This comprehensive guide provides you with an in-depth understanding of FUE hair transplant surgery, including,the ideal candidates for the procedure,what to expect before,during, and after the surgery,the risks and complications,and most frequently asked questions.
What Is An FUE Hair Transplant?
A Follicular Unit Extraction (FUE) hair transplant is a surgical procedure that involves the extraction of individual hair follicles from the skin and their subsequent transplantation to another area of the body.
The success of this technique relies on the principle that the tightest zone of attachment of the arrector muscle to the follicular unit enables the extraction of intact follicular units.
For the FUE procedure, the area of attachment is first loosened and separated from the surrounding dermis. This separation allows for the easy extraction of the lower segment of the follicular unit.
Surgeons utilize micro punches, which are small instruments, to precisely extract single hair follicles from the donor site. The extracted follicles are then carefully transplanted to the desired recipient area.
Due to the precision of the micro punches used during the procedure, the extraction sites are minimal and heal quickly. As a result, there is minimal scarring.
Suitable Candidates for FUE Hair Transplant
Candidates for FUE Hair Transplant :
- FUE hair transplant is suitable for patients who prefer to wear their hair very short and cannot accept a visible linear scar.
- It is recommended for patients with limited hair loss or those who require small sessions.
- Patients with androgenetic alopecia in Norwood class 3 pattern or small vertex balding areas are potential candidates for FUE hair transplant.
- FUE can be used to treat widened scars resulting from traditional strip excisions.
- Individuals with inadequate laxity in their skin for a strip excision procedure can opt for FUE.
- FUE is suitable for patients with scarring caused by dermatologic conditions, trauma, or neurosurgical procedures.
- Patients who tend to develop wide or thickened linear scars after surgeries can consider FUE.
- FUE hair transplant is a viable option for athletes who need to resume full activity immediately after the procedure.
- Patients who have an excessive fear of pain or visible scars may find FUE to be a suitable choice.
FOX test for FUE transplant is as follows:
- The FOX test considers the varying tightness of follicular units in the dermis.
- The surgeon extracts approximately 100 grafts from the donor area for evaluation.
- The number of complete and incomplete follicular units extracted is assessed.
- If the extraction is easy and complete units are obtained, FUE is deemed suitable.
- If the extraction is difficult or incomplete units are extracted, the surgeon should consider using the strip technique instead.
|All follicular units extracted intact, least difficult harvesting
|Excellent. FOX positive
|Significant loss of surrounding fat or <20% amputation
|Good. FOX positive, difficult in subsequent sessions due to scarring
|Difficult emergent angle
|Questionable. Greater surgical skills, experience, and orientation needed. FOX neutral
|Significant surrounding fat avulsed, amputation of many follicles
|Poor. FOX negative
|Significant damage to most grafts, upper portion avulsed from lower
|Poor. FOX negative
Procedure For FUE Hair Transplant
The procedure for FUE transplant is described as:
- The FUE hair transplant procedure starts by administering local infiltration anesthesia to ensure patient comfort during the operation.
- Using a micro punch tool with tip diameters ranging from 0.6 to 0.85 mm, individual grafts are meticulously extracted from the donor area.
- After the extraction, the surgeon creates a series of small incisions using a needle or another small, sharp tool at the recipient site where the extracted follicles will be inserted.
- The extracted grafts are then carefully inserted into these tiny incisions, ensuring that they are placed in the correct direction with the hair roots facing inward.
- Once the grafts are inserted, the surgical area is cleaned, and appropriate bandages are applied to facilitate the recovery process.
Targeted Areas For Treatment
- The primary target area for FUE hair transplant is the scalp, where it is most performed.
- In addition to the scalp, FUE can also be utilized on other parts of the body that have thinning or absent hair.
- Areas such as the arms, legs, and even the genital area can undergo an FUE hair transplant to address hair loss concerns.
Benefits Of FUE Hair Transplant
Benefits of FUE Hair transplant :
- FUE hair transplant allows patients to sport short hair, providing them with the freedom to style their hair as desired.
- The recovery time after FUE is minimal compared to other hair transplant techniques, allowing individuals to resume their regular activities sooner.
- The microscopic scars left in the donor area are almost invisible. The individual extraction of donor follicles results in tiny dot scars that are typically undetectable, even with a very short haircut.
- Unlike other techniques that require stitch removal, FUE eliminates the need for subsequent visits to the surgeon for suture removal.
- FUE offers the unique advantage of utilizing body hair for added density, providing more options for patients with limited donor hair on the scalp.
- FUE can effectively cover preexisting scars from previous strip surgeries, providing a solution for those seeking to address the appearance of scars.
- The healing process is easier with FUE as no sutures are required to close the extraction sites. Patients can engage in normal activities within a few days after the procedure.
