The Most Important Points of Fue Hair Transplantation

The Most Important Points of Fue Hair Transplantation

FUE Hair Transplantation Operation is a surgical operation that should be performed with a multi-disciplinary surgical approach, considering the patient as a whole. It should never be simplified, and all necessary research and planning should be done beforehand.

The patient needs to find a team that is an expert in sapphire hair transplantation, follows global developments, has knowledge about hair loss and hair loss treatments, and can organize not only surgical but also supportive treatments. And besides this, there are the most important points of fue hair transplantation .

At Smile Hair Clinic, our doctors determine the hair loss types of patients, the areas of the scalp that need treatment, and plan the sapphire hair transplantation procedure.

Our patients come to the clinic on the morning of the FUE hair transplantation procedure, sign detailed informed consent forms about sapphire hair transplantation immediately afterwards, and give the infectious disease panel tests required for patient safety and surgical operation.

The tests performed at this stage are Hepatitis B, Hepatitis C and HIV tests. Immediately afterwards, our doctors give our patients a detailed briefing about general information about FUE hair transplantation, hair transplantation stages and details of the procedure, expectations regarding the result and our clinic’s approach.

Then, patients go to the rooms where the FUE hair transplant operation will be performed; our patients are examined one-on-one by our doctors. During the one-on-one consultation, the type of hair loss and the areas of loss are determined, the donor area is determined, as well as the estimated number of grafts, root characteristics, age, head anatomy and the creation of the aesthetic appearance are taken into consideration and the areas to be transplanted are determined.

Each factor that will lead to success in sapphire hair transplantation is carefully evaluated and the wishes of our patients are taken into consideration, and patients are clearly informed about the possible results and drawings are made.

Afterwards, it is decided that the patient will be operated on without shaving or by shaving; if the decision is made for a shaved transplant, the healthcare personnel shaves all the hair; if the decision is made for an unshaved FUE hair transplant, only the donor area is shaved.

Before the operation, healthcare personnel measure the blood pressure and other vital signs, record them in the patient’s medical file, and inform the responsible hair transplant surgeon.

How to create a natural hairline with FUE Hair Transplant?

In the FUE hair transplantation procedure, the hairline of the patients has been determined for many years according to Leonardo Da Vinci’s golden ratios or the criteria of various institutions.

and should carefully evaluate the patient’s age, head anatomy, ethnicity and how the patient wants to see himself, and design a hairline that is natural and satisfactory to the patient.

If the area where the patient will have hair transplantation is very large (the number of grafts is unfortunately usually less in these patients), a more conservative, higher hair line should be determined in order to achieve a natural hair appearance and satisfactory density.

If it is thought that a sufficient number of grafts can be taken from the donor area with the FUE technique and that the desired amount of hair loss can be covered, a hairline can be drawn below accordingly. When drawing the hairline before the hair transplantation procedure, it should fit the shape of the patient’s face from the front. White race, Asian type face, African face type lines are different and can be straight, oval, curved; face shape is a very important factor in determining the hairline.

Under normal conditions, the hairline should start 6.5-7.5 cm above the eyebrows, and in people with little hair loss, a hairline starting at this range is drawn before the sapphire hair transplant procedure. Although it is important for the hairline to look good from the front, it should definitely be evaluated with the help of a mirror to see how it looks in the patient’s eyes, and hair transplantation should be started after the patient’s approval is obtained.

The side view of the hairline should be adjusted to be slightly upwards, so that the hairline that will be formed after the hair transplantation procedure looks natural. If the person who will have a hair transplant is older, the temple areas (temporal region) should be higher, and the side hair and front hair should be combined in the area where they are separated.

Another factor to be taken into consideration when designing the hairline for sapphire hair transplantation is the muscle structure in the forehead. The muscles can be easily detected by the patient raising their eyebrows.

Evaluation of this muscle structure plays an important role in creating a natural line by giving information about the previous hairline, and starting the line just above this muscle structure is the most ideal planning.

Another factor that helps the surgeon who will perform the hair transplantation when planning the hairline is the patient’s pre-hair loss photographs. Planning for FUE hair transplantation by evaluating all these variables is a process that requires mastery. An experienced hair transplant surgeon implements this plan by taking into account regional hair directions during the incision/channel phase.

