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Dr. Bertram Medical Hair Transplant
眉 髮 醫 學 移 植 中 心 ( 香 港 ) |
( 852 ) 3421-1138
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FUE - What You Should Know
Follicular Unit Extraction, or FUE, has recently attracted a lot of attention. It has been promoted as the latest hair transplant technique; minimally invasive; healing without scar; and giving the best result. These messages must be received with care.
5 Facts About FUE
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Fact 1 - FUE Has Been Around For Over 23 Years
In 1988 Masumi Inaba in Japan introduced the Inaba Method. He used a 1mm punch to divide individual follicular unit and then extracted with 2 forceps. This was the same as the modern FUE technique.
So FUE cannot be described as the " latest " technique although refinement has been made over the years.
 
Picture from Inaba "Androgenetic Alopecia", 1996
Fact 2 - FUE Is Minimally Invasive Only When Number Is Small
FUE is a surgical procedure that removes hair follicles as well as scalp tissue. As each punch still has a diameter of 0.8 - 1.2 mm, it is no longer minimally invasive when more than 1,000 grafts are removed. Thousands of white spots will be left on the donor area with underlying scarring of the donor area. The decrease in hair density will cause thinning. Subsequent hair transplant, whether by strip or FUE, is rendered more difficult.
A much larger donor area is required when compared to strip.
Fact 3 - Grafts Are More Traumatized in FUE than in Strip
As FUE is a blind extraction technique, the follicles are subjected to a higher incidence of transection. Also the small size of the punch (0.7-1 mm) produces thin or skeletonized graft. Both leads to lower graft survival and less growth.
FUE graft (left) less protective tissue than strip graft (right)
Fact 4 - FUE Is Not Without Scar
All wound heals with scar, no exception. Though no linear scar as in strip, each FUE punched hole still leave a white spot as shown in this pictures. These spots become very noticable after a large number of grafts are extracted.
Fact 5 - FUE Not Necessarily Gives The Best Result
There are 4 steps in hair transplant :
- Hairline design
- Graft harvesting (by Strip or FUE)
- Incision ( making holes on recipient site )
- FUE is only one part of the procedure. Attention must be given to every single step for good result
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FUE Is Not Without Complications
FUE precedure is generally safe, painless, and with quick recovery. However the following complications may occasionally occur especially when performed by inexperienced surgeons.
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Graft Transection
Being a blind technique, any deviation of the angle and depth during sharp scoring can transect the follicles. A transected follicle has lower growth rate. We take all efforts to minimize graft transection.
Skeletonized Graft
The size of the graft is governed by the size of the punch. The usual FUE graft is "skeletonized" with little surrounding tissue. However the stem cells which initiate hair re-growth are located in that tissue.
Growth rate of a skeletonized graft is less than that of a chubby graft harvested by strip. Therefore we insist of using a larger punch to contain more tissue.
Donor Scar and Mottling
FUE prevents a linear scar but it is not a scarless technique. After thousands of grafts are removed, unsightly mottling and thinning will be visible. This is more a problem for Chinese who has high hair-scalp color contrast. That is why we do not recommend FUE for those with advance baldness.
Poor Result
There are 4 reasons for the poor result :
- Non-Permanent hair was harvested- FUE involves a much larger donor area. Non-permanent hair may be picked up which may be miniaturized with time after transplant. We overcome this problem by carefully confining the donor area
- Graft Traumatized by forced extraction - Transected graft or skeletonized produce thinner hair and lesser coverage. Transection must be minimized.
- Inadequate number of Grafts was harvested - When over 1,400 grafts are planned over a 2-day session, the final number may fall short by a few hundreds grafts. Any change of the initial plan may cause suboptimal result. This is less a problem with our one day session.
- Ttransplanted density was too low - FUE yields less grafts per session. Transplanting in low density cannot achieve good coverage. For this reason we do not offer FUE when a large bald area needs to be covered.
Thinning of Donor Areas
Thinning occurs due to the selective extraction of 2-3 hair FUs. The decrease in hair density and hair quality make scars more visible.
Future session Difficult or Impossible
- Depletion of donor hair - Less hair is available for future use. Most of the good ones would have been extracted in previous session
- More scar - The decrease in density requires a wider strip to be excised to meet the number of graft. Wider strip means wider scar. Also the scar is more visible due to thinning of donor hair
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4 Reasons Why FUE Becomes Popular
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1. Medical Service Commercialized
More and more business people are keen to make profits in the hairloss industries. Setting up a FUE center is the best way to enter the hair transplant market. FUE is easier to master when compared to strip. Minimal training and investment are required.
Their marketing campaign, though successful, is not ethnical. Misleading information has been conveyed to exaggerate the pain and scar from strip in order to push sale for FUE. On the other hand problems associated with FUE are seldom mentioned.
Manpower for (left) strip harvesting, and (right) FUE.
2. Favored by Inexperience Surgeon
Less skill and experience are required. Surgical training is not essential and there are less complications to worry about. Many doctors become a FUE " expert " after attending a 3 days workshop or buying an automatic extractor.
3. Part-Time Surgeon
The minimal requirement for FUE is one assistant and one doctor. This needs no extra man-power for those who perform mainly other cosmetic procedures and only hair transplant occasionally.
4. Minimal set-up
Only 3 instruments are needed for FUE: a punch, a punch holder, and 2 forceps. No investment required and basically anyone can offer FUE hair transplant. There is no need for a large surgical team.
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Misleading Marketing by some FUE Clinics
There is a recent increase of FUE hair transplant clinics all over the world. Their marketing strategy is to attack Strip harvesting as brutal creating horrible scar. You should be aware of this kind of misleading advertising :
- Most of these FUE surgeons have never done or even seen a strip procedure. They just uploaded a strip scar picture onto their websites from somewhere
- They are not paying respects to Dr Frechet, Dr Rose, Dr Marzola ( Tricjophytic Closure ); Dr Mayer ( Laxity Scale ); and Dr Pathomvanich ( Retention Suture ) for their works in minimizing donor scar. Things have changed since 2005
- FUE does not leave better scar than strip if the same amount of grafts is taken
- Make up fancy names for just a FUE procedure
- Some may tell you that hair can regrow from the donor area after FUE. There is only one reason if this happen - the graft has not been extracted properly. So just a cover up for poor extraction technique
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