What is FUE or Follicular Unit Extraction?
FUE is an abbreviation for Follicular Unit Extraction; also known as the follicular isolation technique or “FIT”. It is an alternative hair transplant technique to what is presently the more conventional “strip harvesting” procedure.
It is important to note that the difference in these procedures pertains only to how the hair follicles are obtained from the donor area of the scalp. All other aspects of the transplant procedure, such as site preparation and implanting, are the same between the two methods.
Here is the difference related to obtaining the donor follicles:
With the more common strip harvesting technique, the donor hair is removed as a narrow strip of hair bearing skin, using a conventional surgical incision and removal (excision) of the hair bearing tissue. The donor area is then carefully closed by suturing; using relatively new closure techniques designed to minimize any visible scar and to even promote hair regrowth within the line of healing. The strip obtained is then further dissected under microscopes, to obtain the trimmed follicular units, which are the small groupings of hair follicles which will become the transplanted grafts. Because the entire follicle can be seen under the microscope, the graft trimming process is very controlled and precise as all excess tissue is removed from around the follicular unit groupings of hair follicles. One follicular unit is the same as one “graft”, and they will contain an average of about 2.5 hair follicles per follicular unit graft.
In an FUE procedure, no linear surgical incision is made. Instead, specialized instruments are used to individually extract each follicular unit one by one. These extractions essentially utilize a specialized “drill punch” technique for removing the follicles without damaging them. The punch tools are now motorized and utilize very small punch hole sizes, as the drill head imparts specialized and varied motions to accomplish each extraction with a minimal risk of transection or damage to the hair follicles. The drill punches used are generally no greater than about 1 mm in diameter. When FUE was first introduced, this was done with small, non-motorized biopsy punches. It was effective, but too many hair follicles were damaged by “transection”, as the follicular units cannot be fully visualized by this method as they are removed. Innovations in the motion and design of the punch ends has accomplished the goal of minimizing transections in this method where the follicular units cannot be visualized as they can when dissected from a strip of donor hair.
Gradually, these new and innovative instruments, combined with experience in various techniques accommodating different hair characteristics, has allowed FUE to be accomplished with a minimum transection rate, whereby the procedure has become slowly more acceptable and even preferred by some patients.
There are advantages and disadvantages to doing FUE, and it cannot be said in most cases that one approach is clearly superior in all aspects over the other. However, in most cases it can now be said that FUE is a viable option, if the advantages for a particular patient seem to outweigh any disadvantages. This may vary, depending upon your individual needs, priorities, and plans for future hair styling. For example FUE may be preferred in someone who foresees a desire to where their hair vary short in the back, where even a very fine linear scar may not be completely concealed.
In most cases, it comes down to a guided patient preference, combined with considerations for cost differences.
During your free consultation, we can help you sort out all the considerations, and determine if FUE is a good option for you. It is very fortunate that we have not only one, but two very excellent methods at our disposal to offer!
What are the advantages of having an FUE transplant?
With FUE, there is no incision line, and therefore the possibility of a visible linear scar is eliminated. This might be preferable for someone who wishes to wear their hair quite short, where the very small, circular extraction scars are spread between the existing hairs and blend in after healing, to be practically undetectable. This procedure also results in somewhat less immediate post-op donor area discomfort, and fewer restrictions during the relatively short healing period.
The procedure may also be of advantage to someone who has scars from the much older style transplant techniques, where donor hair can still be obtained, but where risking additional scar is a concern. It may even be a useful approach to obtaining follicles to revise problematic old scars by grafting them; a very effective method of old scar revision!
Again, with newer techniques, most scar issues have been eliminated, even in the strip harvesting method. Still, many candidates for hair transplantation simply do not like the idea of having surgery involving incisions. In some cases this concern is the primary barrier preventing them from having a hair transplant which might otherwise greatly benefit them! If this is the case, FUE just might be the passage way through that barrier, and back to having your hair once again!!
What are the disadvantages of having an FUE?
