Manual vs. Automated FUE Transplant

Follicular Unit Extraction, simply known as FUE, is one of the two primary methods of obtaining hair follicles for hair transplant. The other method is Follicular Unit Transplantation (FUT) also known as strip harvesting. In FUE, the hair follicles are harvested one by one from the donor site of the patient. The donor site refers to the area on the patient’s scalp that has lots of hair in it. The balding area where the hair follicles will be transferred to is called the receiver site.

FUE transplant can be manual or automated. Manual FUE involves the surgeon using old-fashioned needles or punches to harvest a follicle or a group of follicles. The diameter of the punches used ranges anywhere from 0.6mm to about 1.3mm. The most commonly used sizes are the 0.8mm and 1.0mm punches. Manual FUE may also include the use of a special rotating and/or oscillating machine to incise around the follicle faster and more efficiently. The manual FUE technique that utilizes these machines is called mechanical FUE. Mechanical FUE and automated FUE are commonly thought to be the same thing, however the difference between the two depends on who does the actual follicle extraction. In mechanical FUE, the surgeon does the extraction and in automated FUE, the robot does extracts the follicles.

CANDIDACY

A 2010 study published in the Journal of Cutaneous and Aesthetic Surgery listed the following as ideal candidates for a FUE transplant:

- Patients who wear their hair short and might dislike the linear scar produced by strip harvesting.

- Patients who specifically want a FUE transplant and have enough hair in the donor area to transfer to the receiver area.

- Patients whose hair loss is secondary to other dermatologic conditions.

- Patients who have previously undergone strip harvesting and have widened linear scars.

- Patients whose skin is too tight for a strip harvest.

- Patients who have scars brought about by prior head trauma and/or neurosurgical procedures.

- Patients who have a beard or unwanted hairs in other areas of the body that may serve as a donor area.

TREATMENT COMPARISON

Manual FUE is the most difficult method for surgeons to learn among the three. The learning curve is longer and requires good hand to eye coordination. Not every surgeon has the set of skills needed to perform manual FUE using old-fashioned needles and punches.

Automated FUE is the fastest and most efficient method, since the speed of mechanical extraction can approach as much as 2000 grafts an hour as compared to the 1000 grafts per hour of manual FUE.

Automated FUE has many advantages over both manual and mechanical FUE. Robotic surgery has the capacity to reach accuracy in a sub-one millimeter level along with a very small margin for error. Automated FUE works best when the follicles do not grow at an acute angle, such as the hairs on the sides and lower back of the head. The follicles in these areas are very difficult to dissect because the more angular the hair growth is, the larger the wound will be.

TREATMENT LIMITATIONS

Most of the limitations associated with a FUE transplant are for the manual and mechanical types. Manual FUE is a more difficult process requiring more time than mechanical FUE and may lead to fatigue for both the patient and the surgeon. This technique also has a longer learning curve and requires a lot of skill from the surgeon to avoid follicle distortion or displacement. The limitations of mechanical FUE occur when the patient has hairs growing at a very acute angle along the scalp. There is a tendency for the punch to slide on the skin a little bit more.

RISKS

The immediate side effect of FUE is depletion or thinning out of the donor supply. The way to manage this problem is to try and create a density that is somewhat uniform all over the scalp including the entire donor area and recipient area. In other words, the surgeon should make an even density so there will not be any isolated areas that appear thin.

There can also be what surgeons call “white dotting” in the donor area. This pertains to the loss of pigmentation that may occur when the surgeon takes the graft out from the donor site. It can be managed by a treatment called Scalp Micropigmentation.

RECOVERY 

The recovery period is the same for all three methods of FUE hair transplantation. Although automated FUE is faster and much more efficient than the other two, it does not mean that the recovery time is faster as well. In general, a bigger wound heals a bit slower while a smaller one heals more quickly. That is why the healing period for FUE is significantly shorter compared to that of strip harvesting.

MAINTENANCE AND CARE 

Undergoing hair transplant surgery alone is not enough to guarantee that the patient’s hair loss problem will go away forever. Patients should also consider using hair loss treatment medication in conjunction with the transplant procedure. These medications basically help maintain their hair.  Some of the more popular and effective drugs for hair regrowth include Propecia and Rogaine.

Overall, the survival rate is somewhat similar for all three techniques as long as the follicles transplanted are all viable and intact.

RESULTS

In general, any of the three hair restoration techniques for FUE will produce similar results no matter which technique a patient decides to undergo. Every man and woman begins to lose hair at some point in their life simply because there is a normal senescence of hair that occurs in every single one of us. It is a normal part of the aging process. When hair loss does begin to happen, consulting with a board-certified surgeon will help a patient determine their hair treatment options.

Written By Cosmetic Town Editorial Team - AA

Based on an exclusive interview with Dr. John Cole in Alpharetta, GA