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Hair Loss Treatment at NHI

FUE - Frequently Asked Questions

  1. What is FUE (Follicular Unit Extraction)?
    ANSWER:
    This is a technique for harvesting individual follicular units by extracting them directly from the scalp, one at a time, in their natural occurring groups, with a surgical punch-like instrument (see video).
  2. Are FUE grafts qualitatively equal to grafts produced through traditional strip harvesting under microscopic control?
    ANSWER:
    The quality of non-transected follicular units extracted through FUE can vary from patient to patient and doctor to doctor. It is not unusual that transected (damaged) units with FUE can be substantial. Traditional strip harvested grafts, on the other hand, can be controlled from patient to patient and within team members when the surgical team is well disciplined. Some doctors have mastered the patient to patient variability of FUE grafts and can produce graft quality that, under optimal conditions, has hair survival that approaches that of traditional strip harvested grafts. But finding these doctors can be difficult (see photos on our FUE² page).
  3. What are the patient variables that affect the quality of the traditional FUE grafts?
    ANSWER:
    In our publication on the subject we studied the type of prevailing collagen found in the scalp of patients who had both successful and unsuccessful FUE grafts. Studies we had done suggested that grafts which contained more 'elastin' collagen fibers and had thinner follicular capsules made FUE easier for the surgeon and produced better quality grafts.
  4. Do all surgeons use the same tools when performing FUE?
    ANSWER:
    The tools that are used in FUE vary considerably among doctors. This has led many doctors to develop their own specialized tools. What is impressive is the wide range of tools used by doctors who do this type of surgery. Some doctors use sharp punches and some use dull ones; some use combined sharp and dull punches, scoring the skin with a sharp punch followed by dissection of the graft with a dull punch in a two step process; while other use drills that rotate to specified speeds like a dental drill or oscillate back and forth; and others use vibrating tools like the cast cutters used to remove plaster casts from a broken arm, just a small version of one. All of these tools have been found to have similar results. This indicates that no tool or technique seems to work for every surgeon. Whatever tools are used, the survival of the hairs in a graft is what determines the value of the tool. Ask your surgeon what type of tools they use and why they prefer that tool.
  5. How do the surgeons' skills and techniques impact the rate of extraction and success in lowering transection rates with FUE?
    ANSWER:
    The surgeons' skills vary considerably. Some doctors produce an impressive FUE technique with minimal hair damage and good extraction rates. Other doctors produce considerable hair damage in the FUE grafts. Reports indicate harvesting rates vary from 100 grafts/hour to as many as 1000 or more grafts per hour. Ask yourself if claims that show such wide discrepancies in extraction rates can be believed. Also, statistics on transection rates are not published but appropriate questions to the doctor about his/her transection rate will tell you much about the doctor's honesty, integrity and skills.
  6. How do doctors get qualified in performing FUE?
    ANSWER:
    Many doctors have not been trained in performing FUE because training was not generally available until 2004 when courses were first introduced through the ISHRS [International Society for Hair Restoration Surgery]. Prior to that, doctors interested in responding to the high consumer demand for this procedure just learned what they could from reading articles in medical journals or by attending workshops sporadically held in various countries. "Training" for most doctors, however, was essentially a trial and error process and, unfortunately, this does not guarantee that the surgeon offering the procedure has mastered the skills or techniques adequately to produce consistently high quality grafts with minimal hair damage and low transection rates.
  7. Do I have to shave my hair off before my procedure?
    ANSWER:
    For the person who has never had hair transplants and wants to style their hair in a short buzz cut, one can maximize the number of grafts in a single session. For those people who wish to hide their FUE with longer hair, we can perform the extraction in layers of 3-4 mm each, separated by hair of comparable width. However, performing FUE with longer hair may require more sessions than standard FUE.

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