Popular FUE Technique: Definitive Guide

FUE Technique: Definitive Guide

The FUE Technique is a minimally invasive technique used in hair transplantation, it is a surgical procedure where the hair follicles are extracted individually (also known as a one-to-one technique), all this without the need to make a surgical linear incision in the scalp. It is an advanced technique with a minimal scarring process (punctuation <1mm), no suturing is required and it allows treatment to cover areas from small to total.

Today, the controversy is no longer based on whether or not hair transplantation works; but in what technique is the best to do it. FUE technique, with its multiple variants, is shaping up to be the winner in this race where every day the number of doctors and patients who are adept at it increases.

As we commented, basically, the hair transplant is to make a redistribution of head hair, to give the perception of normal hair. In short, it is to pass hair from an area where it abounds (the donor area), to an area where hair has been lost for various reasons (the recipient or implant area). The way to extract the hair from the donor area determines the technique that is being used. 

Extraction techniques

There are two extraction techniques:

  • TStrip Technique or FUT (Follicular Unit Transplantation)
  • FUE Technique (Follicular Unit Extraction).

In the technique FUT, an incision is made of the scalp in the donor area with a scalpel and a "strip" of follicles is removed. Subsequently, the follicles are dissected, producing a set of grafts individual. The surgeon then makes small incisions where the follicles are implanted.

The strip technique was the first follicle removal technique to be used. Despite being performed by an experienced surgeon, a visible scar is usually seen in the donor area. This inconvenience worries many patients.

Due to this, the FUE technique, a new extraction technique in which an incision is not required to extract the follicles and therefore, recovery is faster and subsequent healing is less visible. 

What is the FUE technique?

The FUE technique is a method of hair transplant widely used. It is an outpatient procedure, so it does not require hospitalization to perform it. The patient arrives at the clinic where the procedure is performed, and that same day, the patient goes home to rest. Depending on the case and the number of follicles to be implanted, the procedure can last from 3-10 horas.

The FUE Technique is a minimally invasive technique used in hair transplantation, it is a surgical procedure where the hair follicles are extracted individually (also known as a one-to-one technique), all this without the need to make a surgical linear incision in the scalp. It is an advanced technique with a minimal scarring process (punctuation <1mm), no suturing is required and it allows treatment to cover areas from small to total.

FUE: Extraction of Follicular Units

The most important feature of the FUE Technique is the method of extracting follicular units for the hair graft. It is carried out by means of a “punch” or punch. The advantage of this type of procedure is that a visible scar is not observed in the donor area, when performed by expert hands and with the appropriate technology, which can be very important in patients who want to use short hair.

The measurements of the punch used in "Follicullar Unit Extraction" ranges from 0.6 to 0.8 mm in diameter, leaving practically imperceptible micro-scars.

The motorized FUE technique is the most used today

Process in FUE Technique

The surgery consists of 4 stages:

1. Previous preparation of the patient:

At this stage, the patient is explained what the procedure costs, how it will be performed, the approximate duration of the procedure and possible complications. The recommendations to be followed before and after the procedure are also given and the patient's doubts are resolved. Depending on the place where it is performed, there may be more or fewer steps.  

Shaving the donor site

Due to the nature of the FUE technique, the hair in the donor area must be trimmed to the minimum length possible in order to perform the extraction.

The hair from the donor site is shaved to a length of 1 or 2 mm. Shaving it is essential for this technique, therefore, patients who are not willing to do it cannot be treated with it.

2. Extraction of follicles:

Local Anesthesia Application

The patient lies face down on the bed. Local anesthesia is applied to the donor area, so you can stay awake and conscious throughout the procedure.

The patient lies face down on the bed. Local anesthesia is applied to the donor area, so you can stay awake and conscious throughout the procedure.

Sometimes sedative medication is given to keep the patient calm during the procedure.

Follicular Unit Extraction

Subsequently, the follicles are extracted from the donor area, one by one, until the follicles necessary for the implant are obtained. 

