Understanding Hair
Valued member
FUE has changed over time, occasionally for the better from the consumer´s point of view, possibly also to the detriment in ways. One aspect FUE has evolved is the clinic approach to session size, or the number of grafts harvested over one or multiple procedures.
When FUE became mainstream two plus decades ago, the “FUE purest” doctors´ believed it was the sole domain of a doctor to do it all, with around five hundred grafts in a day session. The best FUE doctors understand hair and skin physiology well, importantly, as they vary. Overtime, experience, understanding, and practice, the numbers grew per session, one thousand, 1500 and 2000 grafts (on a suitable candidate) sessions in a day. FUE is, when performed to a high standard, a slow doctor-orientated technique, with larger sessions performed over two consecutive days. Even with the change from manual to motorised punch instruments taking into consideration the concentration required, the movement around the head, fatigue, and breaks, it´s a slow, pain staking process.
An unofficial cap of up to three thousand grafts (donor allowing) was set as the benchmark for a well performed FUE procedure, even if the hair loss pattern dictated a need for more grafts. Capping the numbers safeguarded improved healing of the six thousand odd open wounds, donor/recipient. Capping the graft numbers helped promote the best yield from the transplanted hair. Adopting an educated extraction pattern minimised the negative changes to the donor area, it´s easier to spread the extraction and not take adjacent hair groups. This stands true today, instruments, medicine may have evolved, but skin and hair physiology has not changed. Ironically, it appears clinics that cap the grafts numbers for care and quality, still only the doctor performs the FUE punching.
Demand for larger sessions grew, the numbers started to rise, leading to 4 – five thousand plus FUE sessions. This in turn helped improve productivity, faster sessions, and greater efficiency with the punching of the grafts performed by multiple hair technicians working on the head at the same time. This focus on speed, multiple, if not double-digit patients per day, a low-cost team, especially compared to a doctor´s pay, achieving high graft numbers, all must seem like a win-win, for the clinic and patient.
There is frequently a give and take in life, a trade off. In this case, higher numbers and speed versus diligence, care, understanding, and control. There can be little control over the harvesting pattern, diligence to avoid transection, care not to split grafts or cause unnecessary trauma to the skin. FUE is a “blind extraction” technique, meaning you cannot see below the skin's surface. So, working with a largely medically ignorant workforce, and diluted protocols, the risk increases to an almost inevitable level of causing open hair-less areas, or over harvesting, more obvious white dot scarring, causing shock loss, sometimes permanent, and damage to the remaining hair from transection, and a lower yield when grown out. The knock on to this is a much reduced, occasionally depleted donor region that can ill afford to fix the lower yield, let alone continued hair restoration.
While FUE may be minimally invasive from the point of view of a single punch wound. Technically, with comparable parameters of performance, more cosmetic surface scarring exists compared to an FUT procedure of comparable size, when over three thousand grafts. This also means the potential long-term number of grafts reduces, and the donor left in a much worse condition, compared with more thought out, smaller sessions. Make your choice, do your research, understand your options, and consider, when something “appears too good to be true, it probably is.”
When FUE became mainstream two plus decades ago, the “FUE purest” doctors´ believed it was the sole domain of a doctor to do it all, with around five hundred grafts in a day session. The best FUE doctors understand hair and skin physiology well, importantly, as they vary. Overtime, experience, understanding, and practice, the numbers grew per session, one thousand, 1500 and 2000 grafts (on a suitable candidate) sessions in a day. FUE is, when performed to a high standard, a slow doctor-orientated technique, with larger sessions performed over two consecutive days. Even with the change from manual to motorised punch instruments taking into consideration the concentration required, the movement around the head, fatigue, and breaks, it´s a slow, pain staking process.
An unofficial cap of up to three thousand grafts (donor allowing) was set as the benchmark for a well performed FUE procedure, even if the hair loss pattern dictated a need for more grafts. Capping the numbers safeguarded improved healing of the six thousand odd open wounds, donor/recipient. Capping the graft numbers helped promote the best yield from the transplanted hair. Adopting an educated extraction pattern minimised the negative changes to the donor area, it´s easier to spread the extraction and not take adjacent hair groups. This stands true today, instruments, medicine may have evolved, but skin and hair physiology has not changed. Ironically, it appears clinics that cap the grafts numbers for care and quality, still only the doctor performs the FUE punching.
There is frequently a give and take in life, a trade off. In this case, higher numbers and speed versus diligence, care, understanding, and control. There can be little control over the harvesting pattern, diligence to avoid transection, care not to split grafts or cause unnecessary trauma to the skin. FUE is a “blind extraction” technique, meaning you cannot see below the skin's surface. So, working with a largely medically ignorant workforce, and diluted protocols, the risk increases to an almost inevitable level of causing open hair-less areas, or over harvesting, more obvious white dot scarring, causing shock loss, sometimes permanent, and damage to the remaining hair from transection, and a lower yield when grown out. The knock on to this is a much reduced, occasionally depleted donor region that can ill afford to fix the lower yield, let alone continued hair restoration.
While FUE may be minimally invasive from the point of view of a single punch wound. Technically, with comparable parameters of performance, more cosmetic surface scarring exists compared to an FUT procedure of comparable size, when over three thousand grafts. This also means the potential long-term number of grafts reduces, and the donor left in a much worse condition, compared with more thought out, smaller sessions. Make your choice, do your research, understand your options, and consider, when something “appears too good to be true, it probably is.”
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