Follicular unit extraction
Follicular Unit Extraction by Dr. Epstein.
The follicular unit extraction technique (FUE), unlike follicular unit grafting (FUG), avoids altogether a linear donor site incision. Instead, each graft is harvested one at a time with tiny 0.8 and 0.9 mm punches which then usually heal as essentially undetectable dots in the scalp.
We at the Foundation primarily utilize our custom-designed E-Fue System, as well as the recently developed WAW System, designed by a European colleague of Dr. Epstein, which utilizes a “hybrid” punch that further reduces graft transection to below 4%.
Dr. Epstein has extensive experience with FUE, performing six to eight procedures weekly, assuring patients of the maximal outcomes and there are many FUE hair transplant cases of study to support Dr. Epstein’s work.
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. If there is one area in which Dr. Epstein is known for, it is here in this key aesthetic step of recipient site creation.
With our outstanding track record in FUE procedures (click here to view our FUE results), over 75% of our patients are able to shave their heads without any visible scars, the rest able to cut their quite short where there are tiny “dots” visible on close inspection.
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 the first two hours, we are able to harvest 1000 to as many as 1600 grafts from the back of the head, which then with the patient rotating onto his back sitting these grafts can be efficiently transplanted to assure the highest rate of regrowth.
Later on in the procedure, additional grafts can then be obtained from the sides of the scalp, allowing us to extract as many as 2200 or more FUE grafts in a single-day procedure. Each graft contains one to three, sometimes four hairs, for the most natural-appearing results.
Result of 1600 FUE grafts to hairline
FUE hair transplant videos
FUE can also be used to harvest grafts from body areas such as the chest, back, and beard. This technique of BHT is one that Dr. Epstein regularly performs, and is capable of providing thousands of additional hairs for transplanting. See here to learn more about BHT. 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 beard and eyebrow hair restoration surgery.
One day after no-shave FUE hair transplant
No-shave FUE Hair Transplant Surgery at 3 days After
One year after 875 FUE grafts to hairline
Dr. Epstein Reputation
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. Over 90% of the hair transplants done at the Foundation for Hair Restoration are done by the FUE technique.
There are a variety of techniques for harvesting the FUE grafts. Dr. Epstein, working with Dr. Gorana Kuka, one of Europe’s most experienced FUE hair transplant surgeons, who like Dr. Epstein is a plastic surgeon, developed the E-Fue System that combines the best in accuracy, hair regrowth, efficiency and ease for the patient, assuring the highest quality results.
Also used is the WAW System, that has the lowest possible rate of graft transection (less than 4%) and utilizes punches of 0.8 to 0.9mm in size.
Candidates for FUE Hair Transplant
Body and Facial Donor Hair for FUE Grafts
Dr. Epstein is just a few of a handful of surgeons in the hair transplant world who can actually harvest body and beard hairs for transplanting into the scalp. These procedures are usually reserved for those candidates who have no more scalp donor hairs and are seeking reparative and/or more extensive work, or those candidates who want a greater amount of scalp coverage than can be provided by the scalp donor hairs.
Using special FUE harvesting techniques that they have developed over the past seven years of using body hairs, these chest and beard hairs can have regrowth rates approaching 70% or higher. One particularly common area that beard or chest hairs can be utilized is the linear donor site scars from prior hair transplants. As many as 3,500 chest and or beard hairs can be harvested over two days.
* All patients are unique and individual results may vary.
Dr. Epstein and the Foundation offer three options how the FUE procedure is performed, each differing in the degree of shaving of the donor area. Here are typical illustrations of these three options. Please note the hairs in the recipient areas where the grafts are transplanted are not shaved.
* All patients are unique and individual results may vary.
Conventionally, FUE is performed by most surgeons with shaving of the entire scalp, donor area (back and sides of the head) and recipient area (area into which the grafts are being transplanted. In Dr. Epstein’s hands, there is no need for any shaving at all if the patient chooses to have the No-Shave FUE. With a Partial-Shave FUE, only the lower back of the head is shaved, and finally with standard FUE the entire sides and back of the head are usually shaved. No matter how the donor area is treated, there is NO reason to shave the areas into which the grafts are being placed, except when the patient is agreeable to this in order to shorten a bit the duration of the procedure.
In no-shave follicular unit extraction, the only hairs trimmed are the donor hairs, leaving all the other hair the same length. The trimmed donor follicles are therefore hidden amidst the remaining full-length hair, and a completely normal appearance post-transplant is achieved.
