What is FUE hair transplant?

In literal translation Follicle Unit Excision means excision of follicular units (not hair, which is important!). Follicular units should be extracted and transplanted entirely without division, then the survival rate of hair will be higher.

The FUE method is the oldest method of hair transplantation!

Yes, you heard right. Let's start by debunking the myths. It would be wrong to call the FUE method the most modern, since it appeared first, and then, only 40 years later, the suture method appeared, which is a more modern and more complex method of hair transplantation. What are the advantages and contraindications of the FUE method, who it is suitable for and who it is not, how hair transplantation is performed using the seamless method - all this is in our article.

What is FUE without complicated terms and fluff?

The term FUE refers to the method of extracting hair for its subsequent transplantation to the desired location. This is a method in which each hair root union is extracted separately (one by one) with a special tool. Externally, this tool resembles a cocktail straw, only it has a micro size. Next comes a large number of different technologies by which the FUE method is performed. These are various punches for extracting hair of simple and complex modifications, CHOI-PEN implanter pens, etc., DHI technology, "sapphire" technology and others. All this diversity is not new methods, but technologies , that is, options for performing the FUE method.

Does the technology of performing the FUE method affect the final result - of course. How and what to choose - we will examine in detail below.

FUE TRIVELLINI punch for the "hairstyle at once" method
"FUE using modern technology is a minimally invasive hair transplant method in which individual follicular units are extracted from the donor area (back of the head, beard or other parts of the body) using a small rotating punch (microtrocar)"

Doctor of Science, plastic surgeon with a degree of FELLOW ISHRS, A. Tsilosani

FUE - Japanese technologies of the last century

The FUE method was invented in Japan in 1939 by Soji Okuda. The doctor performed more than 200 successful FUE operations. Moreover, he performed hair transplantation in scar tissue, which was also unique for those years. Another Japanese doctor who used the seamless technique was Hajime Tamura.

Dr. R. Woods (Ray Woods) from Australia continued to develop the method in the 90s of the last century.

The new era of FUE began in 2002 after the publication of William R. Rassman* and Robert M. Bernstein* - "FOX procedure - minimally invasive technique"*

* William Rossman

* Robert Berstein

* FOX – minimally invasive technique (FOX procedure – previous name of FUE).

These doctors have discovered new possibilities of the seamless method, and what is important – they have told in their research about the disadvantages of the FUE method. Scientific research conducted by R. Bernstein and V. Rossman showed that the FUE method is suitable only for 60% of patients.

ISHRS World Congress, round table discussion, A.Tsilosani and W.Rossman polemicizing about FUE megasessions/

“I popularized the FUE method not to replace the Strip method (FUT), but to offer patients an alternative.”

William R. Rassman, MD

Advantages of the FUE method

An important advantage of the seamless method is that it leaves no marks on the back of the head. But only if the method is performed using the correct technology. What happens when the wrong technology is used in the hands of an inexperienced doctor, you will see below.

"The FUE technique cannot be called completely scarless, this will be confirmed by trichologists who conduct a detailed examination of the patient's scalp. Small point scars remain, the appearance and size of which depend on the technology and experience of the doctor. If the procedure is performed by a plastic surgeon at a high professional level and on modern equipment, then these micro-dots are completely invisible even with a short haircut. Only a specialist can see them during a close examination."

Another important advantage of the seamless hair transplant method is the ability to choose grafts with maximum amount of hair. This depends on the instrumentation (it should not be too small) and the doctor's ability to correctly identify grafts that contain more hair. This means that with the same number of grafts, more hair will be transplanted using the FUE method for the same price.

Minimal invasiveness is undoubtedly an advantage of the seamless transplant method. When the FUE method is performed according to international ISHRS standards, it does not require rehabilitation, healing occurs in 7-10 days, without traces and pain. You can immediately return to normal life and sports without restrictions after the procedure. Prescription of antibiotics is not required.

"Antibiotics help the doctor, not the patient!" - I heard this phrase from one of my teachers. At the beginning of the century, we conducted an extensive clinical study on antibiotics in hair transplantation. The scientific study lasted 6 years, hundreds of people participated in it. The results became a gift for our patients. It was found that when using the low-trauma technology we work with, antibiotics are not required. The load on the body is reduced, which is an environmentally friendly modern approach to the patient's health. We know for sure that the post-operative period will be very easy for the patient, without prescribing antibiotics, without taking medications, without restrictions. Why? Good vascularization of the scalp when using modern gentle transplantation technology and observing all the rules of asepsis in the operating room excludes infectious complications. Preventive administration of antibiotics after hair transplantation does not make any sense, it is inappropriate and wrong."

A. Tsilosani – Doctor of Sciences, plastic surgeon,
author of two world records in hair transplantation.

Another important advantage of the FUE hair transplant method is the ability to extract follicles without incisions and sutures not only in the occipital region, but also to use the beard area, sideburns, and transplant hair from the body. This is a salvation for those patients who have already encountered poor-quality hair transplantation and lost the reserves of the donor area on the head. And also for those whose natural reserves on the head do not allow for a good volume during transplantation.

