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FUE is taken from the initials as an abbreviated form of the English Follicular Unit Extraction. FUE hair transplantation has attracted a lot of attention due to its many advantages over the previous FUT method. The use of body hair such as beard and chest as donor area has brought this technique to advanced levels very rapidly.
The roots between the two ears or the hairs in other parts of the body are removed one by one. These are then transferred to the balding area. This process is called Fue. In 2002, it was described by Dr Rassman. This method has made very rapid progress especially with the use of micro motor. It is known as the newest hair transplantation technique.
There are cases that can reach over 10,000 grafts with this technique. Of course, this is related to the donor area capacity. In FUT method, maximum 3000-4000 grafts can be obtained. In people with a large balding area such as Norwood 6-7, 10,000 grafts can be captured in this way. In addition, the graft / hair follicle ratio in the FUE technique is higher than the FUT method. Therefore, the number of roots obtained from the same number of grafts is higher.

Overview and Advantages of FUE

In the Fut method, only the hair between the two ears can be used as donor area. In FUE, almost all hairs of the body can be used. Especially with the transfer of beard and chest hair to the balding area, FUE has progressed very rapidly. Therefore, the total number of grafts that can be transplanted has become much higher. In addition, the absence of stitches and the absence of linear scarring has placed FUE in the first place in the ranking of the best hair transplantation method today. In patients with short hair, FUT scars are prominent. In FUE, on the other hand, the scars are pointwise and these scars can be easily camouflaged even in short hair.
One of the advantages is the difference in postoperative pain. Pain may continue for 3-4 days after the FUT procedure. Because the scalp is cut and sutured, it is a small invasive surgical procedure. In addition, after the operation, there is numbness and numbness in the nape area for 3-4 months. In some cases, numbness continued for 6 months to 1 year. In FUE, most of the complaints disappear after 48 hours. Numbness and numbness are much less in FUE compared to FUT method. We will examine the differences in detail in another article.
What are the Stages of FUE Technique?
The only difference that distinguishes this technique from the other method, FUT, is the method of taking the roots.
We can summarise the stages of FUE Hair Transplantation operation as follows. Information about the pre- and post-transplantation period is explained in detail in their own topics.
– Local Anaesthesia
– Removal of Hair Roots
– Hair Transplantation (Transplantation of Grafts to the Hairless Area)

How is FUE Hair Transplantation Performed?

The patient is placed face down on the operation chair or placed in a sitting position. While the patient is in the face down position, the back of the head and occipital region hair can be easily removed. The patient is placed in the lateral decubitus position while the side area hair is removed. Lateral decubitus is the way the patient is laid on his/her side. In this way, graft harvesting is made easier. In the lying position, the removal of the roots is relatively faster, but bleeding may be a little more depending on the position. In the sitting position, extraction is slower but bleeding is less common.
Magnifiers called loupes must be used during graft harvesting. 2.5x -4x magnification ratios of loupes are usually sufficient. The rate of incision will increase significantly in the harvesting without using a loupe. The roots are removed one by one with the help of fine punches without cutting and suturing. These extracted roots are placed one by one in glass containers called petri. The hair follicles are kept in cooling containers until the transplantation stage. It is useful to keep the hair follicles in a cold environment at 0-4 degrees centigrade until the transplantation stage.

Donor Area in FUE Method

In the FUE method, it should be known that the hair should be shaved. The donor area is shaved so that the hair is 1 mm in length (zero number). Up to 5000-7000 grafts can be taken from this shaved area depending on the donor capacity.
It is most appropriate to take grafts from the area called safe area. Safe area roots are strong roots. In addition, the roots above the ear and under the occiput (posterior projection of the skull bone) can also be taken with caution. The roots here are relatively thinner and more suitable for the design of the frontal sheet line. Since the roots in the area below the vertex have a high potential for shedding in the future, it is not correct to harvest from these areas. The hair in the parietal region above the ear also has the potential to fall out in the future. Even if it is taken from this area, it is beneficial to take low density grafts. This is more important at young ages.
In addition, a decreasing number of grafts should be taken from the areas near the end of the drawing area. The line should end with a transparent transition, not a sharp line. In terms of natural appearance, it is preferred that the hair in the front line is thinner. Front line transplantation with multiple roots creates an unnatural appearance.
In addition, a decreasing number of grafts should be taken near the end of the drawing area. The line should end with a transparent transition, not a sharp line. In terms of natural appearance, it is preferred that the hair in the front line is thinner. Front line transplantation with multiple roots creates an unnatural appearance.
The diameter of the punches plays an important role in the number of grafts that can be taken. A high number of roots cannot be taken with thick diameter punches. Transection rate is higher. In addition, the scar left by thick panchs on the head course will be larger. For this reason, punches with a diameter of 0.7, 0.8 and 0.9 mm are generally preferred. However, patients usually do not like the idea of a haircut. If the possibilities allow, it is possible to transplant without cutting hair.
Hair Transplantation with FUE Method and 3 Important Rules

Punch Length and Depth Control: The most important issue to be considered in the removal of the roots is the depth of the punch under the skin. If the punch length is too long, it causes the hair follicles, which we call dissection, to be broken and damaged. This means unnecessary graft loss. Hair follicle length may vary from person to person. After a few trials, the ideal punch length is understood and it is necessary to fix it to this length. If the punch length remains short, it becomes difficult to remove the grafts and ruptures may occur.

Fue Punch Entry Angle: It should be entered into the skin at the correct angle. It is inevitable to have a graft incision called transection with the wrong angle of entry. In the hair of the nape area, there is a difference between the skin top and skin horse angles. An experienced doctor can easily understand this angle difference after a few test trials at the beginning of the operation. And directs the course of the operation accordingly. Transection rate (incision rate) means the ratio of the number of grafts taken to the damaged hair follicle. Acceptable transection rate in the world is between 2-10%. In our applications, we limit the transection rate between 1-2%. This is a percentage related to the correct application of the general principles of Fue and manual dexterity.