FUE hair transplantation is an operation that requires the expertise of not only the surgeon in charge but also the entire team. Even if everything goes well, if grafts containing multiple hair follicles are transplanted to the front line, unfortunately it is not possible to achieve a natural appearance. For this reason, grafts containing single hair follicles must be transplanted to the channels in the front rows.

Stages of Sapphire Hair Transplantation

Sapphire hair transplantation consists of three stages. These are as follows, Removal, Channel Opening/Incision and Transplantation. Sapphire hair transplantation is performed with local anesthesia, which means numbing a certain area with drugs administered from the skin. Local anesthesia ensures that the patient does not experience any pain during the hair transplantation and that the procedure is performed comfortably.

Sapphire hair transplantation operations take an average of 6-8 hours, while the local anesthesia procedure takes about 15 minutes of this time, and patients do not feel pain after the local anesthesia is completed. Local anesthesia is applied to the patient who will have hair transplantation twice in total; the first before the extraction phase and the second before the incision phase.

1. Extraction Time: 1.5-2 Hours Before 5-15 min Local Anesthesia
2. Channel Opening (Incision) Duration: 1 – 1.5 Hours Before 5-15 min Local Anesthesia
3. Transplantation (Implantation) Duration: 1.5-2 Hours

Total Sapphire Hair Transplantation Time including preparation and waiting: 6-8 hours

Extraction Phase

This phase of FUE hair transplantation is the most difficult phase for patients, because they have to lie face down for approximately 2 hours. Immediately after the patient lies down on the chair where the hair transplantation will be performed, the donor area where the grafts will be taken is determined, taking into account the hair structure and hair loss.

Then, the first local anesthesia is applied, after which pain control is performed to ensure that the patient who will undergo sapphire hair transplantation will not feel any pain.

Immediately after local anesthesia, another application, swelling (Tumescent), is performed; blood loss is minimized by reducing circulation in the donor area and ensuring minimum damage to the tissues.

FUE hair transplantation begins with control shots using a patient-specific disposable punch that is 0.70-1.00 mm wide and 4-5 mm long and is connected to a medical device called a Micro Motor and is suitable for the patient’s follicle size, enabling hair removal.

Due to the micro motors used, the FUE hair transplantation process is also called Micro FUE in some sources . The aim of the shots made for control purposes is to ensure that the hair is removed as a whole tissue without breaking or damaging it with the correct punch detection.

The main purpose of the extraction phase, which is one of the most important stages of the FUE hair transplantation operation, is to remove it without any problems with a possible damage percentage of 5% or less, which is accepted worldwide. Thus, the number of grafts planned for the patient is reached with minimum damage and high quality, and the best possible result after hair transplantation is largely approached.

In FUE hair transplantation, extreme care is required during the extraction process, each extracted graft is classified and counted according to the number of hair follicles they contain by surgical assistants trained by doctors and it is determined whether they are damaged or not. Doctors must closely monitor the percentage of damaged grafts.

At Smile Hair Clinic, this intake process is meticulously monitored by both our supervisors and doctors, ensuring the quality of the operation and the good results of the hair transplant.

When it comes to the number of grafts, patients generally expect the highest possible numbers. Unfortunately, today, when all kinds of information can be accessed via the internet, some clinics increase patients’ expectations in this direction by promising unattainable graft numbers as a marketing tactic.

However, before the extraction process, the calculation should be made correctly, the number needed by the patient should be determined, the circulation of the area to be transplanted, whether this circulation will feed the transplanted grafts and how the patient’s back donor area will look afterwards should be taken into consideration, and it should be done without damaging the donor area.

Although patients expect high graft numbers, the important thing is to obtain the number that the patient needs and that will not harm him/her, in short, to evaluate the patient as a whole and create a treatment plan accordingly.

The number of grafts that can be taken from the donor area during the harvesting process varies depending on several factors.

1. Width of Donor Area
2. Density of Donor Area
3. Single/Multiple hair ratio
4. Ratio of Thick and Thin Hair

Width of Donor Area in FUE Hair Transplantation:

We can explain many events in the world with physics and mathematics, including FUE hair transplantation. If the rules of physics and mathematics are taken into account, more grafts are taken from the larger area of two donor areas with the same density.

The shedding areas of the patients (top openings) can sometimes enter the borders of the donor area depending on age and sometimes the type of shedding. This shedding, especially in the young patient group, may not be fully formed or may be newly formed; this is one of the most important factors in determining the donor area.

