Follicular Unit Extraction (FUE) Hair Transplant.

Follicular unit extraction or FUE is a hair transplant technique in which a small round punch is used to extract follicular units from a patient's bald resistant donor areas. These 1, 2, 3 and 4 hair follicular unit grafts are then transplanted into a patient's balding areas.

Given the time consuming and tedious nature of this procedure a physician is often limited to transplanting 500 to 600 follicular unit grafts in one day. The cost per graft of FUE is also typically twice the cost of the standard follicular unit hair transplant procedure in which a strip of donor tissue is removed from the back of the head and trimmed under magnification into individual follicular unit grafts.

How a FUE Hair Transplant is performed.

During the Follicular Unit Extraction or FUE procedure individual follicular unit grafts are excised one at a time using a tiny one millimeter or less sized punch. Typically the patient's hair in the donor area where these grafts are being removed is cut short so that the physician is able to see the patient's scalp.

The follicular units are extracted using a multiple step process. First a small sharp punch scores the skin around a follicular unit. Then a small dull punch is used to go deeper into the soft tissue surrounding the follicular unit.

Since the direction and angle of the follicular unit beneath the skin can't be seen and can often differ from the direction of the hair on the surface, a sharp punch if used below the surface of the skin might transect or severe the underlying follicular unit. However, the dull punch tends to envelope the follicular unit, while separating it from the surrounding soft tissues. This process is typically referred to as "blunt dissection".

Once the underlying follicular unit is separated from the surrounding tissues it can then be extracted, often by a forceps gripping the hair above the surface.

The small hole left behind after the follicle is extracted then heals over the next few days. This tiny wound contracts as it heals making the resulting round scar smaller and less noticeable. The FUE patient typically ends up with hundreds of small round white scars, which are normally not detectable to the naked eye once the patient's hair grows out.

Comparing Follicular Unit Extraction (FUE) to the Standard Strip Procedure.

While the FUE procedure has grown in popularity, largely due to the minimally invasive way in which follicular unit grafts are removed, the standard strip excision method is still the most popular hair transplant procedure.

Strip Excision Procedure
Donor strip being excised	Incision sutured together	Hair combed down after suturing

The standard strip excision method involves surgically removing a strip of scalp from the bald resistant donor area of the patient. The donor area is then sutured together.

These sutures (either stitches or staples) are then removed about ten days after surgery. Some physicians use dissolvable sutures so that no removal is needed.

Patient's donor area 2 months after surgery

When the linear incision is fully healed the patient is left with a thin scar in the back of the head. This scar is typically hard to see once the surrounding hair grows out and conceals.

FUE or Strip Excision, which procedure is right for you?

Both the FUE and the Strip Excision procedures have advantages and disadvantages, which have often been debated on our hair restoration discussion forum.

The strip excision procedure is more economical (typically half the price per graft of FUE) and also enables a patient to move much larger numbers of grafts/hairs to the balding areas during a given surgical session. However, the donor area after a strip excision surgery will require more time before it is fully healed when compared to the FUE surgery.

In addition, the FUE procedure, given its minimally invasive nature, does not produce one long linear scar but rather hundreds of tiny scars in the donor area that are often hard to detect. This has fueled interest in the FUE procedure with patients who are highly concerned about potential visible scarring in the donor area.

However, given recent advances and care in donor closure techniques used during strip excision surgery, such as the trichophytic closure technique, the linear donor scar created by the strip excision procedure is now often almost undetectable, even upon close examination. Thus concerns about visible scarring in the donor after strip surgery have diminished. This has made the additional cost and time requirements of doing the FUE procedure relatively less appealing.