Follicular Unit Extraction (FUE) transplant is a hair transplantation technique first applied by Rassman et al. in 2002. According to this technique, with the help of a punch, hair follicles are obtained from donor areas on the scalp and made ready for hair transplantation. This technique can be used especially in patients who like short hairstyles because scarring rates are somewhat low. Although a much larger area is needed to obtain grafts, with the advancement of technology, various automatic systems have been developed to obtain these grafts. It has been supported by academic studies that the risk of damage to follicles is reduced with these devices. In the FUE hair transplant technique, there are many indistinct scars in the hair transplantation area. In addition, experience and the punch used are important when taking grafts in this technique. Since the grafts are more isolated from the surrounding tissue, they become more sensitive and are more susceptible to drying and trauma. They need to be placed in the area to be transplanted at an early stage. The FUE hair transplantaion technique is more sensitive than the other method. Between 1000 and 5000 grafts can be obtained with a minimum of 35-45 grafts per unit area. While wound healing is faster in FUE hair transplantaion method compared to other methods, post-operative pain is less common. In the 2nd and 3rd weeks, hair loss may develop in the transplanted areas, while new hair production may take 3-6 months. The total number of grafts that can be transplanted can be 3000-3500 units in the first session with FUE hair transplant and a second operation may be necessary for more grafts.
HAIR TRANSPLANTATION PROCESS
In the pre-operative period, the patient and the physician should act together and the planned procedure should satisfy both parties. Before hair transplant surgery, the patient should be prepared both physically and psychologically for the hair transplant procedure and the situations he/she will encounter afterwards. The patient should be informed about the stages of the surgical procedure, namely the examination and preparation stage, anesthesia application, extraction stage, canal stage, transplantation stage, and should be warned against the risks of complications.
Inspection and Preparation Phase
Pre-operative preparations have an important place in the hair transplantation process. In this sense, even the comfort of the accommodation is important, even if it seems simple. The FUE hair transplantation process begins with determining the patient’s wishes, reviewing the patient’s current condition with online consultation or face-to-face consultation and determining whether the patient is suitable for FUE hair transplantation. In the pre-operative process, it is important to establish mutual trust by jointly evaluating the patient’s expectations by the patient and the physician. A complete medical anamnesis (such as hypertension, bleeding problems, drug and alcohol use, etc.) should be taken by the physician, all systems should be reviewed, necessary blood tests (complete blood, complete urine, etc. tests, investigation of infectious diseases) and other pre-operative procedures should be performed. An adequate donor area should consist of hair that is not prone to hair loss. The most commonly used area is around the occipital protuberance at least 4 cm above the posterior neck hairline. This is considered a “safe donor area” in the literature. First, the donor site density (FU number) is determined. Here it is important to calculate the recipient area and with a donor density of 50 percent it will have a natural appearance. Most donor sites contain 2000 FUs. Assuming an average of about 4600 hair strands per strand in each FU, this means a density of 50 percent of the donor area. Men and women of all skin types and hair colors are candidates for hair transplantation. Important physical characteristics are the diameter of the patient’s hair, hair follicles per cm² and the degree of hair loss. This assessment is made using the Norwood scale for men and the Ludwig scale for women. In the physical examination, the scalp of the candidates is examined and the caliber and density of the donor hair on the scalp at the back of the head are determined. Determining the density and caliber of donor hair will help in calculating the expected hair density after hair transplantation. Coarse, wavy hair exhibits a higher density compared to the same number of fine straight hair. Therefore, a patient with coarse, wavy hair transplanted may have a denser hair appearance than a patient with an equal number of fine straight hair transplanted. The part that will define and reveal the face and make the patient the most happy is that the patient has a new hairline. Since a healthy hairline has irregularly located weaker hair in the front and strong, dense hair in the back, grafts containing irregular, few hair follicles are placed in the front. After the patient evaluation and examination, the person is taken to the surgery and the procedure is started with the application of anesthesia.
Hair transplantation can be performed with local anesthesia alone or with sedation. Patients using sedation must be monitored. Anesthesia is the most important part of hair transplantation practice. Patients should feel as comfortable as possible throughout the hair transplant procedure, both physically and psychologically. This is only possible by minimizing anxiety and pain. The hair transplant procedure should be physiologically and psychologically as painless as possible.
It is the process of obtaining hair follicles “in vivo” from the donor area without making a linear incision. It is the method in which each follicular unit is taken one by one. It can be performed manually with a 0.6-1 mm wide incision tip called punch for extraction, or with electric motors whose rotation can be adjusted. It is the process of removing follicular units one by one from the scalp after round incisions made around the follicular unit with punches, without the need for a subsequent separation process.
In hair transplantation, the stage of making small incisions in the recipient area where the grafts to be transplanted will be placed is called channel opening. Among the many factors affecting the success of hair transplantation, opening the channels correctly is important for the success of the procedure. The channels are opened in accordance with the natural hair direction and angle of the person. When opening the channels, it is important to create the best direction and angle to achieve the natural result in the size of the grafts, sufficient density, and not to damage the natural hair follicles in the area.
In hair transplantation, it is technically difficult to place a large number of thin grafts into small and narrow graft slots, i.e. channels. Problems at this stage play an important role in the success of the procedure. Today, there is no single method in use for transplantation, many methods are used for this purpose and new graft placement devices have been used in recent years with the development of technology. When choosing these methods, factors such as the density of the donor area, the condition of the recipient area, cost, speed, experience, experience and training of the transplant team are taken into consideration. The success rate increases when the right technique is used for the appropriate patient. Following the creation of all recipient sites, the grafts are placed. The logic of the procedure is to place the graft at the appropriate angle and order in the channel opened without drying the graft while holding it in a way that does not damage the graft. Experienced people can transplant up to five hundred grafts in one hour.
FUE HAIR TRANSPLANT IN TURKEY
Today, hair transplantation has become an easy procedure to perform in Turkey, especially thanks to medical and technological advances in aesthetic surgery. In recent years, Turkey has become a popular destination for individuals looking for solutions to their baldness problems and the hair transplantation sector has grown rapidly. With the quality services it offers, it is a leading and preferred center for FUE hair transplants surgeries in Turkey and has an important prestige in this field. Affordable prices combined with world-class expertise are the main reasons why people from all over the world come to Turkey for FUE hair transplantation. While the average cost of a hair transplant operation in Turkey is between $1,700 and $2,000, the same procedure in the UK or the US can cost up to $25,000. It is stated in different sources that 498 thousand people came to Turkey for hair transplantation in 2019.