The follicular units are extracted from the donor site with a 0,6 to 1 mm instrument, depending on the specialist, it may be necessary to use a magnifying glass.

The punch is drawn into the skin, tucked in the emerging hair, and pressed in the presumed direction of the hair follicle in the dermis and hypodermis. When the follicular unit has been deposited, it is gently removed.

The grafts are selected, verified and maintained under a maintenance solution. They are classified according to the number of hairs in each follicular unit and placed in saline or lactated Ringer's solution until they are ready to be implanted.

The extracted follicular units can have from 1 to 5 follicles depending on the hair quality of each patient.

3. Design of the implant area:

During this stage, the doctor explains to the patient how the grafts will be distributed. It is important that the patient agrees with the design that the doctor proposes in order to make the implant and that the patient is satisfied with the subsequent results. 

4. Implantation or placement in the grafts:

At this stage, the follicles are implanted one by one. Depending on the doctor and the place where the procedure is performed, there will be small variations in the implantation technique, but care must always be taken in the way the hair is implanted so that the result is completely natural. The implantation is the same for FUT or FUE, small incisions are made to make the recipient container and then insert the follicle. In some clinics we use "Implants" that perform the incision and inversion in a single time, in addition to allowing greater control of the angle, direction and depth of the implant.

To take into account ...

There are basic aspects to consider:

  • The front line of the implant.
  • The implant density.
  • The direction, angle and depth of the implant.
FUE Technical Infographic
FUE Technique Process

FUE Technique Indications

The FUE technique is indicated in the following cases, patients:

  • What do they need to incorporate immediately into their work, social life, etc.
  • With previous transplant surgeries
  • They require from any number of follicles within the safety zone
  • Who wish to have their hair short
  • With little skin laxity, since it makes it difficult to do it by FUT
  • With several FUT pre-procedures that make it impossible to repeat
  • What they want to do Body Hair Transplant (BHT)
  • With medium or large areas to cover
  • Having a history of poor healing or clotting
  • With scars

And the FUT or FUSS technique?

The FUT technique or “strip technique” continues to be used in many countries (including Mexico), although the preferences of both doctors and patients have changed and it is less and less practiced. It was thought in the past that a greater number of follicles could be obtained by means of FUT, but nowadays with the advancement of technology and the training of surgical teams, it is possible to carry out procedures with an even greater number of follicles by means of FUE.

Although it is still a slower method in the extraction of the follicles due to its nature, since being one by one requires a lot of technical skill and will always take longer than FUT, on the other hand with FUE there is less manipulation of the post-extraction hair allowing it to be maintained with greater vitality.

How do I know if I am a candidate for the procedure?

The most important requirements to be a candidate for the procedure is that you have a suitable donor area for the procedure, that is, that you have good capillary density, and that the thickness and strength of the hair are optimal. The best way to know if you are a candidate for the procedure is through the assessment of a hair specialist.

How is the extraction of follicles carried out?

As we mentioned previously, the structure that gives rise to the hair that we see on our head is the follicle. The follicular units they generally contain multiple hairs, that is, from a single point they grow from 1 to 5 hairs. The basic procedure of the FUE technique consists of identify a follicle in the donor area and extract the individual unit with the help of a device known as "Punch". Unlike the strip technique, the FUE technique does not produce such a visible linear scar. However, if the hair is left too short, they can be seen hypo-pigmented maculesIn other words, a slight white streak in the area where the follicle that was removed was located. 

The extraction of follicular units known as the FUE technique is delicate and requires a high level of preparation by the surgeon, working with an optical magnification to precisely discover the angle of implantation of the follicle and follow the path as it is inserted into the skin. The angle of the sprouting hair is generally sharper than the angle of implantation of the follicle in the dermis. This makes it essential that the orientation of the follicle is followed rather than the direction of the hair.

The instrument used for the implantation must have a size of 0.8 mm, this is the diameter sufficient not to alter the structure of the follicular units made up of more than one hair follicle. An advantage of this method is the result of undetectable micro-scars unless the hair is fully shaved.

