Follicular Unit Extraction (FUE)
Extraction (FUE) is a new method of harvesting donor grafts that is less invasive than previous techniques. Since 2002 Drs. True and Dorin are on the forefront of developing this new technology.
To explain FUE we need to contrast it with the current gold standard state-of-the-art hair transplantation technique, Follicular Unit Transplantation (FUT)
With FUT, we carefully excise a strip of skin from the donor area, suture the edges back together, and create individual grafts with microscopes. Because we are very meticulous in avoiding cutting across hair follicles as we take the strip, because we use two suture layers to close the skin, and because we use the trichophytic technique we consistently produce a fine line scar in the donor area that is easily hidden underneath hair worn normal styling length (including hair a short as a number 2 clipper setting). However, these scars can be visible if the head is shaved to the skin. The length of scar is determined by the size of treatment. With large treatments the scar will begin in front of one ear and extend around the back.
Some early advocates of FUE have over sensationalized the risk of wide donor scars with FUT strip harvesting. The examples they present are not something we have ever seen with our strip technique. Patients considering FUT with strip harvesting at our clinic should be assured that because we are careful they will have a very thin scar as described above.
PLEASE VISIT LINK BELOW FOR DONOR EXAMPLES:
http://www.truedorin.com/faq.php?id=8
http://www.hairtransplantnetwork.com/blog/home-page.asp?WebID=114
Extraction is performed under local anesthesia. Under very high-powered magnification, individual follicle units are isolated and removed. We use tiny 0.75 to 1.00 mm punches to cut around the follicle unit. This procedure can be properly considered Minimally Invasive because only the most superficial layer of the skin is cut and the holes are so tiny.
While healing really is excellent with extraction, we cannot say that the procedure is scarless. Once again some early advocates of this procedure have falsely portrayed FUE as procedure that leaves no scar. The truth is scars do result, but they are usually very tiny pinpoint spots that are not evident even with the head shaved. It must be noted, however, that patients who have had extensive FUE will not be able to shave their heads without the scarring being evident.
FUE must be considered a developmental procedure, not only in our hands but, by every practitioner. Having performed thousands of strip FUT cases, the process has become highly perfected and predictable. However, it will be several years before many questions about FUE are answered. For, example: will the yield be as consistently high as with FUT, are there some people who do not respond well to the technique, what are the complications, can we consistently achieve density comparable to FUT? This being said, we are confident that we have evolved an advanced FUE technique that unifirmly produces high yield and excellent healing.
Postoperative discomfort does appear to be significantly less for FUE compared to FUT. It should be pointed out, however, that FUT patients generally experience only mild to moderate pain easily controlled by prescription medications for a one to three day period. FUE patients rarely need anything after one day.
One hidden disadvantage to FUE is that larger areas of the donor zone must be shaved to enable harvesting of large number of grafts. By contrast, with FUT, only the area of the donor strip is shaved. Thus, when patients walk out of the office after FUT the donor area does not show evidence of treatment. If their treatment is small enough to be covered by existing hair, they can often go about in public immediately without detectable evidence of treatment.
For more extensively bald patients, the new transplants will show for about 10 days requiring most patients to take time off to keep others from knowing they have had treatment.; that is, unless they can wear a hat, work alone, or just do not care that others know they had treatment. In these cases the extensive donor shaving required with FUE will not present additional issues as within 10 days the donor sites will heal and the hair will have grown sufficiently that signs of treatment will no longer be evident.
When we are doing smaller FUE treatments extensive shaving is not necessary. FUE grafts can even be taken withou cuttinh the hair at all or shaving very narrow bands eaisily covered by adjacent hair.
The most impressive aspect of FUE is the rapid and excellent healing. We have found that after a week the majority of patients show no signs of surgery in the donor area.
The ideal intervals between treatments for FUT are well established at 10 to 12 months; they are not yet defined with FUE. It is possible to do extraction treatments several days in a row. This is often the best option for an extensively bald patient who needs a large number of grafts and is going to need to take 10 days off work to prevent detection. With smaller treatments which do not require extensive shaving and can be concealed it is probably best to wait one to six months between treatment. Graft healing and new hair growth are the key determinates of timing.
FUE currently seems best suited for those who are committed to continuing to wear their hair shaved or who are particularly fearful of surgery or pain. Most patients will still find that FUT offers many advantages making it their best treatment option.
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MIT (Minimally Invasive Transplantation AKA FUE) |
Follicular Unit Transplantation
(FUT) |
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Description
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Extraction of individual follicle units by superficial excision. No sutures required. |
Single strip of donor removed and grafts containing individual follicle units dissected with microscopes. Incision edges sutured. |
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Procedure
Status |
Developmental, i.e., not enough scientific experience and evaluation yet to know all the advantages, disadvantages, and predictability of outcome |
This is the current Gold Standard for hair transplantation. Widely used , scientifically evaluated, and refined, so that all risks, complications, patient variables, and outcomes readily predictable. |
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Grafts
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ü Rates of follicle damage during extraction may vary from 1 – 5%
ü Extraction survival rates not yet documented
ü Placement same as FUT
ü We no longer advise a test to determine candidacy
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ü We use high power magnification and a single blade scalpel to carefully excise margins of strip and skilled staff to prepare grafts with microscopes.
ü Damage to follicles is at worst 1-2%
ü Long term follicle survival is 98 – 100% |
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Donor
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ü Dispersed widely
ü Healing very rapid
ü Additional resource of body hair can be included |
ü Sutures required
ü Healing in 7 – 14 days
ü Limited to scalp donor |
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Concealability
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ü wide areas must be shaved
ü not evident in 7 – 10 days
ü can wear hair shaved without detection after treatment
ü when harvesting has been extensive hair must be worn longer to hide donor scars |
ü donor shaving is localized
ü hair covers suture and scar
ü previous scars removed with each successive treatment
ü when harvesting has been extensive hair must be worn longer to hide single donor scar line |
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Pain
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1out of 5 pain level in donor area first 24 hours |
2-3/5 pain level in donor area first 24 to 72 hours; 1/5 for following week |
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Treatment
Size
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400 to 1500 per session |
Up to 4000 per session |
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Cost
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Usually more than double the cost of FUT |
High efficiency allows lower cost (range $4 - $8/graft depending on treatment size |
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Popular
Misconceptions |
ü skin not cut (it is, but very superficially)
ü no scarring (there is, but it is diffuse and more easily concealed with head shaved, at least until harvesting has become extensive
ü increases donor supply ( may in fact reduce the amount that can be harvested from the scalp donor; is true in the respect of adding body hair to the supply) |
ü Wide donor scars are common
ü Shrinks donor area
ü Is a risky procedure in reality complications are uncommon and confined to temporary self resolving issues
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Main Reasons
To
Choose |
ü Want to wear head shaved
üComfortable with less invasive
ü Comfortable with higher cost
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ü Proven & Cost Effective procedure
ü Minimize number of treatments
ü Will wear hair ½ inch or longer | Please explore TrueDorin.com for up-to-date hair transplant information. As leading hair transplant doctors, True & Dorin can ensure you make best decision, whether it be an FUE Hair Transplant or hair replacement procedure |