There are two methods for performing hair restoration, Follicular Unit Extraction (FUE) or strip hair transplant, also known as FUT (FollicluarUnit Traction). This page will be dedicated to Follicular Unit Extraction (FUE). Dr Sean has answered the main and most important questions about FUE asked by patients. Please read below.
What is FUE?
Follicular Unit Extraction or Follicle Unit Extraction is the removal of individual hair follicles to be transplanted from one part of the body to another part where the patient desires hair. Its a very advanced procedure performed by limited number of even dedicated hair transplant specialists where individual grafts are removed one at a time from the donor area without leaving a linear scar as the strip procedure does.
1 milimeter punches are used to punch out individual grafts and then very fine forceps are used to gently remove the grafts out of the body. The individual grafts are then inspected under the microscope and then placed back very gently in the recipient area. This process, which integrates science and art typically takes about 8 to 12 hours to successfully transplant about 1,000 grafts.
Dr. Behnam performs one surgery per day in order to ensure the entire process goes smoothly.
Before and after just about 980 grafts in the hairline using FUE. This person has significant curly hair. Dr. Sean Behnam uses special techniques to successfully extract the grafts even if they are curly.
FUE Hair Transplant in Los Angeles
A little over 50% of Dr. behnam’s cases are F.U.E and he has been performing them since 2008. The procedure is much more challenging to perform than the strip procedure so it needs to be performed by a doctor who does it frequently for the patient to have a good result.
The challenge mainly comes from the angle of the hair under the skin. The doctor must determine the angle of each graft before extracting it. An inexperienced surgeon often damages the grafts while attempting extraction. This is called transection.
Dr. Behnam’s transection is below 2% even when working with difficult hairs with a curl. Performing only one surgery per day has allowed him to take his time with each procedure. His experience with this difficult procedure has made him one of the leaders in the field.
What are the advantages of FUE?
The F.U.E procedure leaves dispersed scarring that is less visible than the scars left by traditional strip procedures. Dr. Behnam also uses Acell which diffuses each scar and reduces it up to 30%. This allows patients to wear really short hairstyles.
Another advantage to F.U.E. is that the Dr. chooses the grafts that best suits the area to be filled. For example, if a patient has an area that only requires 500 grafts, Dr. Behnam will choose the grafts that create the desired effect.
If the area is on the top or crown of the scalp where density is desired, he will choose the thicker multi-haired grafts. If the area is in the front of the scalp, he will choose the finer single hair grafts for a natural soft hairline.
How is FUE different than the strip procedure?
In the strip procedure, a strip of tissue is removed from the back of the scalp. The wound is then closed at 3 different levels. It does require the use of sutures and staples. It does leave a small scar on the back of the scalp. With the FUE method no strip of tissue is actually removed from the back of the scalp.
Individual grafts are removed one at a time. One millimeter punches are made around the grafts and they are then individually removed from the tissue.
There is no linear scar there is no use of sutures or staples in the FUE method.
This gentleman had a 1,200 grafts FUE procedure. The picture on the left shows the back of the scalp at the end of the procedure day. You can see the individual holes where the grafts have been removed from. The picture on the right is 6 days later. Its important to show how nicely the back of the scalp heals. This person has also been using Acell. which accelerated wound healing.
How is pain and discomfort in the donor area different between FUE and strip removal?
Since FUE does not require sutures or staples, there is less discomfort. Majority of the patients feel sore in the back of the scalp, but very few require the use of pain medication like Vicodin.
What are the benefits and disadvantages of the FUE compared to the Strip?
There are different benefits to each.
The main benefit of the FUE is that it does not leave a linear scar in the back of the scalp so the patient may wear a shorter hair style. The following 4 pictures demonstrate this point. The 4 pictures below show a natural proferssion of the FUE procedure. The far picture on the right lower hand shows part of the back of the scalp shaved after one year after the procedure.
The picture on the left is at the end of the procedure day. The picture on the right is just after 6 days post procedure. Please notice how quickly it is healing.
The picture on the left is 10 days after the procedure. The picture on t he right is one year later, Dr Sean drew the blue line and shaved the area. This patient did use ACell. It shows significant wound healing to a point that the scars are very minimal.
Its hard to even detect that there are any scarring. The individual tiny scars are even hard to detect. We contribute this to the use of Acell, which we believe makes the 1 millimeter punch even smaller when it scar, blurs the borders of the scar and there is a study that shows that some of the hair follicles actually regrow as well.
The video below shows the wound healing effect at 7 months after the procedure:
The following video is a closeup of the donor area shaved after one year post FUE procedure.
The disadvantages of FUE is that large procedures such as 1,200 to 2,000 grafts will take 2 days to perform. This is because each graft must be removed one at a time and very carefully. This takes time. At the end of the day, what counts is good quality work.
Although it may sound easy to punch out 2,000 grafts in one day, but to extract grafts of the highest quality with the highest graft survival takes time. We rather split it into two days and focus on extracting and placing half of the grafts each day. The number of grafts that can be extracted in each day is actually based on the curliness of the hair, making your 1 on 1 consultation with Dr. Behnam crucial.
Further, the the donor area must be shaved in order to perform an F.U.E. procedure. It will take about 10 days for the back of the scalp to heal. The use of Acell will accelerate this healing. The shaving may be a downside for some people, specially if you war your hair typically longer.
For smaller cases a no-shave method can be utilized but for larger procedures, shaving can not be avoided. The F.U.E. procedure is also more expensive than the strip procedure.
The benefit of the strip procedure is that large amounts of grafts can be removed and placed in one day. The scalp in the back does not have to be shaved. The disadvantage with the strip method is that it leaves a slight linear scar in the back of the scalp.
Dr. Sean Behnam takes measures to ensure the smallest scar possible. His patients who are scheduled to have a strip procedure must perform a scalp exercise to stretch out the donor area prior to the procedure. This has helped to significantly reduce the scarring in the back of the scalp. In fact over 1,000 patients that have done the strip removal using the scalp exercise, very few have had a scar larger than one millimeter.
Please click here ( FUE Hair Transplant ) to read more as well as the frequently asked questions.