Follicular Unit Extraction or FUE is an excellent surgical option for people hoping to restore their hairs with minimal scarring and discomfort. Since its introduction in 2002, FUE has become an increasingly popular method to obtain donor hair. Despite its numerous advantages and some disadvantages, patients are more likely to choose FUE instead of FUSS or follicular unit strip surgery today.
In this procedure, individual follicular units or groups of one to four hairs are harvested directly from the scalp. In order to extract an optimal number of follicle units, the surgeon would generally shave the donor area. After this, the patient would have the predetermined quantity of follicle units that are 0.9 mm or less in diameter.
By doing so, individual hair grafts can be precisely extracted from the skin’s outer most layer. This procedure is agreeable with patients since there exists a recent trend towards minimally invasive procedures. Patients can expect negligible scars that are barely detectable while sporting short hairstyles in vogue today. This is one of the reasons behind its immense popularity.
Depending on the number of grafts to implant along with the experience of the surgeons doing it, the process can last anywhere between 6-10 hours. Due to the intricacies and skills involved, the FUE procedure is a labor-intensive process, which requires co-ordinated teamwork of a high order for it to be successful. After about 6 months of the surgery, nearly 85% of the follicles would grow new hairs while the remaining can take a year.
Here are some of the instant advantages of FUE to FUT:
i) The surgeon is with the patient for a longer time in the OR
ii) Minimal appearance of scarring
iii) FUE procedure doesn’t require any stitches or incisions while with FUT, a portion of the patient’s scalp is excised and stitched up
i) Shorter recovery time
v) Patients can wear trending hairstyles.
But, does the FUE procedure really come with No Trauma?
There is nothing that is scarless in this field but scars are not discernible. There is also some trauma to the hair that has been extracted and surrounding tissues especially when cheaper instrumentation and heat producing motors are used. This trauma in expert hands does not affect graft survival or regrowth of hairs, but when the procedure is done casually or in a hurried manner, the graft survival and neighboring shock loss can be considerable. Patients have to be informed about this in the informed consent prior to surgery.
One of the most common terms that you would get to hear with respect to FUE is transection rate. It measures the total number of hair bulbs that get irreversibly destroyed or harmed at the time of follicle extraction. Additionally, the transection rate shares an inverse relationship with the chances of survival of the follicular units after their extraction from the scalp. This implies that higher the rate of transection would lead to lower the rate of survival, thereby making the treatment less effective as far as coverage and results are concerned.
Generally, the transection rate of FUE procedure is 2 – 5% with minimum complications. This can skyrocket to 35% in inexperienced hands and in clinics where the team is in a hurry to cater to more patients listed for the day. Low transection rates can be encountered only in skilfully hands that are unhurried and which do just one case a day.
1042 grafts at random from 42 patients of Indian origin were selected in a study in 2017 at our Clinic. Using a 20x magnifying microscope and then a 4.5x magnifying loupe, with double-blind method. The aim here was to address the lack of evidence on the extent and nature of injuries caused to the follicles at the time of FUE procedure.
With the 20x magnifying binocular microscope, an average of 3.56 % full transection rate was found while 1.36%, 0.82%, 0.30% and 1.11% follicles showed four types of minor trauma, which included partial injury to the dermal papilla, partial injury to the hair bulb, pairing and fracture respectively. With the 4.5x magnifying loupe, an average of 1.89% transaction rate was found while 0.88%, 0.39%, 0.19% and ).08% f grafts showed the above enumerated four types of minor trauma, respectively.
Thus we come to know that no surgery, even FUE, is trauma-free. Trauma can be found frequently with all the associated types of damage under high-resolution high magnification microscope. This stands true especially with respect to hair bulb injury and pairing. Since hair bulbs are essentially responsible for initiating new hair growth and the follicles are only a finite resource – injuries like the ones mentioned here can have a severe impact on the survival chances of the hair grafts. This can in turn lower the rate of a successful hair transplant rather drastically.
Even though the transection rate remains a crucial factor to consider before deciding to get FUE surgery done, both patients and doctors need to discuss about trauma and minor injuries that can happen. This needs to be done at the time of the consultation while deciding the best treatment for the patient. Several other factors can also affect the survival rate of the follicle, such as dryness, out-of-body time, physical trauma and more. However, nothing can affect FUE’s success rate as much as the experience and skill sets of the operating team. And always remember, transected hair roots grow back but loss of roots in FUT do not! That is a savior statement for clients seeking an FUE hair transplant.
The best way to move ahead with your surgical procedure is to not have any unrealistic expectations. This holds true more for hair transplant than any other cosmetic surgery procedure. The chosen surgeon should discuss all factors of hair transplant in general and FUE in particular with you without missing out on his transection rates. Transection rates are visible in results that show a thin hairline. Such less than desirable hairlines are a reflection of high transection rates and less than optimal technique of hair transplant.
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