Follicular Unit Extraction (FUE)
Follicular Unit Extraction (FUE) is a method of donor hair harvesting for
Follicular Unit Transplantation (FUT), where individual follicular units are extracted directly from the donor area, without the need for a strip excision. In this procedure, a 0.8-1.1 mm punches are used to make a small circular incision in the skin around the upper part of the follicular unit, which is then extracted directly from the scalp.
Motorized FUE equipment and manual punch
1 mm punch is used for incision
individual follicles are extracted
FUT and FUE are sometimes viewed as being two totally different procedures. FUE, in fact, is a type of FUT where the follicular units are extracted directly from the scalp, rather than being microscopically dissected from a strip that has already been removed. In other word, FUT, individual follicular units can be obtained in one of two ways; either through single-strip harvesting and stereo-microscopic dissection, or through FUE.
Therefore, when comparisons are made between FUT and FUE, what is really being compared is the way the follicular grafts are obtained (i.e. strip harvesting and dissection vs. direct extraction) rather than placed into the scalp.
| FUE procedure of 1000 grafts. |
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| Pre-op |
Scalp shaved
& marked |
Post-op
1,000 FUE |
Grafted area |
1 month
Post-op |
Comparing FUE to the Standard Strip Procedure
While the FUE has grown in popularity, largely due to the minimally invasive way in which follicular unit grafts are removed, the standard strip excision method is still the most popular hair transplant procedure.
(more detail of strip procedure)
Strip Procedure
Scalp prepped and marked
Donor strip being excised
Incision sutured together
Hair combed down after suturing
donor scar, 6 months after surgery
The standard strip excision method involves surgically removing a strip of scalp from the bald resistant donor area of the patient. The donor area is then sutured together.
However, recent advances and care in donor closure techniques used during strip excision surgery, such as the
lower Trichophytic Closure technique and retention stitches, the linear donor scar is now often almost undetectable (
see more our results), even upon close examination. Thus concerns about visible scarring in the donor after strip surgery have diminished. This has made the additional cost and time requirements of doing the FUE procedure relatively less appealing.
FUE or Strip Excision, which procedure is right for you?
Both the FUE and the Strip Excision procedures have advantages and disadvantages.
| FUE |
Strip Procedure |
| Extraction of individual follicle units by superficial excision. |
Single strip of donor removed and grafts containing individual follicle units dissected with microscopes. Incision edges sutured. |
| Developmental, i.e., not enough scientific experience and evaluation yet to know all the advantages, disadvantages, and predictability of outcome |
This is the current Gold Standard for hair transplantation. Widely used, scientifically evaluated, and refined, so that all risks, complications, patient variables, and outcomes readily predictable. |
- Rates of follicle damage during extraction may vary from 3 - 10%
- Extraction survival rates not yet documented
-Grafts are more fragile and subject to trauma during placing, since they often lack the protective dermis and fat of microscopically dissected grafts. This may result in poor growth
- Placement same as FUT |
-We use high power magnification and a single blade scalpel to carefully excise margins of strip and skilled staff to prepare grafts with microscopes.
- Damage to follicles is at worst 1-2%
-Long term follicle survival is 90 – 100% |
-No suture required
-Dispersed widely donor area
- wide donor areas must be shaved
- not evident in 7 – 10 days
- can wear hair shaved without detection after treatment
- when harvesting has been extensive hair must be worn longer to hide donor scars
- No linear scar, enable to wear their hair very short |
- Sutures required
- Limited to scalp donor
- donor shaving is localized
- hair covers suture and scar
- previous scars removed with each successive treatment
- when harvesting has been extensive hair must be worn longer to hide single donor scar line
-Thin linear scar covered with hair |
| Less pain, Less post-op discomfort, mild level pain |
Mild to moderate pain level in donor area first 24 to 48 hours |
| Quicker healing time in the donor area |
Healing in 7 – 14 days |
| No limitations on strenuous exercise of donor area after the procedure |
Limited activities in first week |
| Up to 1500 grafts per session |
Up to 4000 grafts per session |
| Usually more expensive than the cost of FUT |
High efficiency allows lower cost depending on treatment size |
| Useful for those with a high risk of donor scarring such as keloid |
Risk of donor scarring in Asians or who has history of abnormal healing |
| Repairing donor scars that cannot be revised |
Donor scar may be wide after multiple sessions |
| An alternative way when the scalp is too tight for a strip method |
Donor scalp is tighter after multiple sessions |
| Increase the number of grafts combined or added to strip procedure |
Limited donor scalp |
| Enables one to harvest finer hair from the nape of the neck to be used at the hairline or for eyebrows, eyelashes transplants |
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| Enable to harvest non-scalp hair ex. facial or body hair |
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| Microscopic dissection may still be needed if the number of single-hair grafts is inadequate or to remove excessive hair fragments |
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| The scarring and distortion of the donor scalp from FUE makes subsequent FUE sessions more difficult |
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