Follicular Unit Extraction (FUE)

Hair transplantation is a surgical technique that moves groups of hair follicles (follicular units) from one part of the body (typically the back or sides of the scalp) to balding or thinning areas on the scalp, providing a permanent solution for certain types of hair loss in both men and women. The procedure is based on the principle of “donor dominance,” meaning that the transplanted hair follicles from the donor area remain resistant to balding and will not miniaturize over time.

There are two main methods of hair transplantation: follicular unit transplantation (FUT) and follicular unit extraction (FUE). FUT involves removing a strip of skin containing hair follicles from the donor site, dissecting it into individual follicular units, and transplanting them into the recipient site. This procedure leaves a thin linear scar in the occipital scalp. FUE, on the other hand, extracts individual follicular units directly from the donor site one by one using a small punch tool before transplanting them into the recipient site.

Both FUT and FUE can produce excellent results, with the choice of technique depending on the patient’s individual needs and preferences. FUT may be preferred for patients requiring a larger number of grafts or with more extensive balding areas, while FUE is often favored by patients who want to avoid a linear scar and wear their hair short in the back. FUE also offers versatility by allowing non-scalp hair harvesting, such as from the chest or beard, if the scalp donor supply is limited. Generally, most patients prefer FUE, which is the service we provide in our office.

The success of hair transplantation depends on several factors, including the surgeon and their team’s skill and experience, the quality and quantity of donor hair, and the patient’s individual characteristics. A good candidate for hair transplantation is typically in good health, has a stable pattern of hair loss, and adequate donor capacity. Our ability to restore one’s hair loss is determined by the number of hairs that can be taken from the donor area without making that area too thin. In general, approximately 4-5,000 grafts can be taken from the donor site with FUE (although this varies from person to person). For reference, around 2,000 grafts may be needed to rebuild the frontal hairline and anterior scalp, over 4,000 to rebuild the entire top (excluding the vertex), and at least 3,000 to rebuild the vertex scalp. The more grafts available, the better coverage someone will achieve after their transplant. Thus, it’s essential to understand the procedure’s limitations and that multiple sessions over time or a combination with medical therapy may be required for optimal results.

Patients should be aware that they will continue to lose non-transplanted hairs within susceptible areas following hair transplantation. Continuing medical treatment with minoxidil, finasteride, LLLT, or PRP after a hair transplant procedure may help limit further loss. In a randomized trial of 79 men who underwent hair transplantation for androgenetic alopecia, those treated with finasteride 1 mg for four weeks before and 48 weeks after the transplant achieved better results. Visible increases in superior/frontal scalp hair post-transplant were recorded for 94% of patients in the finasteride group compared to 67% in the placebo group. Therefore, concurrent use of finasteride will provide increased density post-transplant, especially in the most cosmetically critical areas.

It’s crucial to understand that a hair transplant is the only way to put hair in a completely bald area. If no hairs are visible, medical management will be ineffective.

Hair transplantation is generally a safe and effective procedure with few risks and complications. Some common side effects include temporary swelling, redness, and scabbing in the recipient site, as well as temporary numbness or tingling in the scalp. In rare cases, infection, bleeding, or scarring may occur.

The recovery period after hair transplantation can vary depending on the technique used and the individual patient. Most patients can return to work and normal activities within a few days to a week after the procedure, but strenuous physical activity should be avoided for a few weeks to allow the transplanted hair to take root. The transplanted hair will initially shed within a few weeks after the procedure but will begin to regrow within a few months, with full results visible within 12 to 18 months.

As a note, while hair transplantation surgery is most often used to treat hair loss on the scalp, it can also treat hair loss on the eyebrows and beard, with satisfactory results.