FUE Vs. Other Hair Transplant Techniques
Comparing FUE with other hair transplant techniques:
FUE v/s FUT (Strip Method)
|Less painful recovery period than FUT
|Stitches are required
|No stitches required
|Longer recovery time
|No linear scarring
|Longer healing time
|Short hair is possible without visible scar
|Less comfortable recovery period
|Donor site heals quicker than FUT
|Possibility of visible scarring
|Scars require longer hair to cover them
|Lower yield of hair compared to FUT
|Cheaper than FUE
|More expensive than FUT
|The procedure takes less time
|Larger sections of scalp need to be shaved
|Easier to perform larger transplant sessions
|More time-consuming procedure than FUT
|FUT first, then FUE if further treatment needed
FUE Vs. Robotic Hair Transplant
|FUE Hair Transplant
|Robotic Hair Transplant
|Entire procedure performed manually
|Half of the procedure performed automatically
|Suitable for various hair textures
|Limited to patients with dark, straight hair
|Can be performed on African or Caribbean hair
|May not be suitable for all hair types
|Utilizes manual FUE punches
|Uses larger diameter punches
|Lower risk of healing complications
|Increased risk of healing complications
|Less potential to damage nearby follicles
|Higher potential to damage nearby follicles
Preparing For FUE Hair Transplant
Two weeks before the procedure:
- Avoid taking vitamins and supplements that can thin your blood.
- Refrain from consuming aspirin or NSAIDs, as they also thin the blood.
- Avoid tea and protein shakes, as they have blood-thinning properties.
- Stay away from alcohol in any form, as it acts as a blood thinner.
One week before the procedure:
- Cease activities such as jogging, running, and weight lifting to preserve platelets, which aid in clotting.
Three days before the procedure:
- Prioritize getting sufficient sleep to ensure a well-rested state.
The morning of the hair transplant:
- Take a shower and thoroughly shampoo your hair, paying attention to scrubbing your scalp.
- Have a nutritious breakfast to provide energy for the procedure.
Recovery And Aftercare Tips
After 6 hours of the surgery:
- Remove the bandages from the back of your head.
- Take the prescribed antibiotic and painkiller provided to you.
- During sleep, ensure that the pillow does not touch the implanted area.
- In the morning, use lukewarm water to shower the back of your head and gently wash away dried blood clots.
- Spray the implanted area every two hours with the provided solution, using 2-3 squirts.
- gently soak your entire head with a lukewarm shower for 15-20 minutes. If needed, use a towel to carefully absorb any remaining water, avoiding rubbing.
- After soaking for 15-20 minutes in the bath or shower, wash the implanted area with baby shampoo using gentle finger movements to remove small crusts.
- Repeat this daily until the crusts at the implanted area fall off. Do not rub the crusts.
Note: The upper visible part of the hairs may fall off with the crusts, but the hair follicles remain in place.
- Avoid consuming alcohol for a few days after surgery to prevent thinning of the blood, which can hinder the healing process.
- Refrain from taking vitamins, ibuprofen, and arthritis medications in the initial days, as they can thin the blood and cause excessive bleeding.
- Follow the instructions for taking prescribed medications, including pain relievers, antibiotics, and prednisone.
- Avoid engaging in vigorous physical activities for one week.
- Keep the upper part of your body elevated whenever possible.
- If there is light bleeding, gently apply pressure using a moist clean cloth.
- Avoid using warm air to dry your hair for at least 5 days after surgery.
Contraindications For FUE
Contraindications for FUE transplants are:
- Lack of experience in performing FUE techniques.
- Absence of proper instrumentation required for the procedure.
- Unrealistic expectations from the patient regarding the outcome of the surgery.
- Insufficient availability of donor supply, such as an inadequate amount of healthy hair follicles.
- Existing scarring in the donor area could affect the success of the FUE procedure.
- Patients falling under FOX grade 4 and 5 categories indicate severe hair loss and limited donor hair.
- Patients who are unwilling to undergo long sessions lasting several hours or multiple sessions due to the slower nature of the FUE process.
- Individuals who are unwilling to cut their hair short make women less suitable candidates for FUE.
- Large bald areas that require more than 2500 grafts, exceeding the capacity of the FUE procedure.
Potential Risks And Side Effects
- Edema (5%): Swelling of the scalp after the procedure.
- Bleeding (0.5%): Occasional bleeding during or after the surgery.
- Folliculitis: Inflammation of the hair follicles.
- Numbness of the scalp: Temporary or rarely permanent numbness, especially if dissection remains superficial.
- Telogen effluvium: Uncommon hair shedding at the donor or recipient site due to stress and microtrauma.
