Follicular unit extraction is a more advanced version of the follicular unit transplantation. It might cost a little more, the comfort for the patient is certainly much more than in FUE. As a matter of fact, a majority of people are preferring this treatment as opposed to FUT.

The Procedure:

Just as the case with a FUT procedure, you will be asked to come a little before the time allotted for the actual surgical procedure. This time is utilised to talk you through the entire process one more time, ensuring there are no doubts in your mind. The staff at the clinic will also make sure that all the paperwork is in order and all the required consent forms are signed.

As is with FUT, the doctor will yet again mark the hairline in a clear manner, often utilising the photographs which would have been taken at the time of previous consultations. Once the entire hairline has been chalked out, a few more photographs will be clicked, which will go on to become a part of your permanent medical records. In case, you have any issues with the planned hairline, you can talk to the doctor, and get them sorted out immediately. This is important, because once the doctor starts making slits, then changes will become difficult.

You will be given sedatives, which will not only relax your body, but also your mind, both important factors before the start of the procedure. Most of the clinics will offer you the chance to watch a movie, your favourite television show, listen to music or even chat with their staff members. You will be able to take regular breaks to use the washroom or eat a snack or just simply stretch! The time taken for your procedure will depend on the number of grafts being implanted. Small sessions of upto 1000 grafts can get over in a half a day, while larger ones of 2000-2500 would take a full day.

  • Anasthesia

While the first sedative is given to you moments after reaching  the clinic, but the actual anaesthesia will be administered only before the surgical procedure starts. Normally, medications such as Lidocaine and Bupivicaine are used, but some doctors might also consider utilising high frequency vibration & anesthetic gel to the scalp for reducing the sensation of the needles. All this is done to ensure that the scalp is numb and the person undergoing the FUE procedure feels no pain. If the doctor feels that the anaesthesia is wearing off, they will administer more.

  • Donor Tissue

Follicular unit extraction is different from follicular unit transplant on several levels. For starts, there are no strips of hair being removed; rather individual follicles are removed using a micropunching technique. The donor area has to be chosen with extreme care within the permanent zone, because the hair being taken from here has to offer stability for a long time . In most cases, the hair is trimmed to a short length, as this allows the doctor to take a closer look at the follicles.

In the FUE process, you might be asked to lie down on the table with the head facing down or sit on the chair. The grafts will be removed very carefully, either by the doctor ( Take care that it is your doctor and not technician who is punching in your scalp) Each graft will be placed in a physiological solution, which will ensure that the grafts do not wither away. After the grafts have been harvested, the dressing will be done of the donor area which can be removed the third day only.

  • The Process of Dissection

There is no dissection as such in the FUE procedure, because it is individual follicles that are harvested in this method. However, there are some clinics where the grafts are trimmed and de-epitheliased. However, each of the grafts has to be examined at close range, because the doctor needs to make sure that there is nothing wrong with the grafts and that they can be used effectively. The number of hair is also determined during this procedure and proper sorting becomes possible.

  • Creation of the Recipient Sites

The recipient sites have to be created with extreme care, because these will decide how natural or unnatural your hair looks. In most cases, doctors will create slits in accordance with the natural angles of the hair and then place the grafts within these slits. Most doctors will ensure that the recipient sites are created in tandem with existing hair, so that camouflage becomes easy.

  • Insertion of the Grafts

The minute all the recipient sites are finalised and created, the surgical team will be able to start placing the grafts into the pre-prepared slits. The single follicular units are placed in the front of the scalp, to offer a softer look, while the larger grafts are used to provide a fuller look. This is perhaps the most time consuming part of the entire process and needs to be done with extreme care.

This would be the time when you would be asked to keep your head incredibly still, but you can sleep or listen to songs or watch a movie to make the time go by faster.

  • The End Steps

Once the grafts have all been placed, they are all checked yet again and you will be given a detailed list of instructions that you will have to follow, after the completion of the procedure. While the donor area will be covered with a temporary bandage, nothing will be required on the transplanted area. All the bandages can be removed the third day.

