Pure FUE performed by Dr. Artur Kierach, removes natural groups of hairs known as follicular units from around the back and sides of the head. These natural groups ranging from 1 to 4 hairs per are then distributed in a refined pattern of placement to restore areas of lost hair, from small procedures such as eyebrow reconstruction to creating new hairlines to treating more advanced levels of hair loss. IMPORTANT HAIR NUMBERS AND GRAFT NUMBERS ARE DIFFERENT The number of grafts only relates to the number placed in the recipient sites, it should not relate to the number of hairs transplanted. A graft should be a follicular unit, so between 1 to 4 hairs, and this equates on average to 2.2 hairs being transplanted per graft with a FUE hair transplant, for example, 1500 FUE can be approximately 3300 actual hairs. This is important as the distribution of the different follicular units builds natural soft hairlines with single hair units and increases the fullness in areas behind the hairline. WHAT IS THE FUE HAIR TRANSPLANT TECHNIQUE? Follicular Unit Extraction is now termed Follicular Unit Excision, the name change was brought about by the International Society Hair Restoration Surgeons (ISHRS) to better emphasise the surgical aspect of the technique. In recent years there has been a tendency for some to play down the medical and surgical aspects required to perform the procedure to the highest standard, something Dr. Artur is a firm believer in. The FUE method, when compared with other methods including the FUT method, is considered the least invasive and unlike FUT does not leave a linear scar in the donor, no need for stitches and overall the post-op healing is simpler. This is possible because the FUE technique involves a small cylindrical punch tool 0.8 – 1mm in diameter to isolate the hair unit and puncture around it. FUE is more laborious and time-consuming, having to often change seating position around the head as the angle and orientation of the hairs changes. FUE is practised widely throughout the world in different forms to harvest and place the follicular units from the donor to the recipient area. Changes to the technique in recent years often appear to focus more on speed and being able to remove more grafts faster. Faster methods of extraction have meant more grafts per day, but this does not necessarily consider the need for donor preservation, a harvesting protocol and educated extraction pattern to ensure graft care, minimal transection, donor management and high yield in the recipient. PURE FUE AND WHY TIME IS LESS IMPORTANT VERSES THE QUALITY OF THE GRAFTS In the Pure form of FUE the extraction is slower with experienced FUE specialist preferring not to harvest and place more than 1500 and 2000 in a one-day session. This is to protect two aspects for the patient, the donor and recipient areas and essentially healing and graft survival. Larger sessions are possible, planned and over consecutive days and even then, all due care must be given to donor preservation, healing and yield in the recipient. A reason Pure FUE is technically more skilled is the punch instrument is manually controlled by the doctor. Whilst this causes the extraction to be slower it has the benefit of being able to sense and feel the depth, angle and orientation of the follicular units under the skin. For example, the exit angle and direction of the hair is often different to the potion of the follicular unit under the skin, often opposite. AN INTELLEGENT HARVESTING PROTOCOL = THE MAXIMUM NUMBER OF GRAFTS AND CARING FOR THE SURROUNDING HAIRS AND SKIN The FUE technique widens the donor area allowing hair to be removed in areas an FUT procedure could not. Unlike with FUT when a strip of hair bearing skin is removed the skin surface remains the same with FUE, the change is the amount of hair that remains around the back and sides of the head. The hair density and size of follicular units alters around the head. The sides of the head have a slightly lower hair density and more one and two hair follicular units, while the back of the head has the highest hair density and a greater number of three and four hair follicular units. Removing the hair must be evenly distributed around the donor area to ensure the balance of hair density is maintained around the head, taking more from one area will result in a patchy look of hair growth with long or short hair. Each follicular unit removed must leave the surrounding hair groups alone otherwise larger hair-less areas are created resulting in patchy hair growth. Having an educated harvesting pattern will ensure each FUE procedure performed leaves the donor area in the best condition, reduces transection and over time more hair can safely be removed.
Most of the patients who decide to have a hair transplant are men who want to improve their appearance, and all the same – feeling well. Establishing expectations at the very beginning is in the interest of both the patient and the physician. Facilitates the selection of the appropriate surgical method and satisfactory distribution of the collected hair follicles. The main reasons why patients decide to have a hair transplant are: – improved appearance – reducing the feeling of premature aging due to hair loss – improvement in well-being – restoring self-confidence Many men do not admit that baldness is a problem for them and is the cause of negative emotions. However, it has an impact on their self-esteem, the way they perceive themselves in society, among friends, family and peers. Premature hair loss can be particularly severe for people who feel young at heart, which in turn leads to feelings of incompatibility with well-being. Another group of men has the feeling that the lack of hair begins to define them. Therefore, the patient and the doctor must jointly select the appropriate method of treatment, meeting the patient’s expectations and giving the doctor the opportunity to meet these expectations. Patients who have unrealistic expectations about the procedure should be presented with real, real possibilities and options. The possibilities are usually limited by the quality of the area from which the hair is taken. If, for example, the area is also thinned, it will be impossible to reproduce dense hair of the scalp. The doctor carrying out the procedure is limited by the potential of the patient’s donor area.
