Is a Follicular Unit Extraction Right for Me?

[Posted on February 28th, 2013 by Dr. Carlos Puig]

More people are turning to hair transplant to regain their crowning glory. Of the many available procedures and treatments available, more and more hair loss sufferers are turning to a once little-known process known as Follicular Unit Extraction. A Follicular Unit Extraction is often the best procedure to pursue, but many potential candidates are wary of surgery that they have not previously been exposed to. However, it’s easy to learn more about Follicular Unit Extraction and see why it is steadily gaining in popularity.

Follicular Unit Extraction, or FUE, is a hair transplant procedure wherein donor hair is extracted from other parts of the body. In this method, an instrument is utilized to create a small incision in the skin encircling the follicular unit to separate it from the tissue that surrounds it. Thereafter, the unit is extracted from the scalp, and a small opening is left behind. This process is done repeatedly up to the time when a sufficient number of hair follicles has been harvested for the proposed hair restoration. For the process to be accomplished, it usually takes one or more hours, but can cover the span of two days if necessary.

History of FUE

In an effort to provide a solution to scarring that sometimes occurs during strip surgery, Follicular Unit Extraction was developed. The remaining donor hair can easily cover the scar if it is more that 1 cm. in length. However, there are times when a scar is wider, and this makes it harder to hide. As graft sessions become larger, the donor strip’s width also becomes larger to be able to acquire the greater number of grafts. Larger sessions significantly improved the outcome in the recipient area. Because of the excitement of the field with regard to the results, it took time before it could notice the prevalence of wider scars surfacing in the donor area.

To address this problem, a number of physicians began to develop Follicular Unit Extraction, an alternative process of harvesting grafts. Extracting individual grafts using a small micro punch prevents the formation of a linear scar. It is unfortunate though that the previous versions of this procedure had its drawbacks. It was difficult to extract each graft and most of the time, damage to grafts and a high transaction rate took place. It was also considered as a slow, expensive process and fewer grafts could be accomplished at the same time by means of strip harvesting method. Finally, it was realized that visible scarring is possible, and it just came in a different form.

The scarring that occurred with FUE came in the form of several little white dots, which are located in the donor area where the extraction took place. Instead of a linear scar, a spotted look can be noticed when hair is too short. This is the reason why FUE was not accepted at first. Additionally, traditional strip harvesting had gone through major enhancements. These included more precise methods to foresee scalp laxity, exercises to enhance this, improved stapling, and suturing techniques, plus the trichphytic closure development. These enhancements let strip surgeries just leave a very small scar. Even if the hair was only 1 cm, the scar will not be noticed.

FUE has significantly improved in the last five years with regard to instrumentation and technique. The advancements included using smaller punches, which reduced the occurrence of spotted scarring; motorized punches, which make it easy to score the skin; limited depth scoring, which reduced transaction; improved understanding of the number of extractions, which can happen per area before the occurrence of scarring. With these improvements, FUE can be performed more consistently with less scarring, less damage to grafts, and more grafts for every procedure.

At present, Follicular Unit Extraction and strip harvesting are the popular procedures used for the removal of grafts from the donor area. The future will see more of these two methods, especially, as more improvements are underway.