Follicular Unit Extraction/FUE hair transplant technique does not involve any stripping or cutting of skin from the donor area, instead individual 2-5 hair follicular unit grafts are plucked directly from the scalp much strenuously by the hair transplant surgeon with the use of specialized equipments. However, this doesn’t make the procedure non-surgical or scar less, there will be scars but less prominent that will heal faster than the strip excision wound.
Following the initial consultation at Harley Hair Transplant Clinic London, the course of the procedure is determined between the surgeon and patient, and the surgery is fixed at least 2weeks later.
Pre-Operative instructions are then given out to the patient to follow which includes refraining or altercation of usage of a list of drugs like blood thinning drugs; broad beta blockers; refraining from smoking etc. On the day of the surgery the patient is strongly advised to wear a button down shirt; to refrain from having coffee etc.
Preparation for the surgery
The surgery takes place at Harley Hair Transplant Clinic London at morning shift. At the day of the surgery, once more the predetermined course of the procedure is revised with the patient and with the patient’s confident consent the hair transplant surgeon starts the operation. The surgery begins with the surgeon marking the expected hair line to be covered. Meanwhile photographs might be taken for medical record.
Local anaesthetics will be injected to the scalp intramuscularly and it is just as painful as an injection can be; vibratory anaesthesia which is the use of sound vibrations might be used during the injection to minimize the pain for overtly sensitive patients. Oral Sedatives are optional if the patient asks for it.
Preparing the Donor Site
In the FUE hair restoration technique the donor site is cropped short to about 1mm length. For large hair transplantation, the entire back of the scalp might be used as the donor site and smaller band for smaller grafting.
Usage of blunt instruments for graft extraction outdates the sharp extraction wherein the harvested follicular grafts would be much prone damage and wastage out of the instruments itself.
2-Step Procedure – A sharp punch is pierced to make a tiny hole around each follicular unit keeping the depth till the epidermis level which consists of fatty tissue. Secondly, a fine forceps is pierced and holding the follicular unit intact it is twisted a little so that way the whole follicular graft with the follicular unit bound in the fatty tissue is separated from the scalp and thus the surgeon can harvest the whole hair graft intact. Once harvested the follicular grafts are immediately placed under a holding solution that mimics the properties of body fluids that the follicles are more used to.
3-Step Procedure – The two step procedure is further advanced with the three step procedure that includes the follicular isolation technique (FIT).
At the first step the surgeon scores the donor area with a sharp micro punch. Second and then introducing blunt micro punches to the hole and the intact follicular unit twisted a little loosening the follicular unit from the scalp tissue and finally pulling it out. And the same thing is repeated until the determined amount grafts have been harvested.
Follicular Isolation technique (FIT) – refers to FUE technique that uses a punch with a ‘stop’ to limit the depth of penetration. Although the need for a depth stop in the extraction technique is still a contentious issue, FIT is possibly a better term than FUE if the entire unit is not being captured. In our view, when the goal is just to extract hair, rather than intact follicular units, the term FIT is preferable.
The expanding needle technique – offers a customary extraction of body hair possible with the FUE where surgeons can extract even body hair like beard, arms and legs under a magnified vision and hypodermic needles to maximize donor hair availability.
Graft Dissection – Once the grafts are harvested kept under the holding solution; they are placed under the stereo microscope in the same way as the FUT technique. And the 2, 3, 4 and 5 hair grafts are selected as according to their overall quality and integrity. Excess tissues are trimmed off making a clean and intact follicular graft kept in separate plates all ready to facilitate the graft insertion be inserted to the recipient site.
Preparing the Recipient Site – Preparing the recipient site for FUE hair transplantation is also similar to that as FUT. As the graft dissection is being done by the assistant surgeons, the preparation of the recipient site is done by hair transplant surgeon himself. Using fine hypodermic needles of about 21 and 19 gauges, tiny slits are made to the recipient area, most significantly at a perpendicular/lateral angle. But the angling of the slits very much depends on the artistry and skill of the surgeon to create the pattern that is best suitable for the individual patient where the end result is ultimately to have a fuller coverage.
Graft Insertion – As the recipient sites are created, it is time for the ultimate step of the procedure. The hair transplant surgeon gently places the hair grafts to the pre-made slits. According to the hair loss pattern, 1 and 2 hair grafts are placed to the frontal parts of the scalp while the 3-4 hair grafts are placed to the central areas, as it would naturally.
Post Operative Care
Once the determined grafting has been achieved, the scalp a tennis bandage is put around the head to absorb any bleeding. There won’t be any dressings or bandages to the transplanted area and is left open, while the recipient area will be dressed with or without sutures. The patient can cover the head with a scarf or clean hat to resist dust and pollution on their way home.
It would take the whole night for the anaesthesia to wear off completely and patient is likely to feel some amount of pain and discomfort on the first night or more 2-3 days. All wounds are expected to be healed at the end of 10 days.