Upon entering the follicle is rotated slightly while applying pressure to pierce the skin, these measurements are essential to keep the transection rate low and produce a maximum number of viable follicular units.

It is important that the doctor discuss with each patient the convenience of applying the FUE technique. The follicles should not be too tight for the piloerector muscle for the technique to be viable.

With this technique, the area of ​​follicular protuberance is not detectable, which is essential for the survival of the follicular unit once transplanted. This is because the extraction procedure is a blind collection technique.

It is also important for the surgeon to note the different depths of hair follicles that are closest to each other on the surface of the skin during the extraction phase. This means that the implantation direction of the entire hair follicle is not linear. Therefore, during the puncture removal procedure, the surgeon must change the angle once the surface portion of the follicle has been exceeded.

Once completely separated, the follicular units are gently harvested to avoid trauma to the follicular structures.

FUE Technique Variations

Hair Transplant Robot
The robotic FUE technique is in the process of improvement, but it promises an interesting future

Depending on the doctor and the place where the procedure is performed, there are variations in the way to carry out the extraction: 

  • Manual punch: In this type, a "Punch"Handbook. These devices have a hollow tip, with which a micro-incision is made around the follicle. They generally have a diameter of 0.8 to 1.5 mm. Once the incision is made, the follicles are manually removed one by one, using forceps or forceps
  • Motorized and automatic “punch”: In the variant motorized the device "Punch"It is coupled to a micro-motor, so the incision is made automatically; although the surgeon has to control the device manually and make the micro-incisions one by one. The follicles are then removed manually using forceps or small forceps. On the device automatic, the "Punch" It is attached to a suction system. In this way, the follicles are aspirated and do not have to be removed manually. 
  • Robotic extraction: It was developed by a North American company. The system known as ARTS, use a robot that has a camera system controlled by computer software that guides the process of extraction of the follicles. The cameras they take pictures of the scalp and the computer analyzes the data using complex algorithms that predict the location of the follicles. Using this information, a robotic arm with a device "Punch" coupled to it, it makes the incisions and collects the follicles. 

Implementation Techniques

Stick and place

Its name, "paste and place", is a surgical technique that comes from a needle to extract the follicle from the donor area to immediately implant it in the recipient area. In this way, the procedure will be a movement without pauses.

Implants

In this technique, an instrument called "Implanter" is used. This instrument is shaped like a ballpoint pen and helps to extract the follicle as if it were a dropper; that is, it takes the part of the follicle and then "sucks" it, to finally implant it, by means of a push, in the receiving area. The benefits of using this method are that you have better direction, angle and depth to transplant into the follicle. Just like it's direct.

DHI technique (Direct Hair Transplantation)

It is a method that is used to implant hair faster, because what it does is that, unlike the FUE technique, it preserves the life of the follicles so that when they are extracted they are transplanted to the area to be grafted . Its function is simultaneous, since at the same time it extracts the follicle, it immediately grafts it where it is required. The procedure is as follows: a microinsition is made in the hair with the help of a device called a “puch”, then the follicle is extracted with special tweezers to finally apply them to the receiving area.  

For its realization, it must be taken into account that the patient must shave his hair so that they can be extracted more easily from the area. Subsequently, a small insertion will be made in the area to be able to extract it. And finally, healing will be quick if the patient properly performs the care that the doctor left him.

FUE Sapphire Technique

For hair transplantation, this technique is also used, which consists of making an insertion using sapphire blades or a razor blade to extract the follicle and then implant it in the receiving area. The insertions that are made vary in size but are minimally noticeable.

What is the ideal donor area for the FUE technique? 

The donor area for a transplant using the FUE technique is the posterior area of ​​the head, specifically the occipital and parietal area, this means neck area and back sidesAlthough in some cases, when the density of the back is inadequate, hair can be obtained from other areas of the body. 

How long does the transplanted hair last?

