FUE: Follicualr Unit Extraction – A novel way to move hair

Hair transplantation has experienced more transformation than most cosmetic surgery subspecialties in the past decades.  Gone are the days of “plugs,” scalp reductions and flaps of hair meant to simulate hairline.  Modern hair restoration is both natural and undetectable and has spawned its own generation of specialist solely dedicated to achieving perfection in this one (admittedly) labor-intensive procedure.

To that end, the goal of extracting and then transplanting hair one single follicular unit at a time, a process known as Follicular Unit Extraction (FUE) has been in development by hair surgeons around the world.  The process is slightly different from the traditional (also known as “strip”) method, where the hair is extracted in large quantities but still transplanted one single follicular unit at a time.  Extracting one graft at a time has several advantages, but you have to understand the process to get the gist of what is going on.  Here’s how it works;

It’s Cake!

Imagine that your scalp is a sheet cake with all the hairs being candles.  In the traditional method of hair surgery, the hair was taken out in a strip, like a big long slice of cake out of the center with all of the candles and everything taken at once.  The two sides of the scalp were then sewn closed just as if the cut ends of the cake were then brought together and the individual candles were then separated out just like the grafts of hair were separated before being placed back into the other areas of the scalp (usually the front or the hairline).

(L) immediately after FUE surgery (R) 10 days post op


Using this analogy, FUE is the process of removing one candle at a time with something like the tube from a roll of toilet paper. The candles have to be short (i.e. the patient has to shave their head) and your surgeon has to have good aim (and a high tolerance for tedium) to get each candle out intact with a little bit of cake around it.

In this analogy, your scalp is a really large cake since many surgeries have been known to extract one to two thousand grafts at a time.  However the process does not work if your candles are curved under the icing (as would be the case with curly hair since it arcs under the skin) or if the candles are fragile since in both of these cases transection (like a half-cut candle) might result and then the hair grafts would not grow.  As one might imagine, this process also requires more care for the individual grafts and an experienced surgical team.

The Icing on the Cake…

The advantages of FUE are that while each graft leaves a tiny little scar where it was taken from, the diffuse pattern these scars create is nearly invisible.  Since the human eye is trained to see lines, a scattered pattern of dots on the back of your scalp is tough to recognize.  About the only way to see these scars if you had an FUE hair transplant would be to shave your head with razor and go out and get a tan.  Since the spots are scar and would remain white (scar does not tan), little scattered dots would result, but they would still be difficult to see.  The hair on the front of the head grows normally (assuming you have a well-trained hair transplant surgeon) and is nearly impossible to distinguish as well.

This begs the question, though, that if you are going to shave your head, why would you want a hair transplant?  For many people, the idea of preserving the ability to choose that hairstyle is important, particularly if they are experiencing hair loss at a young age or have a profession (actor, swimmer, CEO, etc) that might require them to shave their head or camouflage the fact that they have had a hair transplant.  FUE also provides new alternatives to those patients with old plug-type scarring, multiple previous hair surgeries, and tight scalps who might otherwise not be candidates for hair restoration.

FUE truly represents a technological leap and an overall improvement for the entire hair loss profession. No matter which category a patient falls into, having a less-invasive option is a benefit for all hair patients.  Check with your local hair surgeon (www.ISHRS.org or www.ABHRS.org) for the option that best suits your goals.

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