To help with an idea of costing for Pure FUE with Dr. Kierach Hairline and temples from approximately €2,950 Frontal third including the hairline and temples from approximately €4,500 The crown/vertex from approximately €2,600 (these are approximations based on the minimum graft numbers generally required to make an aesthetic improvement and not necessarily relevant to any individual case)
FACTORS AFFECTING THE PLANNING THE TREATMENT AND ITS EFFECT:
PATIENT’S AGE
Male baldness is a progressive process and young people are prone to experience more rapid hair loss compared to patients older than 50 who may have a more stable level of hair loss.
TYPE OF HAIR LOSS
The progress of hair loss and the possible need for future treatment.
FAMILY BALDNESS
Cases of baldness in immediate family can give an indication of possible scenarios.
HAIR TYPE/CHARACTERISTICS
Hair thickness, colour and type must also be considered when planning hair transplantation. Thick and slightly curly hair give a better coverage effect as well as a low contrast between the hair colour and the skin complexion.
PAST TREATMENTS
Previous surgical procedures may impair the quality of the donor area and effect what can safely be removed in the future. In cases of multiple procedures in the past it is recommended a personal consultation to assess the potential graft numbers that can be achieved from a subsequent procedure.
HEALTH STATUS OF THE PATIENT
Hair reconstruction via the FUE method is a minor surgical procedure, however, it does not mean that everyone can undergo this treatment. During the surgery, the patient will receive certain medicines and it is possible that contraindications in some patients may occur. Therefore, it is crucial that patients undergo a medical check-up prior to the surgery.
FINANCIAL CONCERNS
Patients must be aware of all the costs that will be incurred for their treatment before committing themselves to the procedure.
THE COURSE OF TREATMENT
STAGE I
MEDICAL CONSULTATION
The purpose of the first step is to determine the cause of hair loss and to assess the risk of progression of the process. Younger patients must first consider other methods of treatment before choosing hair transplantation. After all other methods have been excluded, it is advisable that the patient chooses the appropriate hair transplant method by closely working with doctor during the consultation to identify the needs and options available. We offer a convenient initial online consultation. We will evaluate the donor area, suggest the most optimal treatment and provide the patient with a tentative price. At the end of the consultation, we will send an offer tailored to the patient’s specific needs.
STAGE II
PREPARING FOR SURGERY
After the patient has gone through the consultation stage, the next step will be to visit the clinic for a thorough evaluation of the donor area. During this visit, the doctor will collect the patient’s complete medical history; run blood tests and complete photographic documentation. After this evaluation, the final personalised proposal of costs and methods can be given for the hair transplant.
STAGE III
TREATMENT
Hair transplantation is a routine procedure performed on an outpatient basis. Each method has different technical aspects which are discussed elsewhere on this website. The first step of the process is to collect hair follicles via one of the methods such as the FUE method. With the FUE method, surgeons can instantly collect individual micro transplants (hair follicles) from the donor area. Assistants, then, group them according to the number of hairs in each micro transplant, which usually varies between 1–4 hairs. Learn more about the FUE method. Once all the required hair follicles have been collected, they are moved to the recipient areas identified during the previous stages. A complete surgery lasts approximately 5–8 hours depending on the extent of treatment.
STAGE IV
HEALING
Once the surgery has been completed, the patient receives detailed after-care instructions along with postoperative discharge instructions. All instructions will be discussed with the doctor and the patient can return to their regular activity the next day, except for heavy exercise, which must be avoided for 2 weeks after the surgery.
IMMDIATLY POST FUE HAIR TRANSPLANT
he follicular units have been carefully removed from the donor area, they are cleaned and examined under magnification and then placed into the skin, the recipient area. (as per the image). The immediate result are tiny grafts with a short hair present just over the skin surface.
TIME FRAME
WHAT TO EXPECT
WHAT TO DO
First night
Your scalp will be slightly reddish pink with the grafts in the recipient still freshly placed and the small round wounds in the donor area beginning to close and heal. In general, there is little to no pain in either area, a pain killer can be taken and occasionally some numbness.
Do not touch the recipient area/the grafted area and ideally sleep in an upright position with a travel type pillow giving your neck support. Avoid drinking alcohol, spicy foods or anything that can thin the blood, smoking, vitamins etc. Follow the instruction provided and if you have a doubt contact the Clinic.
Day 1
The redness will start to diminish slightly, and small scabs or crust appear over both areas.
Refrain from touching the recipient area.
Days 2 to 4
If hairline work there maybe some swelling over the forehead, this is natural and causes not danger medically and will naturally go over the next days. The scabbing will start to remove and the skin show signs of returning to normal.
Although the grafts are embedded after four days be careful not to scratch or rub the grafted area. Avoid prolonged exposure to the sun or chlorinated water.