FUE is generally a more time consuming procedure, requiring specialized instruments and technical assistance, which adds to the cost of the procedure. There are also practical limits on how many grafts can be obtained in a single session. Although automation of the devices has slowly narrowed the gap between the maximum numbers of grafts that can be done in a single session, FUE procedures should generally be limited to no more than 1500-2000 grafts per session; whereas with strip harvesting, it may be possible to perform procedures of 3000 or more grafts in a single session if needed. There is however no prolonged waiting period required between sessions with FUE, if more grafts are required for coverage. They may even be performed on consecutive days!
Another minor disadvantage of FUE, is that more shaving is required in the donor area before the extraction can be performed. In strip harvesting, the only hair shaved is in the strip itself, which is to be removed. Surrounding hair then easily covers the suture line which remains undetectable. In FUE, hair must be shaved in the areas to be harvested by extractions, because the individual punch sites will be spread over a greater area since it is not coming from a concentrated strip of donor tissue. This could leave some shaved areas that may need concealment until the hair re-grows in the extraction field.
Contrary to some exaggerated marketing statements, FUE is not a “scar-less surgery”. However, the very small scars are spread out through a larger area, and tend to blend in. The risk of a visible linear scar being seen with shorter haircuts is diminished with FUE. The difference in scarring is of little practical importance in those who would ordinarily have at least a ¼ to ½ inch of hair length in the donor area, and with newer strip harvesting closure techniques, sometimes even these linear scars are very hard to find later. Therefore, FUE might be given preference over conventional strip harvesting for a client anticipating wearing the hair relatively short, who is worried about a faint, linear scar being visible or has general fears related to surgical incisions.
The final disadvantage to the FUE procedure relates to cost. Requiring specialized equipment, and greater time to harvest the donor hair, the price/graft is proportionally higher. If all other factors are neutral, the conventional strip harvesting approach is more economical for the same number of grafts.
FUE Equipment and Technical Aspects:
In reading about FUE, you will come about a good bit of “marketing” of various brand name devices for extracting follicles. These are very innovative and interesting units. However, let me say that almost all modern extracting technology incorporates the same basic essential extraction motions needed to accomplish clean extractions with a minimum amount of dissection. Robotic units such as ARTAS, and other high end “fixed” units such as NeoGraft, have features related more to the user’s comforts. A client who has a particular interest or desire in FUE, should shop beyond the brand names of the extraction units. It is not necessary to travel to a center that markets the exclusive use of a computerized robotic instrument, or a particular brand name of extracting unit. With many excellent FUE extraction devices now available, the quality of the transplant once again comes down to the experience and expertise of the surgeon and technicians performing all aspects of the procedure. This is always the most important consideration to weigh.
At Holt Hair Restoration, I utilize only the most experienced technical assistants in the hair restoration industry for doing the FUE case. Remember; the extraction method of obtaining the donor follicles is the only part of a hair transplant that is different than the much more common “strip harvesting” technique. All other aspects of the transplant, from hairline design, planning, recipient site making, implanting, and aesthetics, are the same.
As noted, FUE is a newer procedure where the technology to extract larger numbers of grafts in a single session is still growing. Since each follicle must be carefully extracted from the donor scalp one F.U. at a time, this is a more time and labor intensive procedure. It also requires the highly expensive extraction units to efficiently obtain high quality grafts. As a result, one could expect to pay over $6 / FUE graft, vs. about $4 / conventional FU graft at present pricing. In summary, FUE is a rapidly developing and acceptable method of obtaining donor hair in an otherwise conventional HT. It may be beneficial to those who are concerned about a scar being visible with their hair cut short, or as a concern simply from the general thought of having a surgical incision. It may also be useful in those patients where a more modest 1500-2000 FU graft HT is thought to be adequate as a completed first procedure, and perhaps the only procedure that might ever be needed. It might be particular beneficial to the client who can afford the slightly higher costs to achieve the special benefits. If FUE is not for you, however, keep in mind that modern day strip harvesting transplants obtain the same natural follicular units for transplant into the deficient scalp area, resulting in natural and undetectable restoration of your hairline and visibly thin areas. There is no better way to deal with hair loss than with a modern day hair replacement surgery from an experienced, board certified hair specialist, and a seasoned and highly experienced surgical team of technicians! Call me today at 616-940-3640 or use our Contact Form. Steven Paul Holt MD, A.B.H.R.S.