An LH-FUE hair transplant hour by hour: what really happens on the procedure day

Updated: 7 September 2026 — Dr Khalil El Cadhi (Dar El Hakim, Djerba).

An LH-FUE (Long Hair FUE) hair transplant takes place over a single day, under local anaesthesia, without shaving the donor or the recipient area: reception and checks in the morning, hairline design, extraction of long-hair follicular units, a lunch break, then incisions and implantation in the afternoon. Expect 6 to 9 hours at the practice depending on the number of grafts, and discharge the same evening — hair styled, with an immediate preview of the result since the transplanted hairs are implanted at their original length. Here is, hour by hour, what really happens.

8 am — Reception, checks and photographs: nothing starts without a check

The day begins with a full medical check: vital signs, review of the pre-operative instructions (no anti-inflammatories or alcohol, breakfast eaten, hair washed), consent re-read and signed, last-minute questions. Standardised photographs are taken from several angles: they serve as an objective reference for following progress at 6 and 12 months. It is also the moment when the plan drawn up at the consultation is reconfirmed — areas to cover, planned number of follicular units, priorities if density has to be arbitrated. No design decision is taken “in the chair”: the procedure day executes a plan, it does not improvise one.

8:30 am — Designing the hairline: the most decisive step of the day

The hairline is drawn with a dermographic pencil by the surgeon, in front of the mirror and with your approval, respecting the proportional landmarks of the face (position of the mid-frontal point, temporal curvature, natural asymmetries). Ten minutes of drawing commit years of visible result: a hairline that is too low or too straight is the first cause of an artificial-looking result — and one of the most frequent reasons for repair requests. With LH-FUE, the simulation is easier to read than with a shaved technique: since your existing hair is at its normal length, you can see directly how the new line will blend into your hair.

9 am — Local anaesthesia and preparation of the donor area

The procedure is performed under local anaesthesia only: injections in the donor area (occipital and temporal) and then, later, in the recipient area. The first minutes of injection remain the least comfortable moment of the day; once the anaesthesia has taken effect, the work is well tolerated by the great majority of patients, and top-ups are added as soon as sensation returns. A tumescent solution (saline with additives) is then infiltrated to straighten the follicles and make precise extraction easier. You remain conscious all day — free to talk, listen to a podcast or doze.

9:30 am → 1 pm — Long-hair extraction: the technical core of LH-FUE

Each follicular unit (1 to 3 hairs, more rarely 4) is harvested individually with a 0.8 to 1 mm punch, hair left long — this is the specificity of LH-FUE: no prior trimming; the surgeon selects and extracts the grafts working lock by lock, the neighbouring hairs immediately covering the extraction points. This requirement has two honest consequences worth knowing: extraction is slower than in shaved FUE, and an LH-FUE day most often covers a more measured volume of grafts for an equivalent session — selection is based on quality (calibre, number of hairs per unit) and on preserving the donor capital, not on chasing a number. At the practice, the extraction is performed by the surgeon himself: it is an organisational choice that sets the pace of the day, and it is a deliberate one. The grafts are immediately sorted, counted and stored in a dedicated cold solution until implantation.

1 pm — Lunch break: a real pause

A meal is provided at the practice, with the light dressing on the donor area already in place. This break of about 45 minutes is not incidental comfort: it lets you rehydrate, stand up, and approach the afternoon — the implantation phase, which requires you to stay relatively still — in good conditions.

2 pm → 5 pm — Incisions and implantation: angle, direction, density

The afternoon starts with anaesthesia of the recipient area, then the incisions: the surgeon creates each implantation site while controlling three parameters — the angle (10 to 45° depending on the area), the direction (which follows the natural direction of the existing hair) and the distribution of density (tighter on the hairline and the frontal tuft, graded towards the back). It is this geometry, invisible on a quote, that makes a natural result. The follicular units are then implanted one by one: single-hair units on the front line, 2-3-hair units behind for density. With LH-FUE, each implanted graft is immediately visible at its real length: the surgeon adjusts the composition live, the way one adjusts a painting — and you leave the practice with a concrete preview, not of a promise, but of the architecture laid down that day.

