Guide to FUE Hair Transplant: Benefits, Process & Recovery

What is a FUE Hair Transplant?

Follicular unit excision (FUE) hair transplant involves removing individual follicular units (natural clusters of hairs grouped in 1-4 hairs each) from the back of the head and at times from the beard and other body regions to be transplanted typically back into balding areas of the scalp or other areas of the body as aesthetically needed.  FUE uses micro punches that span from 0.7 to 1.2 mm in size to harvest these follicular units. Micro-punches vary in their type and include manual, motorized, and robotic.

Originally, the term FUE was expanded to “follicular unit extraction” but has since changed, more correctly, to be called “follicular unit excision” to denote the truly operative decision-making and skills required to harvest FUE grafts.

Beware of the Black Market

No matter what method is chosen by the surgeon, the key is that the procedure is physician-driven and performed, who has the ethical and legal obligation to perform the harvesting procedure, as compared to the problematic rise today of unlicensed technicians (the so-called black market) who have been assigned this duty.  The skill in harvesting follicular units really relies on the mastery and experience on the part of the hair transplant surgeon, as the procedure requires a delicate touch, stamina, and judgment. See Fight The Fight.

FUE and FUT

FUE and FUT are two major methods of harvesting hairs used in hair transplant surgery. We have already described FUE. FUT(follicular unit transplantation) or LSE(linear strip excision) is the older, traditional technique for harvesting hair from the scalp. FUT stands for follicular unit transplantation, which describes harvesting a linear strip of tissue including skin and hair follicles in which the donor incision is then closed with sutures or staples and the strip of tissue must be dissected into individual grafts by skilled technicians in preparation for transplantation. These individual grafts are then transplanted into the recipient area of the scalp. FUT leaves a linear scar, unlike FUE.

Also Read: FUE Vs. FUT and Maximizing the Hair Graft Harvest

Benefits of FUE Hair Transplant

The are several distinct advantages of FUE that a patient should be aware of.

• There is no linear scar (even though, FUE is not scarless).
• A patient can afford a more closely cropped hairstyle as there is no linear scar that he needs to worry about.
• FUE offers a faster recovery than FUT.
• Many patients have also reported less postoperative pain following FUE compared with FUT.
• FUE allows for harvesting in non-scalp regions like the beard, chest, etc., where FUT would not be allowed due to visible linear scarring.

FUE Risks and Side Effects

Risks

Going to a qualified FUE hair surgeon who practices ethical and skilled surgery will help minimize unnecessary risk. Nevertheless, no surgery is without risk. Some of the greatest risks involve overharvesting the donor area or harvesting too wide an area outside of the SDA(safe donor area).

Side Effects

Side effects of fue include minor issues like scalp cysts, mild infections, etc. You can also experience temporary telogen effluvium, which is unwanted hair shedding of your original, native hairs, that should come back over the ensuing months following the procedure but that can be quite psychologically devastating.

Ultimately, if you have done your homework and chosen a qualified surgeon, your risks and side effects should be relatively low and temporary.

Ideal Candidates for FUE

The ideal candidate for FUE is someone who has one’s hair stabilized with medical therapy like finasteride and minoxidil, who is preferably older (the younger the riskier like in one’s 20s, for example, due to the risk of unpredictable future hair loss), who has great donor hair to supply not only the transplant but also reserves for future use, and who is realistic about goals of the transplant.  Obviously, the patient must also be medically safe to undergo a surgical procedure.
Many other factors can affect the outcome of the result that derives from a patient’s anatomy. For example, wavier hair, thicker hair, and hair that has a low contrast in color to the scalp are all favorable characteristics that make hair look denser.

FUE Procedure Steps

The FUE procedure varies from surgeon to surgeon in terms of setup, execution, sequence, instrumentation, staffing, anesthesia, etc. To describe the procedure in great detail may mislead the reader into thinking that what is described are actually universal steps recommended for all surgeons, and that is simply not the case. However, the fundamental components of the procedure remain the same.

Outlining Donor and Recipient Areas

The first step of any hair transplant procedure, after reviewing the goals of the transplant with the patient, is to outline the donor and recipient areas including hairline design, and then to confirm that the patient is satisfied with the proposed areas for transplant. For example, if the crown is the area the patient wants to transplant, but the surgeon performs a transplant only in the hairline, then that would not be a good situation.

Administering Anesthesia

Then, the patient is administered anesthesia to numb the scalp in preparation for the procedure. Some surgeons prefer sedation, orally, intramuscularly, or intravenously, to further enhance comfort during the procedure.

Preparing Recipient Sites

If recipient sites (the slits into which the grafts will ultimately be placed) will be made first, then the surgeon typically harvests a few grafts from the donor area to test that the grafts will fit the recipient sites that the surgeon will make, and then the surgeon makes those sites.
Remember: Not every surgeon will opt to make the recipient sites before harvesting the donor grafts.

Hairline (left) and crown (right) recipient sites are shown before grafts are placed.

