves combining FUE with a strip operation, thereby greatly increasing the number of hairs available for transplantation. FUE is also suitable for patients wanting to avoid the long linear scar they would get through FUT.
Whether, which and to what extent follicular units can be extracted varies from patient to patient. In certain patients, hundreds of FUs per hour can be extracted without damaging hair follicles, while in others this is impossible. FU quality, the structure of the hair roots and the skin, the different growth directions of hairs in the various donor regions are factors determining which extraction method is best. This highlights the importance of good planning, in-depth consultation, pre-treatment examinations and the weighing up of possible alternatives.
Compared to FUT, much fewer hairs can be extracted from the donor area in any one treatment session. In an FUT, the strip of hair is taken from the optimal part of the donor area, meaning that even bald patches between follicular units are removed.
By contrast, FUE removes individual hairs or hair units, leaving the bald patches in between. This means that in such areas enough hair needs to be retained to avoid making the removal visible. This basically means that only about half the amount of hairs can be extracted through FUE than would be taken through FUT. Generally speaking, about 20 - 25% of hairs can be extracted per square cm. This is a major disadvantage, greatly limiting the amount of donor hair. To gain enough donor hair for a transplant, a hair restoration surgeon is therefore often forced to extract hair follicles from above and below the ideal donor area.
Follicular Unit Extraction leaves behind a large number of wounds. Though these are all very small, they can still cause scarring. Such micro-scars can have a negative effect on the surrounding FUs, making any further treatment more difficult as the amount of potential donor hair is reduced. Although new techniques and instruments have helped reduce these disadvantages, it needs to be stated clearly that FUE is not always the right option for patients with medium or advanced hair loss. A further disadvantage of FUE is that it is generally very time-consuming and causes high lab costs, making it relatively expensive.
- No linear scar
- Wounds heal much quicker
- Less pain in the donor area
- Advantageous technique with a tendency to decrease scarring
- Recommended as a way of repairing scars in the donor area that cannot be cut out
- Extends the donor area
- Allows donor hairs to be extracted from the body and beard
- Recommended for patients only needing a small number of grafts
One of the most important factors in successful hair restoration surgery is the efficient use of the donor area when restoring a patient’s hair situation. To be able to accomplish “safe” donor site management, the hair surgeon needs to understand how to plan and evaluate the patient’s donor area carefully without risking visible thinning of the donor site. This requires meticulous measurements and is relevant to the hair surgeon’s extensive skills and expertise. There are several factors that influence the safe donor site management.
Your hair is 90% of your selfie