This highly advanced surgical follicular unit extraction procedure for hair loss has become the industry standard for high quality hair restoration. There is simply no better way to restore your natural hairline, hence why thousands of men around the world choose follicular unit extraction (FUE) as their preferred restoration method.
Follicular unit extraction offers the recipient:
Shorter recovery time than other hair surgery
Less scarring, almost invisible in many cases
A high level of hair retention
The most natural looking hairline
Just look at a few of the follicular unit extraction results (follicular unit extraction before and after pictures) recently achieved at Evolve Hair Clinic, globally recognized experts in hair transplant surgery:
FUE hair transplant surgery is an excellent technique in it’s own right and suits the requirements of most people, however at Evolve Hair Clinic we took the process one step further. We are recognized as global leaders in the development of combination procedures involving the use of both follicular unit extraction, and scalp micropigmentation. These two techniques work in tandem to create the most natural looking hair, with virtually unlimited density, regardless of how much donor hair you have at your disposal.
The client above had a FUE/SMP combination procedure. The result we achieved for him, as you can see, is outstanding.
For more information about our innovative combination service please see this page. To discuss follicular unit extraction in more detail, call us on 1-866-678-4330
WHAT IS FOLLICULAR UNIT EXTRACTION?
Follicular Unit Extraction (FUE) is defined as the removal of individual hair follicles, usually from the scalp. Follicular Unit Transplantation (FUT), on the other hand, is the re-implantation of these follicles into different areas of the scalp to replace hair that has been lost. However, most of the time when people speak about an “FUE procedure” it is understood that they are talking about both the extraction and the re-implantation (transplantation) of hair follicles during one surgical procedure. We will do the same in this and other articles from our clinic.
FUE hair transplant is a hair restoration procedure developed in 2002 by an American physician and his dedicated staff members. As with all medical/surgical improvements it modified an older technology to decrease the diameter of the extraction tools, to decrease visible scarring and to avoid the linear scar produced by the strip method of hair extraction.
Hair follicles, like all other body structures, have both nerve and blood supply. During FUE hair transplant a single follicular unit is removed and with each unit a small amount of surrounding connective tissue is also removed. This type of extraction has been shown to have a higher rate of follicle survival after transplantation because of inherently less damage to the follicular structure. The hair follicle survival rate for follicular unit extraction is usually upwards of 95% or more in skilled hands.
Hair follicles come in different sizes. The reason for this is that one hair follicle can have up to five hairs coming from it! Stated differently, an FUE hair transplant procedure with 2000 individual hair follicles will, on the average, mean that over 4500 hairs were moved from one scalp area to another. The number of hairs coming from one follicle also determine where on the scalp they are re-implanted. With experience physicians have learned how and where to implant the extracted follicles so that the end result of the transplantation looks natural.
THE FUE Hair Transplant PROCEDURE
The FUE hair transplant procedure extracts follicular units from one area of the scalp or body and moves the grafts to balding or bald areas. The procedure is performed under a local anesthesia and does not require sutures, extended recovery times, or hair direction change. In addition, FUE does not leave a linear scar on the back of the scalp, and the transplanted hair follicles do not undergo “shockloss”. (Shockloss is the transient loss of hair just after a hair restoration.) However the procedure on average does take longer to perform than a traditional strip linear procedure, but this slightly longer operative time is outweighed by the visibility of linear scars and the potential complications of a linear procedure.
The FUE hair transplant procedure may be broken down into 3 distinct parts:
Hair Follicle Extraction (Graft Extraction)
Recipient Site Creation (Graft Site Incisions)
Follicular Transplantation (Graft Placement)
1. Hair Follicle Extraction
Hair follicle extraction is the taking of the grafts from a donor region, usually the back and sides of the scalp, that is not susceptible to genetically related male pattern baldness. Extraction is laborious and time consuming, and requires experience and expertise. Extraction generally takes about four hours, typically lasting from 8AM to 12PM at our clinic. The patient will sit upright and watch movies or chat.
2. Recipient Site Creation
The second part of a follicular unit extraction procedure is creating the places to insert the grafts for transplant. Graft site incisions are typically done by the physician, Dr. Maragos in our case, and take between 30 minutes and an hour to make. This also is a skill, an art form if you will, because incision sites dictate where the hair follicles will be re-implanted, at what angle the hairs will grow, and what the new hairline will look like.
3. Follicular Transplantation
Graft placement is the part of the procedure requiring the most skill in hair restoration. Every hair restoration clinic must have skilled hair technicians and/or technologists. Operative skill level divides the typical technician from the seasoned technologist. Evolve Hair Clinic is fortunate to have two hair technologists with over 14 years of scalp grafting experience. Graft placement typically takes four hours or less.
Unlike some clinic reports, we believe that FUE hair transplant in some shape or fashion is for everyone. FUE hair transplant may be performed even in over harvested strip areas, low hair density donors, highly curly-haired individuals, etc. However, the previously mentioned difficulties are best managed by an experienced staff such as at Evolve.
