What you should know when considering FUE hair transplantation.

What is FUE?

Follicular Unit Extraction (FUE) is a specific method used to remove donor hair follicles for transplantation. Individual follicular units are extracted one at a time from the back and sides of the scalp leaving tiny round scars about 1mm around. Follicular Units may be extracted using a variety of incision techniques including manual, power assisted and robotic fully automated.

FUE technique is an alternative to Follicular Unit Transplant, or FUT, where donor hair is removed as a narrow strip of scalp about 10 to 15mm wide, and separated into individual follicular units under a microscope.  FUE and FUT are simply different methods to remove donor hair follicles.   The technique used to place transplant grafts into bald/thinning recipient areas of the scalp is a separate topic, and is not addressed by the method of acquiring the donor hair.  FUE is relatively new to hair restoration surgery, and has proven to be a versatile graft harvesting method and an excellent complement to the FUT strip method.

The above patient had prior strip hair transplant (FUT) and is currently having FUE hair transplantation. Hair was shaved so the surgeon could see and follow the angle the hair comes out of the scalp.

So how do you decide if FUE is right for you? Consider what matters most for you.  What are your expectations for hair restoration as you consider the FUE method?

Donor scar visibility –
Compared to a linear donor scar, the “mosaic” of dot scars created by FUE are preferred by patients who:
•    Prefer short hair styles.
•    Notice scalp showing through their hair even with a longer style.
•    Are at risk for thickened donor scars due to excessive scalp tightness or laxity.

More conspicuous immediately after surgery –
The entire donor area needs to be shaved for most FUE procedures. If your hair is not already trimmed high and tight, you will be explaining your new hairstyle to a lot of people.

Scalp comfort –
Multiple small round FUE incisions are spread out over a larger portion of the donor scalp compared to a single strip incision, so FUE patients experience:
•    Less pain in the donor scalp
•    Faster healing and no sutures or staples to remove
•    Return to physical activity more quickly.

Added Value –
Scar management – FUE is an excellent method to disguise scar tissue that can’t be simply excised. Using FUE, bald scar tissue can be removed and replaced with hair bearing grafts.

Expanded donor hair supply – patients with excessive donor scars, scalp tightness, and/or patchy donor density have very limited options with traditional strip harvesting. FUE accesses areas that FUT can’t including upper and lower fringe of the donor scalp, beard and body hair for patients who have a shortage of donor hair

Fine hair can be harvested from the nape of the neck or temporal scalp for eyebrow and eyelash restoration.

Limitations of FUE

Hair Type – FUE is not as successful for patients with tightly curled hair because the curved “root” of the follicle is easily transected during extraction.

Graft quality – FUE often strips fat and other connective tissue from the lower portions of the follicle making the grafts more susceptible to damage from dehydration and physical injury during placement into the recipient sites.

Graft quantity –  damaged graft rates are significantly higher for FUE compared to grafts prepared under a microscope with FUT.   With the FUE method, the average number of hairs per graft is reduced due to difficulty removing the entire follicular unit.

Convenience – the number of grafts placed during a single FUE transplant session is limited due to the additional time required to precisely remove each individual graft. Larger sessions over 1500 grafts may need to be performed over consecutive days.

Financial – FUE is usually more expensive than FUT.

This article was written by Dr. Robert Niedbalski of Northwest Hair Restoration in Tacoma, WA

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