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Follicular Unit Extraction (FUE)

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Follicular Unit Extraction (FUE) is a relatively new hair loss surgery technique that involves individual removal of follicular units from the donor site. Plastic surgeon Carrie Houssock, MD offers this surgical option as an alternative to the strip harvest method. The technique is essentially a process in which a 0.8 – 1.0 mm round donor harvest tool is used to extract the entire intact follicular unit. There are two primary advantages to this type of donor harvest technique. The first advantage is a much less tender donor area following surgery. The second advantage is the ability for the patient to generally wear shorter hair in the donor area than following a strip method. Additionaly, there are also patients who require a very small number of transplants and FUE may be ideally suited for their needs. On the other end of the spectrum, some patients have been severely donor depleted or have very ‘tight’ scalps as a result of over harvesting using the strip method. FUE to selected areas of the scalp and even the beard offer a terrific alternative for these patients as well.

Of course, there are disadvantages to the FUE procedure. These include the requirement of a near complete donor head shave for large FUE cases (>1200), and also in some cases the donor area can become ‘thinned out’ due to over harvest and lowering of the follicular density. Smaller FUE punch sizes (0.8 and smaller) reduce this risk significantly. When smaller FUE cases are performed discrete areas of scalp can be shaved in such a manner to allow the surrounding hair above the harvest site to hide the shaved donor area. This is known as a “stealth” donor technique for FUE harvesting. Because the FUE donor harvest process takes longer to perform than strip harvesting and is considerably more labor intensive, the procedure is also more expensive as well. The general cost for FUE is about twice that of the strip procedure. Your individual consultation will be the best opportunity for a detailed discussion to determine if FUE is right for you.

Follicular Unit Extractions (FUE) Photos

Note the appearance of the grafts that are harvested using follicular unit extraction. The grafts are intact and the supportive fat and surrounding tissue is remarkably preserved, even though a 0.8 mm round harvest tool has been used. In situations that require fewer than 3-4 hairs per follicular unit, these follicular units can be subdivided for a softer, more delicate result.

Individual follicular units are shown in the shaved donor area. (Below) This is a microscopic view of the intact follicular unit, scored and ready for final extraction.

The appearance of the donor area once the FUE sites are harvested and the follicular units have been removed. (Below) The healed appearance several months later

View our full patient results photo gallery

Above, is an example of large session FUE harvest and the excellent subsequent healing. This patient chose FUE as his primary donor option even though strip harvesting was offered as well.

These photos show the appearance of the “stealth” FUE donor harvest technique. A discrete area of the donor scalp is shaved and harvested. Once the FUE process is complete, the donor hair above completely covers the surgical area. The important thing to remember is that the FUE process only refers to the donor area. Once the grafts are harvested, the transplant procedure is identical in all ways to the strip donor harvest method. Namely, individual small follicular unit grafts are placed artistically to create a natural hair line and larger follicular unit grafts are placed behind these to create more density. When the crown area is grafted, the same angulation of grafts is performed to create the whorl pattern and provide excellent coverage. The FUE process is simply another method of harvesting the donor hair!