Posts Tagged: Follicular Unit Extraction

What is Follicular Unit Extraction and What Other Terms are Associated with the Procedure?

November 6th, 2006

Q: I am considering having an FUE procedure and have heard the phrases topping, capping, and tethering as part of the procedure. What do all these terms mean?

A: These are all terms that refer to the types of injury that can occur to grafts during a follicular unit extraction procedure.

In FUE, a sharp instrument (or sharp instrument followed by a blunt one) is used to separate follicular units from the surrounding donor tissue. Forceps are then used to remove the follicular units from the scalp.

Topping occurs in the first step when the doctor accidentally cuts off the top of the graft so that the remainder of the graft cannot be removed.

Capping occurs when the doctor grabs a graft with forceps and the top of the graft (the epidermis and upper dermis) pulls off, leaving the rest of the graft behind.

Tethering occurs when the bottom of the graft is still attached to the deeper tissues after the first step causing the follicular unit to pull apart during extraction.

There are a few other terms used as well.

Shredding occurs when the follicular unit is not totally separated from the surrounding tissue and pulls apart upon extraction. Shredding can also occur when the follicular unit was partially damaged in the first step.

Transection is like topping, but here the mid or lower portion of the hairs in the unit are cut.

Buried grafts occur when the graft is pushed into the sub-cutaneous space rather than extracted. Buried grafts can usually be removed, but if not removed completely, may turn form small cysts.

Go to the Follicular Unit Extraction page on the Bernstein Medical – Center for Hair Restoration website.

Topic: Follicular Unit Extraction

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Posted by Robert M. Bernstein M.D. at 9:23 am

What is Hair Transplant Cost for Hair Plug Removal?

August 30th, 2006

Q: I was looking at your prices for repair work and you mentioned that you charge $75 per graft removed. I had a hair transplant and received follicular unit grafts (one-hair follicles) but I think my hair loss is going to continue so I might in the future want to remove them. Am I interpreting your fees correctly, or does this price apply to people who have had the plug like transplants?

A: The fee applies to the removal of plugs and includes graft (plug) excision, suturing of the site, dissection of the plug into individual follicular units and re-implantation.

Generally the best way to reverse a procedure of follicular unit transplantation is with laser hair removal. This is particularly true if the hair restoration was done properly and the underlying skin is normal. Alexandrite and diode lasers are the best for hair removal. Typically, there are too many small grafts in FUT procedures to make excision practical.

Removal via Follicular Unit Extraction (FUE) will leave scars in a cosmetically important area. As an aside, if you received all “one-hair follicles”, your procedure was NOT follicular unit hair transplantation and may explain why you are unhappy and want to reverse it.

Visit the page on hair transplant costs and consultation fees for more information.

Topic: Repairs

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Posted by Robert M. Bernstein M.D. at 5:39 am

After Follicular Unit Extraction Hair Transplant, Why Pimples and Redness?

July 21st, 2006

Q: I had a hair transplant of over 600 grafts using Follicular Unit Extraction (FUE) to my frontal hairline and the frontal part of my scalp. The procedure was done less than a year ago by another doctor. Since then I have had persistent pimples and redness in the area that the grafts were placed. Also, the surface of the skin in the area is irregular.

A: One of the causes of having pimples and redness following Follicular Unit Extraction may be buried hair fragments and there are significantly more hair fragments generated with the two-step FUE technique than with the three-step method.

In the three-step procedure, we use blunt dissection which minimizes transection (cutting of hair follicles) and thus reduces the incidence of hair fragments. See the Instrumentation for Three-Step FUE page at the Bernstein Medical – Center for Hair Restoration website.

In our practice, we also place every extracted graft under the microscope. This serves a number of purposes:

  1. It gives me immediate feedback on transection rates, so that I can adjust my technique in real-time (using a stereo-microscope is much better than visual inspection for this purpose)
  2. It enables us to trim away excess tissue and hair fragments (we use the same judgment as we do with strip harvesting, so that a “viable looking” fragment would be left attached
  3. It allows us to accurately count the number of hairs in each follicular unit graft, as it is particularly important to have pure 1-hair grafts for the frontal hairline. This also allows us to better anticipate the end cosmetic result.
  4. It allows us to dissect larger follicular units into smaller ones for specific cosmetic purposes, i.e. eyebrows, hairlines, temples etc.

One of the ironies of FUE is that it is more efficient to extract the larger FUEs, since this gives us a greater hairs/hole ratio, but this often leaves us with an inadequate number of 1-hair units, which must be obtained though traditional stereo-microscopic dissection of the larger extracted grafts.

Other causes of folliculitis (manifested by pimples and redness) can result from placing the grafts too deep in the recipient site (where they may get buried) and secondary infection. A mild, transient folliculitis is often seen after a hair transplant without any precipitation factors.

Topic: Follicular Unit Extraction

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Posted by Robert M. Bernstein M.D. at 8:03 am

Can One Have Hair Transplant if Scalp is Tight from Prior Surgery?

July 5th, 2006

Q: What can be done if I want to have a hair transplant and my scalp is very tight from prior surgeries?

A: Follicular Unit Extraction is ideal in very tight scalps, provided that there is enough hair to extract without leaving the donor area too thin and provided that the follicles are not too distorted from the scarring.

With strip harvesting, undermining techniques may be helpful to close the wound edges once the strip is removed.

In undermining, the surgeon uses either a sharp instrument (scalpel) or blunt instrument (the dull edge of scissors) to separate the upper layers of the scalp (dermis and epidermis) from the lower part of the scalp (fascia). The hair transplant surgeon accomplishes this by spreading apart the fat layer of the skin or by cutting through scar tissue.

Undermining allows the upper layers of skin to literally slide over the lower layers and can significantly increase the ability to close a tight wound. However, if not done carefully, it may increase the risk of bleeding and injury to nerves and occasionally may damage hair follicles.

Undermining is usually used with a layered closure where the deeper tissues are brought together first with a layer of absorbable sutures before the surface of the skin is sutured closed with sutures that are removed.

Topic: Hair Transplant

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Posted by Robert M. Bernstein M.D. at 6:33 am

After Follicular Unit Extraction Hair Transplant, Can One Shave Their Head?

June 29th, 2006

Q: I am trying to have my donor scar repaired after a 1000 graft hair transplant. I was told the FUE’s placed into the scar would conceal it enough to shave my head? I would like to shave my head completely bald with a razor.

A: In general, after a scar correction with follicular unit extraction you can clip your hair very short, but not shave your head. If you shaved your hair completely bald, you would generally see a vague outline of the linear scar as well as the small scars from FUE.

Topic: Follicular Unit Extraction

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Posted by Robert M. Bernstein M.D. at 8:21 am



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