Number of Grafts and Donor Capacity: The important point in FUE application is to take an equal number of grafts from each square centimetre. There are some criteria for calculating the number to be harvested. The most important one is the donor capacity in the area to be harvested, i.e. the total number of grafts. In our applications, we do not find it right to exceed the total number of grafts by 25-30% in one session. If the second session is necessary, the maximum total capacity can be increased up to 30-35%. For example, in a person with a donor capacity of 15.000 grafts, it is not correct to exceed 6000 grafts in total. In addition, it is not right to take such a high number of hair follicles in 1 session. It is more accurate to divide it into two or three sessions. If homogenous harvesting is performed, a disturbing image does not appear.

Tools Used in FUE Hair Transplantation

In the FUE method, two methods are used to remove the roots. Both methods are removed with the help of tools of various diameters called punches. These punches can be sharp, round punches, fish mouth punches, serrated punches and U punches used by Dr Umar. The diameter of the punches may vary according to the thickness of the grafts. There are many companies producing punches in the market. Their diameters vary between 0.6- 1.5 mm. We do not find it right to use very wide tipped punches. In general, punches with diameters of 0-7, 0.7.5, 0.8 and 0.9 mm are suitable for hair follicle removal. If the hair follicles are harvested with very wide tipped punches, the shock shedding rate in the donor area will increase. In addition, the length of the punches used is as important as their diameter. Punches of 3 mm, 3.5 mm or 4 mm in length should be selected according to the length of the roots.

a) Manual Method: Hair follicles are manually removed manually with the help of very thin and sharp punches. There are different punches used in manual fue. According to the micromotor, the intake of grafts is slower. Round and fish-mouth punches are suitable for manual method. In round punches, the grafts are freed by rotating by hand. In fish-mouth punches, hair follicles are liberated with a single forward and backward movement.

b) Micromotor Technique: Punches are fixed to the slot of the tool we call micromotor. And it works electrically, the rotation speed is adjusted and the hair follicles are removed by rotating. It is faster than the manual method. But if it is operated at very high speeds, it damages the graft. Due to the misuse of the micro motor, there is a false belief that the micro motor damages the grafts. If it is applied correctly, very good results are obtained. Today, it is much more widely used than manual FUE.

c) Robotic Hair Transplantation: It is a computerised hair transplantation device developed in the USA in recent years. It is produced by Artas company. Roots are marked by the computer. Only with a motorised rotation movement, the grafts are freed. Then they are collected by hand as in the classical method. In robotic hair transplantation method, the graft incision rate is higher than other methods. In addition, the punch tips used are generally 1.2 mm. In addition, there is a possibility of damaging other grafts on the side due to wide-tipped punches. There is a serious scar in the intake area.

What are the Advantages and Disadvantages of FUE Hair Transplantation?

1. As a result of experience, it is not correct to take more than 2000-2500 grafts in one session in fue hair transplant surgery. If it is necessary to take a higher number of grafts, it is more accurate to perform the operation by dividing it into consecutive days, 2 or 3 days.
2. One session should not exceed 5-6 hours on average. As mentioned above, if the duration will be longer, it is more beneficial to divide it into days in terms of the survival of the grafts.
3. In women, the FUE method has replaced the old technique of FUT. In addition, the unshaven application is a great advantage for women. One of the best application areas of FUE is eyebrow transplantation.
4. FUE, especially with the pen technique, has become an indispensable method of beard transplantation. Since the hair follicles are visually removed one by one, strong hair is removed.
5. It is not true to say that there will be no scars in FUE hair transplantation. Let’s not forget that every surgical intervention on the skin leaves more or less scars. However, since the other hair in the donor area grows, these scars are not visible when viewed from the outside. However, in excessive and disproportionate graft harvesting, these scars can be seen when the hair is short. And a disturbing situation may arise in terms of appearance. The scar increases in proportion to the number of grafts taken and the punch diameter.
6. There is no connection between FUE hair transplantation and pen method. FUE is the method of taking hair follicles, while the pen method is the method of transplantation. Pen method has been recognised in our country in recent years. And there is a misunderstanding as if the pen method is only applied in FUE.

After FUE Hair Transplantation (Donor Area)

After hair transplantation, the donor area will start to heal rapidly. If correct and homogenous harvesting is performed, it will not be obvious that the donor area has been harvested for about 10 days.

Frequently Asked Questions and Common Misconceptions

They say we get unlimited grafts, is it birth?
Everyone has their own donor capacity. While there is a 3000 graft capacity, if you try to get 6000 grafts, you will both lose your roots and start looking for the best hair transplant doctor to fix the donor area.

Is Record Hair Transplantation 10,000 Grafts in One Session True?

It sounds good, but no sane doctor who has made a name in the world would do this. In fact, if the duration of hair transplantation exceeds 5-6 hours, the operation must be divided into days. Although it seems like a record to perform the procedure by taking 5000-6000 grafts in one session, unfortunately it is not satisfactory in terms of results.

Sapphire Fue, Gold, Ice Fue etc. Which one should I prefer?

In recent years, with the increase in advertising sales marketing techniques, a false perception is created as if a different method of transplantation is being performed. Please note that there are absolutely no applications such as ice, gold, nano, plus, micro, etc., which contain fue at the beginning and end. These are word games to deceive people with different sales techniques. These are nothing but methods of attracting customers for hair transplantation with word games. Be the one who will perform the operation. Make sure it is a reliable doctor.

*Page content is for informational purposes only. Please consult your doctor for diagnosis and treatment.*

DHI Hair Transplant | Pen Technique

DHI Hair Transplantation (implanter pen) was designed by Dr Young Choi in the 1990s. It is a graft placement technique widely used especially in Far East Asia. There have been different nomenclatures. Choi implanter pen, hair transplanter can be counted among them. Another name is no touch hair transplantation (transplantation without touching the hair follicles).
Unfortunately, this technique, which has become widespread in our country in recent years, is known as DHI hair transplantation. In fact, DHI is a company that performs hair transplantation in Greece. It is formed from the initials of the company named “Direct Hair Implant”. This company operates with the implanter technique. Let’s not forget that there is actually no such method as DHI hair transplantation. This name has become widespread in our country.

