What is Follicular Unit Extraction?
Follicular Unit Extraction (FUE) is a type of procedure which harvests hair grafts from the donor site This hair restoration procedure is performed with a 1mm punch instrument. Instead of cutting a strip of hair, the hair will be extracted one by one with the punch. The punch is placed in the skin around the upper part of the follicular unit, making a small circular incision so that the hair grafts can be extracted directly from the scalp. FUT is a process of hair restoration which requires the transplant of hair follicle/graft at a time, in hope of creating natural hair growth. Both the strip harvesting and FUE procedures involve with FUT.
FUE is ideal and advantageous for the following type of patients:
 Patients who wish to wear their hair very short.
Patients who healed poorly from traditional strip harvesting method.
Patients who had numerous hair transplant procedure done in the past.
Patients who do not wish to have linear scar in the donor area.
Every patient have different response in respect to the extraction and removal of follicular units from the scalp. Some patients may produce a high level of transaction (damaged hair follicles). It is recommended that patient who considers FUE as their hair transplant option, should be tested with the FOX test to determine the ease of follicular unit extraction. This process helps identify the degree of transaction and any difficulties which may occurred before hand. The FOX test can be easily done in our office, and takes less than 15 minutes to find out the result.
FUE: the two and three step techniques
Follicular Unit Extraction involves with the use of a circular biopsy punch for the extraction and removal of hair grafts from the donor site. This process can be achieved with either the three or two steps technique:
The three step technique
1. A circular incision is made with the biopsy punch. The incision occurs in the epidermis area of the skin.
2. A dull punch is used to separate the grafts from the surrounding deeper dermis.
3. Remove hair graft from the scalp with forceps.
The disadvantage of the three step technique is the higher chance of developing buried grafts. The grafts may get bury underneath the epidermis, and cause cyst to occur. However, buried graft can be extracted by applying pressure to the surrounding skin. If this method fails, then a small incision is made to enlarge the opening and allows the removal of the grafts. This procedure can be done easily in the office. Another problem that may occur is during the extraction process, the epidermis and the dermis may get separated from the rest of the follicle. When this occurs, it is referred to as “capping”. The lower portion of graft can sometimes be grabbed and extracted. If this is not possible, the lower portion is left alone, and new hair will be produced.
The two step technique
At MHTA, our surgeon uses the two step technique. The main advantage of this method is time saving and can potentially produce large amount of follicular grafts. Our surgeon designed his own, one of a kind biopsy punch instrument called the “Diep Extractor”. This instrument is especially designed for FUE procedure. The Diep Extractor helps reduce high rate of transection (damaged hair follicles). The instrument is placed around the scored upper part of the follicle, allowing the surgeon to make circular incision of the follicular unit from the scalp with ease. The follicular unit is then removed from the scalp with fine forceps. With the Diep Extractor, the surgeon is able to remove large amount of follicular grafts from the donor area in a given time. Patients who receive the two step technique may also experience side effects such as buried grafts and capping.
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