Patients that are interested in having a hair transplant have many questions ranging from what is FUE (follicular unit extraction), how is the procedure performed and how long do the final results last. We have compiled a list of frequently asked FUE questions in the hopes of further clarifying the procedure.
How does FUE work?
Follicular unit extraction, also known as FUE, allows for hair follicles or hair follicular units to be individually removed one by one. The follicles naturally occur in groups of 1-4 hairs in the donor area of the scalp. FUE can be performed by a manual or automated method or even both depending on the case. The extraction method utilized varies based on whether the hair is curly, sharply angled, deep long shafts, etc.
What are the advantages and disadvantages of FUE?
Some advantages of FUE include:
- Significantly less post-op discomfort.
- No linear scars with surgical wounds that are much smaller and less obvious and only require days to heal.
- Individual hair follicle harvesting allows for donor hair to be extracted from the permanent zone located on the sides and back of the scalp as well as the beard or body if necessary.
- Extraction of hair from dense donor areas of the scalp and redistributing those hairs to the balding areas in order to minimize the contrast of balding and donor areas. This reallocation allows for a more blended and even distribution of hair that minimizes the appearance of balding.
Some disadvantages of FUE include:
- FUE is limited by the number of grafts which can be extracted/placed in a single day. In some cases, a 2 day mega-session may be scheduled.
- The surgical expertise, operating room time and/or multiple days required to perform FUE is reflected in the overall higher price of this procedure.
Does FUE leave a scar?
The method of individually removing the hair units allows them to be harvested without leaving a linear scalp scar. There will be some small wounds immediately after the procedure in the area where the hair was removed. After about 3 to 5 days, the wounds will close and the resulting small scabs will resolve after the first week. By the next week, it will be difficult to spot where the grafts were removed.
Who are ideal FUE candidates?
Since FUE does not result in a linear scar, it is a good option for patients who prefer to wear their hair in a short style. FUE does not require an entire strip of scalp to be removed which makes it the preferred method for patients with a small donor area from which to extract or those who have a tight scalp. Patients with scarring from a prior FUT procedure may now be able to conceal their scar during the second procedure with the option of placing FUE grafts directly into the scar line. FUE is ideal for patients who have a limited amount of time set aside before returning to work.
What is Robotic FUE – ARTAS?
A robotic hair transplant, also known as R-FUE – ARTAS, is a procedure in which the donor hair is removed from the back of the scalp through the use of a robotic arm. ARTAS makes use of imaging software and an image-guided robotic arm to harvest the grafts on an individual basis. The robotic system is designed to decrease the risk of over harvesting the donor hair as well as minimize the chance of scarring.
After the donor area is marked by the doctor, the patient is placed in a semi-prone position with their face placed in a donut shaped pillow. The donor area of the scalp is secured to prevent movement while the robotic arm is in use. ARTAS uses cameras to take video images of the follicular units so they can be identified by the 3D camera on the robot. The dual punch system of the robotic arm allows for easy scoring of the grafts. In general, ideal patients for robotic FUE are the same patients that are candidates
for the more traditional FUE technique.
How much does FUE cost?
Each case is different with the cost based on a number of factors including the number of grafts and the final results, in terms of coverage, the patient is hoping to achieve. In general, the total cost of an FUE procedure is more than FUT strip per number of grafts. The FUE hair transplant may also be different based on the technique used. Patients need to have a consultation appointment with us in order to determine the final price. Learn more about pricing and financing options on our Hair Transplant Cost page.
What is the recovery time after FUE?
Most patients set aside 2-7 days after their surgery to recover. While FUE scars usually heal within 3 to 4 days, it may take up to 10 days for the donor area to have a well healed and scab free appearance. Individual results may vary. Keep in mind our office sees patients the day after surgery and once again on the 10th day.Want to know more about what you should expect after an FUE procedure? Visit our After Hair Transplant Page.
Is FUE painful?
