What is Follicular Unit Extraction (FUE)?

Follicular Unit Extraction (FUE) is a type of hair transplant procedure which harvests hair grafts from the donor site to the balding area of the scalp or face. This hair restoration procedure is performed with a punch instrument. Instead of cutting a strip of hair from the scalp, the hair will be extracted one by one with the very small 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. FUE does not leave a linear scar. However, a tiny circular scar, will be scattered in the donor area.

FUE is a process of hair restoration which requires the transplant of a single hair follicle/graft at a time.

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 methods.
Patients who had numerous hair transplant procedures done in the past.
Patients who do not wish to have linear scars in the donor area.

Every patient is different and responds to the extraction and removal of follicular units from the scalp differently. Some patients may experience a negative reaction (damaged hair follicles). While others may have a low transaction rate. The type of hair can also affect the process. For example, straight hair is easier to extract than curly hair is.

FUE: The two and three step techniques
Follicular Unit Extraction involves 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 a three or two steps technique:

The three step technique

A circular incision is made with the biopsy punch. The incision occurs in the epidermis area of the skin.
A punch is used to separate the grafts from the surrounding deeper dermis.
Hair graft is removed from the scalp with forceps.

The disadvantage of the three step technique is the higher chance of developing buried grafts, which are grafts that get buried underneath the epidermis and can potentially cause a cyst to occur. However, buried grafts can be extracted by applying pressure to the surrounding skin. If this method fails, then a small incision is made to enlarge the opening to remove the graft. This procedure can be done easily in the office. Another problem may occur during the extraction process if the epidermis and the dermis get separated from the rest of the follicle. When this occurs, it is referred to as “capping”. The lower portion of the 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 FUE technique.The main advantage of this method is time saving and can potentially produce large amounts of follicular grafts. Our surgeon uses an instrument that is especially designed for the FUE procedure. This instrument helps reduce high rates of transection (damaged hair follicles). The instrument is placed around the scored upper part of the follicle, allowing the surgeon to make circular incisions with ease. The follicular unit is then removed from the scalp with fine forceps. The surgeon is able to remove large amounts of follicular grafts from the donor area in a given time.
Note: Patients who receive the two step technique may also experience side effects such as buried grafts and capping.