What is DHI Hair Transplantation?

DHI hair transplantation has been named implanter pen kimi (pen technique) due to the description of a spring tool similar to a ballpoint pen by Dr Choi. What makes this method different from normal FUE is that the holes are not drilled in bulk. While one hole is drilled, the graft is placed simultaneously in the drilled hole. There are cylindrical and sharp needles at the implanter tips. We can say that it is the best method if applied correctly. DHI The procedures to be performed before hair transplantation are the same as classical FUE transplantation.

How is DHI hair transplantation done?

Here we will explain the answer to the question of how DHI hair transplantation is done in 2 stages. Implaneter pen, as mentioned above, is a small mechanical device that works with a spring system similar to a ballpoint pen. Its outer protection is made of teflon and is resistant to sterilisation up to approximately 130-140 degrees. It is a ballpoint pen with 5-6 intertwined complex structures. At the extreme end are the needle tips where the roots are inserted. This is similar to the syringe tips, but the vertical needle tips are split. This is so that the hair grafts can be placed into these slits before transplantation. An average of 4-6 implanter pens are needed for synchronised and rapid application.

1-Placement of Hair Roots into the Pen

Auxiliary personnel take hair follicles from the petri dishes in series. They place them one by one into the needle tips at the bottom of the pens. During the placement, the root part of the grafts is never touched, it is grasped with the help of pliers at the top and placed by sliding into the slit. The roots should never remain in the implanter for a long time and the roots should not be allowed to dry out. If necessary, the assistant personnel should wet the pens with isotonic spray.

There should be full co-ordination between the doctor and the auxiliary staff during the exchange of empty and full pens. Accidents in the form of needle sticks should be prevented. The doctor places the empty pen on the table with the tip facing him/her. The auxiliary staff places the filled pen on the table parallel to the table and the doctor. There should be a distance of at least 30-40 cm between empty and filled pens. In this way, it is possible to work quickly and to prevent the hands of the doctor and the auxiliary staff from colliding.

In another way of working, only the wrist of the doctor moves. The doctor’s arm is fixed at the elbow. The third assistant is in front of the doctor. He takes the empty implanter from the doctor’s hand and places the full one between the doctor’s thumb and forefinger at the same time. This allows the hair transplantation procedure to be carried out quickly. In addition, excessive fatigue of the doctor due to reduced arm movement is prevented and performance increases.

2- Transplantation of the grafts placed in the pen by the doctor:

The pen tips are brought closer to the balding area at an appropriate angle. The skin is pierced with a needle tip. The pressing part at the top of the pen is pressed. The thin wire pushed from the tip of the needle is pushed from the top of the hair root and the root is pushed in. Simultaneously, the needle tip is removed from the skin by means of the spring system and the transplantation process is completed. The patient’s neck should not be tense during transplantation. Otherwise, bleeding may increase due to vascular compression.

The doctor should grip the pen comfortably with his/her hand. The 3rd, 4th and 5th fingers grasp and support the pen from the bottom and back. The thumb grasps the pen from the front. In this way, the filled implanter is inserted into the skin. The graft should be placed synchronously as the pen enters the skin. The second or third knuckle of the index finger is pressed on the top of the pen simultaneously. Thus, the hair follicle is left in its nest in the skin. Again, after the graft is placed in the skin in a synchronised manner, the pen is quickly removed from the skin. The doctor who performs the application adapts to this rhythm in a short time and hair transplantation turns into an automatic rhythm.

Unusual Situations that may occur during hair transplantation with pen

DHI hair transplantation is not as easy as we describe in theory. While the operation is sometimes as easy as pulling a hair out of the cress, sometimes there may be undesirable situations. Let’s take a brief look at these situations and solution methods

Haemorrhage: If there is more bleeding than expected, the patient’s sitting position in the armchair is first checked. If there is tension in the neck due to the position, this compresses the veins and bleeding increases. When the neck position is changed, it can be seen that bleeding will decrease in a short time. A sitting position of 45 degrees is ideal for frontal transplants and a sitting position of 60-70 degrees is ideal for transplants in the hill region. We have also mentioned above that bleeding may increase depending on the neck of the needle tip.

Popping: When piercing the skin with a pencil and placing the graft, the grafts placed around it pop out with pressure. This is an undesirable situation during DHI hair transplantation. There are two reasons for this. The first is a decrease in the sharpness of the implanter tips. If this is the case, the tips should be replaced immediately. The second is the condition related to skin elasticity. This is most commonly seen in the elderly, in skin that has been overexposed to sunlight and in transplantation on scarred areas. To prevent this, the correct stretching movement should be made while the needle is inserted into the skin. Thus, the pressure of the tip on the skin is reduced and it is prevented from going deeper.

Choi Hair Transplantation on Scars

DHI hair transplantation can be performed on scars due to reasons such as wounds or traffic accidents. Transplanting on scarred areas is different from transplanting on normal skin. Because the skin is harder and more pressure is required for the pen to enter the skin. In this case, it causes the other transplanted roots, which we call popping. We find it right to open as many channels as the number to be transplanted with dhi on the scar first. This can be a hypodermic needle or an empty implanter pen.
Then, the roots are placed into the canals opened with the classical DHI method and thus prevented from expulsion.

What can be done with the DHI technique?

– Hair transplantation can be performed between sparse hairs without shaving and hair tightening.
– In beard hair transplantation, we have found that we get the best results with DHI hair transplantation.
– This method is the most ideal for the favourite and temple area. We will explain the use of DHI technique in the favourite area in detail in another article.
– It is the best type of transplantation that can be applied in women. In women, hair is transplanted without shaving.
– DHI technique is the best method without exception in eyebrow transplantation. It is much easier to determine the angle and eyebrow transplantation can be done with very fine tips such as 0.6 mm. Dhi application for eyebrow transplantation has its own tricks. We have explained them in detail in our article called eyebrow transplantation.
– Angle determination is very important in beard transplantation applications. For this, it is possible to get the best results with DHI hair transplantation.

