Follicular unit extraction or FUE hair transplantation is a form of hair transplant with a difference. FUE hair transplant has many benefits including completely natural results, very little bleeding, no visible scar formation and less recovery time for patients. FUE hair transplant is, in fact, an adaptation of standard follicular unit transplantation. In follicular unit transplantation, a strip of skin is removed from the donor area and from this, hair follicle units of 1 to 4 hairs are dissected ready for transplanting. However, this approach results in a very large scar in the donor area where the two sides of the skin, where the skin strip was removed, are sutured together and heal. In contrast, the FUE extraction and transplantation technique allows the surgeon to harvest each follicular unit one at a time from the donor area. Once the graft is harvested, each hair is creatively transplanted into the balding or thinning areas of the scalp, allowing for complete hair restoration.
With FUE hair transplants there is no need for a large, linear strip of skin to be removed from the donor area. On the contrary, the method involves harvesting individual follicular units directly from the donor area. A 1-mm steel 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. This process is done many times to isolate hair follicles units ready for implantation to the bald areas. In short, the hair follicles in the donor area are “thinned out” and the removed hair follicles are used for the transplantation. In this way large, visible scar formation is avoided. However, there may be a disadvantage in that the hair at the back of the scalp becomes less dense. The procedure is best for patients who wish to wear their hair very short and are concerned about a scar being visible or who are afraid of surgery involving strip skin removal.
The procedure was first described in the medical literature by Rassman and Bernstein in 2002. The procedure was further refined by Harris by adding an additional step of blunt dissection to the technique. The procedure is also useful for those who have healed inadequately from traditional strip harvesting or who have a very tight scalp. In individuals who have a very tight scalp skin, it is difficult to pull and suture the edges of skin together after donor strip removal and this can causes problems with skin healing. Possibly the most important application of this technique is to hide a widened linear donor scar from a prior hair transplant procedure. For the purpose of FUE hair transplant, patients differ significantly with respect to the ease in which the units can be removed from the scalp, with extraction in some patients producing unacceptable levels of damage due to cut hair follicles. Patients claim that the advantage is less noticeable scarring and no tightness of the scalp because no tissue has been brought together and sutured as in standard follicular unit transplantation.