Author Bio: Dr. Sanusi Umar MD is the author of this article.
Definition – What is Follicular Unit Extraction – FUE : Follicular Unit Extraction (FUE) is a no linear scar surgical hair harvesting method used in hair transplantation that involves extracting a natural group of individual hair follicles one at a time directly from the patient’s head. This minimally invasive procedure does not involve use of scalpels, thus avoiding the kind of linear scarring that often results from other forms of transplant. During a hair transplant surgery, the surgeon usually extracts follicles from the sides and back of the head and before implanting them into the balding or thinning areas. The main advantages of FUE are:
- No linear scars
- No stitches
- No scalpels or knives
- No Staples
- No stitches or sutures
- Faster healing
- Ability to carry a short hair cut
Type of FUE Hair Transplant Methods
There are currently two broad forms of Follicular Unit Extraction:
- Basic Follicular Unit Extraction:This is the simplest and most common form of FUE, where only the back and sides of the head are used for donor sources. These methods can reliably extract straight and loosely waved hairs. However, this classic FUE has limitations for extracting curly or tightly wound hair and for patients suffering severe balding. These limitations widely restrict the number of good candidates that qualify for the procedure.
- Advanced Follicular Unit Extraction:The advanced techniques like Dr.UGraft procedure have design advantages that makes it possible to reliably and consistently:
- Extract hair from the head as well as nape, peri-auricular areas of the scalp, neck and all body areas
- Extract the most tightly curled hairs and even in thick scalp skins. Most individuals with tightly curled Afro-textured hair are not good candidates for basic FUE. Dr.UGraft advanced FUE tools and techniques consistently extract these types of hairs successfully. The following video Describes attributes of the Dr UGraft – UPunch Rotor system:
Before The Era Of Linear Scar Free FUE Hair Transplant
Prior to the linear scar free FUE method, doctors widely performed follicular unit strip surgery (FUSS) as the most popular form of transplant surgery. In FUSS, a surgeon cuts a linear piece from the back or sides of the scalp to utilize as a solid donor strip. The strip is then microscopically divided by units in order to provide separate follicles for transplanting purposes. However, the surgery leaves behind a wide and long scar around the base or side of the head. Commonly known as “strip harvesting,” doctors considered FUSS the most traditional method of hair transplantation up until the introduction of no linear scar FUE. However, this method had severe limitations that has yielded perilous outcomes to many individuals seeking a natural looking and permanent hair restoration solution.
Unfortunately, FUSS has a number of disadvantages for the patient. Extracting a full strip of flesh during the procedure permanently leaves behind a linear scar at the donor site. This scar does not fade over time. Unless the patient decides to conceal the scar by wearing a long hairstyle, the linear scar also remains highly visible. Additionally, the invasive nature of strip surgery can cause possible nerve damage at the incision site. The nerves running across the incision are at a higher risk of being severed.
The Evolution of No Linear Scar Minimally Invasive Hair Transplantation
- So what is a FUE hair transplant? Restoring hair loss through transplantation originated in Japan in the early 1900s, but a variety of temporary and surgical techniques have been developed throughout the decades. Originally, the procedure entailed the use of very large 4-5mm punch tools. This was also reiterated by Oreintrich in the 1950s. These large punches created large pencil head sized scars on the donor site, as well as a “pluggy” doll-like appearance on the bald areas.
- In the 1980s, Japanese Dermatologist Masumi Inaba introduced smaller punches in the order of 1mm in place of the 4mm punches. This resulted in smaller wounds and smaller unit grafts. This can be considered the first description of follicular unit extraction which was memorialized in a text book written by Dr Inaba.
- in the 1990s. Drs Willian Rassman and Robert Bernstein first coined the term follicular unti extraction a dermatologic surgery Journal publication.
- Dr James Harris developed a sharp and dull dula punch system for FUE in which the shallow scoring of the skin using a sharp punch is followed by a deeper score using a dull punch so as to minimize follicular transection. Dull punches were an improvement but the two step technique was cumbersome and the dull punches recorded a higher incidence of buried grafts.
- In late 2005 Dr Sanusi Umar began developing a punch system that combines sharp and dull approach in one punch. At this point all FUE systems largely rely on head donor supply and could be classified as Basic FUE. In 2009 Dr U patented the Dr UPunch Rotor which resolves many of the problems associated with the dull punches. As part of the Dr UGraft system, the UPunch Rotor was very effective in its ability to successfully harvest hair from the head, nape areas and all body areas.