Are DHI Hair Transplant Prices Expensive?

Yes, DHI hair transplantation prices are expensive, the cost is higher than other techniques. If we briefly list the reasons for this;
– The implanter tips used in pen method transplantation are disposable and should never be used in another patient. An average of 4-6 implanter pens are used in the operation. There is a significant difference in terms of cost with classical fue. Therefore, pen transplantation is expensive in terms of consumables.
– DHI hair transplantation requires a qualified doctor and qualified auxiliary personnel. The most important reason for unsuccessful results is the lack of knowledge and experience of the doctor and assistant personnel in this technique. The cost of auxiliary personnel is also high, as the auxiliary technicians who place them in the pens must be qualified.
– Although we do not find it correct, many centres state that they can transplant 5000-6000 grafts per day with the classical method. It is not correct to transplant more than 2000-2500 in one session in hair transplantation with a pen. Therefore, the duration of 5000-6000 operation may take up to 3 days.
For the reasons we have explained, it is normal for the DHI method to be more expensive than classical FUE in terms of price.

What Should I Pay Attention to When Researching the Pen Technique?

– Is there a doctor actively involved in the operation within the pen method? If so, what is his/her experience in this field?
– Will the operation be performed with the pen technique from start to finish? Or will there be a pen application for show?
– How much experience do the assistant technicians have in the DHI technique? Where did they receive this experience or training?
– What are the before and after results with this technique, if possible, are there any live examples?
– Are the tips used disposable for each patient and are they sterile?

What are the Advantages of DHI Technique?

– Hair transplantation with pen is one of the best hair transplantation methods as we explained above. It has many advantages compared to the classical method.
– Bleeding is very little compared to the canal method. A very clean image appears after the operation. Washing can be started earlier after transplantation. Recovery time is short in DHI hair transplantation.
– Since it is worked with very fine tips, there is no scarring on the scalp.
– One of the most important criteria that ensures naturalness in hair transplantation is the correct angle determination. With the pen technique, the desired angles can be achieved very easily. Therefore, it is possible to obtain natural images that cannot be distinguished from the real one. Unnatural results are unlikely to be seen in the pen method.
– In classical fue transplantation, the grafts are more likely to dry out than in choi technique.
– When DHI hair transplantation is applied with the right techniques, the roots are much less damaged than classical fue.
– If desired, it can be transplanted quite frequently.
– The waiting time of the roots outside can be shortened considerably with this method.
– Simultaneous transplantation can be done more easily. Hair follicle can be removed and transplanted without waiting.
– In DHI method, transplantation is performed by piercing the skin. In the classical FUE technique, transplantation is performed by cutting the skin and trauma scar is relatively more common. Everyone has had at least one serum inserted or given blood for analysis at least once in their lives. Have you ever seen a scar on your arm after recovery? We can explain the advantage of the pen method in this way.
– There is no need to use adrenaline to reduce bleeding as in canal transplantation. There is no need to give isotonic liquid saline to swell the scalp. Therefore, swelling after transplantation is relatively less common. Therefore, complications such as necrosis due to the use of adrenaline almost never occur in DHI hair transplantation.
– Shock spillage is relatively less common compared to other methods. (The reason is that adrenaline is not used)

What are the Disadvantages of DHI Hair Transplantation?

DHI hair transplantation has disadvantages as well as advantages. Let me examine these disadvantages
– For the reasons mentioned above, DHI hair transplantation requires a very high level of technical knowledge and experience. There are many tricks. Anyone who does not know these tricks is likely to have negative results after the procedure.
– It is expensive in terms of cost compared to other hair transplantation types.
– There should be only one doctor performing the transplantation. In canal transplantation, three people can place the roots from the right, left and top. In implanter pen transplantation, it is a single doctor who performs the transplantation. It is not correct to transplant more than 2000-2500 grafts in one session.

Frequently Asked Questions

Is DHI Technique better than FUE?

We can briefly say yes to this question. DHI method has many advantages over FUE. We will explain them below. The most important advantages are the possibility of unshaven transplantation and frequent transplantation.

Is DHI Hair Transplantation Painful?

Local anaesthesia is performed before transplantation. No pain will be felt after anaesthesia.

FUE or DHI?

DHI because the percentage of people who are happy with DHI is higher than FUE.
What is the Recovery Time in DHI Hair Transplantation?
Recovery time is shorter in DHI transplantation compared to FUE. The reason for this is that adrenaline is not used in the DHI method, collective canal opening is not performed and the wound heals quickly.

What is Choi Hair Transplant?

It is the other name of DHI. Since Dr Choi was the first to apply it, it is known as the Choi method under the name of this doctor. One channel is opened with implanter pens and then the hair follicle is placed simultaneously.

What is DHI Pro Hair Transplantation?

This is a fabricated term that is not in the medical literature. It is a scenario term made to attract customers developed entirely with marketing tactics. We recommend that you do not listen to such fabrications.

*Page content is for informational purposes only. Please consult your doctor for diagnosis and treatment.*

How Hair Transplantation Is Performed

Are you considering hair transplantation? We are sure that you are looking for the answer to the question of how hair transplantation is done. You want to get information on this subject. In this article, we will examine the stages of hair transplant operation one by one. There are two different methods called FUT and FUE in hair transplantation. We will examine the FUE method here.

We can explain a hair transplant operation in 3 parts.

a) Pre-Hair Transplant Period
b) Operation Process
c) After Hair Transplantation

How Hair Transplantation Is Performed Which Stages Are There

Firstly, it is useful to take a brief look at the stages of a hair transplant operation. Some transplants may take a few days depending on the number of grafts.