THE PHILOSOPHY BEHIND FOLLICULAR UNIT EXTRACTION
As with all newer surgical procedures, Follicular Unit Extraction went through an initial slow-growth period. Generally speaking, surgeons and practitioners need convincing before they will change from the procedure they know how to do to a procedure that is new and untested, and rightly so. Changes in philosophy and approach to medical problems take time, and along the way surgeons and technicians gravitate toward a new procedure only if it agrees with their overall treatment philosophy, and it is in their technical skill set to do so. Those who continue with the procedure are those for whom the procedure “works” (their clinical follicular unit extraction results are as good or better than before and their patients are grateful).
Even before convincing individual surgeons of a procedure’s efficacy the earliest surgeons need to partner with medical instrument companies to engineer the tools necessary to do the new procedure. This includes instrument modification or creation to allow the operators to perform the surgery with a low complication rate and a high success rate. In the case of FUE hair transplant special instruments were designed to extract single follicles with as little trauma to the follicular unit as possible, and smaller knives were made to make graft site incisions large enough to accept the individual follicle and small enough to keep it in place during healing.
Finally, and most importantly, every patient is different, because every human being is different. We all have different shaped heads, lose hair or keep hair in different places and in different amounts, have thin or thick hair, and everything in between. This may seem like an obvious truth, but in all societies there is a tendency to treat people not as individuals but as part of a larger group. That doesn’t work in medicine and especially with surgical treatment because each patient must be treated to best suit his or her situation. At Evolve, we individualize our treatment for each patient and have at our disposal all the tools necessary to do so.
GRAFT SURVIVAL IN FOLLICULAR UNIT EXTRACTION
In the past, many clinics and physicians felt that follicular unit extraction was a sub-standard procedure with at best only 65-80% graft survival while implant survival using a strip method of extracting donor hair was over 95%. Actually this was true, but only for the newer, start-up, 2nd generation follicular unit extraction (FUE) hair transplant clinics. The 1st generation FUE hair transplant clinics instead were showing increased graft survival as their experience increased. Today 1st generation FUE clinics like Evolve have matched and/or exceeded the 95% yield of the strip method and, of course, have avoided any linear scalp scarring.
COMPLICATIONS OF HAIR TRANSPLANTATION
Transection of follicle grafts, the accidental “cutting” across the follicle, is not uncommon with any method of donor hair extraction. However there is a difference between harvesting donor hair follicles with a scalp strip excision and harvesting with the follicular unit extraction (FUE) technique. In the strip method any transection of a hair follicle will be during the dissection of the grafts or the excision of the scalp itself. After a strip of hair is excised from the posterior scalp the strip must be further dissected, that is, each harvested follicle must be cut away from the follicles next to it. Excess tissue (especially skin or connective tissue) then must be trimmed around each follicle so the graft will fit into a grafting site. This is a labor-intensive job requiring several technicians of varying skills to do it. Fortunately, the strip excision yields many more hair follicles than are necessary to complete an operation, so damaged follicles that will not survive implantation may be discarded.
With FUE hair transplant, each follicle is first separated from its surrounding tissue using a hollow drill of appropriate size. Individual follicles are then extracted from the scalp with a micro-forceps and placed in iced saline. The follicles are then separated under microscopic vision into groups of 1-hair, 2-hair, and 3-hair follicles, and any trimming of excess tissue done. Drills have been perfected over the past ten to fifteen years so that follicular damage is minimal. If for some reason a follicle is transected (e.g. the drill angle was slightly off), then that follicle is just left in place to regrow as it should.
Transection Rates are very important in all FUE hair transplant. A transection rate is the number of follicles “left behind” divided by the number of follicles successfully transferred to the recipient area. An experienced FUE hair transplant clinic like Evolve will have a transection rate that is less than 1%, and we have maintained this rate for years. For comparison, a good FUE hair transplant clinic will have a transection rate of 5 to 15%, and a poor FUE hair transplant clinic will have a transection rate as high as 65%.
The last major complication worth mentioning is scarring at the donor site. The risk of scarring from FUE hair transplant is generally dependent and much more common in clinics that use drill punch sizes greater than 1.0mm in diameter. Our clinic uses drill punches with diameters of 0.9mm or less for 99.5% of all of our patients, and so we have yet to see an appreciable scarring issue, visible to the naked eye, in our patients.
USING OTHER HAIR DONOR SITES IN FUE
Follicular unit extraction may also be used to harvest donor hair follicles from either the body (typically chest hair) or the beard among other places. Body hair harvesting was also first performed by the American physician and his staff that modified the original follicular unit extraction procedure in 2002. The extraction of hair follicles from areas other than the scalp expanded the possibilities of hair restoration for patients with a previously limited donor source at the scalp. However, after many trials that occurred over several years using hair follicle extractions from legs, chest, back and beard, follicular survival in body hair follicular unit extraction was found found to be essentially random with reported yields of 0% to 50% at best for several years. Transection rates were also reported as high as 100%. Today only the very skilled clinics can claim a decent yield and a low transection rate. A fully informed patient will be told that body hair extractions can be slow and difficult. Also donor site healing after harvesting body hair does take more time than scalp healing, primarily because of the rich blood supply of the scalp.