Disadvantages of the FUE method

Of course they exist, and we will tell you about them honestly and in detail. What every patient wants to get from a hair transplant is right, hair survival in a new place and growth for life, not just for a couple of years. One of the very important factors influencing hair survival is maintaining the "natural environment" around the hair follicles. This environment for hair is the connective tissue that surrounds the hair roots. If the hair roots are too "exposed" during transplantation, this reduces their chances of survival in a new place. Such grafts are too sensitive to mechanical trauma and are prone to dehydration.

The second disadvantage of the method is the high level of damage to the hair roots when extracting from the scalp. It is quite obvious that if FUE tools for graft extraction could cope with their task 100%, they would not need to be constantly improved. Therefore, every year the world's best developers of FUE punches, such as Harris (dull punches), Cole (sharp punches), Devroye (trumpet punches), Trivellini (long hair transplant), and Tsilosani (sharp panch) try to improve hair extraction tools.

However, a punch that can guarantee the absence of damage during hair extraction has not yet been invented . Therefore, the result still depends on the doctor's ability to handle even the most expensive instruments, on his experience. The number of damaged grafts is the responsibility of a specific surgeon, and not of the "ideal instrument". If many grafts were damaged, then more than half of the hair does not take root. And hair is a non-renewable resource.

The disadvantages of the seamless FUE hair transplant method include volume limitations . The same patient can always receive fewer grafts using the FUE method than the FUT suture method. This is due to the fact that the hair on the back of the head thins. Hair transplantation is hair relocation, not cloning. Nothing will grow in the place where the hair was extracted. This means that when extracting hair, the fact of thinning of the occipital region must be taken into account. The doctor must have sufficient experience to correctly calculate the donor area reserve and not deplete it.

Examples of destruction of the donor area due to poor use of the FUE method (man-made alopecia).

"We often encounter patients who have suffered from poor-quality hair transplantation - a bald spot has formed on the back of the head and closer to the neck. This does not happen by nature. This is "man-made alopecia" - a typical example of the destruction of the donor area, when in pursuit of profit, significantly more grafts were extracted than established by international protocols and common sense. If, in addition, half of the transplanted grafts do not take root, we get general thinning of the hair. As a result, there is almost no hair on the back of the head and insufficient density remains in the front, as well as in the parietal area. Modern science does not know how to restore hair to such patients, since donor follicles from other people and artificial hair do not take root! (In the USA, artificial hair transplantation is prohibited by law due to serious consequences for health and appearance).

The only thing left to do is to use beard and body hair for transplantation in order to somehow correct the situation. But this is not possible in all cases and depends on the natural reserves and structure of the hair."

Teacher Worl dFU EInstitute>
Professor of the American Academy of Aesthetic Medicine,
AAHRS member, PhD, A. Tsilosani.

Another disadvantage of the seamless FUE method is the aesthetic aspect – the procedure requires shaving the head. And if the surgeon does not have modern FUE no shave technology (without shaving the head), then patients with longer hair have to experience discomfort. Complete shaving of the head is usually used solely for the convenience of the surgeon, or when the transplant is performed by a doctor with little experience in this field. There are no medical indications for shaving the head with the FUE method. Therefore, now you can choose modern technology and not experience severe discomfort, becoming the temporary owner of a completely bald head with red dots.

What is FUE no shave?

This is an aesthetic modern technology that does not require shaving the head. There are several options for performing the method, they are selected together with the patient based on his wishes and existing hairstyle.

There are 3 options for no-shave FUE:

1. Half-box haircut. This option is used when the patient initially has a fairly short haircut. The back of the head is shortened (cut) with a transition to longer hair. Graft implantation also occurs without shaving. Including right between growing hairs, when adding density.
2. Ladder shortening. Suitable for patients who initially have a longer hairstyle. In this case, the hair is shortened in portions, in a ladder, and these areas are covered with other hair on top. From the side, this option looks like a normal hairstyle, nothing is noticeable under the hair.
3. Completely unshaven FUE. This is a variant of the seamless method, when grafts are extracted from between growing hairs without cutting or shaving individual areas.

Haircut option for FUE no shave

FUE unshaven (completely without shaving) – grafts are extracted directly between growing hairs, photo immediately after extraction (work by A. Tsilosani)

What is DHI hair transplant, Choi-pen, direct implantation, "sapphire" and others?

According to international medical standards, there are no other seamless methods except FUE (Follicle Unit Excision). All these names are just different technologies by which the FUE method is performed. How to understand the large number of different technologies and choose the best one?

First of all, it is necessary to understand why another technology is being created and implemented. It is logical that it is for the benefit of the patient, for a better result. However, no one has cancelled the commercial side of paid services. Therefore, there is another reason - the desire to reduce the clinic's costs for purchasing equipment and training personnel, the desire to reduce the procedure time and put it "on stream".