Typically, patients report little to no pain during or after the procedure. A sedative is given at the beginning of the procedure followed by periodic subcutaneous local anesthetic consisting of lidocaine/Bupivacaine. On rare occasions, patients may experience mild discomfort, itching and/or swelling following the procedure which resolves within several days. We provide patients with pain medication after their procedure. However, a mild pain medication such as Tylenol can usually keep the pain under control.
How many grafts will be needed?
The number of grafts necessary depends on the size of the area to be covered and the desired density. Thick hair and grafts containing larger numbers of 3’s and 4’s give the illusion of a fuller head of hair. Unfortunately, this is genetically predetermined. We review patient goals and possible options before determining the number of required grafts during the initial consultation.
How long do FUE results last?
The results from an FUE transplant procedure will last a lifetime as long as the grafts are selected from the permanent zone in a thoughtful and careful manner. Furthermore, hormonal changes should not affect the grafts. Some patients might see some thinning of their donor area as they age. In those cases, transplanted hair could go through the same phenomenon. However, this is not true for all patients.
Do FUE results look natural?
When performed by an experienced and skilled hair restoration physician, the final results should be so natural in appearance that others will not be able to tell that the hair was transplanted. To view our most recent before and after hair transplant results, visit our Before and After Photos page for our latest results on actual patients.
How long does FUE take?
The length of the procedure depends on the planned number of grafts being transplanted. In general, the procedure may take between 4 to 10 hours. If there are over 2000 grafts to be transplanted, AKA a mega-session, the surgery will be scheduled over a 2 day period.
What are the risks and complications of FUE?
Some of the most common complications of FUE include swelling, bruising, itching and pain. There is also the risk of some bleeding/oozing as well as numbness of the scalp but this is typically self-limiting. One noteworthy risk to mention is “shock loss” which is a post-surgical loss of hair that can be greatly diminished if patients resume/start finasteride and continue it for a period of 6 months after their surgery. You can find more information about this topic in general at hair transplant complications.
Will the new hair grow right away?
Shortly after undergoing a hair transplant, the new hair will look more like stubble on the head. The transplanted hairs may grow very gradually and will then enter the resting telogen phase and most likely fall out. The transplanted hair will grow once again as it enters the anagen phase. Once hairs are in the anagen growth phase, they will grow as they normally would.
When will the final results be visible?
Once the transplanted hairs enter the anagen growth phase at 3-4 months, the new hair will start as thin and fine hair. Over the course of the next several months, the hair will become longer and thicker. Between 10 to 12 months, more coarse hair will start to become evident with final results visible at about 12 months after FUE. Please note that every individual heals at a different rate and the results vary per patient.
What to know after the procedure?
On the day following the hair transplant, patients return to our office for instructions on how to properly wash hair after the procedure. Patients are told to wash their hair twice a day for the first 4 days after the surgery.
Patients are required to sleep in a semi-sitting position, at a 45-degree angle, in order to minimize swelling. Patients will be given a neck pillow to use at night to prevent accidental rubbing or movement of the grafts during sleep. After the 4th day, daily activities can be resumed but strenuous exercises should be avoided for a full week after the transplant.
Patients need to avoid direct sunlight on the grafts/scalp for the next 6 months. Sun block SPF 30 or greater should be used every half hour when swimming or being out in the sun unprotected. A cap to cover the scalp/grafts will be given to patients after their surgery. More information about this topic can be found at after FUE transplant.
Is FUE the right choice?
Choosing whether to take the step of having a hair transplant is a personal decision. However, deciding between the two types of hair transplant procedures largely depends on the final goals of the patient. Issues that play a role in the final decision include how to style the hair, the lifestyle of the patient and the quality of the hair. All of these topics will be discussed during the initial consultation with the doctor. In order to make a more informed decision, take a close look at FUE vs. FUT.
Is there a need for follow-up or revision FUE?
As patient age, they can progress to a higher Norwood class of hair loss with further loss of their native hair. In this case, patients often return for a second hair transplant to cover the new balding areas. The previously transplanted hairs are permanent hairs and patients will not lose them. Some patients may need more transplantation to add density and fullness to the previously transplanted area.