How Follicular unit extraction (FUE hair transplant) works?

The old school of hair transplant was depending on the single strip harvesting to obtain the required tissues for follicular unit transplantation. A new technique emerged in the last few years to proof that it is a new era of hair transplant. Follicular unit extraction (FUE hair transplant) is that new technique of hair restoration.

However, the old method produces a noticeable linear scar in the areas from which the follicles are grafted. It needs a meticulous method in dealing with the wound to close it in a fine way. Nevertheless, in case the surgeon takes a wide strip, the scalp of the patient may be subject to some tightness in the scalp.

The FUT hair transplant produces a corn-row appearance in the frontal line and in the front of the scalp. The conclusion is unacceptable on the frontal line and a noticeable scar on the back of the scalp. However, the modern instruments of follicular unit transplantation can improve the procedure. It can hide the scar on the back of the scalp as well.

In the 1990s, scientists and surgeons started a new era of hair restoration. The target of the revolutionary movement was aiming at inventing a special technique to avoid the linear scar of the old method. They invented the technique of using the small punch to avoid the linear scar and to develop the old technique of the strip harvesting.

The new technique aims to remove individual grafts and to transplant them in the specified areas that suffer from baldness. The only difficulty that faced the early attempts to transplant hair using the FUE hair transplant is the crosswise cutting off the follicular unit. As a result, scientists tried hard to pass through this dilemma. They developed the punch and the technique of rolling over the follicular unit to achieve their aim. Finally, in 2002, they were able to use the small punch tool, and the first operation was done thoroughly.

The results were wonderful, but they faced another problem pertaining to the post-operation recovery and incisions treatment. After a short period, they could control these small incisions and the operation ran on the desired way.

What is the fue hair transplant?

Fue hair transplant is a new technique to obtain hair from the donor area. The surgeon will extract the individual follicular units directly from the back and sides of the scalp. The extraction process depends on making small incisions around each follicular unit without doing any linear scar.

The basic instrument in doing the round incisions is the small punch tool. This punch is able to dig around the follicular unit to extract the grafts safely. The unique process can extract the specified follicular units directly from the donor area. While in the old method of follicular unit transplant, the follicular units were dissected from the strip microscopically. The new technique uses a unique process of obtaining the grafts from the donor area. It is not a completely new procedure, but only a logical development to avoid doing linear scars.

Follicular Unit Extraction (FUE) is a method of obtaining donor hair for Follicular Unit Transplantation (FUT). The surgeon will harvest individual follicular units directly from the donor area. In this procedure, a surgeon uses a small punch to make a small circular incision in the skin around the follicular unit.

Follicular Unit Transplantation and Follicular Unit Extraction are two distinct procedures. However, FUE is actually a type FUT where the follicular units use an extraction of the follicles directly from the scalp. Rather than being microscopically dissected from a donor strip that has already been removed from the scalp. When comparisons are made between FUT and FUE, what is really being compared is the way the follicular grafts are obtained.

related article: Strip harvesting (FUT) versus FUE: a fair comparison

Follicular unit extraction (FUE) principles

To intact some follicular units, the surgeon should depend on the principle of attaching the rector muscle of the follicular unit. When the surgeon untightens the grafts from the dermis around it, the lower part is now ready for extraction easily. The narrow surface of the follicular unit is top and peak, so the surgeon should use micro-punches of some specific size 0.6 mm. The use of these micro-punches will make the resulting scars too small and can not be discovered easily.

The basic limitation of the follicular unit extraction is perhaps the inability to specify the bulb of the hair from outside. Whenever some scientists call it the blind procedure, the surgeon can do the process easily using the small and micro punches. The transection happens when the hair with its intact unit found at the lower part in diverse directions. The speed of the procedure is perhaps slow. The surgeon extracts the follicles individually and slowly.

FUE hair transplant: prerequisites and requirements

There are some requirements before starting an FUE hair transplant. These requirements are necessary for the operation and its success. First, the surgeon is on of the main pillars in the operation. The experience, skills, and training of the surgeon should be adequate to the qualified surgeon for doing such operations. Second, the magnification process is a basic point of consideration. The whole process can not run without the magnifying process and the suitable lighting to clearly see the anatomy of the scalp and hair. Third, the angle and direction of the hair and the below surface of the scalp are points of considerations. So the surgeon should be aware of the anatomy of these items and how to deal with them thoroughly.

The angle of the growing hair is much important than the angle of the stable follicle that roots inside the dermis. The incision on the surface of the scalp is much important if compared to the angle of the emerging hair. If the incision inclined away from the specified angle of the growing hair. It will be a hinder to the future of the transplanted hair. Fourth, the small or the micro punch is a basic prerequisite for doing the hair transplant with the FUE.

Sharp punch or Blunt punch for FUE incisions  

The motion of the hand should be proper and neat on the scalp. The hand of the surgeon must be stable and with no hesitation to accurately specify the direction of the growing hair. It is the determiner of the skill of the surgeon and the future success of the whole operation. Most of the surgeons advocate the clockwise rotation to obtain the highest stability. The punch should be of 0.6 or 0.8 mm size. The size of the punch should be with enough diameter to encompass the follicular unit when extracting it from the scalp.

The benefit of the small punch is to minimize the wound size and it makes the process much harder. The less size of the punch, the harder of defining the angle of the hair and in determining the angle of the follicular unit. To avoid any transection, the surgeon should avoid the back and forth motions and rotations. The use of the blind and sharp punches is also a basic matter in determining the technique of the surgeon in the operation. Some surgeons prefer to use the sharp punch to avoid the more steps in extracting the follicular units. Others prefer to the blind punch to avoid transection in three-step technique. As a result, the sharp punch achieves a two-step technique with low rates of twisting and rotations. While the blunt punch is a three-step technique and it is a suitable technique of decreasing the amount of transection.

The procedure of FUE hair transplant

FUE is that procedure in which the method of implanting hair is similar to FUT, but the only difference is the method of extraction. It is a procedure that needs no sutures post operation, and it extracts the follicles from the donor area. It uses local anesthesia with a small or micro punch. The day of the operation, the hair on the scalp is trimmed to one or two mm. Local anesthesia with lidocaine or xylocaine will cover the whole donor area slowly. After half an hour, the surgeon will start to do his work thoroughly. The surgeon will extract the follicular units from the donor area using the special micro or small punch. The magnification process will be 3-5X to extract the follicles.

The extraction of the follicles may be of two techniques. On the one hand, the two-step technique using the sharp punch is to control the follicular unit to the specified direction of the hair shaft. The surgeon should control the punch thoroughly and do not to push it deeply to avoid any transection. Then, the surgeon uses a forceps to track the top and peak of the follicles until the tool deeply pulled in the dermis. On the other hand, the three-step technique uses a blunt tool. the aim of the blunt tool is to avoid the damage of the follicles or the so-called transection.


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