FUE HAIR TRANSPLANTATION
FUE is a method of Hair Transplantation where the follicular units are extracted individually by means of an FUE machine from the back of the head and are implanted where they are required. There is no need to take the strip of scalp technique, hence there is no need for stitches. The recovery is hence much quicker, is less painful and leaves no linear scar at the back of the head.
The advantages of FUE over strip technique are:
- There is no linear scar at the back of the head(if you want to wear your hair short)
- Less painful
- Quicker recovery
- Can wear short hair styles
- Useful in those people who have a tendency to scar or form keloids
- Useful for body hair and beard hair extraction in those who do not have good donor area
There are various causes of hair loss but the most common pattern is the male pattern alopecia. The most permanent solution to this type of hair loss is of course Hair Transplantation.
Women are also concerned about scanty areas of hair growth and of large areas of parting showing through in pictures for which they seek help.
Hair transplantation is broadly achieved by removing grafts/follicles from the back of the head. In this area the growth of hair is more permanent and it is more resistant to hormonal changes. Follicles taken from here are then placed in areas of scanty growth or baldness. The removal of the grafts varies in FUE and FUT methods.
Follicular units/grafts are naturally grouped hairs that are found either singly or in two’s and three’s. (Fig.1)
IN FUT method of Hair Transplantation, a strip of scalp is cut from the back of the head and is then dissected into individual grafts or follicles. (Fig 2, fig 3)
In Follicular unit Extraction (FUE) method of hair transplantation the individual follicular units/grafts are removed directly from the back of the head one by one with the help of a tiny specialized machine.(fig.4, fig.5) The process is tedious and takes a few hours but should be painless after a few numbing injections are given.
The grafts or follicular units once removed look like in Fig.6
The rest of the procedure remains the same in both techniques. Tiny sites are created using very fine blades and needles in the balding areas after numbing the area with local anesthetic injections. These grafts are then inserted in the sites on the front of the head or wherever there is hair loss. (Fig.7)
The implanted grafts will scab over and will fall off over the next 2-3 weeks. Hair growth will be seen at 3 months taking 6 months for further full growth.
Advantages of FUE:
As this method of Hair transplantation does not involve taking an entire length of strip of scalp from the back of the head like in strip surgery, there are no cuts or stitches;
The recovery time is much quicker with the patient often returning to work from next day itself.
There is no linear scar
Procedure is suitable for people that want to wear their hair shorter so that the scar is not seen
Lends itself to body hair transplantation, smaller areas transplantation
Advantages of FUT:
Larger areas of baldness can be covered in fewer sittings
Resection rate (the grafts that get cut whilst removing) may be lesser providing superior results. However the resection rate depends on several factors, like the curl of the hair, history of previous scar, previous hair transplantation, direction of hair growth, the skill of the surgeon and his or her staff etc.
However there is a transaction rate even in FUT technique as beginners and novices tend to damage some grafts whilst dissecting.
Preparing for the surgery
Both methods involve surgery hence a proper consultation with the surgeon is required who can explain the procedure and its advantages and disadvantages. It takes several hours to perform the surgery and implant hence it is important to block the day out completely and mentally prepare for it. Most surgeons will want to shave the entire head before embarking on the procedure so make sure that you factor it. Discuss your entire medical history and all the medication that you take regularly. It is important to have Blood pressure and Diabetes under control. You can have a good breakfast with your medication in the morning before the surgery. In the afternoon you will be provided with lunch in between the procedure. You might like to carry loose t-shirt and a cap so it’s easier to wear and to cover after transplantation.
Post Op: It is important to follow the post op instructions from the doctor and take good care of the grafts and use the medication recommended. Swelling of the scalp, face is common for a few days. You will be on antibiotics, steroids, painkillers for a few days and will be asked to use Minoxidil and or or Finasteride. The grafts are wetted with saline repeatedly for a few days after the transplant. Hair is washed with a diluted shampoo the next day in a specific manner without disturbing the grafts. The grafts will eventually fall out after 2 weeks and the new growth will be seen anywhere between 3 and 6 months. In FUT method, post op wound care of the scar is important and the sutures are removed 7 days afterwards.
Who should go in for FUE?
Suitable for people who have smaller areas of baldness
People who want to wear shorter hair styles
People with active lifestyles like sportsmen etc
Women with smaller areas of baldness, low density, parting showing through etc
People who prefer less invasive procedures and don’t want cuts, stitches
Those want faster quicker recovery
Who should go in for FUT?
If they have larger areas of baldness and they would like it covered in single sitting
Don’t mind cuts, stitches, longer recovery period
Cost for FUE is 30 rs/hair
Cost of FUT is 15 rs/hair
Contraindications (when HT cannot be performed):
If the person is too young below 25 yrs and with ongoing hair fall
If expectations are too high esp. people that have been wearing wigs are usually not as satisfied with hair Transplantation as it can never give them ‘wig type’ results
Undiagnosed hair fall. If it isn’t Androgenetic alopecia, the reason for hair fall needs to be identified. If they have burning, itching on scalp or rashes, then the condition needs to be identified and corrected
Trichotillomania- These people have psychological issues and they pull out their own hair and frequently become habituated to it. If their condition is active they need psychiatric counseling
Low density on the back of the head- will not be able to produce enough follicles for transplantation and gives poorer results
If they have multiple medical conditions or heart problems, uncontrolled diabetes or hypertension,
Keloid tendency etc
Different clinicians set different limits. I am not comfortable doing HT on anyone below the age of 25 esp. if they have ongoing hair fall. Ages 25-28 can be considered provided hair fall has decreased. High age >65 with multiple medical problems or if they have uncontrolled diabetes, high blood pressure, h/o heart problems also are best avoided.
What should you look for?
Doctor/Surgeon performing the procedure should be:
An AHRS certified doctor/surgeon
Dermatologist who has had extensive Hair Transplant Training and experience
Doctor/Surgeon/Dermatologist that has had recognized training by a pioneer in the field of Hair Transplantation
These surgeons and doctors must be performing Hair Transplant Surgeries regularly and frequently
So, check on the qualifications, check if the surgeon is performing the procedure on you himself as a lot of them allow their technicians or quacks to perform the surgery on you. Whilst a lot of surgeons rely on their technicians for help and with implantation, the supervision and presence of a Hair Transplant surgeon is very necessary and he should be designing your hairline himself. A good surgeon also extracts the follicles himself as this minimizes the transection rate (when a follicle is cut midway whilst extraction or dissection, it’s called transection)
Cost cutting and downright low rates don’t mean quality. If a surgeon is offering very low rates, it’s most likely he is getting his technicians to perform the surgery or is putting you in a trainee’s hands.
Do your research about the surgeon that will be operating on you, check whether he is performing the surgery on you himself and ask to see their before and after results of HT’s they have done themselves.