Best FUE Hair Transplant Clinic (Follicular unit extraction)
FUE is one of the most effective and advanced surgical methods for permanent hair restoration. Avoiding linear scarring, it takes hair transplant surgery techniques much further and becomes one of the least invasive procedures. Being almost a scarless surgery, FUE’s worldwide popularity mostly stems from its promising results and relatively short healing process.
The advancements in FUE technologies is making the dream of nearly no visible scarring a reality. This is the most impressive advantage of follicular unit extraction (FUE); unlike more invasive methods such as the FUG / FUT / FUSS transplant techniques in which the hair follicles extracted by a strip method, in FUE, the permanent grafts are removed and implanted manually as individual follicular units, and as a result of these process, scarring on the scalp is largely avoided.
Considering the delicate nature of the process, it is important to note that acquiring a natural look and protecting the donor area depends on the accurate transplant provider, that is to say that the success rate of the operation primarily requires a specialized and professional clinical team.
How is FUE operation performed
Before beginning the FUE procedure, the patient will be examined by a number of professionals to determine that this type of operation is the one that he/she needs. After the evaluation, informed about the transplant process, advantages and disadvantages, the patient will be ready to undergo the follicular unit extraction.
As a first step, surgeons will identify the donor areas, and for the most possible natural-looking results, there will be a personalized planning process. After the non-surgical preparations are completed, the scalp will be shaved in order for the surgeons to get a clear vision of the donor area; otherwise, there may occur several complications as a result of over-harvesting, such as telogen effluvium.
Extracting the hair follicles
Before the extraction of the hair follicles begin, your surgeon will clean and benumb the donor area, using a local anesthetic agent, so that the patient won’t feel pain. Considering your individual transplant needs, he/she will decide on an extraction technique between two options: sharp or blunt dissection. Preventing hair follicle transection, sharp punch dissection method inhibits the depth of punch insertion and thus, increases the consistency of the grafts. On the other hand, the blunt punch technique makes use of some kind of a dull tip which is less prone to transect the follicles. While placing the follicles into the center of the punch, this tip enhances the depth of the dissection level and decreases the manipulation, and ultimately the graft extraction requires less force.
Using a powerful microscopic magnifier, the surgeon operates with a one-millimeter in diameter instrument, such as a small punch or forceps, and extracts each individual follicular unit from the donor area at one time. Multiple steps are needed to complete the extraction process: firstly, in an attempt to isolate the graft, a circular incision around the follicle must be done. After then, the grafts are extracted directly from the donor area via the aforementioned instrument and set aside until the placement process. It is critically important that these grafts are maintained in optimal condition; therefore, they are split into groups depending on the number of hairs within each follicle, and soaked into an isotonic saline solution.
Once the extraction procedure has been completed, the small holes created at the donor area are left to heal – approximately for a few days –, and the patient is asked to sit on an upright position for the implantation process. At the end of the extraction procedure, your doctors will have harvested 2,400 to 5,000 grafts.
As the last step of the follicle extraction, your doctors will consider the optimal positioning of each follicle in order for reaching the desired results, based on your unique hair loss pattern.
Placement of the follicular units
As soon as the follicular grafts are ready to use, razor blades or needles of 1 mm in width and 5–6 mm in length are prepared, in order to use while opening slits in the recipient area. After that, the hair grafts are delicately and strategically implanted in each cut one by one, depending on the number of the hairs within each follicle.
The tissue damage resulted from the cutting process usually starts to reverse in 3 to 4 weeks. By the third week, the hair follicles remain within the skin, but hair tips start to shed. While there may be no hair loss in some rare cases, it is typically 4 to 6 months required for transplanted hair to start growing again.
The whole hair transplant operation will be completed in 4 to 8 hours, depending on the scale of the transplant process.
Who is the optimal candidate for FUE hair transplant
Follicular unit extraction has several advantages over the other hair transplant techniques, especially almost invisible scarring. By undergoing FUE hair transplantation, you can completely change your appearance, resulting in a dramatic confidence boost, but it is very important to have a realistic approach to the operation. Even though there are numerous patients who would like to obtain these magical results, sadly not everyone is an optimal candidate for FUE procedure. Since achieving the best results is the highest priority, a doctor’s main objective is to utilize the existing hair as effectively and strategically as possible.
When determining the needed hair transplantation technique and assessing the patient’s compatibility with FUE transplantation, surgeons consider the following as evaluative factors:
- The number of grafts required to achieve the optimum results
- The number of grafts which can be extracted from the donor area
- Adequate density of the hair within the donor site
- Having limited scalp elasticity, as it makes the small diameter punches the best option
- Hair type of the patient, straight or slightly curled hair is preferable
- Patient’s plan to wear his/her hair very shortly, an attempt to camouflage any scarring maybe
- Cause of the hair loss, in some cases it will be an unnecessary procedure
- Patient’s sensitivity to pain
- Overall health and lifestyle
- Patient’s wish for the least post-surgical restrictions
- Patient’s willingness to achieve long-term results
- Possibility of future hair loss
Recovery period
After the surgery, your scalp will be quite tender for a while. You will be wearing bandages on your scalp for about a day, and there is a high chance of feeling pain or soreness both at the implantation site and the extraction area. In order to keep the swelling and other possible complications under control, your surgeon might prescribe medications including:
- pain medications, such as ibuprofen
- antibiotics to avert infections
- anti-inflammatories, such as an oral steroid
- medications such as finasteride (Propecia) or minoxidil (Rogaine) to help trigger the hair growth
Since each person experiences the hair transplantation period individually and differently, it is important to be aware of the fact that there is neither a way to know the duration of the after-effects nor the time of the hair growth.
