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FFollicular Unit Excision (formerly Follicular Unit Extraction) (FUE): A Revolutionary Hair Transplant Procedure?

4/20/2017 6:54:21 AM

What is Follicular Unit Excision (formerly known as Follicular Unit Extraction)?

In 2002, world renowned hair transplant surgeons and Coalition members Dr. William Rassman and Dr. Robert Bernstein published a paper defining follicular unit excision (FUE), a new type of surgical hair restoration procedure distinct from the "tried and true" method of follicular unit transplantation (FUT).

Unlike FUT, where a “strip” of donor tissue is removed from the sides and back of the scalp, dissected, and implanted into balding scalp, follicular unit extraction involves the removal of follicular units one by one directly from the donor region. This procedure has become increasingly popular, in particular because it eliminates the linear scar that accompanies the traditional FUT procedure. This enables men to keep the hair on the sides and back of their scalp cropped short after surgery while minimizing the appearance of scarring.

Because follicular unit extraction is considered less invasive, recovery times are faster and minimizes the appearance of scarring, FUE has become increasingly popular amongst the patient community. But are all hair loss suffering men and women a good candidate for this procedure?

Are you a Candidate for Follicular Unit Excision?

Although some hair transplant surgeons believe the two procedures are equivalent and simply provide patients with options, both FUT and FUE are quite different and come with their own laundry list of advantages, disadvantages and potential problems. More importantly, most leading hair restoration physicians agree that there are fewer candidates for follicular unit extraction than today's gold standard follicular unit hair transplant (via strip harvesting) procedure.

Though each patient is unique and should be evaluated by a talented hair restoration surgeon, some elements of good FUE candidacy are fairly universal. The following are categories all hair loss suffering men and women can utilize to determine whether or not they may be a good candidate for follicular unit extraction:

1. Donor Issues: Quality of the Hair, Skin and Scalp

According to several leading FUE hair transplant practioners, the quality of a patient’s donor tissue is something often overlooked during a FUE candidacy evaluation. Patients with thin, tough, or brittle skin may not possess the physiology necessary for successful removal of individual follicular unit grafts. If a patient’s donor tissue is too delicate for refined graft removal, he/she is likely not a good candidate for this procedure and should explore the possibility of undergoing follicular unit transplantation (FUT).

2. Size of Recipient Region

While large FUE megasessions (procedures of 2,000 plus grafts implanted in a single procedure) are becoming more common, they still do not match the quantity and quality of the follicular units transplanted during a typical FUT gigasession. With leading hair surgeons reporting session sizes exceeding 4,000 follicular units in a single procedure (at an estimated 95% - 97% growth rate) when appropriate for the patient, it’s evident that patients with more advanced balding patterns seeking both density and coverage are likely better candidates for FUT procedures. Those who are qualified candidates may be able to undergo a series of smaller FUE procedures and achieve similar results, but variables like possible graft transaction (due to "blind dissection") and less density via FUE may still lead hair loss sufferers to the same conclusion: those with advanced balding are likely better candidates for follicular unit transplantation.

3. The Inevitable Hair Transplant Scar

For many patients, the most enticing aspect of follicular unit excision hair transplant surgery is the lack of the traditional linear scar that accompanies traditional FUT "strip" surgery. But be careful. While some falsely advertise FUE as a “scarless” procedure, all surgery comes with some degree of scarring. While the scarring may be small and inconspicuous, FUE still does create a series of circular blemishes in the donor region.

Conversely, while some prospective patients have become discouraged because of the strip scarring “horror stories” (usually involving inexperienced surgeons, excessive tension applied on overly wide strips, and poor patient compliance), FUT scarring can be extremely manageable in experienced hands. While FUT procedures will always create a linear scar in the donor region (extending to the level of the ears in patients requiring a larger strip); removal of a thin, long strip, appropriate suturing techniques, application of the trichophytic closure, and patient compliance typically results in a very minimal, manageable scar in a significant number of patients.


Many veteran patients, hair loss forum members and expert physicians alike pit these two surgical hair restoration procedures against each other and make claims that one is better than the other. In reality however, both follicular unit transplantation via strip harvesting (FUT) and follicular unit excision (FUE) are here to stay and come with their own laundry list of benefits, limitations and potential problems.

Thus, hair loss suffering men and women considering hair transplant surgery are advised to consider all of their options and educate themselves as much as possible before undergoing surgery.

Written and Published By,

Bill - Managing Publisher of the Hair Transplant Network, the Coalition Hair Loss Learning Center, the Hair Loss Q & A Blog and the Hair Restoration Forum and Social Community

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