What is Follicular Unit Extraction (FUE)?

A follicular unit extraction (FUE) is the removal of each follicular unit individually with a small punch device (an instrument that extracts the follicular unit by making a round incision in the scalp). The result in the donor zone are tiny holes or slits where the follicular unit use to reside. Once a procedure is complete the donor zone has significant healing in a matter of two to three days, to the point where normal activities can be resumed.

How Does Follicular Unit Extraction Work?

To perform a follicular unit extraction, the doctor will buzz the patient’s hair very short so that the surgeon can see the scalp itself. This also allows the doctor to see the exact angle and direction of the target follicular units. After this is complete, the following steps occur:

  • Donor hairs are extracted one-by-one using a small, cylindrical instrument. This delicate process is very time-consuming, and may necessitate two consecutive days of treatment to harvest the target number of follicular units. Donor hairs can be from a larger overall area of the safe donor zone than what is normally available with FUSS.
  • The extracted follicular units are sometimes further treated under stereoscopic dissecting microscopes for additional refinement and inspection for quality control.
  • The grafts are chilled so that bacteria cannot interfere and cause damage. This also extends the vitality of the extracted follicles as they await transplantation into the scalp.
  • The extracted follicles are re-inserted back into scalp, which over time will allow hair to regrow.

What is the Difference between FUSS and FUE?

The main difference between FUSS and FUE is that FUE does not remove a large segment of skin tissue from the occipital scalp, but instead directly extracts hair follicles from the scalp itself using a small punch device. Each extraction matches each follicular unit on a one to one ratio.

Since there is no removal of scalp tissue from the back of the head, there is no stitching required, which means patients are able to recover much more quickly and reportedly with minimal amounts of pain. FUE is becoming the preferred method of hair restoration for most patients due to the lack of a linear scar common to patients of FUSS procedures. The lack of a linear scar allows FUE patients to wear shorter hairstyles than those of FUSS, who have to wear their hair longer so as to cover up the donor zone scarring. That is not to say that there is no scarring with FUE, but the scars caused by FUE are small, circular, and easily concealable even under shorter hairstyles.

Sometimes FUE and FUT methods are used in together to achieve a greater number of grafts which translates into greater coverage, density or both. Most of the time a patient will utilize FUSS first then once there is no more FUSS procedures possible (due to diminishing levels of donor laxity) they will then be switched to FUE.

When can I Expect to See Results from my Follicular Unit Extraction?

Just like with FUSS, most patients typically see results within half a year, though it typically takes a number of months before the transplanted hair begins to grow on its own.

Follicular Unit Extraction Surgery and Diffuse Unpatterned Alopecia (DUPA)

DUPA is a rare form of hair loss that even affects hair on the occipital scalp (the area commonly used for FUSS). The lack of occipital scalp hair means that a FUE is a possibility for those with DUPA, whereas FUSS is not. However, hair transplants for those affected by DUPA have a low success rate, and the FUE process is no different. While FUE may provide seemingly good results at first, these effects rarely last. Hairs that are affected by DUPA will continue to be lost no matter where they are relocated. As such, any progress made by FUE surgery typically diminishes within a number of years as the hair loss continues to spread.

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