Follicular Unit Extraction - FUE

How a Hair Transplant Works

Follicular Unit Extraction (FUE) is becoming increasingly favored by our patients in New York, New Jersey, and Boston. A relatively new method of harvesting donor grafts, it is less invasive than previous techniques. Since 2002, Dr.True and Dr. Dorin have been at the forefront of developing this new approach to hair restoration. FUE is now a well-established procedure.  Nevertheless, results can vary widely depending on the skill and experience of the person by which the process is being performed. This being said, we have evolved a highly advanced FUE technique that produces high yield results and excellent healing.

Video: Follicular Unit Extraction

Dr. True explains how Follicular Unit Extraction (FUE) works.

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Donor area view after manual motorized FUE extraction immediately post-op. This is a non-robotic process with all extraction performed exclusively by Dr. Dorin or Dr. True using customized punches.

Hair Transplantation Donor Area

Donor area view after manual motorized FUE extraction immediately post-op. This is a non-robotic process with all extraction performed exclusively by Dr. Dorin or Dr. True using customized punches.

No linear scar with FUE

Donor area view 4.5 months after FUE donor harvesting. There is no linear scar with FUE.

  

Follicular Units Groups

Follicular units prepared microscopically Graft technicians dissecting follicular units Dr. Dorin creating receptor sites
Follicular units prepared microscopically Graft technicians dissecting follicular units Dr. Dorin creating receptor sites
 

Actual Patient Results

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Follicular Unit Extraction (FUE) Process

Doctor performing surgical hair restorationWhen preparing for follicular unit extraction, larger areas of the donor zone must be shaved to enable the harvesting of the optimal number of grafts. When we are doing smaller FUE treatments, extensive shaving is not necessary. FUE grafts can even be taken without cutting the hair at all, or by shaving very narrow bands easily covered by adjacent hair.

The treatment 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 is considered minimally invasive, because only the most superficial layer of the skin is cut and the holes are very tiny. Follicular unit extraction currently seems best suited for New York, New Jersey, and Boston patients who are committed to continuing to wear their hair shaved, or who are particularly fearful of surgery or pain.

Receptor Sites

The receptor sites are the tiny incisions into which the follicular unit grafts will be placed. The creation of receptor sites is truly the artistic portion of the procedure. The sites are exclusively created by either Dr. True of Dr. Dorin. Both doctors use our own unique custom-cut-to-size micro blades to make the sites. These blades range from .7 mm to 1.3 mm in width and are created for each patient, based on specific individual criteria. The size of the patient's grafts, the characteristics of the recipient skin, and the density at which the grafts will be placed all determine the customization of the receptor blades. This practice enables the doctors to perform an ultra-refined transplant at densities of 50 grafts per square centimeter. Dr. True and Dr. Dorin combine coronal, saggital, and a blend of coronal-saggital receptor sites to produce a unique appearance for each patient. Design nuances such as direction and angle of hair growth, hairline shape, crown whorl, and overall hair flow are attained by subtly varying the combination and orientation of these tiny incisions. We believe a denser, more natural result is achieved through this methodology.

Graft Placement

Once the doctor has completed his design, a team of nurses and/or certified surgical technologists will place the grafts into the incisions. The grafts are carefully placed using very fine forceps. The placement process usually takes a few hours (the patient can watch television while the work is being done). At True & Dorin, we are proud of the skill level of our technicians. Most of our staff has been an integral part of the practice since the early 1990s, each member having placed over two million grafts. Each team of technicians is assigned to only one hair transplantation case per day at our facilities in New York, New Jersey, and Boston.

The grafts are preserved in saline under the ideal temperature conditions during the placement process. They are handled with the accuracy, delicacy, and precision necessary to assure optimal survival. Once the grafts have been placed, the doctor will inspect the transplanted area to ensure that the grafts are properly situated. A hair dryer is then used to blow cool air on the grafts, which will help form a natural adhesion and set the grafts in place. Bandages are not necessary, although the patient will be required to wear a baseball cap for the trip home.