Days 5 to 7
Much of the scabbing or crust over the grafts will have removed but gentle washing will help to keep your scalp clean. In the donor the small punch marks are healing and becoming harder to see especially as your surrounding hair has grown a little longer. Any slight irritation is part of the natural healing process
Shampooing will help to relieve any mild discomfort and clean both the recipient and donor areas. Moisturising the scalp will help reduce any irritation.
Weeks 2 to 4
The hair follicles enter a resting phase and the hair shaft begins to shed from the hair follicle that is embedded in the skin. The odd spot may appear over the scalp which is normal, and no action is required.
Keep your scalp clean with regular washing and do not panic if you see small hair shafts shedding when you wash
Months 2 to 4
A relatively small percentage of the transplanted hair grafts begin to regrow; the hair quality may be finer and wispier than normal, and this will change over the months. The existing hair may also be affected by the hair transplant and will also mature over time
Maintain washing your hair regularly as you would normally, refrain from prolonged exposure to the sun and chlorinated water.
Months 4 to 6
More of the transplanted hair is now growing and improving in quality and strength and a good time frame to assess the progress at 6 months.
Maintain common sense approach to skin and hair care and if in doubt ask your Clinic.
Month 6 to 12
With more transplanted hair growth being visible month on month and the hair quality improving and maturing all the time as the hair goes through growth cycles.
Styling and cutting begins to become more flexible as more hair is now growing and the design becoming easier to manage as the hair grows longer.
Month 12 to 18
By this time all your transplanted hair will have grown and almost all have fully matured over the month with body and fullness.
Enjoy your new hair!
FUE FAQ
Patients interested in hair transplant have many questions starting with what FUE is, what does the procedure look like and ending with how long do the results last. We prepared a list of frequently asked questions on FUE and we hope that these will help to explain the procedure.
Hair follicles are extracted one after another. FUE may use manual or automatic method depending on case. Extraction method varies depending on hair type, angle at which they grow, follicle depth etc.
Some of FUE advantages include: Significantly reduced discomfort after the procedure. Lack of linear scars for surgical wounds as in the FUT i.e. "strip" method. Quick healing. Extraction of hair from thicker donor areas and redistribution to balding areas also allows to minimize contrast between the donor and balding areas. Hair reallocations also allows for more equal hair distribution which reduces balding visibility. Some of FUE disadvantages include: FUE is limited to the number of transplants that can be extracted /planted during a single day. In some cases a 2-day mega session may be planned.
The method of extracting hairs one by one allows for collecting them without leaving linear scars on the scalp. Directly after the procedure you will have small wounds in the area from where follicles have been extracted. After 3 to 5 days these wounds heal and a week after the procedure it is difficult to recognize where the follicles have been extracted from.
Each case is different and the cost of the procedure depends on many factors such as the number of transplants and the final result that the patient wants to achieve. The total price for FUE procedure is higher than for FUT for a similar number of transplant. FUE hair transplant may also differ depending on the technique used. Patients should book a visit to get a final price.
Most patients reserve 2-7 for recovery after the procedure. Small wounds after FUE heal within 3-6 days but this depends on predispositions of a given person. Would you like to learn more on what to expect after FUE? Visit After transplant page.
Usually patients do not complaint of pain after the procedure. At the beginning of the procedure local lidocaine anaesthesia is administered. In rare cases patients may experience mild discomfort, itching and/or swelling after the procedure. These symptoms usually subdue within a couple of days. Various pain killers may be used after the procedure. Mild painkillers such as paracetamol usually allow for sufficient pain control.
The number of necessary transplants depends on the size of area to be covered and desired thickness. Thick hair and follicles with three or four hairs give better scalp covering results. Unfortunately, this is genetically conditioned. During the first visit we revise patient's coal and possible options before determining the number of necessary follicles.
FUE results last for a lifetime on condition that follicles have been carefully selected. Moreover, hormonal changes should not have any influence on transplant results. With age some patients may observe some thinning in donor areas. In such cases, the transplanted hair will be submitted to the same phenomenon. However, this does not happen for all the patients.
If the procedure is performed by an experienced and qualified physician, the result should look so natural that others won't notice that the hair has been transplanted. See our latest before and after photos for transplants made to our patients.
Just after the transplant the hair will look like a couple-of-days growth. The transplanted hair may grow gradually and when they enter the telogen phase you will probably lose them. However, the transplanted hair will grow again once their reach growth phase. As soon as they reach the growth phase, i.e. anagen, they will keep growing normally.
When the transplanted hair enters the anagen phase after 3-4 months new, thin hair will start growing. In the following months, hair will grow longer and thicker. Within 10 to 12 months thicker hair should be visible and final result is visible in about 12 months after FUE. Please note, that each person recovers in a different tempo and results might differ depending on patient.
With age patients may reach higher balding degrees on Norwood scale and lose more of their native hair. In such a case patients often return for another transplant to cover the new balding area. Previously transplanted hair is permanent and you will not lose it.
