Hair transplantation with the FUE method; It is a minimally-invasive microsurgical procedure. Considering patient satisfaction as the primary goal in hair transplantation as in all aesthetic operations, Dr Kul will reveal how the FUE method, which is considered the last point in hair transplantation, will provide natural and aesthetic results with the right technique and realistic planning.
The common opinion of us Plastic Surgeons, who act with the awareness that hair transplantation is a microsurgical operation; “With the right planning and the right technique, the FUE method offers excellent results”. Aesthetic surgery is developing day by day, minimally invasive procedures without incisions and stitches and where the post-operative period is quite comfortable are gaining value. Although the FUE method is one of them, the term FUE (follicle unit extraction) represents and describes only the extraction process of hair follicles. However, the success in hair transplantation is mostly determined by the technique of planting hair follicles. The “stick and plant” technique, which is accepted as the gold standard today; In other words, opening a canal with a needle and then performing the transplantation process is practiced by few surgeons all over the world. Although it takes time and the technique is difficult for the surgeon, obtaining hair with a density and naturalness that cannot be distinguished from the original hair shows that the technique is indispensable. It should not be forgotten that the purpose of hair transplantation, as in all aesthetic surgical interventions, is to ensure that you will be happy for a lifetime with a permanent and natural result.
WHAT IS FUE?
Fue –follicle unit extraction- is the process of removing the hair or hair groups, which we call the follicular unit, with the skin by making a semi-circular movement and separating the roots from the subcutaneous layer and taking them to the outside.
Moving the tools called “micropunch” of various diameters in the appropriate direction and at the appropriate depth ensures that the roots are not damaged. Although the term “Fue” describes the removal of the roots, it now represents a hair transplant technique. Post-operative process; Most of the patients prefer the Fue technique because it is very comfortable compared to the process experienced after the FUT technique and because of the advantages that will be mentioned in the future. The reason why the Fue technique is presented as a scarless operation is that wounds smaller than 1 mm in our body heal without leaving a trace.
Determination of the number of grafts
The hair of the donor area between the two ears from which the hair follicles will be obtained should be shortened to 1 mm in length. In this region, the number of follicle units in an area of 1 cm² is determined by a special computer program. And the maximum number of grafts that can be taken per cm² is calculated. This number is 25% of the total follicular unit.
Moving the tools called “micropunch” of various diameters in the appropriate direction and at the appropriate depth ensures that the roots are not damaged. Although the term “Fue” describes the removal of the roots, it now represents a hair transplant technique. Post-operative process; Most of the patients prefer the Fue technique because it is very comfortable compared to the process experienced after the FUT technique and because of the advantages that will be mentioned in the future. The reason why the Fue technique is presented as a scarless operation is that wounds smaller than 1 mm in our body heal without leaving a trace.
For example; If 150 1cm² areas are marked and the average number of follicle units in each 1 cm² area is 70, the total number of follicle units in our donor area is 150x 70:10500.
25% of this number is 2625 grafts. In other words, when 2625 grafts are taken, no density loss occurs in this region.
In the area to be planted, 70 single follicle units per cm² are sufficient to create a front line, and 40 follicle units per cm² in inner areas are sufficient. These values are not standard values for every patient, and some factors may increase or decrease the number of grafts needed. These:
Hair colour
Bristle diameter
Contrast difference between skin and hair color
Having straight or curly hair
The area of hair loss (the number of grafts required for the front hairline and the crown area will be different.
Local anesthesia
The reason why the Fue method is a painless procedure is that the procedure is performed under local anesthesia and there is no pain after the procedure, as there is no surgical incision and skin tension compared to the FUT method. Since the procedure starts with the removal of hair follicles, the scalp in the area between the two ears should be anesthetized. By using block anesthesia, anesthetic substance is administered only to the necessary points, thus providing nerve blockage of the entire donor area. Thus, no pain occurs during the extraction period of the roots. At the same time, adrenaline added to the local anesthetic both prevents bleeding in this area and prolongs the effective time of the anesthetic agent. The same block anesthesia and adrenaline serum injection are also performed for the area to be transplanted. The astringent effect of adrenaline prevents bleeding and excessive crusting. In addition, this adrenaline serum given under the skin removes the skin layer to be transplanted from the deep layers and ensures that the subcutaneous thin vascular network is not damaged while opening channels and planting.
