($5.75 per graft or $4.99 per graft for cases that require 1800 grafts or more.)
FUE stands for ‘ Follicular Unit Extraction ‘. Follicular Unit Extraction procedure is an advanced and automated hair transplant procedure (using NeoGraft process) where individual hair follicles or hair grafts are removed one at a time from back of the scalp and transplanted into the recipient areas. FUE does not have the disadvantages of any linear scars or long recovery periods.
FUE hair transplant method involves just making micro punches (to harvest hair) with a very specialized NeoGraft instrument allowing for the majority of the scalp to be left intact. FUE is an instrument-dependent hair transplant procedure. Hence the type and the quality of tools used for FUE significantly affects its artistic outcome. The creation of increasingly better FUE extraction tools such as NeoGraft has closely paralleled the advances in the FUE procedure. It is important to note that the creation of recipient sites and the placing of hair grafts are exactly the same in both FUE and FUT (strip) procedures. The only difference is the way hair grafts are harvested. Hence as far as final cosmetic look is concerned, both method should and must provide the same cosmetic results if done by the same surgeon.
Using Acell For FUE
Acell is a protein scaffold that is derived from pig bladder. It contains growth factors and it promotes wound healing. Overall, studies have indicated that it reduces scarring. At the ISHRS (International Society of Hair restoration) meeting, it was demonstrated that the use of Acell in FUE decreases the size of punch scar from 1 milimeter to 0.6 milimeter, meaning that once the site of the punch heals, the scar is much smaller than the punch size itself.
This can be demonstrated by the picture below, where we performed FUE using 1 milimeter punches and we asked our patient to come back one year later. We shaved the area that the FUEs were done. Please look at the result. It is very difficult to decipher that many punches were made in that area.Another study has demonstrated that 54% of grafts removed via FUE would regenerate in the donor area. This does not mean cloning. But, it probably indicates that if part of a graft is not fully removed using the punch, Acell may help it regenerate.
Again, Acell does not do magic, but its use in FUE hair transplant promotes minimal scarring and even some regeneration of some hair follicles in the donor area.
In terms of wound healing and pain, FUE is also noted to have a faster healing time, less post operative pain (no pain in most instances) and there is no need to remove stitches or staples, compared to the strip method. In our practice many professional athletes prefer FUE for this exact reason and since they can resume strenuous activities and contact sports much sooner. Since FUE procedure does not leave a linear scar, it is also preferred by patients who want to wear their hair short. People with tight scalp also prefer FUE to minimize scaring as a result of tightness of the scalp. For hair transplant repair, an interesting application of FUE is to cover linear scars from past faulty hair transplant procedure.
Dr. Behnam has performed a lot of FUE procedures since 2008, and his experience and expertise are crucial in achieving great results. On average, each hair graft has 2 to 3 individual hairs. Dr. Behnam charges $5.75 per hair graft for FUE (which includes 10 percent discount). Dr. Behnam has just completed a 3300 FUE grafts hair transplantation. This is one of the largest FUE hair transplants in the world. Dr. Behnam charges a flat fee of $4.99 per hair graft for cases that require 1800 hair grafts or more.
How is FUE performed?
First, the recipient sites (sites where the grafts are placed) is created. Once we know the exact number of grafts that are needed, the back of the scalp is then shaved and each individual hair graft is removed using NeoGraft. The grafts are then placed one at a time back in to the recipient area. The beauty of the procedure is that there is no linear cutting. The placing of grafts in the recipient area is performed the same way it is done in the traditional strip method.
How long does it take for the donor area to heal?
Once the hair is removed from he back of the scalp (the donor area), it then heals on its own. The healing process takes about 1 to 2 weeks. By the time the patient comes back for follow up by day #10, those small holes have already healed. Please look at the flowing few examples.
The pictures above demonstrate how fast the donor area heals. The picture on the left was taken immediately after 1,100 grafts were extracted. The picture to the right was taken 6 days later (please see dates on the right lower side of the pictures). The sites have healed pretty well. The skin has healed, and the hairs surrounding the extraction sites are growing. In this individual, by the 6th day, no one would notice he had a procedure done.
The picture to the left was taken 11 days after the procedure. As demonstrated, it has healed very well. The picture to the right was taken one year after the procedure to see whether there was any scarring. The blue line represents the area to be shaved. As shown, its very difficult to detect scarring.
How is the healing on the donor area different in women than men?
The healing is identical. However, because women usually wear longer hair in the donor area , they can hide it better. Please see the below examples.
The picture to the left was taken before the procedure. The needed area is shaved. Please notice that we only shave what we need so the the area can be easily covered with your own hair. So, after the procedure, your own natural hair can cover up the donor area.
The picture to the left was taken the next day and the picture to the right was taken 6 days later. The skin is healing very quickly and the hairs are growing.
Is there linear scar associated with follicular unit extraction?