- Epidermal cysts and Ingrown Hair: Rare conditions that can trigger an inflammatory response affecting the grafts.
- Infection: Occurs in less than 1% of patients and requires treatment with warm compresses, shampooing, and antibiotics.
- Crusts: Scabs that may appear in the donor area.
- Pinpoint Scarring: Small scars, almost invisible to the naked eye, which may be more visible in individuals with darker skin types.
- Buried Graft: Grafts pushed too deep into the dermis, usually caused by improper alignment or the use of a blunt punch.
- Donor Site Depletion: Patchy appearance of the donor site due to aggressive and non-uniform graft removal, regardless of the punch type used.
How Much Does An FUE Hair Transplant Cost In India?
In one session of FUE, the patient can receive 500 to 3,500 grafts. The cost per graft typically ranges from Rs. 36 to Rs. 45.
- For 1st-grade baldness, approximately 700 to 1,200 grafts are needed. The cost for this range of grafts is around Rs. 22,000 to Rs. 40,000.
- 2nd-grade baldness requires approximately 1,500 to 1,800 grafts, costing around Rs. 29,000 to Rs. 50,000.
- 3A grade baldness may require up to 1,500 to 1,900 grafts, with a cost ranging from Rs. 40,000 to Rs. 60,000.
- The 4th grade of baldness typically requires around 1,400 to 2,300 grafts. The cost for this range is between Rs. 32,000 and Rs. 65,000.
- For 4A grade baldness, 1,800 to 2,500 grafts are used, with a cost ranging from Rs. 45,000 to Rs. 70,000.
- 5th-grade baldness may require 2,000 to 2,500 grafts, costing around Rs. 50,000 to Rs. 80,000.
- If the number of grafts exceeds 4,500 to 6,000, the patient will likely require multiple sessions. In these cases, the cost per graft decreases, ranging from Rs. 30 to Rs. 45.
Advancements in FUE
New advancements in FUE are as follows :
Follicular Isolation Technique (FIT): FIT is a variation of FUE that uses a punch with a ‘stop’ to control the depth of penetration. This term is used when the entire hair unit is not being captured, making it a more precise description.
Automated FUE hair transplantation: The FUE Matic machine is an automated system designed to assist doctors in performing FUE hair transplants. It allows for a faster extraction rate of grafts within a limited timeframe. However, this method carries a higher risk of graft damage due to increased pulling and twisting.
Robotics in hair transplantation: Robotic techniques involve an automated system that performs half of the procedure, while the transplantation section is conducted by the surgeon. The AARTAS machine is commonly used for robotic hair transplants, but it is primarily suitable for patients with dark, straight hair.
These advancements in FUE have brought improvements and efficiency to the hair transplant process. The use of automated systems and robotics aims to enhance accuracy and speed, providing better results for patients undergoing FUE procedures
FUE hair transplant is not painful due to the application of anesthesia during the procedure. Although rare, some patients may experience a headache afterward, which is considered normal. However, as the healing process progresses in the following days, the patient typically experiences minimal to no pain.
On average, the FUE procedure typically lasts around 6 to 8 hours. However, if the extent of balding is relatively small, a single session of FUE may suffice for the patient’s needs.
Hair transplant procedures, specifically FUE, are available for women if necessary. Unlike male pattern baldness, identifying genetic female pattern hair loss or determining the underlying cause can be less straightforward in women.
Therefore, a comprehensive assessment is required to evaluate the suitability of a hair transplant for female patients.
To ensure a natural appearance of transplanted hair, it is crucial to select a hair transplant surgeon who utilizes high magnification to accurately observe the direction of existing hair.
This allows for precise guidance during the implantation process. Additionally, the use of high-quality titanium or stainless-steel blades instead of easily dulled needles for making incisions ensures minimal scarring and promotes faster healing.
These measures contribute to achieving the most natural-looking results after a hair transplant procedure.
With the FUE technique, there is minimal to no visible scarring. This is because the grafts are extracted individually, eliminating the need for stitches, unlike the traditional strip method.
The scalp typically heals within two weeks after the procedure. Within three to four months, patients will observe the growth of new hair, indicating successful transplantation.
Within the timeframe of 3 to 6 months following the hair transplant, approximately 60-70% of the transplanted hairs begin to grow. However, their appearance may still be fragile, which is influenced by the level of care they receive.
As the first year progresses, you will observe that most of the implanted hairs have grown and taken on a more natural and thicker appearance.
The success rate of FUE hair transplants is exceptionally high, ranging from 95% to 100%. For an FUE hair transplant to be deemed successful, a minimum of 60-70% of the grafts must survive.
This success rate applies not only to the crown area of the hair transplant but also ensures that clients achieve satisfactory hair growth and coverage.