Because the genetics of these follicles is different from that of the frontal zone follicles, these follicles are not lost in cases of androgenetic alopecia; therefore, once they survive the transplant procedure, the implanted follicles they are permanent. As it is natural hair, implanted hair behaves like natural hair. Therefore, it will grow and you will put it cut and comb it without problem.

How are the follicles implanted in the FUE Technique?

The way the grafts are implanted will also depend a lot on the place and the doctor who performs the procedure. In one of the techniques used, first incisions are made in the recipient area, where the grafts will be placed. It is important to control the angle, direction and depth of incision so that the end result looks natural. The size of the incision will depend on the follicle to be implanted. For follicles of a just hair hypodermic needles are used with gauges ranging from de 0.7 to 0.9 mm. For multiple follicles with 2-3 hair needles with diameters of 1.0 to 1.1 mm. The depth of the incision will depend on the length of the patient's follicles, as well as the design of the front hairline.

Some doctors also use special implants to perform the graft. These devices are shaped like a retractable pen, they have a hollow needle at the tip, where the follicle is inserted. The advantage with implants is that the incision and grafting of the follicle is done in one step. Perfecting the use of these devices generally takes a few years. 

What is the ideal density after a hair transplant?

The density will depend on each case, it is not possible to speak of a specific number since this can vary taking into account the hair quality of each patient. 

How many follicles can be implanted in one session? 

Review of follicles in FUE Technique
The follicles are reviewed one by one to assess their distribution and quality

Again, the number of follicles that are implanted per session will depend on each particular case. Most surgeons perform sessions in which they graft 1000 to 5000 follicles per session. However, when hair loss is extensive, several sessions are sometimes required to achieve adequate coverage. 

How many sessions are needed with the FUE Technique?

The FUE technique requires a high surgical training by the surgeon, the integrity of the follicles at the time of extraction, as well as their temporary manipulation until implantation will be vital and requires careful care.

Depending on the severity of the case, one or more sessions may be required. It is recommended to discuss it with your doctor and give you an honest opinion about your needs. It is important to understand that no one can assure you of a high density result with a single session, even though the most common thing is that one session is sufficient, the doctor in turn depends on the thickness and quality of the hair. For this reason, the guarantees are more aimed at straightened hair than at the level of coverage, because International quality guidelines absolutely prohibit overpromising and guarantee that the most spectacular result will always be with just one session.

Are there any complications after the procedure?

Due to the minimally invasive nature of surgery, the risk of complication is extremely low. However, it is not without complications. Especially if the patient does not follow the doctor's recommendations. The main complication The procedure is that there is subsequent inflammation of the face, which can be mild to severe. However, this inflammation is not dangerous and lasts for a few days. 

Doctor reviewing a patient to do FUE Technique
It is important that you mention everything that you consider important to your doctor to avoid complications

What care should I have after the procedure?

A series of post-procedure care. Approximately needed 5 - 10 days so that the grafted follicles are completely fixed to their new area. The most important is do not touch the implant area, do not expose yourself to the sun, do not make intense physical effort, do not drink alcohol. It is also required to be very careful when cleaning the implant area during this time. Because care is focused on the implant site, most patients are able to resume much of their activities the day after surgery. In later videos we will talk in more detail about all the care required, so don't miss out.  

How long does it take to see the result?

The transplanted hair goes through a process lasting approximately one year, it can vary depending on the patient. During this period it will go through different stages; but we can start to see growth approximately 4 to 6 months after the procedure and more or less after one year almost everything will have grown.

If you are interested or are already determined to have a hair transplant procedure, you should go to a specialized clinic.

FUE Technique Video

More information

  1. Harvard Health: https://www.health.harvard.edu

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Dr. Enrique Orozco
Dr. Enrique Orozcohttps://dreoclinic.com/
General Director, Specialist in Trichology and Hair Transplantation Certified by ABHRS. Only ABHRS Certified with residence in Mexico.

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Dr. Enrique Orozco
General Director, Specialist in Trichology and Hair Transplantation Certified by ABHRS. Only ABHRS Certified with residence in Mexico.

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