Frequently Asked FUE Questions

What is FUE (Follicular Unit Extraction)

This is a technique for harvesting individual follicular units by extracting them directly from the scalp, one at a time, in their natural occurring groups, with a surgical manual punch-like instrument or with a punch like instrument controlled by a robot.

Are FUE grafts qualitatively equal to grafts produced through traditional strip harvesting under microscopic control

The quality of non-transected follicular units extracted through FUE can vary from patient to patient and doctor to doctor. It is not unusual that transected (damaged) units occur with the manual FUE process and with inexperienced doctors, the degree of damage can be considerable. Traditional strip harvested grafts, on the other hand, can be controlled from patient to patient and within team members when the surgical team is well disciplined. Some doctors have mastered the patient to patient variability of FUE grafts and can produce graft quality that, under optimal conditions, has hair survival that approaches that of traditional strip harvested grafts. But finding doctors having the skills and competence in using manual FUE can be difficult.

What are the patient variables that affect the quality of the traditional FUE grafts?

In our publication on the subject we studied the type of prevailing collagen found in the scalp of patients who had both successful and unsuccessful FUE grafts. Studies we had done suggested that grafts which contained more ‘elastin’ collagen fibers and had thinner follicular capsules made FUE easier for the surgeon and produced better quality grafts in the manual FUE process. When the robot is used, the variability on quality is minimized.

Do all surgeons use the same tools when performing FUE?

The tools that are used in FUE vary considerably among doctors. This has led many doctors to develop their own specialized tools. What is impressive is the wide range of tools used by doctors who do this type of surgery. Some doctors use sharp punches and some use dull ones; some use combined sharp and dull punches (this is the way the Artas robot does FUE), scoring the skin with a sharp punch followed by dissection of the graft with a dull punch in a two step process; while other use drills that rotate to specified speeds like a dental drill or oscillate back and forth; and others use vibrating tools like the cast cutters used to remove plaster casts from a broken arm, just a small version of one. All of these tools have been found to have similar results. This indicates that no tool or technique seems to work for every surgeon other than the Artas Robot. Whatever tools are used, the survival of the hairs in a graft is what determines the value of the tool. Ask your surgeon what type of tools they use and why they prefer that tool. The Artas Robot is more predictable in the hands of less skilled surgeons. NHI has been doing FUE since 1996, and during that time it developed both tools and skills that make their results comparable to the robot.

How do the surgeons' skills and techniques impact the rate of extraction and success in lowering transection rates with FUE?

The surgeons’ skills vary considerably. Some doctors produce an impressive FUE technique with minimal hair damage and good extraction rates using manual instruments. Other doctors produce considerable hair damage in the FUE grafts. Reports indicate harvesting rates vary from 100 grafts/hour to as many as 1000 or more grafts per hour. NHI’s rate often runs in excess of 1000 grafts/hour. Ask yourself if claims that show such wide discrepancies in extraction rates can be believed. Also, statistics on transection rates are not published but appropriate questions to the doctor about his/her transection rate will tell you much about the doctor’s honesty, integrity and skills. When you speak to the doctor about this, read both his words and his body language as you hear his/her answer to this question.

How do doctors get qualified in performing FUE?

Few doctors have not been trained in performing FUE because training is not generally available. When courses were first introduced through the ISHRS [International Society for Hair Restoration Surgery] in 2004, didactic work and work shops were offered to new doctors, but these opportunities are not a substitute to human learning. Prior to that, doctors interested in responding to the high consumer demand for this procedure just learned what they could from reading articles in medical journals or by attending workshops sporadically held in various countries. “Training” for most doctors, however, was essentially a trial and error process and, unfortunately, this does not guarantee that the surgeon offering the procedure has mastered the skills or techniques adequately to produce consistently high quality grafts with minimal hair damage and low transection rates. There is no certification for manual FUE, but the Artas robot, on the other hand, does guarantee that the FUE process itself, will work ideally; however, if the surgical team does not have the skills and quality control mechanisms in place and a long history of successful hair transplantation, even with the Artas Robot, there is no guarantee the the FUE will work well producing the results you would expect to get.

Do I have to shave my hair from the donor area before my procedure?

For the person who has never had hair transplants and wants to style their hair in a short buzz cut, one can maximize the number of grafts in a single session or have NHI perform a Long Hair FUE where the donor area is not shaved. For those people who wish to hide their FUE with longer hair, we can perform the extraction in shaved layers of 3-4 mm each, separated by longer hair of comparable width. However, performing FUE with longer hair with strips of skin shaved, may require more sessions than standard FUE. Alternatively, Long Haired FUE is an option invented and regularly performed at NHI.