- The extraction of curly Afro -textured hair continued to be a challenge to the FUE world however. Dr Umar found a solution by developing the Dr UPunch Curl which worked by a non rotary plunge action mechanism, thus beginning an era of non rotary punches. Both the Dr UPunch Rotor and the Dr UPunch Curl are integrated into a unit called Dr.UGraft Revolution Advanced FUE System. Dr UGraft systems mark the era of Advanced FUE.
- FUE hair transplants and all head hair transplants restricted hair extraction to a narrow corridor in the middle of the back and sides of the head for fear of using impermanent hair if the patient were to progress to severe baldness. Dr U described in a publication in the Aesthetic Surgery Journal the “FUE Shave Test” for screening patients and determining when to use hairs in areas outside the so called safe narrow corridor. This opened up the ability to use hairs in the nape and temple areas in many patients. It expanded the donor potential of these patients and enabled the use of finer nape hairs in crafting more natural looking hairlines, temple points, eyebrows and eyelashes.
BASIC FUE Hair Transplant Methods and Their Techniques
All basic follicular hair extraction solely rely on head hair donor supply which is limiting on several fronts. It is performed using either a manual punch or powered rotary punch device. Similar to a pen, manual punches are mounted on a holder and require the practitioner to execute rotation through precision.
There has been a attempt to increase speed in basic FUE procedures including the suction devices or robotic punch devices for help. For instance, the Neograft FUE incorporates the use of suction that pulls the grafts through a circuitous air drying vacuumed tube, with possibly deleterious effects on the hair graft. Robotic devices on the other hand like the ARTAS Robotic FUE, a pre-programmed robotic machine performs parts of the hair follicle extraction process. However, robots typically require the use of relatively larger punches which cause larger wounds and scars in the head donor areas. Smaller punches in the robot would lead to an increase in transections especially in the sides of the head
ARTAS allows for minimal work by the surgeon during the extraction process in FUE hair transplants.
Advantages OF BASIC FUE Over Strip Surgery
Some of the benefits of basic FUE hair transplant over Strip Surgery include the following:
- Avoidance of the Linear scars
- Preserved scalp anatomy
- Less likelihood of Nerve damage
- Faster recovery
- Ability to cut hair short
Advanced FUE Methods Using Dr.UGraft
Dr.UGraft Advanced FUE Technique and Body Hair Transplantation
Advanced FUE practitioner Dr. Sanusi Umar revolutionized the FUE hair transplant process by developing Dr.UGraft Advanced FUE system which enables the efficient utilization of body and head hair in hair restoration surgeries. Expanding FUE to include these donors provides for a more promising hair restoration technique even in cases of extreme baldness. Dr Umar’s patented, revolutionary Dr.UGraft Advanced FUE system creates a quicker process with little to no risk of damaging the donor grafts during extraction. His state-of-the-art, patented Dr.UGraft Advanced FUE system and Dr.UPunch tool have ultimately earned Dr Umar a reputation as a world-leader in FUE body hair transplantation.
Unlike other FUE tools, Dr.UPunch tool completely avoids the added risk of buried grafts that other devices carry. While traditional straight punch grafts can cause trauma to the hair graft during extraction, Dr.UPunch angles away from the graft. It then creates a gentle pulling action of the graft for removal. Dr Umar’s patented irrigation system then helps gently flush any impacted grafts from the punch with no damage to the hair follicle. Dr.UPunch’s fluid irrigation system creates a final seal when the gentle pulling action separates the graft from the tissue.
Advantages of Dr.UGraft Advanced FUE Over Basic FUE Methods
Advantages of the UGraft over other basic FUE includes the following:
- Ability to utilize body hairs as well as head hair as donors allows Dr.UGraft Advanced FUE method to have a number of advantages for both patients and surgeons. Body Hair Transplant – BHT permits the use of donor hair from the beard, chest, stomach, arms and legs, as well as the head and nape hairs for extraction. By expanding the donor pool to the body as well as the head, can now restore hair in even the most severely bald or and repair patients.Using finer hairs for the hairline, and eyebrows both situations where softness is desired makes for more natural looking results.
- Ability to extract very curly hair from patients with African type hair in all patients using the UPunch Curl feature of the UGraft makes it a truly superior procedure Basic FUE lac this ability.
