Follicular Unit Extraction (FUE)

What Is FUE Hair Transplant?

Follicular Unit Extraction (FUE) is a minimally invasive hair transplant technique that involves extracting individual follicular units directly from a donor area, typically the back of the scalp, and implanting them into balding or thinning areas. This method avoids linear scarring, creates a natural-looking hairline, and maintains the density of the donor area. Like the strip FUT method, FUE provides permanent results.

During FUE procedures, each graft is harvested individually with a small micro punch (0.7 mm to 1.0 mm in diameter). This device makes a small circular incision around the upper part of the hair follicle, which is then extracted, leaving a tiny hole in the scalp. This is repeated until the surgeon has enough grafts to complete the procedure. 

Diagram of Graft Extraction in FUE

A&B show scoring of follicular unite with micro-punch. Figure C shows removal of follicular unit with forceps.

Photo Showing Graft Extraction with Micro Punch in FUE

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FUE does not leave a linear scar in the donor area, which is an important advantage for patients who prefer shorter hairstyles. Post-operative discomfort is also reduced, and the donor area heals more quickly.

Excellent Healing and No Linear Scar 1 Week Post-Op

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Both strip FUT and FUE techniques have their own advantages and disadvantages, and in many cases, a combination of techniques works best. SMG’s expertise with both techniques enables our physicians to work with each patient to help them choose the best approach for their particular goals. This is part of the Shapiro Medical experience.

Example SMG FUE Patient #1

HOW FUE HAIR TRANSPLANT IS DONE 

HYBRID PUNCH AND OSCILLATION SYSTEM

At Shapiro Medical Group (SMG), we use the Hybrid Punch and Oscillation System for FUE extraction. The two main components of this technique are:

1. Using a hybrid flat punch instead of a sharp punch helps reduce damage and collect grafts with more protective tissue, improving graft yield. The hybrid punch has a flat front surface and cutting edges on the outside, pointed away from the hair.
2. A motorized system that produces variable-speed oscillation instead of constant one-way rotation to mimic the accuracy, sensitivity and control of a punch being held by a human hand. A highly sensitive foot pedal enables control over oscillation speed and arc.

This amazing advance was developed by Dr. Shapiro’s good friend, Dr Jean Deveroye in Belgium and we are proud to say that SMG was one of the first clinics to use this device. Since then, hundreds of clinics have switched over to it.

Before the development of the Hybrid System there was much controversy and debate over what FUE technique was the best. Much of the controversy centered around the differences between:

1) Sharp Punch Vs Dull Punch Technique; and

2) Manual Vs Motorized Technique. 

Each technique has its strengths and weaknesses. The beauty of the Hybrid Punch and Oscillation System is that it combines the best features of all these techniques while eliminating their weaknesses.

BENEFITS OF THE HYBRID PUNCH 

The Hybrid punch offers the following advantages: 

• It uses the power of sharp punches to easily penetrate the top layer of skin without distorting grafts. The thin wall and fast oscillation provide the cutting power of sharp punches. However, unlike sharp punches, it reduces the risk of transection (damage to the hair grafts) when the oscillation slows down and the punch goes deeper, allowing for healthier grafts with more tissue.
• It utilizes the benefits of blunt tip punches to limit transection. The flat, smooth tip of the Hybrid Punch allows the punch to go deeper without increasing the risk of damaging grafts, producing healthier grafts with more protective tissue around the follicle.
• It leverages the precision of manual techniques. The manual technique uses a slow oscillation movement to give the best feel and control while extracting grafts. This is the same movement used with the Hybrid Punch and Oscillation System but without the fatigue experienced by manual systems.
• It uses motorized techniques for easier alignment with hairs. The motorized oscillation keeps the punch aligned with the hairs, allowing the physician to focus on direction and alignment rather than the tricky rotational movement. This reduces fatigue and increases speed and accuracy.

At the 2015 Mediterranean FUE Workshop in Istanbul, Turkey, this system outperformed all other FUE devices, producing healthier follicular unit grafts with a higher survival rate. We believe the Hybrid Punch and Oscillation System will soon become the preferred technique for most surgeons. 

Shapiro Medical Group is one of the first hair transplant clinics in the world to master this procedure. Our physicians have been invited to speak about it at FUE hair transplant conferences worldwide.

FUE & BIO-ENHANCEMENT TECHNOLOGY

At SMG, we use bio-enhancement technological breakthroughs to get maximum growth from an FUE procedure. It includes using: 

• PRP/ACell Therapy to improve hair growth, survival, and healing.
• Liposomal ATP Therapy to supply the grafts with life-giving energy during and after surgery while they are re-establishing their blood supply.
• Low-Level Light Treatment (laser) to promote post-operative healing and maximum growth.

Example SMG FUE Patient #2

ADVANCED DONOR MANAGEMENT

One of the biggest challenges with FUE is obtaining a large number of grafts without depleting the donor area or making it look unnatural.  SMG addresses this with several advanced techniques, including:

• Selective donor harvesting or splitting the more complex, larger follicular units to leave hair in the donor area.
• The use of PRP/ACell in the donor area to stimulate the regrowth of transected hairs or stems cells that may have been left behind
• The use of scalp micropigmentation to fill in the spaces in the donor area caused by higher numbers of grafts removed by FUE.

FUE ADVANTAGES & DISADVANTAGES

ADVANTAGES OF FUE

The main advantage of FUE is that it does not create linear scars, only tiny ‘dot-like’ scars that are almost unnoticeable. FUE also results in a more gentle postoperative recovery with quicker healing of the donor area. 

FUE is a good choice for the following patients:

• Patients who wear their hair very short (< 1 cm) and want to have less of a visible scar. 