The whole point of follicular unit extraction is to prevent the linear scar that is seen on the back of the scalp that is seen with strip method transplants. With FUE’s, individual grafts are removed one at a time. Below is an example of the donor area one year after 1,100 grafts were removed. As demonstrated we have shaved the area and its hardly noticeable that anything was done. We also take advantage of Acell, which is a growth factor and is FDA approved for wound healing.
Who does the actual extractions, the doctor or the technicians?
Dr. Behnam performs the actual punch insertion. This is very important because as the small punch goes around the grafts, it is very important to be diligent and meticulous in order not to cause any transection. He does not allow any nurse or physician assistant to do the punch insertion except for himself.
How does Dr. Behnam know how many grafts to extract?
Dr. Behnam first creates all of the sites, so he has a very exact count of how many grafts are needed.
What is the follicular unit extraction procedure day like?
Once you arrive at the office, you and Dr. Behnam will go over all the paperwork. You will also go over the hairline design and where you want the hairs to be placed. Then you are taken to procedure room and the required donor area on the back of the scalp is shaved. The back of scalp is numbed. The frontal scalp is numbed as well. Dr. Behnam puts all of the recipient sites in the front of the scalp. He then individually extracts one graft at a time from the donor area. Every 2 hours, the grafts are placed back into the body. Lunch is provided as well. According to the patient, this is one of the most relaxed days when they have had.
Are patients with curly hair candidates for FUE?
What is transection?
Transection is when the hair shaft is cut or damaged with the punch during the extraction method. Transection rate gets better with practice. Dr. Behnam has been performing Follicular Unit Extractions since 2008 and he performs them routinely. His transection rates are around 0.9% to 2.1%.
Does the patient have to shave his/her head before the Follicular Unit procedure?
No, we will shave the needed area in the donor section ourselves. The area will grow back within 10 days. Longer hair in the donor area is beneficial because we can shave below your long hair and the area can be covered with your long hair.
If I had a strip transplant before, can I have a follicular unit extraction performed?
Yes. Having done a strip hair transplant will not prevent you from having a FUE performed in the future. You would need to have a consultation with Dr. Behnam in order to make sure that there are enough donor follicles on the back of the scalp to allow for another hair transplant to take place.
Can follicular unit extraction be used to cover the scars from old transplant surgeries or scars from the facelift?
Yes, if you have a scar in the back of the scalp from a previous strip method that you would like to conceal, we can very easily perform it.
If I have a follicular unit procedure, when can I expect to see the results?
Hairs start to grow by the 3rd months and they continue to grow 1 inch every 3 months. By about 10 to 12 months, you can expect 3 to 4 inches of hair growth. However, because Dr. Behnam places the grafts back into the body every 2 hours, this reduces the external stressors on the grafts and some of the grafts may start growing out faster.
What are the amenities of the office?
Parking is underneath the office. For transplant patients on the day of the procedure, parking is validated. The bathroom is located within the facility, it is right across from the procedure room. You may use bathroom at anytime. Lunch is provided.
How many years has Dr. Behnam been performing follicular unit extraction?
Dr. Behnam has been performing a follicular unit extraction since 2008. He has modified the instruments required in the procedure and he has a proprietary instrument that is used to do the extractions.
How much does follicular unit extraction cost?
Since each individual hair is removed one at a time by Dr. Behnam, the FUE procedure is typically slightly more expensive than the strip method technique. It is $6 per graft.
Why would people choose follicular unit extraction over strip hair transplant?
The benefit for the extraction includes no linear cutting, no staples, no sutures, and no scalpels. Both techniques offer the same results.
Can follicular extraction be used to transplant hairs from other body parts such as chest, arms, or legs to my head?
Yes, Dr. Behnam specializes in extraction of hairs from other body parts to the scalp. He does prefer the hairs from the back of his scalp as a process is faster.
Is follicular extraction more or less safe than the strip procedure?
Follicular extraction is as safe as the strip procedure.
Four Phases of Healing
Typically, absent the use of ACELL Extracellular Matrix Technology, there are four phases to the process of healing a wound:
- The Inflammatory Phase involves bleeding, narrowing of blood vessels, clot formation, and release of chemical substances that will begin healing.
- Next is the Proliferative Phase in which a matrix or latticework of cells begins to form scar tissue.
- The Remodeling Phase begins after 2-3 weeks when the matrix becomes more organized, strengthening the scar tissue.
- The Epithelialization Phase is the process of laying down new skin covering the scar tissue.
Efforts to improve wound care treatment have focused on developing anti-inflammatory drugs and improving surgical techniques, neither of which address the disfiguration and loss of function associated with scarring.
ACELL IS A Revolutionary Breakthrough
Regenerative medicine represents a revolutionary breakthrough in wound healing. Extracellular Matrix (ECM) is the material which holds cells together in the bodies of all mammals. ECM is like an information super highway loaded with information telling cells to grow, divide, and differentiate.
The ACell includes a combination of ECM, growth factors, and proteins which stimulate and guide the process of tissue regeneration. The body recognizes the ECM signals and recruits the appropriate cell factors which differentiate according to what they should be. The process is a recapitulation of developmental biology.