Harvesting Grafts

Based on the number of recipient sites made, the surgeon will then plan the number of donor hair grafts for harvesting. Again, some surgeons prefer to harvest the grafts first, and then make recipient sites with the harvested number of grafts.

Grafts Placement

Finally, donor hair grafts are then placed into the recipient sites, most often by the trained staff. Hair grafts are placed at appropriate angles and orientations which is crucial for the right aesthetic look for one’s hair. This step requires a lot of experience and precision.

FUE Recovery

FUE recovery, as already mentioned, is faster and can be less uncomfortable in many cases. In most cases, FUE is performed with a shaved donor area. In the donor and recipient areas, tiny scabs will form and remain present until they are gently rubbed away usually 1 to 2 weeks later although different surgeons have different policies. After the scabs are gone, most patients return to their “invisible” state where the hair grafts fall out (but the root is still there) and they wait for the transplanted hair to grow over time. It takes several months at a minimum, as hairs grow about 1 cm per month, and oftentimes a year or more for the full result to appear.
Use of postoperative bandages, sprays, etc., along with other policies like return to exercise, water exposure, etc., vary among surgeons, so it is important to follow the instructions given by the surgeon you choose rather than any information found on other websites that you may peruse or visit.

FUE Procedure Costs

The cost of FUE is very broad and cannot be published reasonably on this website. It depends on the surgeon’s experience, type of clinical practice, etc.  Most surgeons charge per graft, whereas a few do not charge per graft but charge a set amount for the procedure based on a projected graft range. You will have to consult a hair transplant surgeon to establish the cost of your FUE hair transplant.

FUE Before and After Pictures

Here are some images of before and after the FUE hair transplant. You can see the changes in hairline and hair density.

This gentleman is shown before and after a FUE hair transplant by Dr. Lam.

Choosing the Right Surgeon

Choosing the right surgeon is the key to a successful outcome.  A surgeon who is willing to tell you no, that a transplant would be a bad idea for you when that is the case, practices ethical medicine. You should choose a surgeon based on his or her credentials and experience along with word of mouth/recommendations and review of the before-and-after photographs.  Ultimately, the surgeon you choose should have spent time with you to outline a safe and reasonable plan and strategy for you that may involve medicine along with surgery to help stabilize and minimize the progression of hair loss.

For a consultation with a hair restoration surgeon, access our Find A Doctor tool, where you can search for an ISHRS member by location.

FAQs

Is a FUE hair transplant permanent?

Yes, a FUE hair transplant is permanent. In general, hair grafts transplanted during FUE by an experienced hair surgeon skilled in FUE should survive in most cases. However, if grafts were not chosen correctly in the safe donor area, those grafts may fail over time. Further, if grafts were taken that were miniaturizing, that is, susceptible to hair loss, by mistake, those grafts would also most likely not survive.

Do I have to shave my head for FUE?

Yes, in most cases, but not always. Shaved FUE is the most common way of performing the procedure. Non-shaved FUE may be performed in select cases but requires much more labor and time and is usually charged at a higher price.

Is FUT cheaper than FUE?

Usually, FUT is cheaper than FUE because FUT requires less surgeon labor to perform. However, with the onset of the “black market” where unlicensed technicians are performing the surgery, there may be cases where FUE may be less expensive than FUT. However, remember always that you get what you pay for, and ruining your donor area is an irreversible problem and irreplaceable source.

What is the failure rate of FUE?

With modern instrumentation and the experience of a qualified surgeon, the failure rate is very low. However, with newer surgeons or with black market cases with unlicensed individuals performing the surgery, failure rates can be much higher.

Does FUE look natural?

In qualified hands, FUE should look very natural. Remember that FUE and FUT are only tools for donor harvesting. The naturalness of the result has also a lot to do with how the hairline is designed, how the recipient sites are angled and distributed, and how the grafts are placed atraumatically with the direction of the hair curl and with the right-sized grafts placed into the right sites.

Does the donor area for FUE grow back?

No. Donor hair, once removed, is gone forever. This is why the judicious use of donor hair with the intent of always having enough hair for future use defines the parameters of safe hair surgery.

References

Beehner M. FUE vs FUT-MD: Study of 1,780 follicles in four patients. Hair Transplant Forum Int. 2016;26(4):160-1.

Josephitis D, Shapiro R.  FUT vs. FUE graft survival: A side-by-side study of 3 patients undergoing a routine 2,000+ graft hair transplantation.  Hair Transplant Forum Int. 2018;28(5):179-82.

Lam SM, Williams KL Jr., eds. Follicular unit excision (FUE), 2^nd ed., Jaypee Brothers Medical Publishers, New Delhi, India, 2022.

Trivellini R. The Trivellini system and technique. Hair Transplant Forum Int. 2018;28(5):188-90. 

 Devroye J. Powered FU extraction with the short-arc-oscillation flat punch FUE system (SFFS). Hair Transplant Forum Int. 2016;26(4):129-36