What’s Hair Replacement with Follicular Unit Extraction?
Hair replacement surgery transfers hair from hairy parts of the scalp to bald parts of the scalp. It’s most commonly used to treat androgenetic alopecia (the hair loss experienced by men as they age), but can also be used for other causes of hair loss. Micro-grafting is the most technologically advanced form of the hair transplant procedure. In this procedure, small transplants containing only one or two hair follicles each are transplanted from a hairy part of the scalp (usually the back of the head) to the bald area (usually the front, just above the forehead). With follicular unit extraction (FUE), these are removed in very small (less than 1mm) units, and these are transplanted into the bald area. This restores a more youthful hairline, which can restore a more youthful and vibrant appearance to the face.
If you’re choosing hair replacement surgery, make sure you’re choosing it because you really want it, not to please someone else or to fit an imagined ideal. No one else can make the choice for you; it’s your body, and you’re in charge of it. After you do your research and understand the procedure, if you believe that hair replacement with FUE is right for you, then proceed. To help you in your decision-making process, we have some information about the risks and benefits of FUE procedures at Hair Replacement with Follicular Unit Extraction: Risks and Benefits.
Please note that this page is for informational purposes only, and is not a substitute for qualified, individualized medical advice. You should discuss your potential elective procedure with your own doctor(s), including your primary care physician and the doctor who will perform your procedure if you decide to proceed.
How it’s done
Your full hair transplant procedure will take several sessions, with a healing interval of a few months after each session.
Hair transplant procedures are usually done under local anesthesia. Your doctor may offer you a prescription sedative to help you relax during the procedure, but you won’t be unconscious. Local anesthesia (a medication similar to Novocain) is injected through small needles into certain areas of the scalp to numb the nerves.
Next, the small grafts are removed from a hairy part of the scalp. The hair in the donor area is trimmed short for this procedure. A small punch tool is usually used for harvesting the grafts. Each graft contains one or a few hair follicles.
The hair grafts are then transferred to the recipient scalp. Usually, a large injection needle is used for this process. The graft is carefully taken up into the needle, and then the needle is placed under the scalp, and the graft is injected into place. Hundreds of grafts will be transferred during your hair transplant session. The grafts must be placed at least 1/8 inch apart, to allow for scalp circulation; the gaps will be filled in during your later sessions. (This is why several sessions are needed to complete the micro-grafting procedure.) The surgeon is careful to place the hairs in the correct direction, so that the growth of hair will appear natural.
When all of the grafts for that session have been placed, the doctor will often place a pressure bandage over the treated scalp. This prevents fluid collection and aids healing.
Preparing for the procedure
Choosing your surgeon
When choosing a plastic surgeon for your hair replacement surgery, you want a highly-trained professional with experience in this type of surgery. A fellow of the American Society of Plastic Surgeons has received training in plastic surgery. Also, choose a surgeon with whom you feel comfortable and safe, and who listens to you and tries to understand your goals. If you have friends who’ve had hair replacement surgery, and you like their results, ask for a referral. While cost may be a consideration, don’t allow this to override more important factors in your decision. Your safety and the quality of your results are worth a little extra spending.
For more help in your search for a vision correction surgeon, visit our How to Find the Best Hair Replacement Surgeon page. At Doctor Review, you can also search providers for patient reviews to help you find the very best.
Getting ready for the procedure
Your surgeon may offer the use of a tissue expander. This is a small balloon that is inserted under the surface of the back of your scalp, and then gradually inflated with saline over the course of about a month. The expander causes the skin of your scalp to grow to cover the expander, so that there is plenty of extra scalp to remove as the donor. Use of a tissue expander can decrease the size of the scar that results from the removal of scalp at the back of your head. This is because if there is tension on a wound as it heals, then the scar will be wider; using a tissue expander allows the growth of enough extra skin that there is significantly less tension on the scalp incision.
After the procedure, you’ll need a family member or trusted friend to drive you home. You should plan to spend the rest of the day resting, especially if you’ve received a sedative to help you relax during your procedure.
You’ll usually be instructed to wear the pressure bandage on your scalp for two to three days following your procedure. Although this may seem like a hassle, taking off the bandage may cause fluid to collect in the treated scalp, and may cause some of the transplanted follicles to be damaged. Keeping the bandage on may increase the quality of your results, so it’s worth the hassle.
Because vigorous activity increases blood flow to the scalp, and this may lead to damage to the transplanted follicles, it’s advised that you avoid vigorous activity (particularly contact sports) for at least three weeks after surgery. Many doctors advise abstaining from sexual activity or similarly vigorous activities for at least ten days. Your surgeon will advise you about when to return to your normal activities, based on your personal situation and medical history. Your surgeon will want to see you for follow-up visits several times in the first month or two after surgery, to ensure that your scalp is healing properly.
You should expect the hair from the transplanted follicles to fall out in about six weeks. This is not a sign that the hair transplant hasn’t worked; it’s normal, and is simply a reaction of the follicles to the transplant procedure. Think of it as the follicles conserving their energy for healing, so they have none left for hair growth. After the hair falls out, it will be about six weeks before new hair starts to grow from the transplanted follicles. Normal hair grows about one half inch per month, and this is what you should expect from the treated follicles as well.