Suitable for both men and women, this technique makes both the process and eventual outcome of a hair transplant surgery undetectable the very next day, as the scalp donor area does not need to be shaved.
This is the technique of choice for those men primarily who wish to avoid shaving their head and thus can return to work and be in public a day or two after the procedure.
The no-shave FUE technique does take more time to perform, and thus the limit of the number of grafts that can be obtained in a one-day procedure is around 1400 grafts, and does have a higher fee because of the additional meticulous work required.
To find out if you are best treated with no-shave FUE, please contact our office.
In Partial-Shave FUE, the only hairs that are shaved are those in the lower back of the head. This permits the hairs above this area to cover over the shaved area, or to blend in with the shaved area as in a “fade” hair style, thus allowing most patients to be presentable within a few days of the procedure without wearing a hat.
Finally, regular FUE
In standard FUE, particularly in larger procedures, the back and sides of the head are shaved to permit the most expedititous harvesting of the grafts. In a single day procedure, as many as 2600 or more grafts can potentially be transplanted, and for this reason as well as the lowest cost per graft, some patients choose this as their technique. The donor area is typically full healed up in two to three days, after which the areas just looks like it had a very close shave. As stated above, no matter the FUE technique, it is not necessary to trim the hairs in the recipient area, allowing the existing hairs to conceal the tiny crusts where the transplants were placed until they fall out after one week or so.
Performing FUE Hair Transplant
- The lowest rate of transection of the grafts. Low transection rates translate into a higher rate of growth of the transplanted hairs. A transection rate of over 5% is usually due to poor technique and or poor instrumentation.
- The least amount of scarring in the donor area. FUE is often mislabeled as “scar free” when in reality where each graft is harvested, there is left behind a typically small “dot” scar. Minimizing this scar is achieved by minimizing the trauma to the donor area, using the very smallest “punch” to remove the graft, properly spreading out the harvesting of the grafts, and optimal care of the donor area
- The least amount of scarring in the reciepint area, as well as minimizing “shock” male hair loss. This assures the most natural appearance, and is achieved by proper trimming of the skin around the graft and or the use of the smallest punches to assure that the grafts cause minimal scarring. Shock loss, characterized as a loss of the original existing hairs in the area being transplanted, while usually temporary can be distressing to the patients, and should be avoided as much as possible.
- In a typical FUE hair transplant surgery, 900 to as many as 2,400 grafts can be obtained in a single day, a testament to the experience and expertise of Dr. Epstein and his team in extracting then planting grafts in an efficient yet meticulous fashion. It is the doctor who will determine the ideal graft count to achieve the patient’s desired results. The occasional patient will return for a second day of grafting, most commonly for those who are having more than 2,200 grafts total.
- And finally, and not least, the aesthetics of recipient site formation to assure ideal angulation, distribution, and feathering of the transplanted hairs. There is no single step more important in the men’s hair transplant than the creation of recipient sites.
Assurance of optimal Grafts
- The use of the most sophisticated FUE devices in the hands of an experienced FUE extractor assures optimal grafts. At our office, we rely primarily on the WAW system (developed by Dr. Epstein’s Belgian colleague and the Trivellini system (a Paraguayan colleague), both which utilize an oscillating rather than a rotary motion, and a “hybrid” or trumpet punchy that minimize hair transection to less than 4%. These systems work well not only on typical straight or wavy hair, but also on ethnically curly hair including Afro-ethnic hair. This is superior to any of the “robot” or other proprietary “automated” drill systems that are heavily promoted and that are typically used by doctors who have little experience with FUE hair transplantation.
- The smaller the punch, the less the scarring. Our use of punches 0.8 and 0.85mm in size, occasionally 0.9mm in select cases, assures minimal scarring. The use of the WAW and Trivellini systems, because of their superior method of graft extraction, permit the use of these smaller punches. Also, when determining the size of the procedure to be performed, one factor is that which will minimize the over-harvesting of grafts that can result in a patchy appearance of the donor area.
- Scarring of the recipient area is usually due to trauma to the skin in the process of making recipient sites, and or the use of grafts that are too large. Using such tiny punches permits Dr. Epstein to use very tiny blades to make the recipient sites, typically 0.5mm (one-half millimeter) for one and usually two hair grafts, and 0.6mm for three and sometimes two hair grafts, and the occasional use of 0.7mm blades for larger three hair grafts. The other factor that allows for the making of such tiny recipient sites is the experience of the assistants in graft placement, a process that is facilitated by the use of implanter pens that minimize trauma to the grafts. Smaller recipient sites are one of the main factor sin reducing “shock loss” of existing hairs, along with several other steps the doctor takes.
