FUE Edmonton Hair Transplant Clinic
Dr. Nakatsui has been doing Follicular Unit Excision (FUE) hair transplants for hair loss for over 15 years. This used to be referred to as Follicular Unit Extraction but we now refer to it as Follicular Unit Excision. With FUE, no scalpel is used and there are no stitches. Each individual follicular unit is incised using a very tiny punch less than 1 mm in diameter, which can be manual, motorized, or robotic (e.g. Artas FUE). The follicles are then extracted from the skin leaving tiny spots less than 1 mm in diameter. The skin heals quickly in the space where the follicles were, with minimal or frequently invisible scarring. One of the good things about FUE is that multi-follicular unit grafts (MFUGs) cannot be extracted using this method as this would produce unacceptable scarring and therefore all FUE procedures are by definition follicular unit procedures.
Dr. Nakatsui started doing FUE treatments for hair loss when it was in its infancy and has used almost all the different types of devices from the manual blunt punch up to the newest devices. He has three favorite powered FUE devices that he currently loves and will use one or the other depending on the patient’s hair characteristics.
Hair restoration using FUE is becoming more and more popular as the extraction technology improves. In addition, more patients would like to keep their hair short and FUE hair transplants allow them to do that. You can now restore your hairline and cut your hair really short without anyone knowing. Changes in punch technology and device technology have made it easier to extract follicular unit hair grafts more quickly and safely. Approximately 50% of our current cases are FUE procedures.
FUE procedures can be easy but they can also be difficult as hair and skin characteristics vary from patient to patient. For example. hair follicles in some patients don’t sit straight but instead curve under the skin. If the surgeon were to insert the punch using a straightline vector, there would be a higher chance of transecting hairs. As a result, in some patients a slight modification in angle can make the difference between a viable graft and one that isn’t going to make it.
What Areas of the Body Can Hair Be Extracted From?
In androgenic alopecia (male pattern baldness or female pattern hair loss), the hair at the back and sides of the scalp are resistant to hair loss, It is this hair that makes up the primary area where follicular units are extracted. The beard is another area where a lot of donor hair can be extracted. In some patients who do not have a lot of scalp or beard donor hair, hair can be extracted from the body. The only downside to body hair transplants is that growth from these hair implants is more unreliable than hair implants taken from the scalp and beard.
What Are the Different Types of Follicular Unit Extraction Punches That Can Be Used?
There are many different types of punches for FUE. Dr. Nakatsui has used many different punches starting with 0.9 mm sharp punches that were rotated by hand. These were useful but had a higher transection rate. Current punch design uses a variety of different edges and angles. There are sharp punches, dull punches, and hybrid punches; the tip of the punch can be angled inwards, outwards, or splay outwards; the punch tip can be smooth or serrated; the punch barrel can be smooth, fluted, or hexagonal; the size of the punch can be small or large. Some sharp punches are bevelled on the inside of the punch and some on the outside of the punch. Dr. Nakatsui will choose which punch type will work best for you.
At the recent International Society of Hair Restoration 2020 meeting, a new type of punch was revealed. Read about it here.
What Are Some of the Variables That Can Affect the Results of FUE?
FUE is not always easy. To ensure the best result possible, you should try to ensure your surgeon understands all the possible variables. There are many variables that can affect the results of the procedure. For example, the type of punch can make a difference (see question above); the rotation of the punch can be unidirectional (spins in one direction) or oscillatory (spins back and forth); the oscillation can be small (e.g. a wiggle) or large (e.g. one full rotation); the motion or vector of incision can be straight or curved; and the initial pressure can be downward, lateral, circular, anterograde, or retrograde. All of these factors can make a difference to your before and after result.
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FUE Edmonton Clinic
Serving Edmonton, St. Albert, Sherwood Park, and Calgary
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What Are the Different FUE Devices You Use for Hair Transplant? How Do They differ?
Dr. Nakatsui currently has three different motorized devices and they each use different approaches to safely extract follicular unit hair grafts. Our dermatologist Dr. Nakatsui will choose which device is best for you, depending on your hair quality and characteristics, and on your skin firmness and type.
- SAFE system (Surgically Advanced Follicular Extraction): This device uses a blunt punch that rotates manually to incise the tissue around each follicular unit. The typical punch also has a hexagonally shaped barrel that helps to vibrate the follicular unit safely out.
- WAW-FUE: This system uses an oscillatory motion to help slide the follicular units out. In addition, the typical punch used with this device is a hybrid punch with a sharp edge that flares outward to decrease transections.
- Mamba FUE: This device is able to use of variety of movements to extract the hair grafts. It can rotate, oscillate, or vibrate, depending on the surgeon’s needs. The punch type varies based on patient characteristics.
