Follicular Unit Extraction (FUE)

Follicular Unit Extraction (FUE) is a method of obtaining donor hair for Follicular Unit Transplantation (FUT), where individual follicular units are harvested directly from the donor area, without the need for a linear incision. In this hair restoration procedure, a 1-mm punch is used to make a small circular incision in the skin around the upper part of the follicular unit, which is then extracted directly from the scalp.

Therefore, when comparisons are made between FUT and FUE, what is really being compared is the way the follicular grafts are obtained (i.e. strip harvesting and dissection vs. direct extraction). The harvesting method does have other implications for the procedure such as the transection (damage) rate, distribution of follicular units, number of grafts per session, post-op care and the total yield.

THE PROCEDURE:

Patients differ significantly with respect to the ease in which the units can be removed from the scalp, with extraction in some patients producing unacceptable levels of transaction (damage due to cut hair follicles).

A sharp punch is used to score the epidermis (cut just the upper part of the skin) and then a dull punch is used to bluntly dissect (separate) the follicular unit grafts from the surrounding deeper dermis. The third step is the same, namely removing the follicular graft from the scalp using fine forceps.

The advantage of this hair transplant technique over the original two-step process is that using a dull punch minimizes follicle transection (damage). As the blunt-tipped punch is advanced into the dermis, the follicles, which naturally separate deeper in the skin, are “gathered together” within the opening of the instrument, rather than risk the lower portions of the follicles being cut off.

ADVANTAGES

  • No linear scar
  • Important for those who wear their hair short
  • Decreases healing time in the donor area
  • Useful for those with a greater risk of donor scarring (Asians)
  • Ideal for repairing donor scars that cannot be excised
  • No limitations on strenuous exercise after the procedure
  • Less post-op discomfort
  • Provides an alternative when the scalp is too tight for a strip excision
  • Extends the size of the donor area (but not necessarily the total number of grafts)
  • Makes it possible to harvest non-scalp hair
  • ex. beard or body hair
  • Most useful when a limited number of grafts are needed.


DISADVANTAGES

  • Maximum follicular unit graft yield is lower than with FUT
  • Due to the inability to harvest all the hair from the mid-permanent zone
  • The scarring and distortion of the donor scalp from FUE makes subsequent FUE sessions more difficult.
  • Greater follicular transection (damage) compared to FUT.  
  • Greater patient variability in who are good candidates compared to FUT.  
  • More difficult to capture the entire follicular unit.  
  • Grafts harvested from outside the donor area will not be permanent.
  • After large numbers of graft are harvested, fine stippled scars may become visible due to thinning of donor area.
  • Size of session is limited
  • Requires multiple sessions to equal the size of a single FUT.  
  • Takes longer to perform
  • More expensive than FUT.  
  • Problems of “capping”
  • This occurs when the top of the graft pulls off during extraction.  
  • Problems of buried grafts
  • This occurs during the blunt phase of the three-step technique when the graft is pushed into to fat and must be removed through a small incision or risked producing a cyst.