Using a four-person team and implanter pens, the graft planting process proceeds smoothly and efficiently, assuring maximum regrowth of transplanted hairs.
- And finally, the “art” of recipient site formation is not merely making tiny slits, but also having those slits made at the ideal angle and pattern and distribution. Every single recipient site is made by Dr. Epstein to assure the transplant creates the final result as he pictures it to look.
Dr. Jeffrey Epstein talks about Hairline
After FUE Hair Transplant
It will take some time before the results of your hair transplant become visible. Usually, the hairs that are transplanted fall out again after a few weeks. That can be alarming, but you can rest assured that they will return. Typically, it takes about three months before the transplanted hairs begin to grow. After about ten months or a year, you should see the final results from the surgery.
Patience is required, while you wait for your new hair to grow. But, once that new hair is in, you can style it as if it had been there along. You can trim the hair, dye it, or use any products you want in it.
Frequently Asked Questions
FUT is a procedure where a small strip of skin with hair is removed from the back of the scalp. This area is then closed with simple sutures or stitches and eventually heals to a fine line scar. And FUE procedure is where individual follicles are extracted one by one without an incision and results in no scar.
FUT technique, it certainly is to your advantage for the reason that FUT techniques get a better take of hair and an overall better result. The FUE is a good technique for people who are planning on having very short hair or people who have obvious scar problems like keloids and hypertrophic scar formation. However, there is a less high percentage of hair take in the transplanted area from that and there is some loss of the follicles in the process of removing the FUE grafts. If you are going to have a second procedure, the fact that that you had FUT is not a problem because most of the new hair removed is done through the old original scar. You do not have to have a second scar, the new one can be placed over the first one and you still look excellent. As long as you keep your hair over about three-quarters of an inch in length, there should be no problem hiding this.
The main reason to get an FUE procedure is to avoid the scar in the donor area. Since you already have a scar, you would be a candidate for another strip procedure. The surgeon would excise the original scar, and you would heal with a scar of the same size as before. In some cases, the patient may opt for a strip and an FUE procedure to maximize the number of available grafts. Unless you are tress you are trying to maximize the donor area.
With FUE techniques, additional grafts can be obtained above and beyond what can be obtained with a strip procedure. When FUE is performed at the same time as a strip procedure, depending upon the donor area, FUE can provide an additional 250 to 400 grafts per procedure. In addition, stand-alone FUE procedures can provide anywhere from 600 to as many as 1800 additional grafts from areas that normally would not be included in areas of donor strips.
It is difficult to significantly change the growth of a cowlick- yes, some of the hairs can be removed and replaced with transplants at a more desirable angle, however you will lose a moderate amount of the density in the area.
While most patients do experience some growth at 3 to 4 months, it is not that unusual to have delayed growth of as long as 8 to 10 months. This delayed growth phenomenon is especially true with FUE, in which it is not uncommon to have growth not start until 4 to 6 months.
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Why choose Dr. Epstein
- Dr. Epstein first attended Swarthmore College, then moved on to medical training at the University of Vermont College of Medicine.
- Trained in head and neck surgery/ear, nose, and throat at the University of Miami/Jackson Memorial Hospital, earning a fellowship from the American Academy of Facial Plastic and Reconstructive Surgery during this time.
- Then trained in the San Francisco Bay area and was awarded the Jack Anderson Memorial Award for achieving the highest score in the nation on his board exams.
- Has been recognized for many years as one of the Best Surgeons in America, and he has been continuously listed for years in Castle Connelly’s Top Doctor Guide, an unbiased rating of doctors in many different specialties.
- Founder and Director of the Foundation for Hair Restoration and Plastic Surgery.
- Unusual for his field, Dr. Epstein holds triple board certifications in the fields of hair restoration surgery, facial plastic surgery, and otolaryngology (head and neck surgery), and is a Fellow of the International Society of Hair Restoration Surgery.
- He is an Assistant Clinical Professor at the University of Miami, a Fellow of the American College of Surgeons, and was previously the President of the Florida Society of Facial Plastic and Reconstructive Surgery.
- To give back to the community, Dr. Epstein provides pro bono reconstructive surgery to children, veterans, and other people in need.