The photo below shows a patient with curled AFrcian type hair who failed basic FUE elswhere but found hope in Dr.UGraft advanced FUE
Poor Candidates For FUE
Some criteria that could exclude an individual from benefiting from FUE hair transplantation include the following:
- Those who lack quality head, beard, or body hair. Patients in this category do not qualify for any type of hair transplant.
- Those with extremely curly hair or kinked follicles should only go to a clinic offering Dr.UPunch Curl™ which is offered by Dr. Umar. Only Dr.UPunch Curl can successfully perform FUE in 100 % in patients with kinky or extremely curled hair.
- Those who have allergies to local anesthesia.
- Those who have bleeding or clotting abnormalities.
- Those with keloids or those with scar hypertrophy, an abnormal tendency to scar.
- Young patient under the age of 24 should be counselled for progressive hair loss, financial implications and a planning that takes into account their lifetime head and body hair donor supplies. However, this applies to practitioners of advanced FUE who are capable of using hair from outside traditional head donor areas.
Who Should Perform FUE
The success of the FUE hair transplant surgery will ultimately rely on who performs the procedure. Follicular unit extraction requires an intense amount of labor and time. With this in mind, only a state licensed FUE surgeon or an experienced associate with the same licensing should perform the procedure. Unlicensed surgeons are forbidden from performing this type of surgery.
Prepping for the Dr UGraft Advanced FUE Hair Transplant Procedure
Patients who qualify for FUE and have chosen a qualified FUE practitioner should make it a point to know who would be performing different aspects of their FUE transplant procedure. Patients should also ask questions regarding the surgery process, and obtain any pre-surgery instructions from the doctor. Your pre-surgical research and actions would carry far reaching consequences and impact your overall surgical outcome immensely.
Patient’s To-Do List Prior to A Dr UGraft FUE Procedure:
- Immediate after booking your surgery, make it a point to go over in detail your written preparatory instructions given to you by the clinic. DO so with an eye for any preparatory instructions with time sensitive mandates examples include when to start or stop certain medications, when, where, and how to shave or not shave.
- The morning of the surgery, eat a plentiful breakfast. This will ultimately help with the anesthesia.
- Make sure to thoroughly shampoo your scalp. This procedure is considered surgical, so cleanliness is dire.
- Arrive to your surgery appointment in a timely manner
- If you leave out of the clinic area, it would be best to find accommodation near the clinic and arrive your new place of abode at least 1 day before your surgery date
- Wear open front shirts with buttons so you do not risk dislodging your grafts when trying to dress or undress after your Dr.UGraft advanced FUE
Dr.UGraft FUE Hair Transplant Procedure Process
Below are some of the processes a patient undergoing a Dr.uGraft FUE procedure should expect
Dr.UGraft FUE Hair Transplant Surgery Preparation
- After arriving at the hair clinic, before-surgery photos will be taken for the purpose of establishing a baseline in the areas marked for surgery.
- Surgical plans would be discussed in details, cataloged and all questions and concerns are addressed.
- The donor areas will then be shaved in preparation for surgery. For Basic FUE clinics, this will be the back or sides of the scalp. For clinics using BHT, alternative areas on the nape, beard, chest, arms or legs may be shaved.
- Once the transplant prep is complete, a blueprint reflecting the surgical plan agreed is drawn
- Next, patients are given light sedatives orally and/or intramuscularly to alleviate anxiety.
- The patient is positioned depending on the planned surgery. Dr U utilizes the latest surgical equipment (specialized surgical chairs and tables) that emphasize patient comfort.
- Next, administration of local anesthesia to the donor areas is performed.
- Dr.UGraft FUE is commenced.
No linear Scar Dr.UGraft FUE Hair Restoration Extraction Process
- Dr U and his associates would first score around a group of follicles (using Dr.UPunch Rotor) one at a time to free them each of their tissue attachments. This method is used for all patients except patients with tightly curled African type hair in whom Dr UPunch Curl is utilized
- Next using a jewler’s forcep with or without the aid of gentle dissection using a hypodermic needle, the grafts are pulled out of the score area.
- The grafts are placed in chilled storage media
- After all the grafts have been extracted for the day, preparations are made for the next step of implanting the grafts. Typically this would coincide with when the patient would take a lunch break.