– Arrival and Welcome to the Hair Transplant Centre
– Operation Preparation Phase
– Hairline Design
– Hair Transplantation (Surgical Phase)
– Finish and Departure from the Centre

Arrival and Welcome to Hair Transplantation Centre

You are entering an exciting period. Today, you will go through a process that you will encounter for the first time in your life. If you are coming from a distance, procedures such as physical examination, anamnesis, questioning, graft planning can be performed before transplantation. If the transplantation will not be performed with sedation, it is recommended to have a light breakfast before the operation. Be sure to share your hesitations and last questions about transplantation with your physician.

Preparation Procedures Before Transplantation

You will undergo some paramedic procedures as a preparation before hair transplantation.

– Hair Transplant Consent Form: Details of the medical intervention to be performed must be given in writing. This is already a legal obligation. The details of the medical intervention performed on you should be included in the annexes of the consent form. Signing this consent form before hair transplantation is a legal sign that you accept the procedure performed on you. You can request a copy of the consent form after the transplantation.

– Blood Pressure and Pulse Control: It is normal to be excited before the operation. Your blood pressure and pulse rate are measured. If there is an abnormal situation, your doctor can make the necessary intervention.

– Putting on the Operation Gown: You will wear a disposable surgical gown to prevent your daily clothes from sinking. Wear comfortable clothes that are easy to put on and take off when you come to the transplant. Do not wear zero collar sweaters etc. It may damage the transplantation area when wearing it again after transplantation. A t-shirt with a wide collar or a buttoned garment may be preferred.

– Pre-shave photo shoot: Photos are taken to compare your condition before and after. If possible, both wet and dry photos should be taken. The photos taken also help the doctor visually during hair transplantation.

– Hair Shaving: Before the transplantation, the hair is shaved to number zero (1mm length). If unshaven hair transplantation is planned by your physician before transplantation, shaving is performed according to that planning.

– Photographing After Shaving: We find it more accurate to compare the hair before and after shaving. Photographs should be taken with high resolution in a quality light environment. It is important to compare the results before and after hair transplantation. The use of the photographs by the hair transplantation centre with open or closed face depends on the written permission of the patient.

– Washing the hair: Hair should be washed with antiseptic solutions before transplantation. It is both better in terms of hygiene and if the hair is oily, it can be removed in this way.

– Vascular Access: It is a routine practice to open a vascular access in all surgical applications. This gives us an advantage for intervention in emergency situations (For example, an allergic condition may develop, sudden blood pressure drops may occur.) The person can be monitored during the operation.

Hairline Design

Hairline is one of the important parts of hair transplantation. For a hairline design suitable for the facial structure of the person, an artistic skill of the doctor is required. Because the hairline is very important for a natural hair transplantation. A hairline that is not designed correctly will definitely make the person unhappy.

The hairline can be done before shaving, after shaving or after the grafts are taken before starting the transplantation.

What are the Stages of Hair Transplantation?

After completing the preparation for the operation and hairline design stages, we now proceed to hair transplantation. We can group the surgical stages of hair transplantation as follows. As an answer to the question of how hair transplantation is done, we can say two parts as intake and transplantation.

Graft Extraction

– Marking the donor area with a pencil
– Donor Site Local Anaesthesia
– Collection of Hair Roots

Hair Transplantation Phase

– Local Anaesthesia of the Sowing Area
– Opening of Channels
– Placement of Grafts into the Canals
as the following.

1. Removal of Grafts

We can divide the collection of grafts into 3 stages.

– Marking the donor area with a pen
– Donor Site Local Anaesthesia
– Collection of Hair Roots

a) Marking the Donor Area with a Pen
The boundaries of the donor area where the hair follicles will be taken are first delimited by drawing with a pencil. It is necessary to be careful especially in the area above the ear. Care should be taken not to go beyond the areas we call safe areas. Let’s not forget that everyone has a number of grafts that can be taken according to their hair density. We can briefly call this donor capacity. It is not correct to take grafts above the donor capacity. The estimated number of grafts that can be taken should be calculated in advance. Nape area hair is generally used as donor area. If it is thought that hair follicles will not be enough, other body hair such as beard and chest can also be used.

b) Local Anaesthesia of the Donor Area

Local anaesthesia is used in hair transplantation. Some physicians who rarely harvest body hair have stated in the literature that they harvest roots from the body under general anaesthesia. We do not prefer it. The most feared part of those who wonder how hair transplantation is done is perhaps the anaesthesia part. Local anaesthesia is the blocking of pain sensation for a certain period of time in the area to be removed or transplanted. Drugs are injected under the skin. Drugs such as jetocaine, Marcain, citanest can be used for anaesthesia. Local anaesthesia is a painful procedure. Pain sensation can be felt differently from person to person. This is called pain threshold.

We can classify the pain threshold in three groups.

– Good: There is almost no reaction to the injection. Anaesthesia can be given easily.
– Moderate: There is a moderate response to the injection.
– Low: Some people have a very low pain threshold. They feel uncomfortable even at the first injection

In people with a very low pain threshold, the patient can be put to sleep for a short time before anaesthesia, which we call sedation. If sedation is to be performed, it must be performed by an anaesthesiologist. Sedation also has its own complications. The duration of anaesthesia in the donor area lasts between 2-5 minutes on average.

c) Removing the hair follicles one by one

The area to be taken was marked and determined, the hairy area was anaesthetised, and now we have come to the stage of taking hair follicles. There are two basic methods of hair harvesting, FUT and FUE. We will explain graft harvesting with FUE method. The patient is placed face down on the hair transplantation chair. Some doctors prefer graft harvesting in sitting position.

It is useful to know some graft definitions before graft harvesting.

– According to Donor Quality (Bad, Good, Medium)

– According to the Length of the Graft (Short, Medium, Long)

– We classify according to the volume of the graft (Thin, Normal, Thick). These are classifications that we have created completely according to our experience. This classification is extremely important in terms of the needle length and width used to open the canal.

