Follicular Unit Extraction-Facts And Myths
Dr. Vivekanand N Bhat
Lavelle road, Bengaluru Feb 9, 2017
What is FUE or Follicular Unit Extraction.
Follicular unit extraction or fue has become very popular now,claiming it is scarless, painless, way to treat androgenetic male pattern baldness.here an extraction device removes one graft at a time from donor area, the advantage is there is no stitching of donor area, and there is a small scar at the spot.The process of extraction can be manual , automated ,Neograft that we use is an automated FUE extraction device.
Advantages of Neograft include less damage to the follicle during extraction as it makes a cut only at skin level and the rest of the graft is lifted up by suction, where as in manual extraction, there is a possibility of damage to graft as it has to be first cut and then pulled out.
Is Fue really scarless and painless as some advertisements claim it to be ?
Not in reality unless the right instrument is used, if you see the scars here of fue then you do get the idea,these are scars that developed following fue done in a clinic,and with poor result requiring a correction in my clinic.
Is FUE painless ?
in respect to pain ,it would depend on the clients capacity to bear the pain, some say hair transplant in both the forms that is strip and extraction its absolutely painless, or they had to take pain killers to reduce the pain.
Is FUE the ideal technique to treat hair loss ?
Yes and No would be the answer, if hair loss is less than 2000 to 2500 grafts requirement i follow fue technique, in my clinic , if the requirement in the first sitting is more than 2500 grafts then clients would need an evaluation to see if they can go ahead.
Who are ideal cases for FUE?
If we see the balding pattern here it is for your reference
Stage 1– No hair loss
stage 2– Minor recession in front of hair line,and some temporal recession.
stage 3– Temporal recession deepens.
stage 4– Frontal and temporal loss progresses and there may be baldness in crown.
stage 5– Baldness in front and at the crown fuse and keep enlarging.
stage 6– More severe version of grade 5,the back portion of the bald area is bigger in size.
stage 7– Severe baldness with only hair resistant to DHT hormone surviving, there is a rim of hair on the back and on sides of the hair.
1.Approximate grafts requirements to show decent hair growth in different stages of baldness varies from as low as 1000 to as high as may be 6000 plus, depending upon the size of the head,to cover from the front hairline to the crown area .
2.Is all of this available purely from the head alone ?
I have been doing Neograft FUE technique for ages now, this automated FUE technique is still the best technique for FUE,a pure Fue yields about 2000 grafts on an average to 2500 plus grafts( from scalp hair) in indians who already suffer from androgenetic male pattern baldness ,this number comes down further as the baldness stage goes up.
3.So who are ideal candidates for FUE ?
Of course if we exclude body hair then stage 3/4 are ideal cases , probably early grade 5 at the most can be considered too.any stage beyond this in absence of body hair would be foolish to venture as we fall way short as baldness levels in 6 and 7 would have less and less of donor area in the back that can yield significant grafts.
4.why does one see more and more of unhappy clients following FUE now days ?
The main problem is not with the technique ,but with proper client selection to avoid unhappy clients.we need to remember that not all transplanted grafts’ grow, hence a refill may be needed ,plus one needs to plan for further hair loss in future,some of the bad results i have seen ,most of the donor area has already been rampaged to deliver moregrafts ,however growth in front is poor, and these clients also have few grafts left in the back of the head for another sitting,another interesting fact is most of these clients have relatively small head size, and are generally bad candidates for fue if requirement is huge.so bad results’ with FUE will continue till clinics start saying no to poor candidates who are not ideal for FUE ,but can benefit from strip.In my clinic we have come to a point where some clients have been promised a huge number of grafts elsewhere with grade 7 baldness and have been promised a head full of hair, which with due respect is not possible, with FUE being turned away.
1.Do not jump in favour of one technique with our trying to understand if its suitable for you or not, take a second opinion when in doubt, take the trouble of actually visiting a clinic to take a second opinion, no one can give you a correct estimates looking at the back of your head from photos.
2.Strip technique still has its own advantages even today, a good hair restoration clinic is one which cando a good job with both techniques and not FUE alone.3.Hindu tradition of shaving ones head when elders die in family ,is what inhibits some from choosingstrip over FUE to avoid a scar, if you see from the photos above a poorly done FUE also gives you bad scars, scars can be camouflaged in a strip by going for trichophytic closure or even be hidden forever either with a small FUE corrective surgery, or with Micropigmentation treatment nowadays,so let that not be the only criteria for choosing a hair restoration clinic.you do your transplant once do it the right way.