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What is it about hair transplants that make people feel they should go for it, as though the ads that promote ‘cures to baldness’  weave a mesmeric spell?  Many surgeons state there is a certain risk. It gives the entire medical fraternity a bad name when fly-by-night operators make tall claims and then fail to deliver. A patient who had undergone 2000 hair grafts was depressed because of his surgeon’s attitude post-surgery. Before selling him the idea of a transplant, the patient was welcomed, convinced but the situation turned sour when the grafts did not grow. To make matters worse, the patient could not even have a short hair cut due to the terrible scar he was saddled with. The recipient area had healed but the surgeon was wrong in making the patient feel as though it were his fault. A surgeon first and foremost needs to be compassionate enough to treat every patient with not just medicines and operations but also proper counseling and adequate or qualitative feedback.  As for patients, they need to do thorough research before signing up for hair transplant or any such procedure and must not consider this to be some mysterious process where the outcome hinges on chance or luck. Most factors are within the control of the surgeon and his team.

However, many times women with undiagnosed conditions like alopecia may face some problems with hair grafts.

People should be aware that as they age they will face thinning hair and not fall prey to miracle peddlers and their false promises. A transplant done at thirty years of age will have different result than one which is done later. New procedures like FUE have made inroads into hair restoration, but before opting for it, a consultation with experts is vital to avoid disappointment later. Any person going in for any kind of treatment should feel free to ask questions such as density coverage, downtime, side-effects or any other concerns like a scar. The best bet would be to seek testimonials of those who have already been through the procedure. At A K Clinics we have a dedicated team of qualified professionals who educate the patient about the procedure and dispel doubts. Our centres in Ludhiana, Delhi, Mumbai are open to people from all walks of life, who want to change their tomorrow and face it with confidence.

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Our esteemed doctors Dr. Kapil Dua & Dr. Aman Dua from AK Clinics conducted a workshop on Hair Transplant in Aesthetics 2013 being held at New Delhi from 23rd Aug – 25th Aug. This conference is being attended by around 600 doctors from across the country and some neighboring countries. The most eminent doctors have been invited from across the globe to share their knowledge & experience.

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Dr Kapil Dua & Dr Aman Dua trained these doctors on various hair transplant techniques. They gave these doctors a hands-on experience of Follicular Unit Extraction ( FUE) technique. Most of them were amazed by the skill & expertise of the duo.

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Dr Kapil Dua & Dr Aman Dua both attended recently 2nd Mediterranean FUE Workshop held in Madrid, Spain. The workshop was hosted by the International Society of Hair Restoration Surgery together with Dr. José Lorenzo and Dr. Alex Ginzburg. This 3-day workshop focused on the specialized donor harvesting technique of follicular unit extraction (FUE). Nine live surgical procedures were offered along with implantation with the implanter pen technique. Several FUE techniques, methodologies and instruments were discussed including both manual and motorized FUE.

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Q. We’ve seen not many doctors actually do hair transplant in African descent males in fact just AK Clinics or may be one or two more in India and likewise rare in world. Is there a particular reason for this kind of pattern. What are the challenges in Hair Transplant procedure of African descent males or Females?

A. In fact it is really difficult and takes large amount of expertise to do transplant in case of African descent males. This pattern is owing to actually few people developing & getting exposure. We’ll share the main reasons & points in the same.

The following characteristics are useful to determine the outcome of the hair transplant surgery in the African patients:

Skull shape:

Africans have a mesocephalic skull of intermediate width and breadth (medium sized skull). This means that head is not particularly short or long from front to back (relative to its width from left to right); as result of which the surgeon has to give them a flat hairline.

Hair characteristics:

 Physical Structure: The African hairs have a curl as a result of which the chances of cutting the hair follicles are more during extraction and graft preparation.

Color: The results are usually good as there is hardly any contrast between the hair color and the skin.

Diameter: The diameter of the African hair is less as compared to other ethnic groups. This determines that the handling of the grafts is generally very carefully done.