In longer-haired patients, the linear scars produced with traditional strip FUT are thin and easily hidden by the remaining donor hair. With FUE, the donor area scar is virtually undetectable at hair lengths of less than 1 cm (if punches less than 0.9 mm are used and fewer than 5,000 grafts have been harvested). Although the risk of visible scarring is less with FUE, a shaved head may make the small white dots noticeable.

• Patients who want a less painful and quicker healing postoperative recovery in the donor area. 

It takes longer for a strip incision to heal, and there are physical limitations put on a patient after a strip FUT procedure that may last up to a month. In contrast, the donor area is virtually healed with an FUE procedure, and there are no limitations within a week or two after surgery.

POTENTIAL DISADVANTAGES OF FUE

• Graft transection.

When FUE first began, the incidence and degree of graft transection were high. High graft transection means an increased risk of lower graft yield. Fortunately, with improved techniques like the Hybrid Punch with Oscillation and experience, the transection rate can be less than 2 to 5%, similar to the strip method. 

However, the potential for high transection still exists in inexperienced hands, especially for patients with difficult characteristics like very curly hair or mushy skin.

• Fragile grafts.

Until recently, the grafts from FUE grafts were typically thinner and stripped of more protective tissue than FUT grafts, making them more fragile and susceptible to decreased yield. However, with the use of flat punches to obtain chubbier grafts and bio-enhancement techniques, the yield between FUE and strip FUT is narrowing and can be the same.

• The limited number of grafts available over the lifetime of the patient.

Most surgeons believe that more grafts can be harvested over the lifetime of the patient with strip FUT surgery than with the exclusive use of FUE. This problem may not apply to patients who need a lower number of grafts (4,000 to 5,000) or are early in their hair-loss journey.

To compensate for the inability to harvest all the hair from the permanent zone, many FUE surgeons harvest hair from the upper and lower margins of the original donor area and risk the hair being of poor quality or being non-permanent. 

Despite this limitation, the number of grafts obtainable from FUE is increasing with new paradigms for graft harvesting and donor management and with the use of bio-enhancement products such as PRP/ACell to stimulate new hair.

• Scarring.

Although FUE does not produce a linear scar, it does cause thousands of tiny punch scars and in some patients a “moth eaten” scar pattern can occur. This is less likely if a punch size of .9 mm or less is used and if the total number of grafts is less than 5,000. PRP/ACell in the donor area and selective harvesting may also limit this problem.

• The need to shave the entire donor area.

The FUE procedure requires that the entire donor area be shaved. For some patients, this is an aesthetic problem. 

At Shapiro Medical Group, you can choose from a variety of hair restoration options in a state-of-the-art facility. To know the best hair loss solution for you, schedule a consultation with our doctors today and start your journey to hair confidence.

WHO ARE GOOD CANDIDATES FOR FUE?

Generally, FUE hair transplant is suitable for young individuals (around 30-45 yrs. old), with minor hair loss, and prefer to wear their hair short. 

Other good candidates for FUE also include: 

• Patients with limited scalp laxity. 

Patients who have had multiple strip harvesting procedures and now have a tight scalp that would make further strip harvesting difficult. FUE can be used to obtain additional grafts from the scalp, beard and body without creating unnecessary risk on the donor scar.

• Patients who need a hair transplant repair.

Patients who have a widened linear donor scar from a prior hair transplant procedure can use FUE to obtain hair to camouflage this scar.

• Young patients with uncertain future hair loss. 

Young patients who currently need only a small amount of grafts, like in the hairline, but are unsure about their future hair loss, can benefit from FUE. Some of these patients prefer the flexibility to shave their head if they experience significant hair loss later on, instead of committing to more surgeries. 

With FUE, they have the option to stop after one or two small procedures and shave their head if needed.

FREQUENTLY ASKED QUESTIONS

How much does FUE hair transplant cost? 

The cost of an FUE hair transplant varies based on your surgeon’s experience, the number of grafts you’ll need, and the location of your provider. It’s typically priced per graft, so getting a consultation to assess your hair loss will give you an accurate estimate.

Which hair transplant method is better? FUE or FUT? 

The best hair transplant method for you depends on a lot of things, including the extent of your hair loss, scarring preference, the number of grafts needed, the quality of your donor hair, your budget, and lifestyle preferences. 

FUE offers minimal scarring and a natural-looking hairline, making it great for hairline reconstruction. On the other hand, FUT leaves a linear scar at the donor site but might be better for larger grafts or those with limited donor area. Consulting a qualified surgeon can help you choose the best method for you.

Can women get a FUE hair transplant?

Yes. FUE hair transplants are a great option for women’s hair loss. This minimally invasive procedure leaves minimal scarring, making it ideal for those who prefer shorter hairstyles. FUE also allows for transplanting smaller grafts, which can better address the diffuse thinning common in female hair loss. Still, you should consult a qualified surgeon if FUE is the right approach for you. 

How long is the recovery for FUE? 

The recovery time for FUE hair transplant is relatively quite short. Most patients can return to their normal activities within 1 to 2 days after the procedure. However, the scalp may take about 7 to 10 days to fully heal. Here’s a general timeline for recovery:

• First 1-2 Days: Rest and avoid strenuous activities. Mild swelling and discomfort are common.
• First Week: The donor and recipient areas will start to heal. Small scabs may form around the transplanted follicles and will typically fall off within 7-10 days.
• 2 Weeks: Most signs of the procedure, such as redness and scabbing, should be gone. Patients can usually resume their regular exercise routines.
• 1 Month: Hair shedding (shock loss) may occur, which is normal. New hair growth will start to become noticeable within 3-4 months.
• 6-12 Months: Full results will gradually become visible as the new hair grows and thickens.

FUE BEFORE AND AFTER PHOTOS