Follicular Unit Excision (FUE) has become the most widely performed technique in hair restoration.

FUE has 4 steps –

1. Step 1 – Duration 30 mins –  1 hour ( Doctor step ) Planning and Slit making ( channel making)  in bald area – decides direction and density of hair transplant . Duration – 1 hour 
2. Step 2 – duration 2 – 4 hours  – (Doctor step) – Follicular unit excision ( FUE ) from donor area – This step uses punches which cut the skin around the graft. If done incorrectly it can damage the grafts and transect the grafts . 
3. Step 3 – Duration – 30 mins ( assitant step ) – plucking of grafts from donor area after FUE  ( sometimes called Graft extraction to confuse patients ) and counting of grafts 
4. Step 4  – Duration 2 – 4 hours – (Accepted as assitant step to reduce cost and do more number of grafts in a day ) – Insertion of grafts into holes / channels /  slits of bald area which were created by surgeon

According to international defined protocol of hair transplant surgery – slitting ( step 1 ) and  graft excision from donor area ( step 2 )  should always be done by doctor himself. These steps cannot be done by nursing staff or assitants or hair technicians. 

Indian national board protocol also defines it step 1 and step 2 as surgeon role and high skill job. 

While FUE is marketed as a uniform procedure, the reality varies significantly between clinics.

In more than 95 % hair transplant centers in India and Turkey , the most critical part of the surgery—the actual follicular unit excision from donor area ( step 2 as defined above)  —is delegated to assistants or nursing staff or unqualified doctors ( trichologist , dentist , ayurveda doctor, homeopathy doctor)  or other junior Doctors.

How it impacts your results – Unfortunately hair transplant depends on number of grafts inserted in bald area. It does not depends on additional donor area damage caused by nursing staff . Suppose you require 3000 grafts to cover area. So if a nursing staff attempt on 5000 grafts and damages 2000 grafts and removes 3000 grafts from donor area , then also result will remain good as result is coming due to 3000 grafts implanted. 2000 grafts loss from donor area will not be visible in photos . Total donor area capicity is 6000 – 7000 grafts in your life so now whenever you will need hair transplant – surgeon can remove less grafts from donor area in future.  Before and after photos of result in hair transplant surgery are not different. So even if nursing staff removes grafts still you can a good result in before after photos .   But It may result in 30 – 80 % additional permanent donar area damage which restrict possibility of future FUE hair transplants. This discrepancy creates a large variation in graft quality, transection rate, donor depletion, and long-term outcomes.

• When patients goes deeper into sugeon role in his hair transplant – More than 50 % hair clinics in India and turkey introduce one of their nursing staff (hair technician /  assitant ) as junior doctor or trichologist so that patient thinks that doctor only doing FUE from donor area. But that junior doctor is their actually their staff rather than a doctor. 

To address this gap and help patients differentiate high-precision, doctor-performed FUE from mass-produced, technician-driven procedures, we introduce DrHV FUE , a FUE protocol in which all graft harvesting is performed exclusively by the surgeon.