Preview Long Hair FUE: Seeing Results in Real Time
- Admin
- 1 day ago
- 5 min read
Hair restoration surgery has evolved remarkably over the past two decades, with follicular unit excision (FUE) becoming the gold standard for minimally invasive procedures that deliver natural-looking results. Among these innovations, Preview Long Hair FUE (PLH-FUE) stands out as a technique that allows surgeons to transplant hair while retaining long hair shafts, providing a real-time “preview” of the final aesthetic outcome.
This article draws on the comprehensive review by Schambach (2025) and aims to provide surgeons with practical guidance, surgical tips, and technical know-how to incorporate PLH-FUE into their practice, enhancing both patient outcomes and professional expertise (Schambach, 2025).
What is Preview Long Hair FUE?
Originally described by Pitchon in 2006 and refined in subsequent years, PLH-FUE enables hair transplantation without shaving donor or recipient areas. Long hair shafts remain intact during implantation, offering several unique advantages:
Immediate visual assessment of hairline and coverage.
Greater control over hair direction and curvature, critical in areas like the frontal hairline and eyebrows.
Enhanced patient satisfaction due to minimal disruption of their appearance.
Unlike conventional FUE, PLH-FUE demands advanced surgical skill, patience, and precise hand-eye coordination, making it a technique suited for experienced hair restoration surgeons aiming to offer premium outcomes.
Key Advantages of PLH-FUE
Enhanced Surgical Planning
Long hair improves visualization of unsafe donor areas and facilitates accurate delineation of recipient zones.
Hairline design can be adjusted trans-operatively, improving precision and aesthetics.
Improved Hair Direction and Curvature Control
Natural hair curvature is visible during implantation, allowing precise adjustments.
Critical for eyebrow restoration and frontal hairline refinement.
Minimized Need for Shaving
Retaining long hair reduces psychological impact and supports faster return to normal activities.
Better Donor Area Management
Surgeons can monitor remaining donor density in real-time and make strategic graft allocation decisions.
Challenges and Considerations
While advantageous, PLH-FUE presents specific challenges:
Longer procedure time due to careful FU identification and excision.
Specialized equipment: Modified punches with protective mechanisms (e.g., Schambach notches, Tornado punch, UGraft™ Intelligent Punch®) are essential.
Hair tangling during extraction, preparation, and placement.
Steep learning curve: Even experienced FUE surgeons need dedicated practice.
Step-by-Step Surgical Insights
1. Donor Area Assessment and Planning
Key Considerations:
Long hair makes unsafe donor areas easier to delineate visually.
Accurate coverage value calculation is more challenging without shaving.
Practical Tips:
Reduce the assessment area to 20 mm² and average multiple counts for follicular unit density.
Measure hair shaft diameters from the scalp or extracted telogen hairs and log them for graft planning.
Use hair clips or Velcro to manage collateral hair and maintain a clear donor field.
2. Excision Phase: Graft Harvesting
Challenges:
Locating FUs in long hair requires precision.
Centering and angling punches without cutting hair shafts is critical.
Techniques to Implement:
SAFE rotational blunt punch for controlled extraction.
Trivellini multiphasic punch for rotation and oscillation.
WAW Tornado punch with Schambach notches for atraumatic harvesting.
Reserve small unshaven patches for practice.
Hold hair shafts gently to avoid tangling alongside the punch.
Oscillation is preferred, but controlled rotation can also be effective.
Practical Tip: Practice in small areas first to refine angle, depth, and force.
3. Extraction Phase
Challenges:
Hair can tangle during extraction and handling.
Visibility of excised FUs may be limited.
Actionable Tips:
Trim grafts to 5–7 cm immediately post-excision.
Use custom “long hair safe finger cups”:
Cover finger cups with a cut glove finger.
Add holding solution.
Insert grafts with hair shafts outside the cup to maintain alignment.
4. Graft Preparation
Roll grafts in moist, chilled gauze with hair shafts aligned in one direction.
Minimize trimming or manipulation to preserve follicle viability.
Organize grafts according to recipient site priorities.
Pro Tip: Maintain grafts in small bundles to simplify placement and reduce tangling.
5. Placement Phase
Challenges:
Hair tangling and accidental pulling on neighboring grafts.
Critical curvature areas require precision.
Techniques for Precision:
Start at the frontal hairline and move posteriorly.
Use visible hair curvature to guide placement; implanters can assist.
Correct misplaced grafts trans-operatively.
Place key grafts in high-visibility areas first, adjusting density elsewhere.
6. Post-Operative Care
Educate patients on careful grooming to prevent graft loss.
Conduct the first wash in-office; instruct combing from mid-length to ends.
Demonstrate hands-on styling to avoid trauma during the first week.
Document immediate results with photos and videos; explain that density may differ at 12 months due to cut hair shafts or crusts.
Devices Enhancing PLH-FUE
SAFE Device: Rotational blunt punch for atraumatic extraction.
Trivellini Device: Multiphasic punch with rotation/oscillation and aspiration.
WAW Tornado Punch: Spiral design with Schambach notches for controlled extraction.
UGraft™ Zeus: AI-assisted, non-shaven FUE with recess-free Intelligent Punch® for efficiency.
These devices optimize graft quality, reduce transection rates, and improve handling efficiency, enabling surgeons to tailor techniques to patient needs.
Clinical Insights and Career Advantages
Mastering PLH-FUE allows surgeons to:
Offer premium hair restoration services that differentiate their practice.
Increase patient satisfaction through immediate visual results and superior aesthetics.
Expand procedural repertoire to include eyebrow restoration, frontal hairline refinement, and body hair transplantation.
Stay at the forefront of technological innovations in hair transplantation.
Conclusion
Preview Long Hair FUE is more than a surgical technique—it is a career-enhancing skill. By mastering donor assessment, graft harvesting, and precise placement, surgeons can deliver superior outcomes while offering a premium patient experience. Although technically demanding, PLH-FUE allows surgeons to:
Reduce patient post-operative anxiety.
Control hair density and direction with precision.
Expand service offerings and enhance professional reputation.
Actionable Next Steps:
Practice on small donor patches before full-scale application.
Incorporate specialized punches with protective notches for long hair.
Standardize graft handling and placement protocols with your team.
Document patient outcomes to refine technique and educate future cases.
PLH-FUE is poised to redefine advanced hair transplantation standards. Surgeons who adopt and master this technique position themselves as leaders in aesthetic hair restoration, providing patients with unparalleled precision and satisfaction.
Reference:
Schambach, M. A. (2025). Preview long hair FUE: Pros & cons, tips & tricks. Hair Transplant Forum International, 35(4), 113–125. https://doi.org/10.33589/35.4.113
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