The follicular unit extraction technique (FUE), unlike follicular unit grafting (FUG), avoids a linear donor site incision- instead, the grafts are harvested one at a time with tiny 0.8 to 1 mm punches which then usually heal as essentially undetectable dots in the scalp. This permits 70% of patients to shave their heads without any visible scars, the rest able to cut their quite short. In order to obtain these grafts, usually the back and sides of the head are first shaved, then with the patient typically lying face down for several hours, as many as 1400 or more grafts - each containing one to three, sometimes four hairs- can be harvested. With smaller procedures of 500 or fewer grafts, oftentimes the entire head does not need to be shaved, instead narrow “bands” of hair can be shaved permitting the overlying longer hairs to conceal these donor areas. Once the grafts are harvested, with the patient placed in a recliner-type position, the surgeon can make the recipient sites into which the grafts can then be transplanted.
A relatively newer technique- Dr. Epstein was one of the earlier embracers of FUE in 2007 – FUE is in some ways more technically challenging than FUG, and there are few surgeons like Dr. Epstein who perform both techniques with such regularity. There are a variety of techniques for harvesting the FUE grafts, with proponents of these different techniques lauding them as the best. It is Dr. Epstein’s approach to utilize a combination of techniques, most commonly relying on the SAFE SCRIBE® drill that utilizes a non-sharp punch that reduces hair transection, supplemented by manual punches- this provides flexibility in allowing for the best technique for each patient, improving outcomes.
While FUE in no way makes obsolete the technique of follicular unit grafting, it is usually the best procedure for the younger male patient, the African-American patient; and/or the patient desiring reparative work who has a limited supply of donor hair. FUE is also a great technique for obtaining grafts that are to be placed into a donor site scar from a prior procedure to help reduce its visibility. In addition to their application in the scalp, FUE grafts can be used in certain cases of beard and eyebrow restoration.
Like with the FUG technique, the key aesthetic step in FUE is the making of the recipient sites. It requires the aesthetic judgment and skills of an experienced surgeon who knows how to create a natural appearing hairline.
In a typical FUE case, 900 to 1,500 grafts can be obtained in a single day, due to the extra time (8 hours or so) required for this meticulous work.
Many patients will have two procedures over two days, allowing for 1,800 to 2,400 FUE grafts total. As FUE cases now constitute almost one-third of the procedures performed in this office, enthusiasm for the technique, appreciation of the advantages for the right patient, and the quality of the outcomes is outstanding.
Together in consultation with Dr. Epstein, the right procedure will be decided upon, after careful consideration of your goals and the nature of your hair loss.
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Dr. Epstein is one of a handful of surgeon in the hair transplant world who can actually utilize body and beard hairs for transplanting into the scalp. These procedures are usually reserved for those who have no more scalp donor hairs and are seeking reparative and/or more extensive work. Using special FUE harvesting techniques that he has developed over the past six years of using body hairs, these chest and beard hairs can have regrowth rates not as high as scalp FUE grafts, but approaching rates of regrowth of 70%. One particularly common area that beard or chest hairs can be utilized is to the linear donor site scars from prior transplants.