Follicular unit extraction using beard hair for donor site hair follicles has become more popular than other body hair extractions. Beard hair seems to grow much like scalp hair in characteristics such as hair length and growth rate. Chest, leg and back hair, on the other hand, do not seem to take on the growth characteristics of their graft site but will keep the hair qualities of their origin. Beard hair also seems to be less susceptible to shedding just after transplant. Several of our patients have reported that the beard hair continued to grow at their transplant sites and did not shed.
Finally, the possibility of scarring at the donor sites of any body hair FUE hair transplant but particularly in the face from a beard FUE hair transplant, was an initial fear in this procedure. However, we have yet to see substantial evidence of scarring in any of our body and beard hair FUE hair transplant extractions. We attribute this to the use of a smaller drill punch size used (<1.0mm diameter) and the experience of our staff.
As with any surgical operation, the instruments used in a follicular unit extraction procedure are very important. Whether you perform follicular unit extraction (FUE) by hand, use a drill, or use a robotic instrument, the chosen instrument is important. We use the highest quality FUE hair transplant extraction tools, microscopes, and eye magnification available today, instruments that are all time tested by our staff and other clinics as well.
Stereo Microscope Zeiss Surgical Loupes
S.A.F.E. System FUE 0.8mm, 0.9mm, 1.0mm drills
Despite assertions to the contrary, there is abundant data available to support the claim that the recovery time after follicular unit extraction (FUE) is less than after strip excision surgery. From the patient perspective recovery after FUE hair transplant is much easier than after strip excision surgery, and this is reported from patients who have had both procedures performed over the years for their hair restoration. In the immediate postoperative period FUE patients will have swelling and some discomfort in the scalp and/or forehead for the first night. In the strip methods the donor area can be painful for days or weeks after a procedure, and numbness of the scalp above the strip site may persist for up to 6 months. Return to their daily routines after FUE are within a week, compared to recovery after a strip harvest method that typically takes 2 to 4 weeks. At Evolve, the recovery time for our FUE patients is, on average, 7 days at the donor site and 10 days at the recipient site.
Quality assurance, or the attention given to the quality at every step of a process, is something that every good business tries to achieve. As a rule of thumb, the larger the staff involved in a procedure the more difficult it is to control the quality of the procedure. Fortunately, at Evolve Hair Clinic, quality assurance and control is at the high end of the spectrum, and this is all because of our staff. Our clinic surgeon, Dr. Nick Maragos, is one of the few board certified, surgically trained physicians in the hair restoration field. Our technologists, are both hand-trained in all aspects of hair restoration and have been performing FUE hair transplant procedures for more than 14 years. They have worked with the most respected hair restoration clinics around the world. Our staff members operate on one patient at a time and this helps us reach greater quality control.
Some clinicians feel that having a small staff could create an issue if the case initiated as an FUE hair transplant had to be changed to a strip method because of a problem with low harvest rate of donor follicles. This fortunately has never happened in any of the cases performed here at Evolve. Evolve Hair Clinic is a standalone, specialized follicular unit extraction and scalp micro pigmentation clinic with a highly experienced medical staff.
COST OF AN FOLLICULAR UNIT EXTRACTION PROCEDURE
The cost of Follicular Unit Extraction is based on the number of follicular units transplanted during the operation and typically costs more than a strip procedure. However, Evolve has maintained a competitive rate because of our low overhead. The range of FUE hair transplant cost has been reported from as low as $1 per graft (India/Malaysia) to as high as $10 per graft (Mumbai/UK/USA/Canada/Japan). Most clinics average around $4 to $6 per graft.
All hair restoration clinics have a goal of cosmetically changing a person’s appearance and restoring confidence in balding individuals. In today’s times there are thousands of hair restoration clinics globally and it is often difficult for potential patients to find the right people to trust for their care. What we believe sets us apart from other clinics are the following:
- Experience: Years of experience in performing and teaching FUE;
- Dedication: Our dedication to restoring your hair;
- Artistry: Making your new hairline look artistically natural on you;
- Knowledge: The knowledge of years in practice;
- Passion: The desire and passion to do our best for every patient.
We would be honored to serve you and take care of your hair restoration needs. Please feel free to call us at any time at 866.678.4330. To see past patient follicular unit extraction results, visit the FUE Hair Transplant Results‘ page.
Dr. Nicolas Maragos, MD
Contact Evolve Hair Clinic for more information on FOLLICULAR UNIT EXTRACTION – FUE Hair Transplant performed at Evolve Hair Clinic. 1-866-678-4330