The method of follicular unit extraction is what distinguishes fue hair transplantation from strip hair transplantation.
With FUE, the follicular units are extracted individually using an instrument called a punch that can be motorized or manual.
The main differences between the existing tools are described in this article.
The extraction step.
The extraction phase is considered the most critical in an FUE hair transplant because of the need to obtain strong follicular units and maximize the regrowth rate.
The high transection rates associated with follicular unit extraction via FUE, which led to low regrowth rates of transplanted hair, were the reason that prompted many surgeons to invest time, energy and financial resources in an attempt to improve this phase of the procedure.
The extraction phase is certainly critical and due attention should be paid to it, but what happens to the follicular units once they are out of the body is crucial and can affect the final result to the same extent.
In recent years great strides have been made in the search for follicular unit preservation solutions that could guarantee better survival once outside the body.
The grafting phase
The grafting of follicular units in FUE hair transplantation in turn can have a real influence on the rate of regrowth and the final result, and therefore particular attention should be paid to the grafting techniques and instruments commonly used (which most often are used for both Fue and strip procedures)
Grafting techniques and follicular unit placement in FUE:
There are two main techniques of creating recipient sites and placing follicular units:
- Pre-executed incisions: All or most incisions in are recipient are made in advance by a trained surgeon and the follicular units are subsequently grafted into these incisions, usually through the use of tweezers. In most clinics, this grafting step is performed by specialized assistants.
- Stick and Place: in this case the creation of a recipient site through the incision is immediately followed by the grafting of the follicular unit which can be done either through tweezers or with an instrument called “implanter”, similar in structure to a pen.
Let’s take a more detailed look at the two methods of FUE hair transplantation
1. Realization of all incisions followed by the grafting phase..
In this case the hair surgeon makes in advance all the incisions in which the follicular unit will subsequently be placed. The incisions are made in the bald area of the scalp, defined as the recipient area. The main incision techniques are the lateral slit (coronal incision) and the sagittal slit (sagittal incision), in this article you can learn more about the differences.
While the surgeon makes the incision, the previously extracted follicular units are preserved in a special solution to prevent dehydration and possible damage.
The follicular units are then placed in the small recipient sites. This step is usually delegated to qualified assistants.
Some surgeons inspect the follicular units under a microscope prior to the grafting phase to verify their quality although this is not a standard procedure in FUE surgery.
2. Stick and Place – Creation of simultaneous recipient and graft sites.
In this case, creation of the recipient sites by incision in the recipient area and grafting of the follicular units are done simultaneously with a process that can be done in one or two stages:
Two-stage stick and place: In this case, the surgeon makes the incision in the recipient area with custom-made blades or needles and immediately afterwards the physician or assistants place the follicular unit in the incision using tweezers or a similar instrument.
One-stage stick and place: In this step, the surgeon uses an instrument called an “implanter” to make the incision to create the recipient site and the graft almost simultaneously.
It should be noted that with this method a preliminary phase is necessary in which the implanter is loaded by inserting the follicular unit before grafting. This phase is particularly delicate and must be performed by qualified personnel.
What is an “Implanter pen” ?
An “implanter pen” is a pen-like instrument consisting of a hollow needle attached to a circular tube with a small plunger. To perform follicular unit placement with the implanter pen, the surgeon loads several implanters with a follicular unit.
To load the implanter, the assistants very gently grasp the top of the follicular unit (epithelial/infundibulum region) with tweezers and place it inside the hollow needle located at the lower end of the implanter. Once the implanter has been loaded the assistant returns it to the doctor who takes charge of the incision/grafting step using the “one-step stick and place” technique we previously discussed. The surgeon, in FUE hair transplantation, inserts the sharp needle of the implanter into the scalp, correctly assessing the exit angle of the native hair and creating the recipient site and then pressing the small plunger at the top of the implanter grafts the follicular unit, previously loaded, into the incision.
Nowadays there are different types of implanters used by surgeons performing surgery via FUE. The operation is very similar to the one described above. Each implanter has its own advantages and disadvantages.