Understanding the Procedure
How a hair transplant is actually performed.
Quick answer: Grafts are taken one at a time from the back and sides of your head, tiny incisions are made where your hair is thinning, and the grafts are placed into them. That's really the whole procedure. FUE is how the grafts are taken, DHI is a tool for placing them, and Sapphire is the type of blade used. They're not different operations. What really decides your result is how the incisions are made and how carefully the grafts are handled.
Hair transplant marketing is full of technique names, but most of them just describe a tool, not a different operation. Behind the branding, almost every modern procedure follows the same steps.
The operation, start to finish
Planning and the hairline
The surgeon looks at the back of your head, works out how much hair can be used, and draws your new hairline on your scalp. You should see it, talk about it and be happy with it before anything else happens.
It should be based on your face, your age and how your hair loss is likely to change, not a one size fits all template.
This decides how natural it looksShaving and anaesthetic
The back of your head is usually shaved so the grafts can be taken accurately. Then you'll have local anaesthetic injections. You're awake the whole time, and to be honest, this is the part most people find the least pleasant.
Extraction
The grafts are taken one at a time from the back and sides, using a tiny round punch that's usually less than a millimetre wide. Each one leaves a small mark that heals to a tiny dot.
The punch can be manual or motorised, but that matters less than how evenly the grafts are taken, and how many.
This decides your donor area for lifeSorting and holding
The grafts are checked, sorted by how many hairs each one has, and kept in a chilled solution until they're placed. Single hairs usually go along the hairline, and bigger grafts go behind it for thickness.
Grafts are living tissue, so how long they're out of your body and how carefully they're handled affects how many survive.
This affects how many grafts surviveCreating the recipient sites
Tiny incisions are made where your hair is thinning. Each one decides the angle, direction and depth of a graft, and how close together they are decides how thick your hair will look.
Hair doesn't grow straight out of your head. It grows at different angles in different places, and getting that right is the difference between hair you can style and hair that sticks up.
This is where your result is decidedPlacement
The grafts are then placed into the incisions, usually with fine tweezers, or with an implanter pen if it's DHI. It's slow, careful work, and it's usually done by trained technicians.
The skill is in handling the grafts gently and placing them at the right depth.
Dressing and instructions
The back of your head is dressed, you'll get your aftercare instructions, and usually you'll go back the next day for a check-up and your first wash.
What the technique names actually mean
This is where a lot of the confusion comes from, so I'd like to keep it simple.
| Name | What it actually refers to |
|---|---|
| FUE | Follicular Unit Extraction. The method of removing grafts one at a time with a punch, rather than cutting out a strip. This is the standard approach in almost all modern clinics. |
| FUT | Follicular Unit Transplantation, the older strip method. A band of scalp is removed and dissected into grafts, leaving a linear scar. Still used, mainly for very large sessions, and now uncommon for international patients. |
| DHI | Direct Hair Implantation. A placement technique using an implanter pen that creates the site and inserts the graft in one movement, rather than placing into pre-made incisions. |
| Sapphire | A blade material. Sapphire-tipped blades are used to create the recipient sites instead of steel. That is the whole difference. |
So what actually affects the result?
Four things, and none of them are in a technique name.
- The plan. Where your hairline goes, how the grafts are shared out, and what's left for later. A good plan matters more than anything else.
- The incisions. The angle, direction, depth and how close together they are. This is the artistic part, and it decides whether your hair looks natural.
- How the grafts are handled. How long they're out of your body, how they're stored, and how gently they're handled.
- Not taking too much from the back. Taking too many grafts, or taking them unevenly, can leave the back of your head thin for good, and that can't be fixed.
Three of those four come down to people's decisions, not equipment. That's why who's making those decisions matters much more than what the clinic calls its technique.
Questions worth asking about the procedure
- Who makes the incisions? This is the step that decides your result.
- How many grafts will you take, and from how wide an area? Spreading them out protects the back of your head.
- How long will the grafts be out of my body? A good clinic will have an answer.
- How many patients are being treated at the same time? It affects everything above.
- Will I be shaved, and how much? A practical one, but people are often surprised on the day.
If a clinic answers these clearly, it shows they've really thought about them, and that tells you a lot.
What it is like on the day
It's a long day. Most procedures take most of the day, with breaks. You're awake and can chat, and once the anaesthetic has worked you shouldn't feel pain, although you'll feel some pressure and movement.
The anaesthetic injections are the bit most people remember as uncomfortable. The rest is more boring than painful, so I'd take headphones and something to watch, because it's a long time to lie still!
You can read about what happens afterwards and how to judge your result once it grows.
Frequently asked questions
What is the difference between FUE and DHI?
FUE describes how grafts are extracted, one at a time using a small punch. DHI describes how they are placed, using an implanter pen that creates the site and inserts the graft in one movement rather than placing into pre-made incisions. They are not competing operations. A DHI procedure still uses FUE extraction.
What is Sapphire FUE?
It's just the type of blade used to make the incisions. Sapphire-tipped blades are used instead of steel, and that's the only difference. It's not a different type of surgery.
Which part of a hair transplant matters most?
The creation of the recipient sites. Each incision sets the angle, direction and depth at which a graft will sit, and the spacing sets the density. This is what determines whether the result looks like hair or looks like a transplant.
Does a hair transplant hurt?
The anaesthetic injections are the uncomfortable part, and most people remember them as the worst bit. Once the area is numb, the rest is more boring than painful. It usually takes most of the day, and you're awake the whole time.
Will my head be shaved for a hair transplant?
The back of your head is usually shaved so the grafts can be taken accurately. Whether the top is shaved depends on the clinic and technique, so it's worth asking, because people are often surprised on the day.
What is FUT and is it still used?
FUT, or the strip method, removes a band of scalp which is then dissected into grafts. It leaves a linear scar and has largely been replaced by FUE for international patients, though it is still used in some cases, particularly very large sessions.
Sources
Independent clinical and regulatory sources consulted in writing this page. Links open in a new tab. Last checked 6 August 2026.
- Position statement on prescribing and advertising prescription only medications used to treat male pattern hair loss. British Association of Hair Restoration Surgery. View source
- Male androgenetic alopecia. Endotext, National Center for Biotechnology Information. View source
- Hair loss, male pattern (androgenetic alopecia): patient information leaflet. British Association of Dermatologists. View source
This is general information, not medical advice. Techniques and protocols vary between clinics and only a qualified clinician can advise on your case.