FUE Technique

Confusion exists when the same technique comes with different names, mostly for the purpose of marketing as a unique or even secret technique. No matter what it is called, the basic principle of graft isolation remains the same. FUE can further be classified according to the instrument used to extract the follicles:

Wood's Technique
The first surgeon performing FUE was believed to be Dr Wood in Australia, who kept his technique a secret.

Inaba Method
Dr Inaba (Japan) described the same technique in his 1996 textbook "Androgenetic Alopecia".

Follicular Unit Extraction (FUE)
The term FUE was introduced by Dr. Rassman and Bernstein in 2002 in the United States, which gained popularity all over the world

Cole Isolation Technique (CIT)
Developed by Dr John Cole (USA) using his devoce and indtrument

Follicular Unit Excision (FUE)
Many hair transplant centers promotes FUE as a non-surgical procedure. In March 2018 the International Society of Hair Restoration Surgery (ISHRS) renamed FUE from Follicular Unit "Extraction" to Follicular Unit "Excision". The reason was to emphasise the highly-skilled, surgical nature of the procedure.

Manual FUE
When extraction performed by hands only

Semi-Automatic FUE
When extraction is by hand and assisted by electric device

Automatic FUE
When extraction is by electric device only
by electric device

ARTAS
When extraction is by Robotic setup

Skin Head or Military Style

For those who prefer to keep hair very short at the back of the head, FUE is the only option.

Low Donor Density

When the hair density is low in the donor site, the FUT linear scar would be visible even if hair is kept long.

Small Jobs

When only a few hundred grafts is required, it may not worth leaving a scar behind. FUE is quite suitable for small jobs when total shaving of the donor area is not required.

When Strip is Not Posible

Sometimes the scalp is just too tight to remove a strip. This happens when the patients already have a few FUT-Strip removed previously.

The world saw our technique in 2008 ISHRS Annual Scientific Meeting in Canada.

Modified Europe / USA Technique for Asians

We have observed the personal techniques of 3 distinguished FUE Surgeons:

Dr Roland Keleman
Dr Keleman has a hair transplant clinic in Slovakia offering exclusively FUE. We spent 3 weeks in Europe with Dr Keleman learning his personal technique. Under his closed supervision we had gained practical and valuable experience.

Dr Jose Lorenzo
He is regarded as one of the best FUE hair transplant surgeons. His cases were proudly presented in the 2009 and 2010 ISHRS Annual Scientific Meetings. He can perform megasession of more than 3,000 grafts ( 6,000 hairs ) using the smallest 0.7mm punch. We visited his Clinic in 2009 to learn the world best FUE technique.

Dr William Rassman
In the United States FUE was introduced by Dr. Rassman in 2002. We visited his clinic in Los Angeles in 2013. His FUE-2 technique has inspired us in exploring other approaches.

Over the last 10 years we refined our FUE technique to overcome the many problems of FUE in asians: high transection, low yield of usable graft, low density implant, and high expectation.

Our Semi-Automatic System

In 2012 we purchased Dr James Harris (USA) S.A.F.E. Automatic System. In 2014 we observed the Robotic-ARTAS system in Scottdale, Arizona USA. We also learned about Dr John Cole (USA) CIT System, Dr Umar (USA) U-System, Dr Devroye (Belgium) WAW System, and Dr Trivellini (Italy) Mamba Device.

After trying the many technique and devices in the last 14 years, we come to the conclusion that the human touch is as important as any latest technology. Based on this concept we have sucessfully developed our own system combining both manual and automatic extraction to cater for different skin texture andhair characters.

Preparation - Donor Hair Shaving

•   Less than 500 grafts - keep at least 1.5 inch of hair to trim "windows" for harvesting
•   600 grafts or more - donor hair MUST be shaved for easy extraction

Number of days for surgery

We are only offering one day FUE session. Reasons are :
•   It is very tiring for the patient lying face down for 4-5 hours
•   Local anesthesia has to be injected again, causing more pain
•   Too much injection on the same area will disrupt the blood and nutrient supply to hair follicles
•   The grafts transplanted on day 1 may be damaged on the second day
•   Affect final result if grafts extracted on second day is less than expected

Number of Grafts Expected

Number of grafts extracted within a day ranges from 1,200 to 2,500 depending on donor density and ease of extraction. If you need over 1,800 grafts, we strongly recommend to consider FUT.

Positioning

Patient lies prone with head turns from time to time. This position has to be kept for 2 -3 hours for 1,200 grafts

Local Anesthesia

We are using the Level One Conscious Sedation that combines local anaesthesia and oral sedative.

Size of Punch

Round punch of our own design (the Funnel Punch) with appropriate size selected: 0.8-1.0mm for Caucasian and 1.0mm-1.1mm for Chinese.

Angle, Direction, and Depth of Punch

The angle of the punch is directed to align with the hair. Scoring stops when tissue resistance is felt (usually 1/3 the follicle length). Passing beyond this point may transect the roots.

Extraction

The follicle is then grasped and pulled out with forceps. Care is taken not to squeeze the mid-portion where the stem cells locate.

Hours of Extraction

Any extracted follicles should be re-implanted as soon as possible. We allow 2-4 hours on extraction, and another 2 hours to inserted into the recipient site. So the whole procedure may last 5-7 hours.

Wound care

The wound is dressed only for one day. Bleeding after 24 hours is most unusual. Pain is mild but expect some numbness and itchiness.