Advantages of FUE
This technique is particularly useful in patients who would like to avoid stitches or would like to keep their hair very short as it can leave almost invisible scars in most patients. In addition, there are some patients with extremely tight scalps, who cannot have sufficient hair removed using traditional methods. FUE can be invaluable for these patients. In addition, hair implants or grafts are sometimes harvested from the beard and body. Hair implants from the beard grow very well, although body hair
Disadvantages of FUE
FUE definitely has some advantages; however, there are disadvantages. One of the disadvantages is that FUE grafts often have very little surrounding protective tissue. These grafts are therefore more susceptible to trauma and dessication as compared to FUT grafts. Another disadvantage is that some patients have hair follicles that are very adherent to the underlying tissue and in these patients, FUE grafts can be very difficult to extract. Lastly, the main disadvantages of FUE hair transplants are time and cost. In the time it takes to move 1200-1500 grafts using FUE, 2500-3000 grafts could be moved using FUT. Consequently, this raises the costs involved when compared to strip harvesting. On the other hand, this technique may be the optimal choice, depending upon the patient’s needs.
Is FUE the Best Hair Transplant Extraction Technique For You?
The answer is: it depends. For example, it you want to be able to cut your hair really short, FUE really is the only option. If you intend to keep your hair a little longer and want to transplant a large area, then FUT may make the most sense.
FUE has definitely become very popular at our clinic. If you decide to do an FUE procedure, we believe that because of our experience, reputation, awards, technology, track record, and specialized recipient site creation and insertion techniques that Nakatsui Hair Transplant can give you the best FUE result Edmonton has to offer.
Is it Possible To Do This Technique Without Shaving?
Yes. At Nakatsui Hair Transplant (formerly Groot DermaSurgery Centre), we can do FUE without shaving the donor area if requested (i.e. “no-shave” technique). There are two techniques: 1) shave thin 2 mm lines of hair follicles over multiple areas of scalp or 2) if the hair is long enough to cover, shave small patches of hair throughout the donor area. The second method is easier but does have a higher chance that the shaved donor areas will be exposed.
There are a few limitations to doing FUE this way. Since we have to leave a large amount of the hair long, this limits the number of potential grafts we can extract so we cannot do large sessions. In addition, it takes longer to extract the follicular units so the procedure will take a little longer. As a result, the cost of the procedure will increase slightly if we don’t shave the entire donor area.
What are FUE Scars Like?
Modern FUE scars are essentially invisible in most cases. Even with the hair completely shaved, there is commonly nothing to see except the lack of hair in that spot.
There can very rarely be some slight pigment change to the tiny <1 mm spots where the follicular units were removed. This can potentially be more obvious in patients with darker skin colour.
What is the Recovery Time Like?
Recovery time after FUE is extremely quick. Even within a few days, the donor sites have begun to heal and are difficult to see within a week. The recipient site will have tiny little scabs that take approximately 10 days to clear.
Video: Dr. Nakatsui demonstrating an FUE procedure
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Dr. Thomas Nakatsui MD FRCPC FAAD
Fifteen Years of Experience with FUE
Questions about FUE or FUT surgeries? Contact us at:
Are There Automated FUE Hair Transplant Techniques?
There are several automated machines and robots available to decrease the need for humans to perform a procedure and cut costs. Although these machines do decrease costs, Dr. Nakatsui does not use any robotic devices because he believes there is a need for a human touch that a robot cannot yet replicate.
Artas, SmartGraft, and Neograft are examples of automated and semi-automated hair transplant systems available in Canada and the USA. These devices have been around for many years now. SmartGraft was developed by Vision Medical over 5 years ago and was more recently acquired by Clarion Medical. NeoGraft is a very similar device that was also developed over 10 years ago by NeoGraft Solutions before being acquired by Venus Concepts. These devices attempt to take the human factor out of hair transplantation by automating some of the steps. However, in Dr. Nakatsui’s opinion, the human factor is precisely what is needed to account for all the variables involved in FUE hair transplantation. If this wasn’t the case, Dr. Nakatsui would himself switch to one of these devices to make the process easier.
What are ARTAS Robotic FUE hair transplants?
ARTAS is a type of robotic FUE for hair transplantation where a computer uses a mechanical arm to select and incise follicular units using tiny punches. The newest version also makes slits for recipient sites. With the recent update, our dermatologist Dr. Nakatsui was interested in the ability of the device to make slits for him but found out that it was incapable of dense packing to our desired density..
Our main hesitation around ARTAS centres around its extraction abilities. It is very important for the physician to consider a multitude of variables that can affect the results of the procedure. For example, the type, strength, and magnitude of punch rotation; the type of punch; the motion of incision, and the type of initial pressure are all factors.
Dr. Nakatsui’s experience will be helpful in adjusting all of these factors for each individual. The main problem with robotic FUE is that although it can adjust for some variables, it does not take into account all variables. As a result, a standard approach will work very well in some cases but will work less well in other cases. Sometimes it takes a human touch and human judgment to account for all variables.
Not only was Artas designed to extract hairs, it was also designed to create recipient sites. This is a great idea; however, the maximal density achievable by Artas is significantly lower than what Dr. Nakatsui likes to use for dense packing.
He has looked very carefully at the Artas robotic FUE system and after discussions with many of the elite hair transplant surgeons in the world, some of whom purchased the Artas system only to sell it thereafter, decided that as of 2021 robotic FUE technology has not quite arrived. However, Dr. Nakatsui remains hopeful that future advances will improve the technology.