CMCC Focus: FUE transplant without shaving

Jeune homme
The FUE transplant without shaving is a hair transplantation technique that involves extracting follicular units from the scalp one by one and then implanting them on bald areas of the scalp. As its name suggests and unlike other FUE methods, this technique does not require shaving the donor area. It is the least invasive and most discreet method of harvesting hair today, but only a limited number of grafts can be extracted in a single session. For this reason, FUE without shaving is usually prescribed to correct minor alopecia.

Clinical examination

Exploration du cuir chevelu

During the clinical examination, the surgeon determines whether an FUE without shaving is appropriate to effectively treat the patient’s alopecia. His decision depends on several factors:
  • the patient’s type of alopecia: an FUE transplant without shaving is only recommended in cases of androgenetic alopecia, scarring alopecia, traction alopecia or trichotillomania that has resulted in the permanent loss of hair follicles. On the other hand, it is not recommended in cases of telogen effluvium or alopecia, as these are temporary pathologies that do not lead to the destruction of hair follicles.
  • the size of the bald area: during the clinical examination, the surgeon precisely measures the size of the bald area to estimate the number of grafts needed to correct it. He will consider prescribing an FUE graft without shaving if 1,200 follicular units are enough to get a satisfying aesthetic result. If more are needed, the patient will be given other options, such as a partially shaved FUE, a fully shaved FUE or a long hair FUT.
  • The hair density of the donor area: the surgeon evaluates the quantity of usable follicular units in the donor area. For an FUE transplant without shaving, it is also important that the patient has sufficient hair density and has not undergone an FUT transplants with long hair in the past.

Preoperative information

The surgeon will provide the patient with comprehensive and detailed information about the no-shave FUE transplant before the actual procedure. In addition, the patient is given a detailed estimate and an information sheet explaining the hair surgery and FUE transplant without shaving. The patient will then have at least 15 days to think about it before the actual procedure.

Preparing the patient before the procedure

Before the procedure, the patient must undergo a complete surgical assessment (blood test, ECG, etc..) to ensure that the patient is fit for a hair transplant.
On the day before the procedure, the patient must start a cyclin-based antibiotic treatment, which has to be taken for four days.
Finally, the patient must use an antiseptic shampoo on the morning of the FUE transplant without shaving.
Preparing the donor area

Preparing the donor area is done in three steps:

  • 1st step: the surgeon takes pictures of the bald areas and the donor areas
  • 2nd step: the surgeon defines the areas to be corrected with a dermographic pencil. This step requires an active participation of the patient, especially if the FUE graft without shaving involves the anterior frontal area
  • 3rd step: the surgeon injects a solution of adrenalized 1% xylocaine to anesthetize the donor area. The anesthesia is not very painful and takes effect almost immediately. However, for more sensitive patients, a topical cream or contact anesthetic can be applied to further reduce pain.

Graft extraction by follicular extraction without shaving

During an FUE transplant, follicular units are extracted one by one with a circular motorized micropunch of 0.8 to 0.9 mm in diameter. The surgeon pushes the micro-punch without applying pressure on the hair follicle in order to cut the hair’s arector muscle attachment. This step is particularly delicate and requires all the skill of the surgeon to avoid damaging the roots of the follicular unit. Once the hair’s attachment is cut, the surgeon extracts the graft using a micro forceps.

Preparing and preserving the grafts

The extracted follicular units are immediately checked under the microscope to assess their viability and to remove excess tissue. They are then sorted according to the number of hairs they contain (between one and five) and their characteristics (size, shape of the stem, color). Finally, they are quickly transferred to an optimized preservation solution. This is done because the grafts cannot survive for more than 16 minutes in the open air.

Transplanting the grafts into the scalp

Transplantation des greffons dans le cuir chevelu

The surgeon anesthetizes the receiving area with 1% adrenalized xylocaine and then proceeds with the implantation of the follicular units.
There are several transplantation methods available today, but the FUE method recommends the use of a Choi-type implanter in order to preserve as many grafts as possible. These grafts often skeletonize during the follicular extraction process. With a Choi-type implanter, the surgeon minimizes the risk of graft trauma, since he can incise the receiving area and insert the follicular units at the same time.
During the transplantation of the grafts, the surgeon must make sure that the graft is not only undetectable to the naked eye, but that it is also aesthetically pleasing. To do this, he will consider three parameters:
  • capillary density: he must randomly create twenty micro-slits per cm² to achieve natural density.
  • orientation and angle of the existing hair: the orientation and angle depend on the regions of the scalp where the hair is implanted. For example, on the frontal line, the hair is inclined towards the front and, on the tonsure, it is arranged radially.
  • the grafts’ characteristics: the choice of grafts will depend on the type of hair (Mediterranean, Asian, Afro), but also on their position on the scalp. It’s better to implant micro-grafts (1 to 2 hairs) on the posterior areas, mini-grafts (3 to 4 hairs) on the anterior areas and a mix of both on the intermediate areas.
Once the follicular unit is injected into the scalp, the surgeon applies gentle pressure for 10 to 15 seconds with a cotton ball soaked in saline solution to stabilize the graft. At the end of the procedure, the surgeon will place wet compresses and a light compression bandage on the grafts for a few hours.

Post-operative care

FUE transplant without shaving is the least invasive method for the patient’s scalp and, as such, the postoperative period is reduced.
Scabs will appear on the grafts a few days after the procedure: they will fall seven to ten days later, causing the grafted hair to fall out.
From a therapeutic perspective, we recommend cleaning the operated areas regularly with an antiseptic for fifteen days. For the first three days, the patient should simply apply an antiseptic to the grafted area; for the next twelve days, the patient should gently massage the scalp. No bandages are necessary.

Possible complications

Post-operative complications are very rare after an FUE transplant without shaving:

  • an edema may develop in the grafted area before disappearing spontaneously after two to three days
  • there may be some post-operative bleeding
  • hair near the donor and receiving areas may fall out two to three weeks after the procedure due to physiological stress. This is a rare and temporary phenomenon.
  • the scalp may become infected (less than 1% of cases)
  • acne may develop on the scalp
  • epidermal cysts may form on the receiving area two to four months after the procedure. Most often, they disappear spontaneously when the transplanted hair starts to grow.

Hair growth

In general, the transplanted hair grows back three to four months after the procedure for men and five to six months for women. It takes a total of nine to twelve months to see the final result of an FUE transplant without shaving.

Please contact us if you would like more information about FUE or FUT transplants by calling 01 84 83 14 00 or by making an appointment here.