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Fue Hair Transplant Method

The method that is named as FUE, in other words follicular unit extraction, is a method for hair transplant defined in 2004. First time it was defined, it was performed with a special pen-like instrument as shown in the following figure. 

In this method named Punch Biopsy, a pen-like apparatus is placed in skin to the depth of the hair's root and the follicular unit was removed as a whole. For example, if the patient needs 2000 grafts, this procedure was repeated 2000 times. Even though this method, which costs a lot of time both for the patient and health personnel, was replaced with a motorized system, there are still doctors insisting to use this method. 
The only difference of this method known as Fue Motor from other old methods is the fact that the operator doesn't have to remove the follicular unit manually. Actually the basic principle is the same, but the operator gains significant amount of time with this new method.  The apparatus at the tip of the punch biopsy pen is connected to a motor and the speed of the motor can be adjusted to the requested level. The thickness of the tips can be changed and tips at the requested lumen diameter according to the donor area can be inserted. The time it saves is of course not the only advantage of the fue motor. The tissue deepness can be standardized thanks to the motorized method, and this removes the obligation to check the tissue deepness constantly.  And again with the Fue Motor, grafts can be removed from closer areas and more grafts can be removed from the same region with the motor. Another advantage of the motor is the lower chance of breaking up grafts with 2-3 or even 4 roots, in other words the higher success in protecting the integrity of the follicular unit.
 

Figure: FUE Motor and Tips Because of these reasons, Fue Motor enables the hair transplant operation to be performed much more comfortably. Even though the method of removing the roots is different, the phases of opening channel and implanting roots are the same. 
 
PLANNING:
Planning is the most important part of the operation. The critical subjects such as the number of grafts that will be implanted, the places that the grafts will be implanted, number of sessions, the blood tests that will be requested, the need for the assistance of another doctor, things that should be considered before the operation, the position of the hairline, the places that the single, double and multiple grafts will be implanted will all be determined in the planning phase.  After planning, it is also required to take pictures of the patient from various angles for the photography archive, to draw the plan of graft distribution to the scalp with pen and take pictures again. A successful planning phase ensures a comfortable operation both for the patient and the doctor. For the doctor to provide the required comfort and safety to the patient, all the above mentioned subjects should be planned carefully. Most of the patients don’t realize the importance of this subject. That’s why they may underestimate it. The role of the doctor is to inform the patient about this subject and to encourage the patient to make all the required preparations. Generally, the patients are much lazier in subjects like going to another doctor and being subject to different tests. That’s why it is important to inform the patient about the fact that all these precautions are for their own benefit. 
 
ANESTHETIST’S OPINION: 
For the risky patient group, anesthetist consultation is very important. Both agitated patients and risky patients should be seen by an anesthetist before the operation and even monitored during the operation by the anesthetist. The patients who require regular treatment like those with drug allergy, cardiovascular disorder, diabetes; the importance of anesthetist consultation is much higher. Since there may be tests that the anesthetist may request, the consultation must be planned at least one day before the operation for the patients that require the opinion of an anesthetist.  
 
LOCAL ANESTHESIA: For the patient to not feel pain, both the donor space where the roots will be taken from and the recipient area where the roots will be implanted to are anesthetized locally. During this procedure performed with a special needle, the patient does not feel pain and the related area to be fully anesthetized takes approximately 3 to 5 minutes. The patient, who doesn't feel any pain throughout the operation, will probably not need any pain killers after the operation. 
 
Course of the operation
REMOVAL OF THE GRAFTS: For this procedure performed with Fue Motor, the anesthetized area should be enlarged with a special liquid. With this surface enlarging liquid, it is enabled for the roots to be freer and the number of obtained roots to be increased. It is possible to remove around 1000-1500 roots per hour in average. This number depends on the tissue state, bleeding amount and the general conditions of the patient besides the expertise of the doctor. 
 