Extraction of a graft with the FUE method is possible only with the help of the FUE punch . But implantation of grafts in a new place occurs with the help of different instruments. It can be surgical tweezers, or it can be an implanter pen (Implanter pen). Such names as CHOI-PEN, DHI, "direct implantation" are well-known. These are different names for instruments of the same type. The Korean invention Choi-pen is an implanter pen that helps the doctor insert a graft into the scalp. There are many different modifications and manufacturers of this instrument. The most famous of them are Hwang implanter, Lion implanter, Devroye implanter. The principle of operation is that grafts (one or more) are loaded into the implanter pen, and then a cut is made in the desired area of the head with the same pen and the graft is pushed out of the pen into the scalp. This is the so-called "direct implantation". The second option is when grafts from the implanter pen are pushed out into pre-prepared micro-holes in the scalp.

The "sapphire" technology includes all 3 important stages of the FUE method - graft extraction, formation of micro-holes and graft implantation. The peculiarity is that the micro-holes are created using very sharp sapphire blades, not metal instruments. Such a micro-knife does not become dull over time, and this is a plus. The minus is that the sapphire knife is used repeatedly, for hundreds of patients, and the issue of its sterilization between patients remains on the conscience of the clinic. Probably, this is why many clinics refuse patients with certain diseases - it is problematic to guarantee sterility and complete safety with such technology.

"We do not use the sapphire instrument for our patients precisely because it is reusable. According to international quality and safety standards, all instruments that touch the patient are used once and only for him. Nothing is reused, it is immediately disposed of! This is a fundamental point. We use a special micro-instrument that is changed every 100 touches of the skin. That is, when transplanting 3,000 grafts, we change the instrument 30 times for one patient! And of course, there can be no talk of reusing the instrument.

In exceptional cases, if the patient himself insists on using the "sapphire" technology or DHI, we can meet halfway. Such patients are less than 1%, and I have already performed successful hair transplants on more than 12,000 patients. Choi-pen technology is usually used by my student surgeons who are beginning to master hair transplantation."

Teacher at World FUE Institute,
Fellow ISHRS degree holder,
Doctor of Science, A. Tsilosani.

What does the back of the head look like after FUE?

Of course, everything depends on the technology used for the seamless method. If a low-trauma technology was used and all international process standards were met, then in 7-10 days there will be no traces left on the back of the head. The red dots will disappear completely. When using the new modern FUE technology, the graft extraction sites heal within 12 hours (???). You can wash your hair the next day. And with regular baby shampoo, not the one that marketers want to sell you.

If the procedure is carried out hastily, on the flow, without observing all regulations, on cheap equipment - then the occipital area can suffer greatly. In such cases, patients not only receive the destruction of the donor area, but also injury, gross aesthetic defects, as well as necrosis (death) of scalp tissue. Therefore, it is necessary to approach the choice of a specialist very seriously. Hair transplantation is a complex jewelry procedure that must be performed by a plastic surgeon. Any hair transplant doctor can be checked on the official website of ISHRS - the International Society of Hair Reconstructive Surgery (a non-profit organization)

Back of head after high-quality and low-quality FUE

Fue is made with the patented Tsilosani punch. The peculiarity and innovation of this punch is the specific treatment of the inner walls and the technology of their sharpening. The Tsilosani punch allowed to reduce damage to the grafts. Subsequently, this type of punch sharpening was repeated in his development by Jean Devroye. 3 and 8 days after the procedure (the back of the head was shaved for clarity).

And the consequences of an unscrupulous FUE (after 2 months)

40% of patients are not suitable for the FUE method

This disappointing fact was established in their scientific research by William R. Rassman and Robert M. Bernstein (Follicular Unit Extraction: Minimally Invasive Surgery for Hair Transplant).

We are all different. This also applies to hair – it has a different structure, thickness, density, sensitivity to hair loss factors and color. It is also worth remembering that hair is in the skin, which means its properties can also be different. It is logical that the same method cannot give the same result with different natural data. The method must be selected individually. There is no one best method for everyone . The one that gives a good result to one patient may be completely unsuitable for another. And vice versa. The best hair transplant method is the one that gives the highest result with your natural data.
Research by FUE method gurus V. Rossman and R. Bernstein showed that the skin of 40% of patients has the ability to hold grafts too tightly due to the rigidity of collagen fibers, which leads to inevitable damage to the grafts during extraction. And this, as we already know, directly affects the survival rate of hair. Therefore, prescribing the FUE method to everyone is at least unprofessional, and often carries the risk of irreversible hair loss.

"The hottest topic we discussed at the last surgical master class of the World FUE Institute in France was how to minimize the risks of graft damage during extraction. Surgeons from different countries shared their experience, and engineers presented new developments in FUE machines. My friend Roberto Trivellini and I, as developers of our graft extraction systems, were awarded for our contribution to the development of the FUE method in the world."

Teacher at World FUE Institute,
Author of 2 world records in hair transplantation,
Doctor of Science, A. Tsilosani.

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