Understanding Hair
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Follicular Unit Extraction, FUE, a minor surgical procedure, performed under local anaesthetic. FUE removes intact follicular units (FU) from the donor area, using a surgical cylindrical punch <> 1mm in diameter. FUE should only remove intact follicular units (FU), between one to four hairs each. FUE has been the go to hair transplant technique for sometime. One appeal of FUE is there is no linear scar as with the FUT technique. However, some have marketed FUE as a non-scarring hair transplant technique. Unfortunately, this is is not true.
Doctor performed FUE donor harvesting
Traditionally, the doctor will plan and perform the surgical aspects of the procedure, aided by technicians. A manual or motorised cylindrical punch instrument removes an intact follicular unit from skin. The doctor will first measure the donor hair density. As well as calculate the extraction pattern to minimise the change in hair density around the back and sides of the head and to reduce the signs of scarring. An experienced and talented FUE doctor will have protocols in place to maximise the donor hair and minimise the negative impact of loss of hair density and scarring.
There are many angles the doctor needs to consider when extracting grafts with the FUE technique. Such as not to overharvest any area, to spread the extraction to maintain a balance hair density around the donor area. To maintain a low transection rate when punching the grafts, by measuring the depth, angle and orientation of the hair follicles under the skin surface. All needing a medical understanding of the hair and skin.
The graft punching was the domain of the doctor. Very occasionally a lead technician maybe asked to “stick and place”, meaning the technician would punch a graft and place the graft in one movement. Normally performed at the end of the procedure, the number of grafts is minimal and even then, not that common. This refined Doctor performed FUE often needs two consecutive days to perform larger procedure. Even then it´s common for the doctor to cap the grafts harvested even if the hair loss pattern cannot be fully covered. This is to protect the donor healing and growth for now and future hair restoration.
Non-Dr FUE
Overtime, while some clinics employ a certified nurse, it´s become more common for non-medically certified technicians to partially aid the doctor and now even perform all the graft extraction. Today, some clinics´ business model is to have FUE hair transplants solely performed by technicians. Mostly with no formal medical training or qualification.
The use of technicians has many benefits for the clinic. For one, multiple technicians cost a great deal less than one qualified doctor. It is common for multiple technicians to be working on the donor at the same time. But this will effect standards and harvesting protocols, if there are any. Issues such as over harvesting, maintaining a balanced hair density, and measuring transaction rates.
Having many more staff improves the business efficiency, faster work means more patients per day. More staff means less accountability and controls. Protocols that promote speed over refinement, all lead to a production line approach to surgical hair restoration. The doctor does still have a role to play under this technician working model. However, it´s rarely hands-on. For instance, to sign-off on the pre operation consultation. As well as needing to be present following local clinic regulations for surgery. FUE hair transplants are still a surgical procedure.
Research carefully
How FUE can differ between clinics. A golden rule – never judge the competency of one clinic by the standards of another. If the assumption is because they are all medical so must have comparable standards, that would be incorrect. Standards vary greatly and should not be assumed all clinics work by the same practices and protocols. Where aspects such as the type of microscope or instruments they use. Which type of clinic you decide to use is your choice. Make an objective decision, not based solely on variables such as location or cost. But on tangibles that can determine the standards and protocols you will receive. Take care with your appearance and research well.
Doctor performed FUE donor harvesting
Traditionally, the doctor will plan and perform the surgical aspects of the procedure, aided by technicians. A manual or motorised cylindrical punch instrument removes an intact follicular unit from skin. The doctor will first measure the donor hair density. As well as calculate the extraction pattern to minimise the change in hair density around the back and sides of the head and to reduce the signs of scarring. An experienced and talented FUE doctor will have protocols in place to maximise the donor hair and minimise the negative impact of loss of hair density and scarring.
There are many angles the doctor needs to consider when extracting grafts with the FUE technique. Such as not to overharvest any area, to spread the extraction to maintain a balance hair density around the donor area. To maintain a low transection rate when punching the grafts, by measuring the depth, angle and orientation of the hair follicles under the skin surface. All needing a medical understanding of the hair and skin.
The graft punching was the domain of the doctor. Very occasionally a lead technician maybe asked to “stick and place”, meaning the technician would punch a graft and place the graft in one movement. Normally performed at the end of the procedure, the number of grafts is minimal and even then, not that common. This refined Doctor performed FUE often needs two consecutive days to perform larger procedure. Even then it´s common for the doctor to cap the grafts harvested even if the hair loss pattern cannot be fully covered. This is to protect the donor healing and growth for now and future hair restoration.
Non-Dr FUE
The use of technicians has many benefits for the clinic. For one, multiple technicians cost a great deal less than one qualified doctor. It is common for multiple technicians to be working on the donor at the same time. But this will effect standards and harvesting protocols, if there are any. Issues such as over harvesting, maintaining a balanced hair density, and measuring transaction rates.
Having many more staff improves the business efficiency, faster work means more patients per day. More staff means less accountability and controls. Protocols that promote speed over refinement, all lead to a production line approach to surgical hair restoration. The doctor does still have a role to play under this technician working model. However, it´s rarely hands-on. For instance, to sign-off on the pre operation consultation. As well as needing to be present following local clinic regulations for surgery. FUE hair transplants are still a surgical procedure.
Research carefully
How FUE can differ between clinics. A golden rule – never judge the competency of one clinic by the standards of another. If the assumption is because they are all medical so must have comparable standards, that would be incorrect. Standards vary greatly and should not be assumed all clinics work by the same practices and protocols. Where aspects such as the type of microscope or instruments they use. Which type of clinic you decide to use is your choice. Make an objective decision, not based solely on variables such as location or cost. But on tangibles that can determine the standards and protocols you will receive. Take care with your appearance and research well.