Hair Density: The hair density is less as compared to others.

Challenges & Expertise Required

Hair Transplant in case of African descent males or Females requires quantum of expertise & skill. So there very few doctors who’ve reached this level of skill and ready to invest time to gain it because it sometimes in not economically viable. But at AK Clinics, it is always our endeavor to serve each and every ethnic race. So Dr Kapil Dua & Dr Aman Dua have travelled length & width of the globe to gain expertise in this area.

Problems during donor closure: Like keloid formation, hypertrophic scarring, hypopigmentation & hyperpigmentation are common.

Harvesting: Give more tumescence as it straightens intradermal curl of the hair. Use of tissue spreader as it will help reduce transection rates further.

Graft Preparation: More perifollicular tissue should be left on the sides of grafts to avoid transection during preparation of grafts.

Recipient Site : Flatter hairline; further placing of grafts is more difficult as the grafts have to be placed in the background of dark color.

Dissection: Slow, there is a curl as a result of which you have to be extra careful

Implantation: Fat is more, so implantation is difficult – need to trim grafts.

Which technique FUE or FUT is better for performing surgeries in African descent males or females?

FUT is better than FUE as the transection rate during extraction is very high. It is imperative to understand that since the roots are curled it is very difficult to presume an angle for extraction. So we generally do a FOX Test to determine the possibility of FUE & transection rate.  If the FOX test is negative, then only FUT is done.

Dissected Grafts & Sutured Line

Dissected Grafts & Sutured Line


Conclusion: Hair Transplant in patients with African descent is tedious procedure and requires expertise to deliver results.

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Millions of men and women are affected by hair loss these days. Slowly and slowly as the age grows and the effect of hormones take over, the follicles become lesser. The hair become thinner and sooner or later the follicle dies and hair can no longer be grown. There can be many reasons for loss but mostly it is genetic. In this modern era, we need not to worry as we are blessed with a new technology of Hair Transplant.Transplant is a surgical process to get back your lost hair and natural looks. However when other types of treatment for hair growth fail, transplant surgery may be a suitable alternative.

What is a Hair Transplant ?
Transplantation is a surgical procedure that redistributes the person’s hair follicles from one part of the body i.e. from the donor site to balding parts or the recipient site. Mainly this type of treatment is used to treat male pattern baldness. In this case, grafts containing hair follicles that are genetically defiant to balding are transplanted to bald scalp. Similarly, it also helps to restore eyelashes, eyebrows, beard hair, chest hair, and pubic hair and to fill in scars caused by accidents or surgery such as face-lifts and previous transplants. There is a difference between Follicular Unit hair transplantation and skin grafting. In skin grafting, grafts contain almost all of the epidermis and dermis surrounding the follicle, and many tiny grafts are transplanted relatively than a single follicular unit of hair follicle. Today, Transplant is the most advanced technique of growing hair naturally. The hair naturally grows in follicles that contain 1 to 4 hair in their natural groupings. Therefore, with this method you can achieve a natural appearance by imitating natural for hair. The transplant procedure is called Follicular Unit Transplantation (FUT). There are two options with which transplant can be done.

Strip Technique
With strip excision, a strip of skin is removed from the permanent ring of hair around the occipital and sides of the head under local anesthesia. The wound is then sutured back together and this piece of scalp tissue is then cut in to small pieces of follicular units called grafts which are then transplanted back in to the thinning area of the patient’s head. This method will leave a linear scar in the donor area, which is covered by patient’s hair. The recovery period is around two weeks and will require the stitches to be removed by surgeon after one week. The most serious problem that occurs is excessive scarring, because the remaining tissue cannot accommodate the tissue that has now been depleted, and over time stretches.

