Preview Long Hair FUE: Pros & Cons, Tips & Tricks

To remove an FU, center a semi-sharp punch at the center of the FU (A), angle the punch in the direction of the hair shaft excision (B), start a gentle oscillation movement to incise the skin without cutting the hair shaft (C), pull the hair shaft to expose the excised FU (D), and remove the FU with forceps as you would for any regular FUE (E).

Trivellini long hair punch with blunt indentations in the distal edge and hexagonal ring in the proximal portion.

Devroye’s Tornado serrated punch, with four equidistant blunt notches that capture and protect the hair shaft while cutting the skin during incision of the FU.

Sanusi’s advanced hybrid Intelligent Punch of the UGraft, showing flaring, with no recess on its cutting edges or tips. There is texturing of the wall immediately proximal to the cutting edge.

Visualization of the probable superior limit of the safe donor area in a patient with long hair.

Frontal hairline can be redesigned if needed when looking at the preview result.

Comparison delimiting the recipient area with different densities needed.

Excision and extraction of FUs from exposed scalp while observing the proper exit angle.

Grouped strands of hair measuring about 1cm in width orientation. Photo courtesy Dr. Laura Caicedo.

Note a small patch of long hair left in the donor area for long hair excision practice.

Punches used for long hair FUE excision: SAFE blunt punch, Intelligent punch and WAW Tornado punch do not have notches at their cutting edge. The modified blunt punch, Trivellini long hair punch, and WAW Tornado Schambach notch punch have blunt notches on the cutting edge to “capture” and “protect” the hair shaft during excision.

Grafts popping out of the skin readily for extraction.

How to perform the long hair FUE technique (blue circle): start with punched hole with a long hair graft in it (A), pull hair shaft and expose distal portion of graft (B), and extract graft (C).

Materials needed for the “long-hair safe finger cups” (A), placing long hair grafts in the holding cup (B), grafts inside the finger cup, leaving hair shafts outside (C).

Long hair grafts tend to tangle (left), so we arrange them in a single direction and roll them into bundles of gauze that have been chilled and moistened in holding solution.

Short hair graft loading into implanter (A), curvature “assumed” within the implanter by observing the position of the sebaceous gland (B), long hair graft loading into implanter (C), curvature observed directly providing the direction of placement needed (D).

Observe the incorrect curvature while placement during eyebrow restoration, which can be corrected (A); after visualization (B).

Start placing long hair grafts at the frontal hairline and move backwards. The grafts should face forward so that they are away from your surgical view, and the need for manipulating them is reduced.

Observe how a simple comb can easily pull the graft out of its site.

Comparison of pre-op, immediate post-op, and 1-year post-op photos showing an increase in hair density at the final result compared to the immediate post-op preview.