In the run-up to any FUE-based hair transplantation, patients should bear the following restrictions/information/instructions in mind, as the optimal healing process and success are highly dependent on them.
These instructions are available as a pdf file below the page under IMPORTANT INSTRUCTIONS.
On the day of the operation
Preparing the donor area for extraction
The operation is usually done under sedation, with a patient generally being given Midazolam as a sedative. This has an effect similar to that of valium. The donor area is also numbed by a local anaesthetic prior to extraction. Dr. Feriduni and at least 2 - 3 medical assistants are present throughout the operation. Individual FUs are painlessly extracted using a micro-needle with a diameter between 0.7 and max. 0.95 mm. Extraction is performed intermittently, i.e. hair-root groups are extracted for a period of 1 - 2 hours, immediately after which the implant incisions are made. Implanting takes 1 - 2 hours. This extraction / implantation procedure is then repeated.
Preparing the incisions
The area where the implant incisions for the individual FUs are made is also locally anaesthetised, allowing the incisions to be made painlessly.
The incisions in the recipient area are made using tiny slit needles, also known as blades. These custom-made blades can be perfectly adapted to the respective size of the patient's FUs. Customized blades are usually 0.6 - 1.0 mm wide. Nearly all incisions are made before implantation (Premade Incision Technique). This part of the operation takes about 2 hours. Dependent on the duration and scope of the treatment, a break is now taken. This can be used for relaxation or having lunch.
Again dependent on the method used and its duration, implantation may follow immediately afterwards. This takes 1 - 2 hours and is performed by medical assistants and Dr. Feriduni. Any major FUE involving the transplantation of a large number of hairs continues after the break with the next bout of extraction and implantation. This iFUE technique (intermittent FU extraction), in which the extracted FUs are implanted immediately afterwards, can be repeated up to three times.
Stick and place – the fine-tuning phase
The following part of the treatment is extremely important, and involves the use of the so-called Stick-and-Place technique. This is used to optimise the result, making the transplant look as natural as possible. This fine-tuning, which involves making additional incisions and directly implanting single FUs in certain areas, is of major importance for the end result, and in particular the shaping of the hairline.
End of treatment
A FUE operation ends with a further medical hair-wash and Dr. Feriduni then checks the result, discussing the operation with the patient.
The patient is then given written instructions on what needs to be done over the next 24. We provide our patients with a so-called after-care kit, containing a post-surgery mousse shampoo, post-surgery serum, post-surgery oil and hair spray treatment.
An inflatable cushion for the neck is also given to the patient as well as a bandana for covering as far as possible all visible signs of the treatment. The patient will receive an emergency telephone number, under which he can contact the surgeon and the head assistant on a 24-hour basis. After a final check-up by Dr. Feriduni, the patient is taken to his hotel by taxi. In most cases the operation lasts the whole day, generally ending sometime between 16:00 and 19:00.
The patient generally returns the next day for a postoperative check-up, he/she then has the opportunity to discuss any issues that might be relevant for the next few weeks. A medical assistant also washes the hair again. There are no stitches needing to be pulled.
After an FUE transplantation, patients need to follow certain instructions. These are also available in the section IMPORTANT INSTRUCTIONS below.
As with normal hair, the growth pattern of transplanted FUs varies from one person to the next - some hair grows faster, other slower. There are so-called fast growers and slow growers, with some patients already clearly seeing results after just 6 months, and others having to wait more than a year.
In the first few days after an FUE transplant, thin scabs develop over the small incisions in the donor area. These disappear as healing progresses. Parallel to these scabs, most of the transplanted hair falls out in the second or third week after transplantation. Patients should not start worrying about this, as this is a completely natural process. The reduced intake of oxygen and nutrients weakens the transplanted roots, leading to the hairs attached to them falling out. As the hair roots are only weakened and not destroyed, new and strong hairs start developing after 3 - 6 months, once the roots have regained their strength. In certain cases, for instance when dense packing has been performed, there is a possibility of not just the donor hairs falling out, but also neighbouring hairs. These will also grow again once this hair loss period has ended. This so-called shock loss is a short-term phenomenon occurring in certain patients, probably triggered by operation stress.
The new hair roots start producing new hairs immediately after being transplanted. In the first three months, these are very thin, akin to flax. Afterwards the hairs get thicker and stronger and after about a year the end result is very visible. All transplanted follicles generally produce new hairs, although there are certain exceptions. These are fairly seldom.
Natural hair density on a person's head is usually 60 - 120 hair root groups per square cm, though density varies in different parts of the scalp. It follows that hair density plays an important role in any hair transplantation. The hair density achieved through hair transplantation is decisive in achieving an aesthetic natural-looking result. So-called Dense Packing involves implanting FUs in a certain density in a certain recipient area.
A personal decision: low, medium or maximum density
It is understandable that any patient will have his own wishes and objectives. However there are not always sufficient donor hairs to fulfil patient hopes. Using the right technique, an experienced hair surgeon will be able to create the optical illusion of high density with just a few hairs, using donor hairs as efficiently as possible.
A higher number of transplanted grafts does not necessarily mean greater naturalness, as hair density is not something that can be measured. Much more, it is subject to how it is seen. It is quite possible for a patient with excellent donor hair and a seemingly low density of about 40 hair root groups per cm² to achieve a result looking more natural than a patient with a much higher density and/or with worse donor hair.
The implantation of extracted hair root groups is done via incisions made in the recipient area. These incisions can be made sagitally (top-down/parallel) or laterally (sideways/ perpendicular). The needle and slit techniques can be done in various ways: lasers are no longer used, as they cause too much tissue damage, with implanted FUs having difficulty taking root. Ready-made needles, scalpels or special blades are now commonly used. Custom-built blades, adaptable to the respective requirements, may also be used. The finer the instruments used are, the more accurately FUs can be implanted, as well as in higher numbers.
Both methods - needle and slit techniques - offer very good results, as they cannot just be used flexibly and adapted to the respective situation, but also cause minimum damage to tissue, thereby considerably increasing the percentage of transplanted hairs taking root and growing. Customized blades can be produced locally in the clinic in different sizes (also intermediate ones) with relatively little effort. They are much sharper than needles, meaning that they are a lot more precise and only cause very small wounds. This has a positive effect on the healing process. In a transplantation involving 3000 FUs for instance, 3000 times less damage is caused. Further advantages are to be found when the wounds heal, as the use of blades generally causes less bleeding, quicker healing and minimum damage to the skin, with little or no scarring. Scalp rashes are also less prevalent.