By ending the donor area lower, the hair transplant surgeon can prevent the donor area from merging with the shedding area in the future and prevent baldness from occurring at the back.

The middle part of the donor area is the area where more grafts can be taken, contains more follicles and where these follicles are thick, while the areas behind the ears and on the sides are areas where more careful harvesting is required in terms of circulation and density, and where thin and single grafts to be planted in the front line can be taken.

Donor Area Density in FUE Hair Transplantation

In FUE hair transplantation, donor area density varies from person to person, and is one of the most important factors that directly affects the result of hair transplantation, the number of follicular units per cm2. Research conducted worldwide has shown that the density is between 40-110 FU/cm2, with an average of 60-80 FU/cm2.

After calculating the area width, these two variables are multiplied to determine the total number of follicles. The maximum number of grafts that can be taken is calculated based on the total number of follicles. 30-40% of the follicles in the donor area can be taken.

The aim here is to prevent a decrease in density to the point where it is not understood that the hair was taken from the donor area after the hair transplant operation and to prevent the formation of scar tissue in the donor area.

Each follicle removed using a punch leaves a gap in the skin that varies according to the size of the punch. These holes are very small and the tissues heal quickly and leave very few scars.

When harvesting, care should be taken not to position these holes too close to each other, otherwise they will merge and reach large diameters. Unfortunately, merged large tissue losses do not heal easily and will definitely heal by leaving scars and marks.

Some clinics do not pay attention to the appearance of the donor area after sapphire hair transplantation by taking more grafts to increase the number. This situation causes the patient to experience trouble in the future, distorts the appearance and causes dissatisfaction.

Avoiding this is one of the first rules of performing a quality operation. In addition, if the patient will have another session of transplantation in the future, since the hair taken does not grow again, the fact that the holes have not merged in the previous session allows the hair that could not be taken to be taken.

Telling patients that the maximum number of follicles will be taken actually means taking and transferring the amount of follicles that will be taken in that session without damaging the donor area, creating scars, disrupting circulation and ensuring that the circulation in the area to be transplanted is nourished.

It is obvious that in patients with low density in the donor area, the number of hairs that can be harvested will be low, while in patients with high density, the follicles are very close due to the density and frequent harvesting from these areas cannot and should not be done. By paying attention to these factors, the image of the patient’s donor area is not distorted and the patient is provided with healthy hair and reserves for future sessions that may be required.

The ratio of Single/Multiple hairs in the grafts in Hair Transplantation

People with healthy hair and no hair loss have a total of 100,000 hairs on their bodies, the majority of which are on the head.

There are an average of 60,000-80,000 hair follicles on the head, and these hairs are distributed in units called follicles, which include 1-5 hairs and other tissues except hair. As a result of research worldwide, it has been determined that there are 2.2 hairs per follicle.

When taking hair from patients for FUE hair transplantation, having more hair per follicle and especially selecting hairs with more multiple hairs will provide better results with fewer grafts.

However, in patients whose hairline is redesigned, it is necessary to select single and thin hairs and transplant them to the front line, and to transplant multiple hairs just behind the hairline and in other transplanted areas to obtain the desired beautiful density and natural looking result.

During hair transplantation, it is therefore important to first aim to take the single hair required for the hairline and then take multiple hairs. In order to take multiple hairs, larger punches are needed that will not damage the hair (just as the blade to be used during incision should be determined according to the graft size).

Because when more hair follicles are taken, a thin-diameter punch can damage the follicle that contains more hair. Paying attention to these details is very important in keeping the previously mentioned transection rates to a minimum. These follicles are again classified and counted as single, double, triple and multiple by surgical assistants, and these numbers are recorded in the patient file.

Ratio of Thick and Thin Hair in FUE Hair Transplantation

Patients with thick hair can get better results with fewer grafts in hair transplantation. For this reason, thick hair in the donor area is targeted during extraction. It should not be forgotten that thin hair will give a sparser appearance.

When patients wear their hair long, they may have a dense hair appearance but actually have thin hair. We can think of the transplanted hair as a single mass. Smile Hair Clinic surgeons call the mass of the transplanted hair Absolute Density.

The value we call absolute density is the thickness value obtained when all the extracted hairs are lined up side by side, divided by the surface area to be transplanted. When we consider absolute density, thick hair always gives a better density in the transplant area.

