FUE has increased in popularity, but why?

Follicular Unit Extraction formerly known as Follicular Unit Extraction has seen an unprecedented increase in popularity since 2013. In fact, according to the International Society of Hair Restoration Surgery (ISHRS) the majority of patients who received a hair transplant in 2017 had an FUE procedure. In this article, we will discuss how FUE has evovled and how it has continued to grow in popularity.

The beginning of FUE

In the 60's and 70's an early form of FUE was practiced which involved using large "black and decker" type punches to extract follicular units from a patients donor site. This unrefined procedure caused large circular scars which left the donor area of patients un-harvestable for subsequent procedures. Around the 80's hair restoration continued to evolve and the previous donor harvesting method of utilizing large "black and decker" punches were then replaced with donor strip harvesting, which started at the time the gold standard Follicular Unit Transplantation (FUT) was born.  To this day, this remains the gold standard for hair restoration.

FUE re-introduction

In the early 2000's the punch method was re-introduced and given the name Follicular Unit Extraction. However, this time, follicular units were harvested and only one at a time.  Thus, both FUE and strip harvesting became the two modern donor harvesting techniques performed in an FUT (follicular unit hair transplantation) procedure.

In the beginning, surgeons found it difficult to extract more than 100 grafts per procedure. In addition, to the difficulty in extracting healthy grafts, the growth rate for FUE was much lower than that of strip harvesting or FUSS. This led to many surgeons abandoning the procedure as a whole as it was not seen as a viable alternative to FUSS. However, a small portion of surgeons continued to hone their surgical techinques and skill and began to hold workshops to teach other surgeons how to perform FUE. This led to an exchange of philosophies and ideas, ranging from whether to use sharp punches or dull punches, manual or automated and even robotic FUE devices.

FUE present day

Today, more than 50% of all hair restoration procedures performed around the world are done via FUE according to the 2017 ISHRS census results. So how has this procedure gone from being widely rejected by the hair restoration community, to being the most popular procedure today? Well the short answer is innovation, in the beginning surgeons found it difficult to perform more than 100 grafts per surgical procedure. However, today surgeons are able to extract and implant as many as 3,000 grafts in one surgical sitting. In addition, the survival rates have increased immensely and now elite surgeons are able to match the survival rate of FUSS.


It is a great time to be a patient, there are two outstanding surgical techiniques to choose from and both carry their own specific pros and cons. With that said, the most important factor for receiving an outstanding result is choosing a competent hair restoration surgeon capable of performing state of the art FUE and FUSS. Consult with a pre-screend hair restoration surgeon and discuss which procedure would best suit your specific goals and needs.