Harley Street HT Clinics
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The margins of a safe FUE (Follicular Unit Extraction) procedure rely heavily on the FUE candidates existing follicular unit (FU) donor density. Extracting too many grafts in one or multiple procedures can destroy the donor zone if limitations are ignored, while pushing past safe harvesting limits often results in noticeable thinning, obvious scarring, and localised hair loss.
Maximum Grafts and Safe Session Sizes
With improvements in medical instruments, an FUE motorised punch in capable hands can safely punch around three thousand grafts in a single day session.
If the punching becomes demanding, difficult skin characteristics, graft splay slowing the doctor down, then a second day could be used to continue punching to reach around three thousand grafts, if safe to do so.
However, a second day, or trying to reach much more than three thousand grafts in a single day push passed the safe limits of FUE harvesting, increase the risk of transection, and patchy donor thinning.
The scalp donor, but any donor resource on the body is a finite resource, there is a biological hair count, which does not regrow, replenish or multiply once the intact FU has been punched and extracted from the donor area. The scalp surface area does not change, but the hair density around the donor area does, it drops with every follicular unit punched and extracted.
Larger FUE Punches
Larger diameter punch instruments are more likely to be used by inexperienced doctors and tech-led FUE clinics that are on the rise in the UK and internationally. Larger punches require less skill and precision but cause greater damage to the donor area.
Larger punches are more likely to transect adjacent follicular units and cause wider scarring. Larger FUE punches require less skill, and extraction can be faster are popular with the less competent.
Of course, these factors overlap, one bad protocol leads to another, with limited standards in place. So, a poor harvesting protocols combined with oversized FUE punches only leads to a greatly depleted and impaired donor.
Complications to the Donor Area Skin and Existing Hair?
Whether FUE is performed by a poorly trained, incompetent doctor or a medically unqualified technician increases the risk of over-harvesting, poor hair growth is a cascade of lax standards and protocols going hand in hand for both the donor and recipient areas. A capable doctor will limit the risk of trauma by having in place protocols and standards.
Donor Area Damage (Skin & Hair):
• Over-harvesting leaves a moth-eaten appearance: punching adjacent follicular units leaves larger hair-less areas, bald patches and results in the micro scarring becoming more visible, as they cannot be camouflaged by the remaining hair.
Donor transection: unskilled, incompetent FUE punching can damage the follicular unit, or surrounding follicular units, cutting the shaft or bulb, causing transection. Once transected the follicular unit is either split, possibly partial hair survival, likely to be miniaturised, or the entire follicular unit is killed.
• Necrosis: An aggressive punching technique, larger FUE punches, or over harvesting can affect the skins blood supply, even cut it off. If the case, at best the remaining hair quality can miniaturise or if the skin tissue dies, it becomes necrotic, forming deep scarring.
• Sub-cutaneous scarring: Aggressive punching can also damage the underlying dermal tissue, making future hair transplants in that area difficult or impossible to perform.
Key Factors for Safety
Limit the size of an FUE procedure rather than chase a number. Cap the number according to donor hair quality limitations and risk protocols. It is considered by capping an FUE session to around three thousand grafts allow the safe healing of the open punch wounds, and recipient sites without putting excessive strain on the body.
Punch Diameter: only performed by experienced & capable doctors, which can use a smaller punch, leave smaller micro-scars, and preserve skin health, and allow for more extractions later.
Extraction percentage: Safe protocols dictate extracting a controlled fraction of follicular units in each square centimetre to avoid creating hair-less areas.
Staged Procedures: by limiting the size of the procedures it can maximise the number of grafts that can safely be extracted over multiple procedures, rather than trying to achieve total restoration in a single procedure, let the skin heal and the blood supply recover.
While FUE seems less invasive than the FUT technique, that only applies to certain size procedures. There is a point that FUE does create more scarring, while it may not be randomly dispersed more actual scarring is created. This must be associated with the competency, the doctor , if not within GMC guidelines tech led FUE hair transplants.
Maximum Grafts and Safe Session Sizes
With improvements in medical instruments, an FUE motorised punch in capable hands can safely punch around three thousand grafts in a single day session.
If the punching becomes demanding, difficult skin characteristics, graft splay slowing the doctor down, then a second day could be used to continue punching to reach around three thousand grafts, if safe to do so.
However, a second day, or trying to reach much more than three thousand grafts in a single day push passed the safe limits of FUE harvesting, increase the risk of transection, and patchy donor thinning.
The scalp donor, but any donor resource on the body is a finite resource, there is a biological hair count, which does not regrow, replenish or multiply once the intact FU has been punched and extracted from the donor area. The scalp surface area does not change, but the hair density around the donor area does, it drops with every follicular unit punched and extracted.
Larger FUE Punches
Larger diameter punch instruments are more likely to be used by inexperienced doctors and tech-led FUE clinics that are on the rise in the UK and internationally. Larger punches require less skill and precision but cause greater damage to the donor area.
Larger punches are more likely to transect adjacent follicular units and cause wider scarring. Larger FUE punches require less skill, and extraction can be faster are popular with the less competent.
Of course, these factors overlap, one bad protocol leads to another, with limited standards in place. So, a poor harvesting protocols combined with oversized FUE punches only leads to a greatly depleted and impaired donor.
Complications to the Donor Area Skin and Existing Hair?
Whether FUE is performed by a poorly trained, incompetent doctor or a medically unqualified technician increases the risk of over-harvesting, poor hair growth is a cascade of lax standards and protocols going hand in hand for both the donor and recipient areas. A capable doctor will limit the risk of trauma by having in place protocols and standards.
Donor Area Damage (Skin & Hair):
• Over-harvesting leaves a moth-eaten appearance: punching adjacent follicular units leaves larger hair-less areas, bald patches and results in the micro scarring becoming more visible, as they cannot be camouflaged by the remaining hair.
Donor transection: unskilled, incompetent FUE punching can damage the follicular unit, or surrounding follicular units, cutting the shaft or bulb, causing transection. Once transected the follicular unit is either split, possibly partial hair survival, likely to be miniaturised, or the entire follicular unit is killed.
• Necrosis: An aggressive punching technique, larger FUE punches, or over harvesting can affect the skins blood supply, even cut it off. If the case, at best the remaining hair quality can miniaturise or if the skin tissue dies, it becomes necrotic, forming deep scarring.
• Sub-cutaneous scarring: Aggressive punching can also damage the underlying dermal tissue, making future hair transplants in that area difficult or impossible to perform.
Key Factors for Safety
Limit the size of an FUE procedure rather than chase a number. Cap the number according to donor hair quality limitations and risk protocols. It is considered by capping an FUE session to around three thousand grafts allow the safe healing of the open punch wounds, and recipient sites without putting excessive strain on the body.
Punch Diameter: only performed by experienced & capable doctors, which can use a smaller punch, leave smaller micro-scars, and preserve skin health, and allow for more extractions later.
Extraction percentage: Safe protocols dictate extracting a controlled fraction of follicular units in each square centimetre to avoid creating hair-less areas.
Staged Procedures: by limiting the size of the procedures it can maximise the number of grafts that can safely be extracted over multiple procedures, rather than trying to achieve total restoration in a single procedure, let the skin heal and the blood supply recover.
While FUE seems less invasive than the FUT technique, that only applies to certain size procedures. There is a point that FUE does create more scarring, while it may not be randomly dispersed more actual scarring is created. This must be associated with the competency, the doctor , if not within GMC guidelines tech led FUE hair transplants.
