FUE hair transplant

FUE hair transplant - characteristics

Human hair falls out and in no case should it be treated as pathological. The standard number of hairs which fall out every day and which should not be a cause for concern is up to 100 hairs a day. We lose hair due to its natural life cycle: each hair goes through three subsequent phases of development (anagen, catagen, telogen) until it eventually falls out.

New hair should grow in the place of lost hair; ultimately the look of the scalp should not change significantly. However, losing more hair than above-mentioned amount may be a reason to worry. There are many reasons for losing hair, which as a consequence leads to baldness. Some examples involve:

• hereditary pattern baldness (a tendency for increased hair loss in a patient’s parents significantly increases the risk of this problem occurring in the case of the patient),
• diseases connected with hair loss ( such as, for example: thyroid disorders, systemic lupus erythematosus, polycystic ovary syndrome),
• excessive androgen levels (this is the main cause of hair loss in men),
• lack of certain nutrients and an unhealthy diet (hair loss may be caused by anaemia or by eating heavily processed foods with large amounts of preservatives),
• radiotherapy of the head area or chemotherapy in the treatment of cancer,
• side effects of taking certain medication (even though it is not common, certain oral contraception may cause hair loss while taking it or afterwards).

In the case of some of the causes as mentioned, once it ceases, hair may grow back again properly. This happens, for example, in persons treated with chemotherapeutic agents or those with anaemia – once the cancer or anaemia is treated, hair loss may stop being a problem for a given patient. Therefore, it is very important for patients with hair loss to find the reason for this condition – it may well turn out that treating the root cause will stop the hair loss. In a slightly worse, however, not hopeless, situation, are those whose balding is caused by an excess of androgens. Nonetheless, these patients may also be helped as modern medicine offers many methods of operative treatment for baldness.

In actual fact, hair transplants are not new in medicine – their first description comes from 1822. Since then, new methods of hair transplants have appeared, from which the most noticeable ones are the FUT and FUE methods. The latter was developed in the 1990s and even though a lot of time has passed since its appearance on the medical market, it is still used successfully to deal with a lack of hair in patients.

The name FUE stands for “follicular unit extraction”. To put it simply, it involves extracting single hair units. During this transplant units of hair instead of single hairs are extracted and transplanted – one such unit comprises of from 1 to 4 hair follicles.

FUE hair transplant- benefits

The most important advantage of FUE hair transplants is the fact that they are minimally-invasive procedures. They require only small, needle-like surgical instruments. Of course, there are some short term restrictions to be followed after the procedure, however, they should not impede to a large extent the everyday activity of a patient. Another benefit of FUE may for many patients be the fact that it does not require hospitalization afterwards and it is possible to get back to work as early as even one day after the procedure. One should not forget about another aspect of FUE; and that is the fact that due to extracting single hair units, possible scars afterwards are not visible to the naked eye.

FUE hair transplant– recommendations

FUE hair transplant is generally recommended to these patients in whose case there is a need to prevent hair loss.
This method is specifically recommended to those patients who:

• would like to avoid having a clearly visible scar - this may refer in particular to men who like having short hair (a hair transplant with the use of the FUT method may result in a kind of scar located at the back of the head),
• want to use for the transplant hair from other areas of the body than the head (for example, skin from the chest or limbs – in these cases, hair is extracted through the use of the FUE method, but the procedure is called BHT),
• must return to work shortly after the procedure,
• would like to have thicker hair on the head or in other body parts, for example: the eyebrows, moustache or beard,
  have to restore hair in the area of scars caused by other procedures or caused by injuries (for example burns).

The FUE technique may be used in patients with androgenetic alopecia as well as in patients whose hair loss is due to other factors. The procedure may be performed both on women and on men.

Contraindications for the treatment

Even though the FUE hair transplant is a minimally invasive procedure, it does not mean, however, that it may be performed on any patient who is willing or who needs to have it.
This procedure in not recommended in the case of:

• bleeding disorders (in particular those which create a tendency to excessive bleeding)
• skin inflammation (in the donor or graft site)
• lack of the appropriate amount of the right quality hair which could be transplanted
• bed general health (related to unstable chronic conditions of the patient or aggravation of a chronic condition)
• allergy to anaesthetic used during the procedure.

Before the procedure

Before the procedure, there is a consultation during which the patient’s problem is diagnosed in detail and it is checked whether an FUE hair transplant may be recommended. During such a consultation it is also checked whether there are actually places available for hair units to be extracted from. A doctor qualifying the patient for the procedure must also make sure that there are no contraindications for the procedure. It may be recommended for the patients who are on antithrombotic medication to stop using it some time before the procedure, providing that their general condition allows it.

If the outcome of the consultation is positive and a patient is qualified for an FUE hair transplant, a date for the procedure may be set. The consultation finishes with recommendations to be followed before the procedure: fortunately there are not many of them. The most important one is to shave the hair in the area where grafts will be extracted from (about 7 days before the procedure) as transplanted hair units should be about 2-3 mm long.

Type of anaesthetic

The FUE hair transplant is a procedure which does not cause significant discomfort in patients, thank to a local anaesthetic used during the procedure.

What is the course of the procedure?