During the extraction, the aim is to select the thin hairs for the hairline and after reaching a sufficient number of them, to target the thick hairs and to get the best result that can be obtained in one session.

As a result, for the best possible result in FUE hair transplantation, the maximum number of hairs to be taken from the donor area should not exceed a certain number for each line, and how much will be taken from which area should be determined according to the patient’s anatomy, donor area width, density and circulation status.

It should not be considered as a race and high numbers should be taken just for the sake of taking. Although the high number of grafts taken from the donor area in FUE hair transplantation satisfies the patient instantly, the patient will be the one who has to live with that image afterwards, and since he/she does not have much information about the possible problems he/she may encounter in the future, these should be explained well by the doctor.

Opening Channels (Incision) in FUE Hair Transplantation

In FUE Hair Transplantation, the grafts whose number and characteristics are planned by the surgeon and taken accordingly are classified and separated by surgical assistants according to the number of hairs in them. The first step of the channel opening process in sapphire hair transplantation is to determine the thinness and length of the grafts and to choose the right sapphire blade for the procedure.

For a natural and dense result, a natural channel direction should be created with a 10-20 degree inclination towards the front lines, and this angle should be gradually steepened and opened towards the back. At this stage, the hair transplant surgeon should imitate the direction and extension of the patient’s own hair.

The channel extension, like the channel direction degree, is another important factor in determining the natural appearance after FUE hair transplantation. The channels should be opened vertically in the front during opening, while the sides should be collected more towards the middle by slowly changing from horizontal to vertical angle, and if necessary, the transition points of the sides should be in the same direction as the existing hair.

Since the width of the channel will directly affect the result, channels should be opened in an interlocking manner; thus, a denser channel opening is provided. The number of grafts to be transplanted should be planned as 60-70 FU/cm2 depending on the hair thickness/thinness in dense areas per cm2.

If the patient does not have enough grafts, channels can be opened with high density in the priority areas according to the patient’s priority, and the channel opening in other areas can be reduced to 20-25 FU/cm2. Another important factor after direction and frequency during channel opening is to provide the correct channel depth so that the hair can be transplanted to the right place without causing damage.

A channel that is too deep or too shallow should not be opened. A channel that is too shallow causes the graft not to receive the necessary circulation, and surgical assistants may cause the graft to bend inside during the transplantation; as a result, the transplanted hair does not grow.

When the channel is too deep, the incision damages the vascular and epithelial structure, tissue collapses may be observed, the graft may be completely buried; as a result, the grafts will not grow. Before the channel opening process, the surgeon must measure the transplant area accurately with rulers and determine the surface area correctly.

In this way, the graft distribution can be planned correctly and the doctor can design the channels correctly. Again, before opening the channel, the doctor should review the number of grafts removed and the plan accordingly, explain it to the patient, and confirm the patient’s priorities.

Another important issue while opening channels in sapphire hair transplantation is that the tumescent/inflation fluid, the fluid we inject containing adrenaline and isotonic, controls the circulation of the area where the channel will be opened, reduces bleeding, and does not damage the surrounding tissues by elevating the tissue.

Inflation expands the tissue surface during the channel opening, and when the skin surface returns to normal, a more dense channel opening is obtained. At the end of the channel opening process, the doctor lifts the patient, the patient and the doctor check the hairline together, the patient’s approval is obtained, it is seen that there are no differences and the process is completed.

During the creation of the hairline, the channels should not be placed on a straight line, irregular and dissimilar indentations and protrusions should be made at irregular intervals (nobody’s hairline is straight), and after the hair grows, a non-artificial, natural and different appearance should be obtained.

October

The grafts taken from the patient during FUE hair transplantation can wait up to 6 hours without any damage; to ensure this, the grafts must be stored in special liquids and at certain cold temperatures during the operation; these factors must be strictly controlled when the transplantation begins.

In this way, health is protected and the quality of the hair transplantation process is ensured. The healthcare personnel who will perform the transplantation must undergo a long training, must know the graft and all its components, and must have the dexterity to place the graft correctly without causing trauma.

Even if all other conditions are perfectly met, the transplantation phase is vital for the result of the hair transplantation, improper transplantation will result in disaster. It is necessary not to hold the graft by the root, not to squeeze it too much and to avoid possible trauma.