FUE hair transplantation method is generally preferred by those who research how hair transplantation is performed. Hair follicles can be extracted in two ways with FUE. These are;

– Manual FUE : It is the manual removal of hair follicles one by one using special tools. Manual method was used in the first years of FUE. Manual punches can be fish mouth, round and U graft punches. The 1 mm long hair follicle is centred and entered into the skin at a certain depth. Then, the hair follicles are removed one by one with right and left rotation movements.
– Micro motor method: The micro motor used by dentists has been modified and started to be used in hair transplantation. In recent years, the micro motor method has become more prominent. By rotating in one direction with a certain rotation speed, the skin is entered and the hair follicle is liberated.

Things to Consider in Graft Procurement

Some medical rules must be followed during graft harvesting.

If we look at these principles briefly;

– It should be taken with the thinnest punches possible. Punches of different diameter and length should be used according to the thickness and length of the hair. An experienced physician can easily determine this after several graft harvesting.

– The micro motor should be used at the lowest possible speed. If we try to take a large number of grafts in a short time, the grafts may be damaged during harvesting.

– It should be taken without going beyond the safe area. Especially from the areas above the ear, harvesting should be done less or harvesting should be done more carefully. Planning should be made according to the graft capacity. According to the number of roots per centimetre, 25-30% of the average density should not be exceeded.

– Homogenous harvesting should be done. If homogenous harvesting is not performed, moth-eaten images may occur.

– Fewer number of grafts should be taken from near the end points of the donor area compared to the inner areas. In this way, there is no sharp transition line between the grafted and non-grafted areas. There is a transparent transition.

2. Hair Transplantation Phase

We can examine the hair transplantation phase in 3 sections.

– Local Anaesthesia of the Transplantation Area

– Opening of Canals

– Placement of Grafts into the Canals

We have divided the hair transplantation stage into three groups: anaesthesia of the transplantation area, opening the canals and placing the roots. Now we can examine these stages. It is the most critical part of a hair transplant operation. This is the most curious subject for those who research how hair transplantation is done. Grafts taken from FUT FUE or body hair are stored in petri dishes before transplantation.

a) Local anaesthesia (Transplantation Area)

Theoretically, the anaesthesia of the extraction site and the transplantation site is performed on the same principles. Transplantation can even be performed simultaneously. In other words, transplantation can be performed without waiting while the graft is taken from the donor area. In such transplants, the anaesthesia of the donor area and the transplantation area is performed together.

b) Opening the Canals

What we describe here is the application performed with the classical fue method. In the balding area, micro channels are opened before the number of grafts to be transplanted. These channels are perforated with special cutting tools such as slit, sapphire tip. In some places, razor blades are used instead of slits. Scalpel blades used to be used in canal opening. However, it is now abandoned because it causes serious scarring. Depending on the diameter of the grafts, channels between 0.7 mm and 1.2 mm can be opened. It is especially important that the diameter of the canal opened is minimum. The canal method is now outdated in terms of how hair transplantation is performed.

When opening micro channels in the canal method, there is a lot of bleeding. Adrenaline is used by some clinics to reduce this bleeding. Adrenaline is one of the major drugs of emergency medicine used in vital situations. It has a vasoconstrictor effect. Therefore, it has a bleeding-reducing effect. However, since it narrows the capillaries, it reduces blood flow. Therefore, it may cause malnutrition in transplanted grafts and a condition called tissue necrosis may occur. It also has effects such as increased blood pressure and heart rhythm disorders.

After anaesthesia, micro channels are opened as many as the number of grafts taken. Hair follicles will be placed into these channels. There are different tools used by physicians to open canals. Canals are opened with sharp and pointed tips such as slit or hypodermic needle etc. There are two important features of the canal opening process

– Depth of the trench: There must be a depth control. The canal should be opened at a depth compatible with the length of the hair follicles. In canals opened in excessive depth, the growth rate of hair follicles decreases. Scars are formed on the scalp and weak hair may grow curly. The deeper a canal is opened, the more folliculitis and acne in the hair follicles

– The width (diameter) of the opened canal: In very wide canals, a sparse appearance occurs. In addition, the risk of scars on the scalp increases. In very narrow channels, the risk of trauma increases when placing hair follicles. These are the disadvantages of the fue method. For this, single and multiple grafts should be opened with slits of different diameters.

The entrance angle of the opened canal is one of the important criteria in ensuring naturalness. Canals can be opened in two ways as lateral and coronal slit.

– Lateral slit technique: The angles are lateral and it is easier to give angle. Coverage in terms of image is more than coranal slit technique. Channels are opened laterally parallel to each other.

– Coronal Slit: Channels are opened vertically, not parallel. It is difficult to provide a natural appearance, but it is easier to place the roots. Those who take the easy way out usually open canals in this way. In our opinion, canal opening with lateral slit technique is better than this.

c) Placement of the grafts in the opened canals

The duration of the canal opening process varies according to the number of grafts. It can usually take up to 1 hour. Adrenaline is usually applied to the scalp to reduce bleeding. In addition, saline is injected into the transplantation area. The reason for this is to place the grafts more easily by expanding the channels. The cause of swelling after hair transplantation is this fluid.

In the opened channels, 1-3 people take hair follicles from petri dishes and place them one by one with the help of pliers. Individual grafts are placed on the front lines. This is important for natural hair transplantation and hairline. Generally, the grafts placed on gauze are kept on the back of the hand. Taking too many grafts on the back of the hand may cause the grafts to dry out. When holding the grafts with pliers, it is necessary not to hold them from the root part, otherwise the grafts may be crushed.

How is Dhi Hair Transplantation Performed with Implanter Pen (Pen Method)?

If you ask how the best hair transplantation is done, it is the implanter pen (pen technique) method. Unfortunately, it is wrongly known as DHI hair transplantation in our country. In fact, there is no such method as DHI hair transplantation. DHI (direct hair implant) is the name of a hair transplantation company that does it with a pen.