5:30 pm — Final check, instructions and discharge

The day ends with a check of both areas, post-operative photographs, written instructions (sleeping with the head raised, sprays, first shampoo according to protocol, what to avoid in the first days) and direct contact details for any question. You leave the same evening, without a bulky dressing, long hair in place — the social discretion of the following days is precisely one of the reasons for choosing this technique (see our dedicated article on recovery and social downtime). Photographic follow-up is then scheduled remotely: the implanted hairs go through a transient shedding phase (shock shedding) before regrowth, the timeline of which is explained before you leave.

What happens next — protecting native hair, treatments, follow-up at twelve months — is detailed in after the transplant: the medical protocol of the first 12 months (in French).

To learn more about this procedure as performed by Dr Khalil El Cadhi in Djerba, see DHI Hair Transplant — Direct Hair Implantation.

FAQ

How long does an LH-FUE hair transplant take?
A full day: 6 to 9 hours on site depending on the number of follicular units and the time needed for anaesthesia and breaks. Long-hair extraction is slower than in shaved FUE — that is the price of not shaving.

Does a hair transplant hurt?
The least comfortable moment is the injection of local anaesthetic, a few minutes at the start of the day. After that, the work is well tolerated by the great majority of patients and the anaesthesia is topped up as soon as sensation returns; the post-operative discomfort of the first days is managed with simple painkillers.

Am I asleep during the procedure?
No: the procedure takes place under local anaesthesia; you remain conscious and can talk, take breaks or doze. General anaesthesia has no indication in this surgery.

How many grafts are implanted in one LH-FUE day?
The volume depends on your plan, but an LH-FUE session generally covers a more measured number of grafts than a shaved FUE of equal duration, long-hair extraction being more demanding. The exact number is defined at the consultation, from the area to be covered and your donor capital.

Who actually performs the steps during the day?
At Dar El Hakim, the design, the anaesthesia, the graft extraction and the incisions are performed by the surgeon; the team assists with sorting, storage and preparation. This question — who does what — deserves to be asked before any hair transplant, wherever it is performed.

Can I come from abroad for a one-day procedure?
Yes: the usual pathway includes a prior consultation (on site, or by video call for the initial exchange), the procedure day, and a check before departure — in other words a short stay in Djerba. The absence of shaving makes a discreet return to professional life easier.

About the author

Dr Khalil El Cadhi — hair transplant surgeon, MBA Paris-Dauphine, Full Member of the ISHRS (International Society of Hair Restoration Surgery), Dar El Hakim practice (Djerba, Tunisia). He performs FUE and LH-FUE (no-shave long-hair transplant), personally carrying out the surgical steps of every procedure — design, extraction, incisions.

General information that does not replace a consultation. Hair transplantation is a surgical procedure that carries risks, limits and individual variability of results, which are explained at the preliminary consultation; the times and volumes quoted are orders of magnitude.

Want to know whether LH-FUE is indicated in your case — and what your day would look like? An assessment consultation examines your donor area, defines the plan and answers every question in this timeline. → drelcadhi.com

Also in this series

• Long Hair FUE: the no-shave hair transplant
• LH-FUE: are you a good candidate?
• LH-FUE: immediate result, recovery and social downtime

Sources
– Practice and recommendations of the International Society of Hair Restoration Surgery (ISHRS): organisation of an FUE session, incision parameters (angle, direction, density), graft storage.
– Descriptive data on the Long Hair FUE technique: long-hair extraction without shaving, immediate visualisation of the result, more measured session volumes than in shaved FUE.
– Pillar article: No-shave hair transplant LH-FUE (drelcadhi.com)
– Related articles: LH-FUE — are you a good candidate? · LH-FUE — recovery and social downtime · Hair transplant: who actually operates on you? (drelcadhi.com)