OPENING CHANNELS: 
The process of opening channels is applied to the recipient area. It is required to open predetermined number of channels on predetermined areas. During the planning that should be made before cutting the hair of the patient, the required number of channels on each point is determined. Even though there may be slight changes during the operation, mainly this plan is applied. With a special apparatus, holes, in other words channels, in the planned number will be opened on the locally anesthetized area. The number of channels should be equal to the number of grafts that will be implanted. The hair growth angle should be considered carefully while opening the channels. This angle can be understood by a specialist with the help of special glasses even though there are no hair strands on that area, and it is determined by staying loyal to the previous appearance of the hair. The concentration of the specialist is very important while opening the channels. During this procedure where opening specific number of channels at an appropriate angle is not enough; various critical issues such as creating a natural hairline, ensuring that transitions are natural, ensuring that the frequency is as requested should be considered carefully. That’s why the channels should be opened by a specialist with an aesthetic view and who can offer something from himself/herself. This process during which the patients can listen to music and watch TV since the patients lie on their back takes approximately one hour for 2500-3000 units.  
 
IMPLANTING GRAFTS: 
It is the final phase of the operation where the roots removed in the first phase are implanted to the channels opened in the second phase.  Since the area will be anesthetized locally, the patient doesn't feel any pain. Grafts are placed into a container including a nourishing fluid that will protect them in a sterile medium. With this procedure which is performed by staying loyal to a regular order and counting, the grafts will be grouped as grafts with single root, grafts with double roots and grafts with multiple roots. And the number of removed grafts is determined accurately and clearly. It is very important to group grafts as single, double and multiple since each point of the recipient area requires a different type of graft. This procedure has vital importance for specific subjects such as implanting single grafts to the front hairline which is very important for a natural look after the appearance, and implanting double and multiple grafts to the back by opening less channels since double and multiple grafts are more in that area naturally. Moreover, it is required to perform processes such as showing the grafts to the patient before transplant not to raise any doubt, informing the patient briefly about how to count it, taking the pictures of grouped grafts and placing these pictures to the patient file. Hair transplant procedure is generally performed by two, and even sometimes by three specialists. Since the channels are narrower and grafts are single on the front hairline, the implantation process is required to be performed more carefully. It is very important for team to be composed of experts and the grafts to be implanted to the channels at the first attempt. Not touching grafts, implanting them immediately after taking them from the fluid, performing the process rapidly are very important. And I should mention that various details such as the place for holding the graft, the angle of the hand while holding the graft are crucial. 
Transplant process takes time as the removal of roots. However, generally it may end more quickly since it is performed by two or three people. During transplantation, the patient is generally more relaxed. This period, where there is no pain and the patient is in a half sitting position in front of the television, can be much easier for the patient also because it is the last phase of the operation. 
 
DISCHARGING THE PATIENT: 
Except the ones who came from other countries and don’t want to stay at a hotel, all the patients are discharged after the operation. They don’t need to stay in the hospital. The area that the tissue is removed is covered with a special liquid silicone. There is no need for any bandage. By this way, contact with outside is prevented aesthetically. With a special hat, both the donor area and the recipient area are covered until the patient reaches home. 
 
After the operation
THE THINGS THAT SHOULD BE DONE AT HOME: 
The patient should remove the hat when he/she arrives at home. This is very important both because of the fact that the wound will heal much sooner with the help of oxygen and to remove the pressure that the hat may cause. It is also important to rest at home in the operation day and the following day. As long as it is not very necessary, the patient should not be engaged in any work. If there are necessary works that should be performed, jobs that won't be hard for the patient such as desk jobs or using computer can be done.  
 
SLEEPING POSITION: 
First day, it can be hard to sleep. Actually the patient may want to fall into sleep right away because he/she doesn’t feel any pain and he/she is tired, but curiosity and fear may interrupt this process. Not having a quality sleep doesn’t indicate a problem. It is necessary for the patient to lie on its back by ensuring that the recipient area does not contact any surface. It would be beneficial for a friend/relative of the patient to check the patient periodically at the first night and a special pillow to be used for supporting the neck. The patient should not lie sideways or face down. After first wash, patients generally feel relieved and sleep much more comfortably. Uninterrupted, comfortable sleep is generally seen after 7-10 days. 
 
