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What is FUE?

Follicular Unit Extraction (FUE) is a method of obtaining donor hair for Follicular Unit Transplantation (FUT) where individual follicular units are harvested directly from the donor area, without the need for a linear incision. With the FUE technique a .8mm to 1 mm punch is 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.
Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE) are sometimes mistakenly viewed as being two different procedures. In fact, FUE is a sub-type 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 Follicular Unit Transplantation, individual follicular units can be obtained in one of two ways; either through single strip harvesting and stereomicroscopic 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). The process in the recipient area is the same.
The main advantage of FUE is that it does not cause a linear scar. Therefore, it is useful in patients who may, in the future, want to wear their donor area very short (<1cm in length). This advantage was the main reason for the development of the technique.

What Type of Patients Benefit from FUE?
The main advantage of FUE is that it does not cause a linear scar and is, therefore, particularly useful for the following type of patients:
Patients who want the option of wearing their hair very short (<1cm) and not have any evidence that a procedure was done. If a patient has his head shaved, a linear scar may be noticeable even if it is very fine. This may be due to the subtle change in direction of hair above and below the scar. With FUE, after the extractions heal, it is very difficult to see the incisions even with the hair short, but there is still a potential for some spotty white dots to be noticible. This result is less likely if the patient has the right skin type, the proper punch size is used, and the number of extractions in a specific area is kept below a critical amount.

Young patients who currently need only a small number of grafts in the hairline and the future degree of hair loss is not known. Some patients in this position say that if they would progress to total hair loss on the top of their head, they would rather shave their hair than go through more surgeries to keep up with the loss. With FUE, they have the option to stop and shave their head if they have only had 1-2 small procedures.
Patients who have already had strip harvesting and now have a tight scalp which would make more harvesting difficult. FUE can be used to obtain more grafts.
Patients who need to camouflage a widened linear donor scar from a prior hair transplant procedure.
 

ADVANTAGES
• No linear scar (important for those who want to wear their hair very short)
• Decreased healing time
• Decreased pain in the donor area
• Useful for those with a tendency to scar (Asians)
• Ideal for repairing donor scars that can't be excised
• Extends the area of donor supply and may add to total donor supply
• Creates the possibility of harvesting of body hair and beard hair
• Useful in specific young patients who need only small number of grafts

DISADVANTAGES
• Maximum graft yield, if used exclusively, is lower that with FUT (due to the inability to harvest all the hair from the mid-permanent zone)
• Distortion from initial FUE makes subsequent FUE difficult
• Greater potential for follicular transaction (damage) than FUT
• Grafts harvested outside the permanent area may be lost in future
• Potential for spotty scarring in the donor area after a larger number of   grafts have been harvested
• Takes longer and is therefore more expensive
• Grafts are finer with less tissue protection and therefore more susceptible to trauma, and there is a potential for less yield
• Capping or buried grafts may occur with certain techniques
• So much attention and time is given to the donor area that the recipient area sometimes does not get the attention it deserves