Once the surgery is done, you will be able to distinguish your new hairline; although it won’t look as good as the final result, after a couple days of rest, you can return to your daily routine. Your doctor will instruct you about post-operative care, including sleeping positions, washing frequency, cleaning procedures etc.
After a couple of days, you will start to notice subtle changes on the outline of your hair. Even if there might be a little bit of swelling at this point, you shouldn’t be alarmed at all, since this is not your expected appearance, and all the pain and tenderness is temporary.
In the next couple of weeks, as an inevitable part of your recovery, some of the hairs on the transplantation site will begin to shed. In the majority of the transplantation cases, this shedding period is completely normal, not an incident requiring panic.
It is important to remember that both typical and transplanted hair grows approximately 1 cm per month, so it is not reasonable to expect some shampoo-ad-locks in just a few days. Once it is the fifth or sixth month after the surgery, the final results will become intensely visible to the eye.
There are a couple of measures you can take in order to not hinder the post-operation period, including:
- Do not wash your hair before a couple of days. Only use the cleansing products advised by your doctor.
- Do not roughly brush or comb your hair for about 3 to 4 weeks
- Until your doctor say the opposite, do not wear hats or jackets with hoods.
- Take a break from exercise for a couple of weeks.
- Apply an ice pack to reduce the swelling.
- Sleep in a semi-upright position to keep grafts in place.
- Avoid extreme heat or cold, these conditions can prevent proper healing.
- Get enough rest and take care of your scalp for faster recovery.
- Do not drink alcohol or smoke for a month, they can interrupt the blood flow to the head.
Advantages of FUE procedure
Advantages of FUE that might be an influential factor on your decision includes:
- With no visible scarring on the extraction site, it is minimally invasive, so that the patients leave the clinic shortly after the operation.
- Operation provides most natural-looking results with permanence.
- During the procedure, local anesthesia is used, therefore the patient is aware of the whole operation, as most of them wish.
- Scars are invisible to the eye, the scalpel used in follicle extraction and implantation is so precise that it leaves a minimal-sized scar which cannot be seen with bare eyes.
- The amount of extracted hair is as little as possible, that way hair density does not decrease.
- Multiple donor sites make it possible to extract hair aside from the scalp if required.
- There is no change in skin sensitivity, once the anesthesia wears off, the sensitivity of the implantation area comes back.
- Since no stiches or noticeable scarring included in the operation, the patient can wear short hairstyles as well as shaving their heads.
- Implantation area looks almost unaffected, so it is optimal for patients who want to try moustache or beard replacement too.
- It is sometimes used by FUT patients trying to look for a way to conceal their linear scar.
- It is also a rational option for patients who cannot get a FUT operation, because of reasons like inadequate amount of hair or softness on the scalp.
- After-treatment care is quite easy, and recovery is fast. In most cases, patients return to their daily lives the next day, and all they have to do is protecting the scalp from harsh actions and extreme temperature conditions.
From the surgeon’s viewpoint:
- Need for manpower is limited, just one doctor and one or two assistants can perform the operation.
- Necessity for hair grafts is much less than the other techniques, therefore preparation process is much shorter.
- Since the procedure is not that traumatic, need for surgical experience is minimal.
- A limited number of equipment is sufficient for the surgical period.
Risks and possible complications
Hair transplantation is an extremely safe procedure and is associated with very few significant risks or complications, but ultimately this is a surgery, and as it is the case in any surgery, risks exist. Moreover, since it is a cosmetic procedure, the complications may impact the patient’s psychology or social life. But there is no need to worry, because most of these complications are avoidable and can be prevented by a surgeon’s proficiency and proper surgical technique. Before the operation, it is important to obtain detailed information about the risks and possible complications of the procedure, and undergo an individualized planning process.
Being mostly minor and temporary, the most common risks and complications of FUE operation can be categorized as follows:
For donor area:
- Donor site depletion
- Hypopigmentation
- Acute effluvium
- Buried grafts
- Higher transection rate
- Keloid/hypertrophic scar
- Epithelial cyst
- Necrosis
- Overharvesting
- Numbness and persistent pain
- Harvesting grafts outside safer zone
For recipient area:
- Poor hairline
- Unnatural appearance with low density
- Recipient area edema
- Necrosis
- Postoperative folliculitis/pustules
- Cysts, usually disappear in a few weeks
General surgical complications:
- Infections, easily treated with antibiotics.
- Pus drainage around the surgical sites
- Scalp pain, itching, and swelling, lasts only a few days
- Inflammation or infection of the hair follicles, which is known as folliculitis
- Bleeding, will stop with simple pressure or rarely with additional stitching
- Losing sensation around the surgical sites
- Noticeably thinner areas of hair
- Continuing to lose hair if your hair is still balding
- Bruising around the eyes
- Numbness or lack of sensation on the treated areas of the scalp, generally lasts from 3 to 18 weeks
- A crust that occurs on the areas of the scalp where hair was removed or implanted
- Unnatural, patchy hair growth
