Follicular Unit Excision (FUE)
Follicular Unit Excision (FUE), formerly called Follicular Unit Extraction, is a method of extracting, or “harvesting,” donor hair in a follicular unit hair transplant procedure. In FUE hair transplant surgery, an instrument is used to make a small, circular incision in the skin around a follicular unit, separating it from the surrounding tissue. The unit is then extracted (pulled) directly from the scalp, leaving a small open hole.
This process is repeated until the hair transplant surgeon has harvested enough follicular units for the planned hair restoration. This process can take 4-6 hours and sometimes in large sessions, may be accomplished over two consecutive days. The donor wounds, approximately 1-mm in size, completely heal over the course of seven to ten days, leaving tiny white scars buried in the hair in the back and sides of the scalp.
This method of donor harvesting, removing follicular units one-by-one directly from the scalp, is what differentiates the FUE hair transplant from a traditional Follicular Unit Transplant (FUT), where the donor hair is removed from the scalp in one thin, long strip and then subsequently dissected into individual follicular units using a stereo-microscope.
Before the grafts are harvested, tiny “recipient sites” are made in the balding area of the scalp using a fine needlepoint instrument. The follicular units are then placed into the recipient sites where they will grow into healthy hair-producing follicles. The creation of recipient sites and the placing of follicular unit grafts are essentially the same in both FUE and FUT procedures. The difference lies in the appearance of the donor area and in the quality and quantity of grafts obtained with each technique.
Follicular Unit Extraction is an instrument dependent procedure; therefore, the type of tool used for this procedure significantly affects its outcome. In fact, the development of increasingly better extraction instruments has closely paralleled advances in the procedure.
Indications for FUE Hair Transplants
Because FUE does not leave a linear scar, it may be appropriate for patients who want to wear their hair very short. It is also an advantage for those involved in very strenuous activities, such as professional athletes, who must resume these activities very soon after their procedure.
The technique is also useful for those who have healed poorly from traditional strip harvesting or who have a very tight scalp. FUE transplants also allow the surgeon to potentially remove hair from parts of the body other than the donor scalp, such as the beard or trunk, although there are many limitations to this process.
Possibly the most straightforward application of this technique is to camouflage a linear donor scar from a prior hair transplant procedure. In this technique, a small amount of hair is extracted from the area around a linear donor scar and then placed directly into it.
Some patients desire Follicular Unit Extraction simply because they heard that it is less invasive than FUT or is non-surgical. The reality is that both procedures involve surgery and in both cases, the depth of the incisions (i.e. into the fat layer right below the hair follicles) is the same. The difference is with the type of incision made. In FUE there are multiple round incisions scattered diffusely through the donor area and in FUT there is one single, long incision in the middle of the donor area. FUE should be chosen if the multiple round incisions are preferred and not because the technique is “non-surgical.