During placement, it is important to ensure that the graft does not bend and that it is placed correctly in the opened channel. After the operation, the grafts must be checked with a lob, the transplanted grafts must be randomly selected from different areas and removed to ensure that the transplantation is done correctly. This is another quality control stage of the operation.

After all these stages, the patient is lifted and the donor area is dressed and bandaged. A bandage should be applied to the forehead, which both ensures the bandage is stable and prevents the swelling from descending to the face due to the effect of gravity.

After the bandage is applied, photographs are taken for the patient’s filing purposes and the patient goes to the main hall to wait for the doctor to discharge him/her.

At the time of discharge, the doctor should indicate the following points to which the patient should pay attention.

1. Protecting the head from trauma as it still has an anaesthetic effect (especially when getting in and out of a car, passing through a place and bending over)
2. Keeping the head upright (especially when using the phone, tying shoes and avoiding bending over)
3. Explaining the sleeping position (adjusting the pillow and neck pillow so that the transplanted hair does not touch them while sleeping)
4. Avoid salty foods for 1-2 days
5. Avoid substances such as coffee and cigarettes for the first few hours.
6. Not drinking alcohol for at least 5 days (until the prescribed medications are finished)
7. How to use the Anti-Infection Antibiotics, Painkillers, Anti-Inflammatory Medicines provided in the bag
8. Avoiding hot, sunny and dusty environments
9. To reduce edema, he/she should massage the forehead area regularly at short intervals and apply cold if possible.

Patients rarely complain of pain after the operation. They may not get enough sleep at night because they feel they have to be careful while sleeping in order not to damage the grafts, as they are frequently warned.

This is a common condition. Also, during the night, there may be discharge from the donor area, which is actually the tumescent fluid injected into the patients. Some leakage occurs, although most of it is absorbed by the bandage.

Although this red-looking fluid is often described as bleeding by patients, as we mentioned, it is a tumescent fluid and should not be worried. In fact, a cover is given to be placed on the pillow by the clinic.

Things to Know About Local Anesthesia:

The most important concern for patients in surgical operations is pain and the fear of feeling pain. Since FUE hair transplantation is also considered a surgical intervention, we often encounter questions from patients about feeling pain. After local anesthesia, our patients do not feel any pain at all and can listen to music, read books and watch movies.

However, the local anesthesia process is a painful procedure. The reason why pain is felt in local anesthesia is the burning sensation that lasts for a few seconds when the medicine enters the tissue. This feeling has nothing to do with the technique used to deliver the medicine to the tissue.

Unfortunately, there are a few global drugs and all of these drugs have the same effect. The intensity of this burning sensation varies depending on the person’s pain threshold. But the feedback we receive afterwards is generally that there is no need to exaggerate this much on the internet.

Our patients are given local anesthesia twice during the entire procedure, and the total duration of these two procedures is at most 30 minutes. Considering that the operation takes approximately 6-8 hours, this is not a significant amount of time.

In our clinic, local anesthesia is applied both by classical injection and by needle-free anesthesia device. These two methods have their own positive and negative aspects. They do not affect the operation process and its success.

Needle-Free Anesthesia

Although local anesthesia prevents the pain felt during the operation, it can cause anxiety for patients who have needle phobia or are worried about the pain they will feel at this stage.

The needle-free anesthesia method, which has been used in many developed countries around the world in recent years, is one of the local anesthesia methods and minimizes patient anxiety, thus facilitating the working process of doctors.

Needle-free anesthesia in hair transplantation is performed with advanced technology devices. Anesthetic drugs are sprayed onto the skin by the high air pressure applied by the device placed on the head area, allowing them to enter the tissue. The drug then spreads into the tissue using the logic of diffusion. The most important point that patients need to know at this point is that the needles will still be used to apply tumescent anesthesia after a certain amount of numbness is created with the device.

Needle-Free Anesthesia Is Not Painless Anesthesia.

Hair transplantation is a big market. Unfortunately, some clinics, in order to be one step ahead in this market, promote needle-free anesthesia as painless and aim to make patients choose their own clinics.

The reason for the pain felt in local anesthesia is not the technique applied but the drug itself. For this reason, even if needle-free anesthesia reduces pain, it is definitely not completely painless. Patients should not believe those who say otherwise while doing research.