FIRST WASH: 
It is beneficial to wash the hair for the first time at the hospital or the clinic under the control of the specialists. It is required to wash the hair at minimum 24 hours after the operation and at maximum 72 hours after the operation. A softening lotion should be applied to the recipient area and this lotion should be kept there for 20-45 minutes. After this process performed to soften dry air, the hair is rinsed with warm water and lotion is removed. Then a special medical shampoo is lathered up in palm or other regions of the hair, and applied both to donor and recipient areas. This process should be performed with finger tips and hand mirror, and the nails should never contact those areas. After the hair is washed, the hair should be dried gently with a paper towel without rubbing. Preferably the donor area should be cleaned with rifampicin ampoule or antiseptic solution for the first 3 days. In the following days, there is no need to do anything special for the donor area. The dosage of washing should be increased each passing day, and no scab, residue, dried blood should remain on the scalp approximately after 7-10 days. This should be repeated every day and the patient should return to its regular washing pattern after the 15th day. The patients may continue to wash their hair every day after the 15th day or they may prefer a less frequent pattern. They may take shower more than once in a day, but it is not recommended to apply shampoo for more than once.  It should be carefully noted that the shampoo that will be used should be a medical shampoo recommended by the doctor. 
 
USE OF DRUGS: 
With the serum attached during the operation, all the drugs needed by the patient should be given to the patient through transfusion. There should be emotional relaxers, pain killer, antibiotics and drugs preventing edema in the serum. With this application, the patient doesn’t feel any pain and discomfort during operation, and infection risk is removed. This application is important both in terms of the comfort it offers to the patient during operation and as a precaution if the patient neglects to use the medicine after the surgery for a reason.  Despite of all of its advantages, the drugs used during the operation are not enough to protect the patient 100% after the operation. That’s why, it is required to use the antibiotics, pain killers and anti-inflammatory drugs, edema preventive drugs and antiseptic drugs that will used during medical dressing.  The antibiotics should be used for 5 to 7 days, pain killers for 1 to 3 days, anti-edema treatment for 4 days and antiseptic for 3 days. After the patient stops using antibiotics, there will be no need for the patient to use any drugs afterwards. 
 
HAIRCUT: 
It is beneficial to not to have haircut for the first 2 weeks after the operation. After the second week, hair can be cut with razor or scissors. After 60 days, the hair can be cut anyway the patient wants. It would be better for the hairdressers experienced in cutting the hair of such patients who gone through hair transplant operation to perform the first haircut of the patient. 
 
HAIR GROWTH PROCESS:
The hair strands fall by leaving their roots inside the scalp within first 3 weeks following the hair transplant. Actually, it would be better to call this event hair splitting. The hair starts to grow after 90 days following the hair transplant. Since hair grows partially each day, this period progresses naturally. Approximately after 8-10 months, the patient welcomes all of the new hair (in ideal conditions, only 3% doesn’t grow).
 
SECOND OR THIRD SESSIONS: 
For patient whose baldness problem cannot be solved with a single session, second and sometimes even third session can be planned. In such a case, it is ideal to wait for 8 months. If the patient wants to go through two sessions one after the other, the patient should be informed about the fact that the number of grafts will be less in such a method. While implanting 2000 grafts in the first day, the second day this number will fall to 1000 grafts and the total number will be 3000. If the patient waits for 8 months after the first session, the number of grafts that can be implanted will increase for example to 1800. By this way, the total number will become 3800 instead of 3000. And this means 1500 more hair strands in average. It is obvious that taking time between the sessions is more advantageous. The paths that the patient, who will have the second session the following day, and the one, who will have it 8 months later, will follow are the same. 

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