FOLLICULAR UNIT EXTRACTION
TECHNIQUE (FUE) FOR SCALP
HAIR TRANSPLANTS

The Root of the Problem:

The cause of baldness is no longer a mystery. Research has confirmed that hair loss is inherited like the color of the eyes. The gene can be inherited from the mother or father’s side, more from mother’s side .The hair follicles are genetically coded. If hair loss genes are present, the hair follicles on top of the head (and not at the back of the head) possess receptors, which are sensitive to the hormone dihydro-testosterone, or DHT. These genetically “programmed” hair follicles begin to shrink in adulthood. When this occurs, the hair follicles grow finer, smaller, lighter in color, shorter and less deeply rooted- hence they are called miniature hairs. In most cases, this “thinning hair” will progress to “baldness” when the shrinking follicles finally stop producing hair and results in baldness. The onset, rate, and severity of hair loss are largely dictated by genetics, hormones, lifestyle and age.

Androgen’s (testosterone, dihydro-testosterone) are necessary for the development of baldness(MPHL) .The blood levels of androgen are normal. It is the sensitivity of the hairs to the hormones which is  abnormal. It is important to note that even in the most extensive cases, a horseshoe-shaped fringe of hair remains in the back of the scalp. This hair-bearing fringe is insensitive to hormones and usually will last a lifetime because hair in this area lacks the androgen receptors required for hormones to work on hair. These hairs, when transplanted into thinning or balding areas, grow and continue to grow for the rest of a person’s life – This is the principle of hair transplantation.

How is hair transplant performed?

The hair in the back of the scalp is genetically programmed and is insensitive to the balding process –hence is the basis for transplantation as they usually will last a lifetime. The transplanted hair is removed from back of the scalp (donor site) and transferred to another (recipient site). The transferred tissue is not “rejected” as it is your own tissue, not a foreign tissue.

There are grossly two techniques in hair transplantation – Strip surgery (also known as FUT) and FUE (Follicular unit extraction).

In strip surgery, a strip of skin is taken from occipital scalp and hair follicular units are dissected out of it and implanted in bald area. The donor site is closed with stitches.

In FUE, instead of excising a linear skin strip, directly individual hair follicular units are extracted known as grafts. Then these grafts are implanted in back in bald area.

Follicular unit with multiple hair

Follicular unit with internal root splay

Procedure of FUE

There are essentially two steps in transplantation – extraction and implantation.

  1. After clicking pre operative photographs and discussing the goals of surgery, hair line is designed depending upon patient’s wishes and his facial anatomical requirement. We do always suggest a hair line which will look natural on patient’s face according to his facial shape and age. But hairline is absolutely personal choice and the final decision on what type of hairline and the level of hair line, we leave it up to patient.
  2. Next we trim patient’s hair to zero level. (few exceptions like small case).
  3. After taking the patient in operative room, we make patient lie down in the operative chair. The donor area is prepared with local anaesthesia.
  4. The follicular units are then extracted one by one from the donor area. Extraction is planned depending upon the number of grafts needed and the availability of grafts.
  5. After extraction, the recepient area is prepared with local anaesthesia.
  6. The follicular units are then implanted using special implanters and implantation technique over the recipient area. The procedure is simple for the patient to undergo, though time consuming (lasting for 4-6 hours depending on the number of hairs to be implanted).
  7. Very little pain is experienced during the procedure. Some discomfort is to be expected as the anesthetic is injected into the scalp. Once the skin is anesthetized, there is no pain.
  8. We apply a bandage on the donor area which patient has to keep for that night and remove next day morning.

Post operative instructions are mentioned in detail to the patient and  the same is given in a sheet.

Our Expertise:

Both the steps, extraction and implantation, though sound very simple and uniform from clinic to clinic, there is a great deal of detailing in both of them.

Extraction is the step which decides the quality and quantity of grafts extracted. Extraction tool is one of the key instrument in this. We at Siddharth Hair Transplant use Dr Trivellini’s mamba device, which is one the cutting edge device which allows us different settings for the graft extraction eg. speed of motor, size of graft, depth of punch, design of punch, different modes like vibration, oscillation, rotation which inturn are soft on graft and gives better quality healthy grafts. This device has minute adjustments as to cycle time as small as in milliseconds which gives precise duration. With all these precision, it also is soft and gentle to the grafts. The machine allows surgeons skill to combine with the technology making it a win – win situation. You will come to know more about it when you are undergoing the procedure and how important it is to have good quality, full and healthy grafts in order to have good results.

Implantation is the step in which we need to insert the grafts without traumatizing them at all in the process. There are different implanters of different size, shape and sharpness available for this. There are some techniques in which implantation can be done without implanters and with better density. We perform implantation by drop technique combining it with implanters in few cases, in which we do not compromise the hair root at all and are able to slide in the root with utmost gentleness and at the same time able to achieve very high density. This is why we are able to perform ‘Dense FUE’ sessions when number of grafts permit and bald area is small to cover. Implantation technique one needs to master for proper implantation. As we are exclusively doing hair transplant, this is what we do everyday, morning till evening increasing our experience and expertise due to which we are able to deliver desired results.

Often more than one session may be needed, depending on the 1) area of scalp treated 2) the number and size of grafts used and 3) the density which the patient desires 4) the individual characteristics of the patient, e.g. coarse hair will provide a more dense look than fine hair.

Number of grafts that can be extracted in first sitting varies form person to person. We have developed expertise in doing big sessions with 5000 to 8000 grafts where we take scalp hair and body hair as source of supply. These are big sessions lasting for 2-3 days sometimes. Its not routine in every case but we can perform it when needed.

You will experience it all when you undergo the procedure with us!