Needle Method (Stick and Place)

It is a very good method in terms of results but difficult to use. One channel is opened with an injector tip and a hair graft is placed at the same time. The doctor does the transplantation alone. Frequent transplantation is possible and the cost is low. There is no collective canal opening process. The disadvantage is that it is a slow method. It is not possible to transplant more than 1000-1500 grafts in one session. Bleeding is slightly higher than the pen method. It does not require a large number of personnel. In fact, we can say that the pen method is a more advanced version of the stick and place method.

End of Operation and Departure from the Clinic

You have finished a difficult process. We can imagine that you are quite tired. After the transplantation, your hair is washed with sterile isotonic spray. This is to remove clot residues. Do not get up suddenly from the table. It may cause a sudden drop in blood pressure as a reflex. If you feel tired, you may be offered fruit juice or buttermilk. This is good because of fluid loss. You may have pain at the end of the operation. Your doctor will solve this situation. A bandage is wrapped around your head to put pressure on the nape of your neck. Do not remove the bandage until washing.

What can be included in a support package?

– Mattress protector: Cover the pillow with this protector when you get home. This is to prevent your pillow from sinking.

– Pillow-collar: You can sleep more comfortably with a cervical collar.

– Painkillers: Even very simple painkillers are usually sufficient.

– Shampoo: In general, the shampoo we recommend in the first 1 month after transplantation is baby shampoos.

– Edema Remover Drug: In general, decort prednol type tablets are very effective for swelling after hair transplantation.

– Washing Lotion: It will help soften the crusts before washing.

Now that the transplantation is over, you can go to your home or hotel and rest. Our advice is not to go out unless you have to until the first wash after hair transplantation.

How is Choi hair transplantation performed?

The pen technique called dhi is also known as choi. In short, we can call it the drill and place method without touching the hair follicles. It is the best hair transplantation method. In addition, unshaven transplantation can be done easily.

How is the best hair transplantation done?

According to our experience since 2006, the best results in hair transplantation are obtained with the pen method. We can say that it is the best method for unshaven, natural and frequent hair transplantation.

How is natural hair transplantation done?

Naturalness is the most important criterion for hair transplantation. It should not be known by others that you have transplantation. Direction determination is a very important criterion for natural hair transplantation. The pen method gives us a great advantage in this regard.

Which one should I prefer, micro motor or manual FUE?

In our opinion, the important thing is not the tool. It is the correct use and experience of the person using that tool. Try to clarify the question of who will do the hair transplantation without getting stuck on this detail.

*Page content is for informational purposes only. Please consult your doctor for diagnosis and treatment.*

Hairline and Natural Hair Transplantation

One of the most important stages of the hair transplantation operation in terms of the result is the creation of the hairline called hairline. It is also the most important evaluation factor for natural hair transplantation. The biggest concern of those who want to have hair transplantation is whether the transplanted hair will look natural. The natural result of the hair transplant operation depends entirely on the artistic skill of the doctor who will perform the operation.

Determining the front line with a correct design will give the hair that will grow out a natural hair transplantation appearance. If we look at the factors in determining the hairline;

– Age of the person (hair transplantation performed at an early age may not be correct in those with a rapid hair loss cycle).

– Hair loss rate and family history of hair loss (father, uncle, brother, uncle). The history of hair loss in the family gives important clues about hair loss and speed in the following years.

– Facial structure and forehead width A line compatible with the facial structure is an important criterion for natural hair transplantation.

– Number of grafts taken or to be taken. The total capacity of the nape, beard and body grafts should be determined. The number of grafts to be taken should be balanced according to the hair loss rate. Replacement hair reserve should be calculated for hair loss in advanced years.

Hairline Definitions

When designing a hairline, it is useful to know some classical definitions in advance. Let’s explain these definitions briefly.

– Frontal hairline FHL We can give this name to the entire frontal hairline. We can give this name to the area extending from right to left until the junction of the beard and sideburn area.

– Mid frontal Point MFP It is the point where the right and left lines meet in the middle.

– Mid Pupillary Point MPP The midpoint where a line drawn vertically from the pupil meets the frontal line.

– Transition zone (TZ) – Transition Zone: It is the most anterior region of the front line. We can say that it is an irregular 1-2 mm wide area where only individual hair follicles should be. This area should be relatively sparse. If possible, the thinnest single grafts should be selected.

– Defined zone (DZ): It is the 5-8 mm wide area just behind the transition zone. This area should be denser than the transition zone. Double grafts are preferred to ensure that the density is seen more in this area.

– Frontal temporal angle (FTA): It is the junction of the frontal hairline and the favourite area called temporal hairline. Both areas are separated by an angle at the junction.

– The lateral hump (LH) or lateral fringe: It is the area where the parietal region (side hair region) and the balding area meet backwards from the temporal hairline.

– Temporal points (TP): It is the point where the triangle in the favourite area, which we call the temporal region, makes an opening on the outer part of the triangle.

– FT (Frontal Truft): The oval or round area with a diameter of 2-3 cm, including the transition area just behind the frontal line. This area is recommended to be the densest. It is the area where multiple roots should be the densest. We recommend this density for dark coloured hair. Excessive density on white coloured hair can spoil the natural look

– Epicant Line: It is the vertical line drawn from the junction of the lower and upper eyelid to the frontotemporal junction, which we call FTA.

How should natural hair transplantation and hairline be?

It should not be forgotten that a person with moderate to severe hair loss can never be promised to regain his/her 18-year-old hair. We can say that hair transplantation is a kind of visual illusion. The hair density born from the mother cannot be achieved especially with a single-session operation. The main feature expected from a hair transplant is a natural appearance. It should not be understood by other people that a hair transplant has been performed, and the other person should not have the perception that he/she has had a hair transplant. Those who prioritise a natural appearance should also be selective in choosing a hair transplant centre or doctor. The patient’s hair loss rate and the maximum degree of hair loss that may occur should be predicted in advance. The age of the patient is the most important factor here.

