FUE Technique

FUE Technique (Follicular Unit Excision) is one of the most widely used microsurgical methods in modern hair surgery and has become the gold standard for the permanent treatment of hair loss. Technically, it is based on the individual excision of follicular units each containing 1–4 hairs using micro‑punches with a diameter of 0.7–1.0 mm, and placing them into micro‑receptor sites opened in the recipient area with controlled angle, direction, and depth. In this approach, each graft is harvested by taking into account the hair’s natural exit direction, root depth, and the elasticity of the surrounding tissue. The goals are to survey the donor area homogeneously, preserve follicular density, and keep tissue trauma to a minimum. The aim is not only to fill the bald area but to create a structure that precisely mimics the direction, wave, and distribution characteristics of the existing hair.

The most important advantage of FUE is that it does not require sutures; therefore the recovery period is short and it does not produce a linear (strip) scar; however, this does not mean it is “completely scar‑free.” At the microscopic scale, point‑like scars with epithelial closure of about 0.8 mm in diameter may form. For these scars not to be noticeable to the naked eye, extraction must be performed homogeneously within donor boundaries, rotationally, and at low density. Harvesting at improper depth or density can increase the risk of donor thinning and fibrosis. Therefore, surgical planning, careful assessment of donor area anatomy, and setting extraction directions in harmony with the natural hair angle are of critical importance to the success of FUE.

1. Scientific Basis and History

The concept of the follicular unit was defined by Bernstein and Rassman in the 1980s, and in the early 2000s the FUE technique gained speed and consistency with the development of micromotor systems instead of manual punches. Today, thanks to punch diameters in the 0.7–1.0 mm range and low‑torque motors, graft integrity can be preserved above 90%. The literature shows that with appropriate patient selection and an experienced surgeon, the graft transection rate can be kept below 5% (StatPearls, 2023). This rate represents a critical threshold for permanent density.

2. Stages of Hair Transplantation with the FUE Technique

a. Planning and Donor Analysis

Prior to the operation, the hair loss pattern, donor density (grafts/cm²), and hair thickness are measured under dermatoscopy or trichoscopy. The aim is to harvest without exceeding the reserve in the donor area. At Hair of Istanbul, this analysis is supported by AI‑assisted imaging systems; the safe donor area is defined according to anatomical boundaries (occipital–parietal region).

b. Hairline Design

The hairline is a decisive parameter for the aesthetic result. Plastic surgeons and medical aesthetic physicians draw it by considering facial proportions (lower–middle–upper face ratio). The boundary drawn with millimetric laser measurements is used as a guidance reference during the operation.

c. Local Anesthesia and Extraction

Local anesthesia is administered with a lidocaine and adrenaline combination. During extraction, micro‑punches are advanced parallel to the direction of the follicular unit; an incorrect angle increases the risk of transection. Punch depth is generally 3.5–4 mm. Grafts are removed with microforceps and stored in hypothermic preservation solutions (e.g., HypoThermosol, ATP solutions). This can maintain graft viability for up to 6 hours.

d. Implantation

In the recipient area, channel creation is performed with 18–21G micro‑blades or sapphire tips. Angles vary between 30–40° at the frontal hairline and 50–60° in the vertex region. The orientation of grafts is arranged to be consistent with the existing hair growth pattern. Implantation is carried out with atraumatic micro‑forceps or, in procedures performed with the DHI technique, with implanter pens.

e. Post‑operative Care

In the first 48 hours after the operation, vascular stabilization is achieved. The first wash is performed on day 2 or 3. Patients are given antibiotics, anti‑inflammatories, and a care protocol. After day 10, scabbing completely disappears; anagen‑phase growth begins at month 3, and final density is obtained at month 12.

3. Hair of Istanbul’s FUE Application Protocol

Hair of Istanbul has performed more than 19 000 FUE operations since 2013. The clinic works with a multidisciplinary team specialized solely in hair transplantation: a plastic surgeon, a medical aesthetic physician, an anesthesiologist, and a cardiology consultant.

Before the operation, the patient’s cardiac and metabolic status is evaluated; throughout the procedure, an anesthesiologist provides monitoring. During extraction, high‑resolution optical magnification systems are used; the aim is to remove grafts without damaging the follicular sheath and adipose tissue. The donor area is managed with the principle of micro‑harvesting distributed at equal density; this preserves a uniform appearance even when the hair is cut short in the future.

The micromotors used at Hair of Istanbul are medical‑grade devices that provide low heat production and constant torque control. This technology reduces tissue trauma and minimizes the risk of scarring. Only epithelialized micro‑punctures with a diameter of 0.8 mm form in the donor area; these epithelialize within 48–72 hours. Therefore, the recovery period is painless and rapid.

In addition, PRP (Platelet‑Rich Plasma) is standard in the clinic protocol. PRP accelerates the anagen phase and supports microcirculation thanks to growth factors (PDGF, VEGF). This approach is a supportive application that has been scientifically shown to increase the graft take rate (Gupta & Carviel, Dermatologic Surgery, 2021).

4. Advantages and Limitations of FUE

Advantages

• No linear scar forms; no visible scar remains with short hair.
• Wound healing is fast; sutures are not required.
• Provides high graft capacity according to donor area breadth.
• Control of density and orientation produces a natural hairline.
• Applicable in women and across different ethnic hair types.

Limitations

• Operation time is longer compared to FUT.
• Expertise directly affects graft quality and outcome.
• Overharvesting may lead to donor thinning; therefore mathematical distribution planning is mandatory.

The Hair of Istanbul team limits extraction density to an average of 15–18 grafts/cm² and varies the harvesting pattern with circular rotation. This technique preserves the natural density of the donor area after each session.

5. Complications and Risk‑Reduction Strategies

Complications after FUE include edema, temporary paresthesia, ingrown hairs, or folliculitis. The majority can be prevented with appropriate sterilization and post‑operative care.

At Hair of Istanbul, sterilization is performed with an autoclave protocol compliant with EN ISO 17665‑1. In addition, the operative field is prepared with single‑use sets for each patient.

To reduce surgical trauma, low‑speed rotation (≤3000 rpm) is preferred; this reduces punch friction and heat generation. Low heat minimizes the risk of necrosis.

6. Clinical Outcomes and Consistency with the Literature

The average graft take rate is 95–98% at Hair of Istanbul, and the complication rate is <1%. These data are in parallel with the international literature.

According to the ISHRS, patient satisfaction rates are over 92% in FUE procedures performed with the correct protocol (ISHRS Practice Survey, 2022).

The clinic also measures density stability in its long‑term follow‑up system with 12‑ and 24‑month check‑ups; the results show that graft loss is minimal.

7. Conclusion

The FUE Technique is an evidence‑based method in hair restoration that combines surgical precision, tissue preservation, and natural design principles. Proper patient selection, safe donor management, and atraumatic application form the basis of successful outcomes. Hair of Istanbul implements these principles to international standards, maximizing the scientific potential of FUE.

Each procedure is not only an aesthetic transformation but also a reflection of medical accuracy, surgical meticulousness, and ethical responsibility.

References (authoritative)

1. International Society of Hair Restoration Surgery (ISHRS). FUE: Follicular Unit Excision Guidelines and Practice Survey 2022.
2. R. Sharma, A. Pathak. Follicular Unit Extraction (FUE) Hair Transplantation. StatPearls [Internet]. National Center for Biotechnology Information (NCBI), 2023.
3. A.K. Gupta, M.N. Carviel. “Platelet‑Rich Plasma as an Adjunct in Hair Restoration Surgery.” Dermatologic Surgery, 2021;47(6):750–757.