What are the steps of FUE Hair Transplant?
Preparation for hair transplant
Our guests arrive at 8:30 in the morning ready for the operation. They fill the consent forms with the help of the receptionist who welcomes them and they receive the necessary information. Photos are taken to be used for “before & after” demonstrations. Clear photos should be taken appropriately from the right angles. A high-quality photo is the first and a very necessary step for the evaluation of the result and for the future plans to be made by the physician who performs the hair transplant operation.
After the photos are taken, a final consultation is made with the plastic surgery specialist who will perform the operation, and previous conversations are reviewed and the hair transplant operation is planned.
Planning before the fue transplant operation
During the planning process, the physician makes a final review regarding the number of hair follicles to be extracted, the number of the hair shafts contained in the follicles and the thickness of the shafts. The sites of and the density of transplantation and the orientation of the hair shafts are determined by taking the patient expectations into consideration. The compatibility between the specialist’s suggestions and the individual’s expectations is crucial in this phase. Being realistic about what we can accomplish and the suitability of the patient’s expectations constitute the essence of a successful hair transplantation operation.
Planning the hairline
A successful fue transplant operation requires a natural result which is not noticeable to the people in connection with the individual who undergoes the operation. And the hairline should be very delicately planned in order to obtain a natural looking hair transplant result.
Expectations and suggestions of the patient should definitely be listened while planning the hairline but the planning should be made in accordance with the person’s current condition by taking the patient’s forehead structure and facial symmetry into consideration, without fully concentrating on the previous condition of the patient. The hairline is determined by maintaining the symmetry with the help of the laser pointer device specifically designed for this purpose.
The hairline is the line that the hairy scalp meets the forehead. The hairline should fit the other aesthetical elements of the face, should be planned at a convenient level and should not be created as a sharp straight line. A natural hairline is created as a symmetrical fragmented line with a triangular wavy form. The follicles to be used for creating the hairline should be those follicles which contain a single and thin hair shaft. While a hairline created by sharply aligned hair follicles which contain thicker hair shafts is noticeable to everybody after the operation, a wavy hairline planned with a slight disorder and created with those follicles which contain a single hair shaft is not noticeable even to the immediate acquaintances of the individual after the operation.
Taking the first step right: Is it possible to correct an inaccurately created hairline?
A significant ratio of the patients who consult to us for a hair transplantation operation are those patients who are not satisfied with the results of the hair transplantation operations they have undergone in other clinics. The hairline result of a hair transplantation operation performed by an unqualified person may be irreparable. Correction of the inaccurate hairline is the most challenging aspect we experience in such extra corrective operations. With such patients, corrective operations can be performed by harvesting the too thick hair follicles inserted and inserting grafts containing a single hair shaft.
Nobody wants it to be apparent that they have undergone a hair transplantation operation. In order to obtain a natural result, the hairline should be planned by a plastic surgeon specialized in the area, who has comprehensive knowledge about facial aesthetics and facial ratios, and who has performed an adequate number of hair transplant operations to understand the patient’s expectations.
After everything is planned and decisions are made for the procedure, the patient is prepared for the operation. The individual who will undergo the hair transplantation operation gets a grade 1 haircut. No haircut is necessary before that stage.
If a small amount of hair will be transplanted, FUE transplant can be performed by shaving thin strips of hair without having a complete haircut. In this way, the person who undergoes the hair transplantation operation can quickly continue their social life without demonstrating any change in their appearance.
After the haircut, a specially prepared local anesthesia mixture is administered in order to have a painless hair transplantation operation that does not hurt the patient or cause bleeding.
Is hair transplantation a painful procedure?
Regarding the FUE transplant, the most important concern of the patients is the answer to the question: “Will I suffer any pain during hair transplantation?” Hair transplantation operations are among those interventions that provide a high level of patient comfort. Just a mild level of pain is felt during local anesthesia injection at the beginning of the operation, and the rest of the hair transplant operation after this stage is entirely painless.
Every individual has a different pain threshold. While a patient with a higher pain threshold is not affected at all by the local anesthesia procedure that lasts about 1 minute, other persons may have complaints of a mild burning and stinging feeling. Those anxious people with a lower pain threshold can tolerate the situation by saying that “I have pain but I can bear it.”
The extraction and collection of hair follicles (follicular unit, graft)
The hair follicles on the site between the ears are genetically resistant to thinning. FUE transplant is performed by the micromotor –a specially designed microsurgical device- without making any incisions or sutures. Hair follicles are individually removed from the scalp by using the micropunches with diameters of 0.6-0.9 mm inserted to the tip of the micromotor.
Extraction procedure is performed under the magnifier equipment by using the microsurgical technique only. Extraction is performed within the limits of the scalp at the level of the follicles. Since the extraction is limited to the level of the scalp, the tissues located deeper get no harm.