In a hair transplantation performed on a person of advanced age (40-50 years), the line should not be too far ahead. Lowering the line downwards disrupts the natural appearance. In addition, applications to the sideburn and temple area require a correct design. The most important reason for the unnatural “grass man” appearance is the lack of a correct hairline design.

In addition, the line design should be made by calculating the shedding rate, the age of the person and the donor capacity. Patients usually want the line to be quite far in front. By showing 18-year-old photos of their hair without hair loss, they actually give us the front line message they want. A young person with a high shedding rate may be satisfied with the appearance in the first plan, but as the shedding continues, there may not be enough grafts for the second or third sessions. If there was an unlimited donor supply, this would not be a problem and drawing in lower areas could be planned. An experienced doctor calculates the total donor capacity and balding area and adjusts the hairline height within a logical proportion.

In addition, the line design should be made by calculating the shedding rate, the age of the person and the donor capacity. Patients usually want the line to be quite far in front. By showing 18-year-old photos of their hair without hair loss, they actually give us the front line message they want. A young person with a high shedding rate may be satisfied with the appearance in the first plan, but as the shedding continues, there may not be enough grafts for the second or third sessions. If there was an unlimited donor supply, this would not be a problem and drawing in lower areas could be planned. An experienced doctor calculates the total donor capacity and balding area and adjusts the hairline height within a logical proportion.

Natural Hair Transplantation requires a correct line design. How to achieve a natural look? In the simplest terms, imitating the hair design in creation is the simplest method to create a natural appearance.

What are the Natural Appearance Criteria?

– The grafts transplanted to the front lines should be single grafts: All of the grafts transplanted to the front lines in the hair transplant operation should consist of single grafts. Even if possible, these single grafts should be selected from the finest ones. The hair in the nape area, i.e. the donor area, is thicker than the hair in the front lines. If thick hair is taken from the nape and transplanted to the front line, this may be a problem in terms of naturalness. For this reason, possible thin and single grafts should be transplanted to the front line. It is not correct to transplant double, triple or more multiple grafts to the front line. Single grafts above the ear and in the lower part of the neck are relatively thinner than other single grafts. It is possible to obtain a more natural appearance by using these thin roots while creating a line. The transition zone called TZ should have an increasing density from front to back. Multiple grafts can be placed behind the single grafts in the first rows. The density of the front hairline is 25-30 grafts per square centimetre. It is not very correct to transplant hair at a very high density per square centimetre. This decreases the survival rate of the grafts. At the front, irregular, thin and single hair grafts are placed in a scattered manner. This contributes to the natural appearance. A flat image is not pleasant in terms of appearance.

– Sufficient and Strong Donor Area: Total donor capacity should be measured. How many grafts can be taken from the person in a strong and strong way and without disturbing the appearance of the donor area? How many cm2 is the area to be transplanted. In other words, how many grafts will be placed in 1 cm2. It is difficult to achieve a natural appearance in cases such as Norwood 6-7 where the opening is excessive and the donor area is insufficient.

– Density: For a natural appearance, the amount of grafts per 1 square centimetre should be at least 30-35 grafts. A sparser image may cause problems in terms of naturalness. In addition, there should be a balanced transition from a sparse or empty area to a dense area. If there is a gap in the transition areas, this may disrupt the natural appearance.

– A correct hairline design: Especially young people expect a straighter line. Because they do not want to accept the hair loss they experience. This is understandable. However, it would not be right to start the line too far in front at an advanced age. It is necessary to draw a balanced and careful drawing, especially in those who experience a rapid hair loss process and in people with the same hair loss type such as father and brother. Especially in young patients, we do not find it right to force the patient to use drugs such as Finasteride / Minoxil for life in order to keep the hairline in front. It should also not be a straight line. In order to ensure naturalness, indentations such as sawtooth also damage the natural appearance. Best of all, it is possible to provide a more natural appearance with light and transparent indentations and protrusions.

– Creating the Front Hairline

– The creation of the front hairline starts by determining the centre point of the line.

– Tepiti of the Centre Point (MFP Determination)

– Two lines are used to determine the centre point.

These are

Glabella line: It is a horizontal line drawn from the upper eyelids and the root of the nose wing.

SEBL line (Supra eyebrow line): It is a horizontal line drawn from the top point of the inner side of the eyebrows.

Both lines can be used for midpoint detection. There is a difference of approximately 1 cm between the two lines. The glabella line is 1cm lower.

A perpendicular line is drawn upwards from the glabella line. a perpendicular line is drawn upwards. A line of 7 cm is drawn upwards from the glabella point. This 8 cm point is the lowest point to be created. We have explained the name of this point as mid frontal point above. It is not correct to start from the 8 cm point in people with a large balding area. Because there may not be many grafts left for the middle and top regions. We believe that it is more accurate to increase this line up to 10 cm in these people. If the SEBL line is to be taken as a basis, these numbers can be reduced by 1 cm.

Another way to adjust the centre point of the front hairline is as follows. A vertical plane is determined from the nose wing upwards and a horizontal plane is determined from the top of the skull. At the junction of the horizontal and vertical planes, we mark the point corresponding to a 45-degree angle. We can design this point as the Mid frontal point. In this way, the centre point of the front line can be easily created. If the midpoint of the front line is based on SEBL, it can be considered as 7-7,5 cm. If the Glabella line is taken as a basis, a distance between 8-8,5 cm can be marked. This distance is the lowest point that can be planned in line design. It is not correct to go lower.

For people with a high degree of hair loss such as Norwood 6-7, it will be useful to keep the midpoint of the line 1-2 cm higher than the determined heights. In addition, factors such as the patient’s facial structure, age, hair loss rate, the person’s expectation and total donor capacity should be taken into consideration in determining this midpoint. Keeping the hairline excessively high increases the appearance of baldness in the forehead area.

Adjusting the Slope of the Hairline

The centre point of the front hairline merges with the angle point of the gulf region by making a slope. This slope, which we call contour, can be done in several ways.

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