Follicular Unit Extraction (FUE)

There are two main methods in performing hair transplant surgery - Follicular Unit Extraction (FUE) and Follicular Unit Transplantation (FUT).

Each method has its own set of advantages and disadvantages, and it is possible that you are not a good candidate for one of the procedures. Therefore, it is best that the patient has a general knowledge of both types.

The emphasis with the FUE method is on the word unit. This procedure surgically extracts groups of one to four individual hairs for transplanting.

What needs to be understood about this method is the concept of transection. In laymen’s terms, transection is the potential damage that is possible each time a hair follicle is removed from the donor area to be transplanted. What this means to the patient is that it is very unlikely there will be zero transections for a procedure, and the greater the number of transections the more unit extractions will have to occur.
The somewhat more technical reason is that damage to the lower portion of the hair follicle can prevent new hair generation. Remember, we are talking about a single hair. The larger the area that needs to be treated, the larger the number of follicles required to be removed and transplanted.

In choosing FUE it is important to know that a much larger area of the scalp will be used to obtain the grafts – as much as eight times the size in comparison to the FUT method.

Another technical term that requires understanding is the concept of yield. The amount of hair growth as a result of either the FUE or FUT methods is called yield. There are many factors that are involved with producing the maximum follicular unit graft yield. Some of these factors involve the skill of the surgeon and the success of the hair transplant, while other factors are solely with the patient, such as the quality of their hair and their body’s response to the procedure itself. In either case, it needs to be understood that it is a joint undertaking where both patient and surgeon have limited control over the final outcome.

When considering using FUE know that because of the larger area required to perform the hair transplant, second or subsequent procedures may either be difficult and not produce earlier results, or may not be possible at all due to the overall scarring caused by the initial procedure. This makes the choice between FUE and FUT somewhat simpler if the patient is expecting to have multiple hair transplants performed over the course of their lifetime.

Scarring in the area where the individual follicles have been removed is a normal part of hair transplantation surgery. In the FUE method, these scars will appear as pits - small, round indentations that will not be noticeable after the surgery unless the hair is close cropped or the head is shaved. The amount of visible scarring will likely abate over time.

A generalization of the actual technique performed will be discussed now.

There are two sites selected by the doctor on the scalp – a donor site and a recipient site.

The recipient site must be prepared before extracting the follicle grafts. This is done by creating recipient sites in the scalp using a precision needle-point tool.

At the donor site, a small incision is made using a precision instrument to separate a single follicle unit from the surrounding skin. The result of the incision is a tiny hole that will heal over a seven to ten day period, producing the aforementioned scar.

This process is repeated until enough units have been extracted to complete the hair transplantation. Depending on the amount of hair to be transplanted, it can take one or more hours, or in cases where the area requiring transplantation is very large the surgery can extend to a second day.

Then who are the best candidates for the FUE method of hair transplant? The first group is younger patients who are likely to have a higher quality of hair, as well as thicker hair. Another group is those whose scalp is too tight to perform an FUT as sewing up the donor area will prove to be very difficult or significant scarring may result. Finally, the cost of FUE will be significantly higher than FUT since the individual removal of hair follicles will simply take more time, and the use of the operating room and subsequent doctor’s hourly rate will increase the size of the final bill.