The most critical point to be taken into consideration in this procedure is giving no harm at all –not only to the hair shafts but- to the totality of the hair follicles with the hair shafts they contain, during the extraction. No hair shaft grows from a damaged hair follicle which is transplanted. If the hair follicle (follicular unit) is damaged, no hair will grow and the result will be unsuccessful. If no hair grows after the hair transplantation operation, one of the main reasons of this is a careless extraction procedure performed by an inexperienced person.
Since no hair follicle forms to replace the damaged hair follicle, a successful hair transplant operation is possible only if the donor site is used with full efficiency. For the complete collection of each hair follicle individually, extraction should be performed carefully by a plastic surgeon.
The distribution of the completely extracted hair follicles is also significant. The number of the hair follicles should separately be calculated for those follicles that contain one, two, three and four hair shafts. Extraction of the hair follicles that contain three or four hair follicles as much as possible and avoiding those follicles containing only a single hair shaft will lead to a denser hair result. While 4000 hair follicles which contain a single shaft correspond to 4000 hair shafts, 4000 hair follicles which contain three shafts correspond to 12,000 hair shafts.
Extraction should not be considered as a simple technical procedure. The diameter of the micropunch, the speed of the micromotor, the orientation and the depth of the hair follicles, and the distance between the extracted follicles should be evaluated separately for each patient. At this stage, the level of experience and the skills of the plastic surgeon as well as the quality of the technical equipment come into play. In this context, we argue that ‘there are no disorders, there are patients’ and we make a separate evaluation for every single patient.
We, the plastic surgeons of Dr. Ilker Apaydin, extract 4000 hair follicles (follicular units) without giving harm to them, during a single session which lasts about 2-3 hours. In addition, the total number of hair shafts targeted for 4000 hair follicles is 10,000 hair shafts at a minimum. The extracted hair follicles are stored inside a special nutritive solution in a cooled ambient in order to keep them alive.
Making the canals for inserting the hair follicles (Graft) during the hair transplant
Preparing the recipient site is exactly the architectural plan of the procedure to be performed. The extraction location, density and the depth of separate follicles, and the distribution of the follicles are determined in this phase. After the canals are prepared in accordance with this architectural plan, the transplantation nurse will need to stick to this plan only. As long as the architectural plan is properly prepared, the resulting structure from a qualified labor will be reliable and aesthetical.
This architectural plan lays the foundations of a successful hair transplantation operation. This is the procedure which determines the orientation and density of the hair follicles and ensures a natural appearance.
The method of preparing the canals and the equipment used for this purpose are highly significant. Hair transplantation canals are made by using specially designed blades (micro slit) with diameters of 0.5 – 0.8 mm. The width and length of the hair canals are planned by evaluating the extracted follicles individually.
The depth of the hair transplant canals to be prepared should suit to the length of the hair follicles, the width of the canals should suit to the thickness of the follicles to be inserted, and the orientation of the canals should suit to the original orientation of existing hair. The canal to be prepared should be as small as possible but it should still be wide enough to allow for a smooth insertion of the hair follicles. In this way, the nurse who performs the insertion can easily adapt the hair follicles to the canals and the blood circulation in the scalp does not get disrupted. As a result, the rate of hair growth from the transplanted hair follicles approximates a hundred percent.
Definitely no visible scar is left and a natural result is obtained as long as the canals are prepared cautiously. Similarly, if the canals are prepared in conformity with the orientation of hair, the recently growing hair can be combed in the desired direction and it looks natural like the original hair.
The most troublesome results of an ill-planned hair transplantation operation include unsuitability of the hair to be combed in the desired direction and the high noticeability of the transplantation. It is highly difficult to change the inaccurate hair orientation to the proper orientation even with corrective operations. The appearance of hair which is popularly described as paving stones or a grass head occurs if the hair canals are made perpendicular or opposite to the orientation of hair or if an inappropriate distribution is made. In addition, incisions wider than adequate lead to noticeable canal scars at the bottom of the hair shafts.
While planning the hairline, the canals should not follow a straight and sharp line; they should rather be prepared a little disorderly as a wavy line which gives a more natural appearance.
If an inaccurate architectural planning is made, the result will not be aesthetical and natural even if hair grows after a successfully performed transplantation. For all these reasons, the hair insertion canals should be prepared by an experienced plastic surgeon who is specialized in the area with comprehensive knowledge.
Implantation of hair follicles
This comprises the implantation of the hair follicles individually extracted by the FUE method into the hair canals prepared. In this last phase of hair transplantation, the hair follicles are inserted at the appropriate depth with the appropriate angle without giving any harm to them. This procedure requires patience and caution. The hair follicles should individually be inserted into every single canal without skipping any of them.