The tiny wounds left behind in the follicular unit extraction process quickly heal and leave minimal trace behind.*
Dr.UGraft FUE Hair Transplantation Graft Implantation Process:
- After the extraction phase, Dr U would proceed numb the recipient area by local injection of lidocaine-epinephrine solution
- Next, Dr U would make slits in the recipient areas using costume sized blades for graft placement. This is what determines the design of the final result
- Next, Dr U’s qualified and well trained medical assistants would place the grafts int the slits Dr U prepared.
- To obtain the most natural looking hairline, Dr U directs his medical assistants to implant hair follicles containing a single hair follicle at the very front of the hairline. This allows him to build a gradual wall of hair. He then fills in the rest with units containing two-to-three hairs in order to provide density in the thinned-out area.
Possible Complications with FUE Hair Restoration Surgery
In general, the FUE hair transplant surgery carries little risks for good candidates. However, there some factors can increase the chance of a complication. For instance, failing to do the proper research on the surgeon can have risky consequences. An inexperienced practitioner or someone who values quantity of grafts over quality may not provide the best results. The following a common side effects of the FUE procedure:
- Extensive work in the hairline and temples could result in transient facial swelling. This is typically a self-resolving phenomenon that could arise at about 3 days after the hairline work was done and would resolve without any treatment within 5-7 days of onset.
- Ingrown hair, folliculitis are very coming in the donor areas (from transected hairs), as well as the recipient area with onset of hair growth
Other side effects are elaborated in the consent forms
Dr.UGraft FUE Hair Transplant After Care
- Upon completion of the graft implantation. The medical assistant would review the discharge instructions.
- Patients must follow the post-surgery instructions carefully, especially in order to insure best results. Post-surgical guidelines include instructions for everything from showering, daily activities, to exercising. The doctor will also prescribe a mild painkiller, antibiotic, and topical medication to help with any form of discomfort.
- Photos are taken and the patient is discharge
Hair Growth After Dr.UGraft Head FUE Hair Transplant: The Healing Process and Results
- The tiny wounds in the Grafted bald area would have scabs that should typically come off within 7-14 days.
- The head donor site continues to heal and overgrown by hair until signs of surgery become invisible to the public typically within one week.
- The donor sites will then typically go through a phase of shedding hair until around the eighth week post surgery.
- Patients will notice signs of growth by three-and-a-half to four months following surgery, usually maxing out after 12 months.
- However for Up to 18 months after surgery there could continue some improvement in growth, hair thickness, hair shine, and hair texture resulting in a better blend with the surrounding natural hair.
Follicular Unit Extraction FUE Hair Transplant Before and After Photos
Here are some examples. However for a more extensive view of results of Dr UGraft FUE using only head donors gallery, visit here
No Linear Scar Follicular Unit Extraction FUE Hair Transplant Results Video
To view a more extensive video gallery of Dr UGraft hair surgery results, visit here
Follicular Unit Extraction FUE Hair Transplant Frequently Asked Questions:
Does Dr. Umar treat patients who live out of the Los Angeles area with linear scar free follicular unit extraction Using The UGraft?
Yes. Dr. Umar has treated scores of patients from all over the world. If travel is a factor for a patient, Dr. Umar and his staff can design a treatment plant to minimize the required travel to his Los Angeles office. Moreover, the close proximity to the LAX airport makes visiting his facilities quite convenient.
How much does no linear scar FUE hair transplant cost with Dr.UGraft?
Cost varies from patient to patient, depending on the amount of hair grafts needed for treatment. For patients that consider cost a major factor, Dr. Umar can help design a plan of treatment that will take cost into consideration while still achieving great results.
I’ve been told I’m not a candidate for hair transplant because of a depleted donor area on my head. Can Dr UGraft FUE hair restoration restore my hair?
Chances are yes, even patients with depleted donor areas on the head can qualify for hair restoration with Dr.UGraft. Dr UGraft procedure has a high degree of versatility and can utilize hair from anywhere it grows on the body. This allows Dr. Umar to develop a restoration plan taking into account the shape and number of other body hairs to restore a full head of thick, natural looking hair.
Dr. U invites all patients to send him any questions they may have about hair restoration via FUE hair transplant through our Ask Dr. U online form:
- Read more on the FUE Healing Process here
- View results of Dr UGraft Follicular Unit Extraction using head hair donor alone here
- New York Times article on the Dr UGraft ‘s use of leg hair in transplantation