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The Top 5 Main Benefits of Follicular Unit Extraction

The science of hair restoration has come a long way, from its days of scalp flap surgery in the 19th century and 4 mm punch grafts in the 1950s, to the advanced, present-day techniques of strip excision and follicular unit extraction.

What are follicular units?

It was long thought that scalp hair grows in individual hair strands, but recently it was discovered that it actually grows in tiny groups called follicular units. One adult follicular unit consists of 1-4 terminal (fully grown) hair follicles. Under sufficient magnification, these tiny bundles can be easily noticed. On the average, there are about 1.8 to 2.3 hairs in one follicular unit. Aside from the terminal hair follicles, each follicular unit contains 1-2 vellus hairs (short, fine and barely visible hair which covers most of the body and serves as thermal insulator), sebaceous glands for lubrication, a tiny muscle, nerves and blood supply, all wrapped up in a band of protein called collagen.

As a result of this structure, follicular units can be viewed as distinct functional entities. Hence, for purposes of follicular unit transplantation, follicles are logically harvested as intact follicular units in order to ensure optimal graft survival and growth.

What is follicular unit extraction (FUE)?

Follicular unit extraction (FUE) and strip excision (strip harvesting) are two subcategories of the follicular unit transplantation method (FUT), the most widely used surgical hair restoration approach today. In essence, follicular unit transplantation involves relocation of whole follicular units obtained from a patient’s donor area (permanent zone) to areas affected by hair loss, or more specifically, into previously incised grafting sites.

The main difference between follicular unit extraction and strip excision is the harvesting part of the process, whereas the actual grafting of the follicular units is more or less the same. In strip excision, as the name suggests, a strip of skin is excised from the patient’s donor area using a traditional scalpel and then stereo-microscopically dissected into individual follicular units.

In follicular unit extraction, follicular units are harvested (extracted) directly from the patient’s donor area, one by one, using tiny circular punches (0.8 mm to 1.0 mm) with the help of a circular punch, instead of a traditional scalpel. The resulting hole is so small that there is no need for suturing and the scar is almost unnoticeable.

What is donor area?

The donor area is one of the key elements of surgical hair restoration, as it supplies the hair grafts. It is located at the back of the head and its key characteristic is its resistance to baldness i.e. the effects of dihydrotestosterone or DHT. Dihydrotestosterone is an androgen hormone, present in both genders, which plays the main role in the development of male and female pattern baldness (androgenetic alopecia).

In this type of hair loss, healthy terminal hair gradually diminishes in size and diameter (miniaturized hair), as a result of the hypersensitivity of hair follicles to the effects of this hormone. DHT affects the nutritional supply of the hair and causes progressive shrinkage of the hair follicles, resulting in thinner and weaker hair and ultimately, permanent hair loss. The donor area concept is closely linked to the donor dominance theory, which creates the foundation of follicular unit harvesting. According to this theory, hairs harvested from the donor area will continue to grow in the new site as they would in their original location, retaining their resistance to DHT.

Who can benefit from FUE?

FUE is widely used in the treatment of androgenetic alopecia and produces the best results in patients with minimal to moderate hair loss. FUE is also the method of choice for women requiring corrective surgery for the so-called widow’s peaks (triangle-shaped frontal receding hairline), patients requiring transplantation of eyebrows, eyelashes and mustaches, as well as treatment of limited alopecia secondary to dermatological conditions. Also, FUE is recommended for patients whose scalp is too tight for strip excision and when regions other than the scalp (beard, abdomen, legs) serve as donor areas.

What are the main benefits of FUE?

Although FUE is a new method, it is the preferred option for people affected by hair loss throughout the world. It is recommended by the majority of hair transplant specialists. FUE is a permanent and visually pleasing solution to hair loss problems. The main benefits of FUE include:

1. Absence of a linear scar

This is one of the main reasons why people choose FUE over strip harvesting, as the latter leaves a visible linear scar. FUE is a treatment of choice for people that prefer to wear their hair very short at the back, because the donor area looks unaffected and unaltered.

2. Fast healing

FUE requires a shorter healing time than some other methods. With FUE, patients recover in a matter of days since the method doesn’t require use of scalpel or sutures. As a result of this, there are minimal restrictions on strenuous physical activities after the first few days. Full recovery takes an average of 7-10 days.

3. Minimal postoperative discomfort

To ensure patient comfort, hair transplant surgeons use simple local anesthesia similar to the one used in dental practices. Patients can drive home immediately after the treatment. If some discomfort occurs, it can be managed by mild analgesics. Moreover, due to the non-invasive nature of the procedure, the possibility of postoperative infections is extremely low.

4. Natural look

The advanced FUE method yields perfectly natural results and the hair transplants can hardly be distinguished from native hair. In FUE, hair grafts are transplanted at a direction and angle that mimics the growth of the surrounding strands. As a result, transplanted hairs merge and blend in with the surrounding hair in the most natural way. In addition, FUE can be used to conceal scars left behind by previous strip harvests.

5. Large harvesting area

FUE offers possibilities for expansion of donor hair reserves, especially for patients with low donor hair supply and high recipient demand. It is generally believed that it is still possible to harvest some additional grafts on a patient who has depleted their donor using the FUT method. In certain situations, donor hair reserves can sometimes be expanded include the donor’s chest, abdomen, and beard.

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Published on June 3, 2015

By Advanced Hair Restoration