A Sapphire FUE procedure takes 6-10 hours and follows four main phases: donor extraction, graft preparation, sapphire channel creation, and graft placement. The entire procedure is performed under local anesthesia while the patient is fully awake. Here is exactly what happens at each stage.
This article is for informational purposes only and does not constitute medical advice.
Pre-Procedure: Morning of Surgery
You arrive at the clinic typically between 7:00 and 9:00 AM. The first 30-60 minutes are spent on administrative and preparatory steps before the procedure begins.
Pre-Op Checklist
| Step | Duration | Details |
|---|---|---|
| Check-in and consent forms | 15 min | Review surgical plan, sign consent |
| Blood pressure and vitals | 5 min | Confirm safe levels for local anesthesia |
| Pre-op photography | 10 min | Standardized angles for before documentation |
| Hairline design and marking | 15-30 min | Surgeon draws proposed hairline with marker |
| Donor area shaving | 10 min | Back and sides trimmed to 1-2mm |
| Surgical gown change | 5 min | Button-front gown for easy removal |
The hairline design step is the most important pre-op moment. The surgeon draws the proposed hairline directly on your scalp, and you review it with a mirror. This is your last opportunity to request adjustments before incisions begin.
Phase 1: Local Anesthesia
Local anesthetic (typically lidocaine with epinephrine) is injected into both the donor area and the recipient area. This is the most uncomfortable part of the entire procedure.
What It Feels Like
The injections feel like a series of sharp pinches, lasting 5-10 minutes total. The scalp numbs quickly once the anesthetic takes effect. Some clinics use a needle-free jet injector (such as the Comfort-in device) that uses air pressure instead of a needle to deliver the anesthetic. This reduces discomfort significantly.
Once the anesthesia is active, you will feel pressure and movement but no pain for the remainder of the procedure. Top-up injections may be needed every 2-3 hours during longer sessions to maintain numbness.
Phase 2: Donor Area Extraction
The surgeon (or in some clinics, a trained technician under surgeon supervision) extracts individual follicular units from the donor area using a micro-punch tool. This phase is identical to standard FUE and is not affected by the sapphire upgrade.
Extraction Details
- Tool: Motorized or manual micro-punch, 0.7-1.0mm diameter
- Technique: The punch scores around each follicular unit, then the graft is lifted out with forceps
- Pattern: Grafts are extracted in a dispersed pattern to avoid visible thinning in the donor zone
- Speed: An experienced surgeon extracts 500-1,000 grafts per hour
- Position: You lie face-down on the operating table during this phase
For a 3,000-graft session, extraction takes approximately 2.5-4 hours.
Graft Storage
Extracted grafts are immediately placed into a chilled holding solution. Common options include:
- Chilled saline: Standard and effective
- Hypothermosol: Extended preservation solution for longer sessions
- PRP-enriched solution: Some clinics add platelet-rich plasma to the holding solution
Grafts should not remain outside the body for more than 6-8 hours. This time constraint is one factor limiting single-session graft counts.
Phase 3: Recipient Site Creation (The Sapphire Step)
This is the phase that distinguishes Sapphire FUE from standard FUE. The surgeon uses synthetic sapphire crystal blades to create the incision channels where grafts will be placed.
How Sapphire Channels Are Made
The surgeon holds the sapphire blade and creates individual incisions in the recipient area. Each incision must match:
- Angle: 40-45 degrees for a natural growth direction
- Depth: 3-4mm to accommodate the graft follicle
- Direction: Matching the natural hair growth pattern (forward and slightly outward at the hairline, progressively steeper toward the crown)
- Spacing: 50-60 incisions per cm2 for high-density work
This phase takes 45-90 minutes depending on the size of the recipient area. The surgeon creates all channels before any grafts are placed.
Why This Phase Determines the Final Result
The channel creation phase is where the artistic skill of the surgeon matters most. The angle, direction, depth, and distribution of every incision determine:
- How natural the hairline looks
- Whether hair grows in the correct direction
- The achievable density per cm2
- How seamlessly transplanted hair blends with native hair
A technically perfect extraction and placement will still produce a poor result if the channels are created at wrong angles or with unnatural distribution. This is why the surgeon's experience with sapphire blades specifically is a critical selection criterion.
Phase 4: Graft Placement
With all channels created, the placement team inserts each graft into its designated channel. This is typically the longest phase of the procedure.
Placement Process
- Single-hair grafts: Placed along the hairline (first 1-2 rows) for a soft, natural edge
- Two-hair grafts: Placed behind the hairline for moderate density
- Three and four-hair grafts: Placed in the mid-scalp and crown for maximum density
- Speed: A skilled placement team inserts 500-800 grafts per hour
- Position: You lie on your back or semi-reclined during this phase
For 3,000 grafts, placement takes approximately 3-5 hours.
What You Do During Placement
Most patients watch content on a tablet or phone, listen to podcasts or music, or simply rest. The clinic provides breaks for meals and bathroom use. You are positioned comfortably in a reclining chair for this phase rather than the face-down position used during extraction.
Procedure Summary by Graft Count
| Graft Count | Total Time | Extraction | Channels | Placement |
|---|---|---|---|---|
| 1,500 | 5-6 hours | 1.5-2 hrs | 30-45 min | 2-3 hrs |
| 2,500 | 6-8 hours | 2.5-3 hrs | 45-60 min | 3-4 hrs |
| 3,500 | 7-9 hours | 3-4 hrs | 60-75 min | 4-5 hrs |
| 5,000 | 8-10 hours | 4-5 hrs | 75-90 min | 5-6 hrs |
Sessions over 4,000 grafts may be split across two consecutive days to reduce graft time outside the body and to manage surgeon and patient fatigue.
Immediately After the Procedure
Once all grafts are placed, the team applies a light bandage to the donor area. The recipient area is left uncovered so grafts are not disturbed. You will receive:
- Antibiotic medication (to prevent infection)
- Pain medication (most patients need only mild analgesics)
- Anti-swelling medication (to reduce forehead swelling in days 2-4)
- A care kit with saline spray and specialized shampoo
- Detailed written aftercare instructions
You leave the clinic the same day, typically 30-60 minutes after the last graft is placed.
For a comparison of this process to the strip method, see the FUE vs FUT comparison. To understand how your hair loss stage affects graft count and procedure planning, see the Norwood scale guide.
Considering Sapphire FUE? Start with a free AI hairline analysis at myhairline.ai/analyze to get an estimated graft count and Norwood stage assessment before booking a consultation.
FAQ
How long does a Sapphire FUE procedure take?
A Sapphire FUE procedure takes 6-10 hours for a single session depending on graft count. A 2,000-graft session typically takes 6-7 hours. A mega-session of 4,000-5,000 grafts takes 8-10 hours and may be split across two consecutive days. Time is divided roughly equally between extraction, recipient site creation, and graft placement.
Does Sapphire FUE hurt?
The procedure is performed under local anesthesia, so patients feel no pain during extraction or implantation. The most uncomfortable part is the initial anesthetic injections into the scalp, which last 5-10 minutes and feel like a series of sharp pinches. Some clinics offer needle-free jet injectors to reduce injection discomfort. Mild soreness and tightness in the donor area are common for 2-3 days after.
Is the patient awake during Sapphire FUE?
Yes. Sapphire FUE is performed under local anesthesia, meaning you are fully awake throughout the procedure. Most patients watch movies, listen to music, or browse their phone during the session. General anesthesia is not used for hair transplants because the risks outweigh the benefits for an elective cosmetic procedure.