National Hair Institute, Follicular Unit Hair Transplantation & Restoration, Melbourne, Sydney, Australia, Hair Loss Solutions

Follicular Unit Extraction

The No Scalpel, No Strip, Minimally Invasive Procedure

Follicular Unit extraction or FUE as it is known is a relatively new technique of extracting grafts individually from the scalp. In this type of procedure a small round punch generally 1.00 mm in diameter is used to make a small circular incision around the follicular unit. These follicular units are then individually plucked from the scalp. This new procedure negates the need for a linear incision at the back and sides of the scalp with the inevitable scar that is produced.

A patient is shown with his existing hair taped up to expose the donor region undergoing FUE with individual hairs being removed from the donor area.

Follicular Unit Grafting and Follicular Unit Extraction are sometimes viewed as being two totally different procedures. Follicular Unit grafting involves surgically removing a strip of skin from the back and sides of the scalp, this strip is then microscopically dissected into follicular units and these are implanted back into the balding areas of scalp.

FUE individually harvests these 1, 2, 3 and 4 hair grafts from the back and sides of the scalp. Each follicle after being extracted is examined under the stereoscopic microscopes and further trimmed of non hair bearing skin if required. And then reimplanted into tiny incisions in the balding area. So effectively once these grafts are out of the scalp the implantation procedure is exactly the same as it is for FUG.

So in effect when a comparison is made between FUE vs. FUG what is really being compared is linear strip excision (FUG) vs. individual graft extraction (FUE). As FUE does net leave a linear scar it is of particular interest for those who wish to wear their hair very short at the back and sides.

 The Process

A patient is shown with his existing hair taped up to expose the donor region undergoing FUE with individual hairs being removed from the donor area.

Step by Step explanation of the FUE procedure

• The donor region at the back and sides of the scalp is clippered down to 1-2 mm in length to allow the doctor to easily pinpoint which follicular units he will extract
• The donor area is aneasthetised to ensure a relatively pain free experience.
• The patient lies face down on a special operating chair that fully supports the head.
• The doctor using a powerful magnifier, extracts follicular units from the donor region one at a time using a small cylindrical punch and forceps.
• As each follicular unit is extracted, they are handed to the technicians who under the microscope will trim off any excess skin on the graft so they may be placed into the smallest incisions possible.
• The many small holes produced at the back of the scalp are then left to heal on their own.
• Once the doctor has extracted the required number of grafts the patient will change position and sit upright to allow the implantation to begin
• The follicular units are then implanted into the scalp one at a time into tiny needlepoint holes.
• Once all the grafts have been implanted the patient is free to go home and generally no bandage is required.

 Advantages and Disadvantages of follicular unit extraction

For many years clients have been concerned about the linear scar that is produced by the strip excision method that is an integral part of the FUG procedure. However FUE’s primary advantage of no linear scar does bring with it, its own unique set of disadvantages.

Advantages

• No linear scar
• Minimally invasive so shorter healing time
• No bandage required after surgery
• Allows a larger portion of the donor area to be harvested(does not increase the yield from a given area though)
• Best used in procedures that require a limited number of grafts
• Possible to use body or beard hair for transplantation if required

Disadvantages

• Almost twice as expensive to achieve the same result as FUG.
• Absolute yield from given area is not as great as with FUG.
• Graft survival rate not as high as with FUG, due to the transection of grafts as they are extracted from the scalp.
• Those with curly or fine hair are generally not good candidates for FUE.
• Due to the labour intensive nature of the extraction process there are limits on how much can be achieved in one session and therefore multiple sessions are required to equal just one FUG.

In summary the one disadvantage of FUG is the visible scar at the back of the scalp. However with the advanced surgical techniques in use at the NHI the reality is that over 90% of our patients have a scar that is 2mm in width or less and is easily camouflaged with a #3 clipper. This combined with the excellent and consistent growth rates of FUG mean that FUG is not likely to be replaced as the current gold standard of hair restoration any time soon.

That said FUE is a fantastic new advance and gives prospective patients an additional treatment modality to choose from.

The National Hair Institute is the only medical practice in Australia specialising in both FUE and FUG. And therefore are well placed to offer unbiased advise to prospective patients on both procedures taking into account their own individual circumstances.