Microsurgical principles and instrumentation
FUE is a completely microsurgical procedure both in the extraction and transplantation stages of hair follicles. During the operation, the surgeon uses spectacle microscopes with various magnifications called loupe. In addition to follicle unit extractors with a diameter of 0.6-0.75-0.80 mm, he uses needles that allow channel opening and planting at the desired angle and density. Plastic surgeon with microsurgery experience and an artistic spirit; While opening the canal with one hand, the dominant hand sows the hair follicles at the right angle with the other hand.
Pre-operative preparation
The following 5 criteria should be considered in the pre-operation preparation and planning phase.
Age; Detection of the shedding pattern is important in terms of benefiting from medical treatment, age-related changes in the face if hair transplantation is planned, and the design of the hairline accordingly.
Whether the hair in the donor area is thin or thick in diameter should be taken into account in the planning in order to obtain a dense appearance in the transplanted area. It is a fact that the same number of hair follicles will give a more sparse appearance with hair follicles with thin diameter.
Density of hair units in the donor area; The determination of the number of follicle units in 1 cm² before the operation and the ability to take a maximum of 25% of these units also determine the total number of units to be transplanted. As a matter of fact, it is a fact that sparseness will occur in the donor area in purchases of more than 25%.
degree of baldness; perhaps the most important criterion in the selection of suitable candidates. This criterion is also important in determining the hairline. The degree of baldness is evaluated with a scale determined by Norwood.
Whether the patient’s expectations are realistic in the first consultation with the patient is important in terms of determining whether the expectations can be realized with Fue.
Because if hair transplantation is performed by ignoring unrealistic expectations, a less dense appearance will occur in the planted area. It should be reminded that the maximum number of grafts we have should be planted in the right area most intensively and that FUE is a repeatable procedure after 6 months. When necessary, as in all aesthetic operations, if there is a situation where the expectations are not realistic, the operation
should be delayed.
Planning the hairline
The most important thing that shows a successful hair transplant is the design of the hairline. If there is a hairline formed by thin and lifeless hair in the area to be transplanted, and if hair transplantation is to be done without changing this hairline, a very natural result is obtained. If a new hairline is to be designed, it is very important to adhere to the proportions of the aesthetic facial anatomy, the height of the hairline in the forehead area, the arrangement of the indentations and protrusions in the natural hairline, the design of the indentations in the upper temple area as close to the natural. grafts are required.
Obtaining hair follicles
In the region where the hair follicles will be obtained, the micropunch tubes with a diameter of 0.60-0.75-0.8 mm, the diameter of which is parallel to the exit direction of the follicular units from the skin, made of specially sharpened titanium, cut only the superficial layer of the skin with a semicircular movement and cut the parts of the hair follicle that adhere to the skin. It separates the roots and prevents the roots from being damaged by going too deep, depending on the surgeon’s dexterity and experience. As a matter of fact, the roots, which are attached to the deeper layer of the skin with loose bonds, can be easily removed to the outside with the circular traction movement of a special micropence. The hair is separated according to the number of roots they contain and stored in a special liquid at + 4 degrees, so that their vitality is completely preserved for up to 8 hours.
Stick and plant technique
In our country, this technique is known as needle transplantation. The aim here is to perform an intensive planting at the desired angle (a 30-40 degree forward angled sowing is required at the front hairline) without causing trauma to the skin in the transplanted area. In classical hair transplantation techniques, using sharp metal pieces called slits or scalpels in various diameters, channels are opened vertically and transplantation begins after the channel opening process is completed – for all grafts. The classical technique has some disadvantages
The possibility of damage to the subcutaneous vascular network with this technique is quite high.
Since transplantation cannot be performed at the desired angle, all hair follicles grow at right angles to the skin, and this image leads to both a sparse appearance and results that are far from natural results.
Trauma in the form of an incision on the skin will reveal itself as a scar. In the stick and plant technique, a much higher number of grafts can be transplanted per cm², since no additional incision or defect is formed in the skin. Adjusting the angle correctly, when the hair grows, a density and density indistinguishable from your natural hair is obtained.
Post-operative
Immediately after the operation, there will be small crusts in the area where each graft is placed in the transplanted area and these will fall off within 1 week. After the operation, when the crusts in the transplanted area are shed, a short growth in the live hair follicles and the absence of scars will reveal that the procedure offers natural results in a short time. However, real and permanent growth begins after the 3rd month. The elongation, which is in the form of thin hair at the beginning, is 5-6. With the thickening of the diameters of the hairs in months, the desired image is reached. At the end of the first year, the matured hair will grow like your own hair, never to be shed again.