The first stage of the procedure is anesthetizing the area subject to the procedure – the aim of local anaesthetic is to make patients as comfortable as possible. Following that, transplants are extracted. In case of FUE, they usually come from the back or the side of the head. A number of special systems are used for extracting hair. However, the most important information for patients is surely that that the instruments used have a small diameter (usually no more than 1 mm) and look like a needle.

Depending on the size of the team performing the procedure, hair units may be extracted first and transplanted later, or they may be transplanted at the same time. Transplants extracted from the donor site are inserted into the graft site into specially-made incisions in the skin. Inserting the hair does not require using any stitches. The duration of the procedure varies and depends mostly on the amount of hair transplanted. Therefore, an FUE hair transplant may take 5, or as many as 10 hours. It is generally accepted that during one transplant session, 2 - 3 thousand hair units may be transplanted.

Once the procedure is finished the patient may go home on the same day.

Course and duration of recovery

FUE hair transplant does not limit to a large extent patients’ everyday activity. Marks after the procedure (such as small scabs or reddening of the skin) will heal on their own within a maximum time of 7-14 days. Sometimes, the head may be dressed; this is rare, however, and patients usually leave the clinic with no dressing.

It is possible to return to work even on the day following the procedure. Detailed recommendations in this respect depend, however, on the patient’s job (as shortly after the procedure, physical activity should be limited), so it is recommended to consult a doctor whether a short time off work may be necessary.

Results of the procedure

A direct result of an FUE transplant is hair restoration. It will be visible at once when the hair units have been transplanted to the graft site, although it will take some time before one will be able to fully enjoy their new hair. This is due to the fact that transplanted hair may soon start falling out, which is natural, however, and should not be a cause to worry. After some time (usually after 2-3 months), the transplanted hair will grow and slowly get to the right length.

The final result depends also on the graft survival rate. The most important for that is the experience and skills of the doctor. A graft survival rate may be as high as 95%; however, to achieve such a high survival rate, appropriately extracted hair units must be transplanted and they may not be damaged during the extraction.

Recommendations following the procedure

Patients who have undergone FUE should avoid considerable physical activity for about one week, as well as exposing their skin to strong sunlight. A doctor may recommend using for a few days antiseptic products on skin where the procedure was performed to limit the risk of infection in those areas.

An issue which is interesting for many patients is washing their hair – some doctors allow it one day after the procedure, although some recommend abstaining from it for 3 days after the procedure. Irrespective, however, of the time after which a doctor will agree to a patient washing his or her hair, for the first 7-14 days, the graft site should be taken special care of. Gentle, ph-neutral hair products should be used. During this time, patients should also avoid applying to the skin of the head any additional cosmetics such as, for example, hair conditioners. Care should be exercised not only during washing but also during drying – towelling dry should be done very gently as excessive rubbing could damage the transplanted structures.

How long do the results last?

It is not possible to say unequivocally how long transplanted hair will stay in the graft site. Everything depends on the patient’s general health. Transplanted hair is affected by certain factors in the same way as they affect the structures which were naturally present in the graft area. If a patient, for example, still has too much androgen, there is a risk that the transplanted hair will fall out after some time (however, transplanted hair is less affected by androgens than hair which was naturally present in the graft site). It is similar in the case of diseases leading to hair loss: for example, unstable hypothyroidism may cause a patient to keep losing hair.

How can complications be avoided?

Complications following an FUE hair transplant are rare and generally unreported. This does not mean, however, that it is not worth preventing them. Most of all, patients should follow the recommendations of their doctor related to the period after the procedure – following them will not only cause the risk of unpleasant occurrences to be limited, but will also allow the maximization of the results obtained. Patients should maintain hygiene of the skin subjected to the treatment (if a doctor recommends using antiseptic products, they should be applied exactly for as long as recommended). The risk of excessive scarring may be reduced, in principle, only by not undergoing a hair transplant.

Possible complications after the procedure

A complication involved in various transplants, that is: organ rejection, in the case of a hair transplant do not, in principle, occur. Such a risk is not present, as the hair transplanted is the patient’s own hair.

Other possible complications are so rare that they are generally unreported. Examples include bleeding of the area subjected to the procedure, inflammation of the donor or graft site, as well excessive scarring or keloid scars.

Recommended additional treatment after the procedure

An FUE transplant may be performed in one session. However, it may also be divided into a few (2 up to 3 sessions).The second option is chosen when there is a need to transplant a large amount of hair - a limited number of hair units may be transplanted in one session, which is why it may be better to divide the procedure into a few sessions.

A separate procedure which is sometimes used to maximise the results of the effects of hair restoration is platelet-rich plasma mesotherapy applied to the skin of the head. It is sometimes done together with a hair transplant or performed some time after the hair transplant. Use of platelet-rich plasma may improve the results obtained due to nourishing the transplanted hair.

Author: Tomasz Nęcki, MD

Literature:
Dua Aman, Dua Kapil, Follicular Unit Extraction Hair Transplant, J Cutan Aesthet Surg. 2010 May-Aug; 3(2): 76–81; Rassman W., Pak J., Kim J., Follicular Unit Extraction: Evolution of a Technology, Journal of Transplantation Technologies & Research 2016 6:158; Epstein J.S., Hair Transplantation, Medscape