Patient Comfort

With the introduction of the CompuMed® Wand, patients are administered local anesthesia before the hair transplantation procedure. Designed by dentists to alleviate the negative stigma associated with needle injections, the CompuMed® Wand is a computer-controlled delivery system that Dr. True and Dorin employ to offer their patients maximum comfort while administering anesthesia. In our landmark 2001 study published in the Journal of Dermatologic Surgery, the CompuMed® pump was shown to not only produce significantly greater comfort during the procedure, but also to reduce post-operative pain.

Those undergoing hair transplantation in New York, New Jersey, and Boston are given a small dose of oral valium prior to surgery to counteract the momentary agitation some patients have from xylocaine/epinephrine. Our goal is to ensure that patients will not feel the slightest pain in the operating room.

Recovery

Post-operative discomfort does appear to be significantly reduced in FUE patients as compared to FUT (follicular unit transplantation) patients. The most impressive advantages 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 are not yet defined with FUE, although it is possible to perform 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. With smaller treatments, which can be concealed, it is probably best to wait one to six months between treatments. Graft healing and new hair growth are the key determinates of timing.

Results

While healing is excellent after FUE, the results will not be completely scarless. 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.

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MIT (Minimally Invasive Transplantation AKA FUE)

Follicular Unit Transplantation (FUT)

Description

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.

Procedure
Status

Widely accepted, i.e. extensive scientific experience and evaluation regarding 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.

Grafts

 
  • We use a mechanical, sharp rotary system that we have developed and is unique to our practice
  • Rates of follicle damage during extraction may vary from 1-5%
  • Doctors extract all grafts
  • We no longer advise a test to determine candidacy
  • Long term follicle survival for scalp & beard is 94-95% and 75-85% for body donor
 
  • We use high power magnification and a single blade scalpel to carefully excise margins of strip and skilled staff to prepare grafts with microscopes.
  • Damage to follicles is at worst 1-2%
  • Long term follicle survival is 98 – 100%

Donor

  • Dispersed widely
  • Healing very rapid
  • Additional resource of body hair can be included
  • Sutures required
  • Healing in 7 – 14 days
  • Limited to scalp donor

Concealability

  • for large treatments donor area must be shaved
  • not evident in 7 – 10 days
  • can wear hair shaved without detection after treatment
  • when harvesting has been extensive hair must be worn longer to hide donor scars
  • donor shaving is localized
  • hair covers suture and scar
  • previous scars removed with each successive treatment
  • when harvesting has been extensive hair must be worn longer to hide single donor scar line

Pain

0-1 out 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

Treatment
Size

400 to 2000 per session

Up to 4000 per session

Cost

Typically more expensive than FUT (range $7.5 - $11/graft depending on treatment size)

High efficiency allows lower cost (range $4 - $6/graft depending on treatment size

Popular
Misconceptions

  • skin not cut (it is, but very superficially)
  • no scarring (there is, but it is diffuse and more easily concealed with head shaved, at least until harvesting has become extensive
  • 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)
  • Wide donor scars are common
  • Shrinks donor area
  • Is a risky procedure in reality complications are uncommon and confined to temporary self resolving issues

Main Reasons
To
Choose

  • Want to wear head shaved
  • Comfortable with less invasive
  • Comfortable with higher cost
  • Proven & Cost Effective procedure
  • Minimize number of treatments
  • Will wear hair ½ inch or longer

Learn More about Follicular Unit Extraction

Please explore our website for up-to-date information on FUE versus FUT and the other procedures we offer at our New York, New Jersey, and Boston facilities. If you have any further questions, or if you would like to schedule an appointment at True & Dorin Medical Group to learn more about the riskscosts and candidacy, feel free to contact our hair restoration practice today.

VIDEO: FUE PROCEDURE BY DR. DORIN

Dr. Dorin performs follicular unit extraction