Follicular Unit Extraction(FUE)
Also known as FUE, it is the advanced technique for transplant. FUE transplant surgery is better and comfortable as compared to the older transplantation procedures, Punch technique that used larger grafts and often produced a plugged, unnatural look. In FUE, individual follicular units are removed under local anesthesia; this micro removal uses tiny punches of between 1.0 mm and 0.8mm in diameter. The removal of hair will leave very small hypopigmentation dot which is not visible to the naked eye most of the times. The recipient site is prepared by injecting a small amount of anesthetic. Once this has been done, tiny incisions with the help of micro blades are made in the scalp. Then the follicular unit grafts are inserted into the incisions one at a time. Eventually the new hair follicles will begin to grow again. After the procedure, there is a likelihood that additional hair will fall out because of the stress of the operation; this is temporary and the hair will grow back shortly.

Benefits of FUE
Benefits of FUE are a quicker healing time, far less trauma, no strip scar, and the surgeon’s ability to individually select follicular units. Discomfort in the donor area has been practically eliminated. In precise, the transplant is a process to remove the donor hair follicles from the back of your head, where the hair are not under the effect of the hormones and follicles will stay forever in the recipient area. Transplant is the most advanced method which gives eternal and appealing look to the person. No doubt it is a minimal surgical process but it completely gives natural look.

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There are various types of hair transplant methods existing today. Each hair transplant treatment center has their own specific procedures. In this modern era, hair transplant techniques have developed and refined into two main methods: the FUE (Follicular Unit Extraction) method and the STRIP method. Both the FUE and the Strip Excision procedures have advantages and disadvantages and after a consultation with a hair transplant specialist, you will know which method is right for you.

The main difference between FUE and STRIP is in the way hair follicles are extracted. The implantation process of the extracted hair follicles is usually the same. Follicular Unit Transplantation (FUT) is often referred to as the “strip” hair transplant procedure. It is an older way of extracting donor hair, whereby the surgeon excises a linear strip of hair and tissue from the back of the scalp.  This tissue is then dissected into individual follicular units, by surgical technicians, and then placed in thinning or balding recipient regions. Meanwhile, the wound is closed with the use of sutures. However, the donor area after a strip excision surgery will require more time before it is fully healed when compared to the FUE surgery. This scar will be detectable if the patient opts to wear their hair very short, and may even stretch over time. Strip procedures also permanently distort the direction of hair growth along the perimeter of the scar.

The strip excision procedure is more economical (typically half the price per graft of FUE). It is usually said that more number of grafts can be extracted by Strip but nowadays, it has become possible to give 2000-2500 grafts from scalp by FUE as compared to the previous days. However, if you need more grafts, then either a second sitting from scalp or more grafts can be extracted from the body (beard, chest, abdomen, etc.) in the first sitting only. Similarly, if more grafts are required from strip technique, even that is possible. In the FUE method, individual hair follicles are picked out and transferred from the neck to the crown. The FUE is a scalpel free and stitchless approach with faster healing. As every single follicle is extracted individually, this is a time consuming procedure. The benefit is that controlled and careful extraction of donor hair is very lenient to the skin and scalp. Complications are very rare, and scars are hard to detect even after only a few weeks. Moreover, FUE doctors can select the follicular units that will offer the most hairs per graft, and produce an optimal yield.  On the contrary, strip procedures limit surgeons to using only those hairs found in a single strip of scalp tissue. In addition, the FUE procedure is modestly invasive nature which produces very tiny scars in donor area and these are very hard to detect.

FUE hair transplantation, therefore offers a number of advantages over FUT or strip procedures like it does not leave a linear scar, nor does it distort the growth angles of hair, less invasive hair transplant procedure,  requires less healing and recovery time post-surgery. Though, with the help of new technology doctors can minimize the visibility of any scars produced by Strip. However FUE cannot reverse any lack of sensation in the area caused by a Strip. If you are planning to go for a hair transplant, FUE is the best option to restore the hair. FUE is also the most excellent choice when the doctor does not advise a Strip, such as when the skin on the scalp is too tight, has existing damage or has already undergone several Strip procedures. At the present time, FUE is considered by many as the latest and refined approach to a hair transplant. While it is essential to understand the main differences between the two methods, only a hair transplant specialist can tell you which method is best for you, considering your specific needs and desired outcome.

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