Follicular Unit Extraction – FUE is a hair harvesting method of hair transplantation surgery in which individual natural hair groupings called follicular units – FU are removed by surgically separating them one by one from their natural location which is typically the back and sides of the head.In short, FUE is a method of obtaining donor hair for Follicular Unit Transplantation (FUT) without the need for a linear incision.

Who Invented FUE?

The hair transplant method called follicular unit extraction (FUE) was invented by the Japanese dermatologist Masumi Inaba in the 1980′s and first described in his textbook, which was published in 1996. In fact, FUE is a type of FUT where the follicular units are extracted directly from the scalp, rather than being microscopically dissected from a strip that has already been removed. The procedure is a refinement of the large punch graft technique that was performed by New York dermatologist Dr. Norman Orentreich in the early 1950′s.

FUE Method

During the Follicular Unit Extraction or FUE procedure individual follicular unit grafts are excised one at a time using a tiny one millimeter or less sized punch. Typically the patient’s hair in the donor area where these grafts are being removed is cut short so that the physician is able to see the patient’s scalp.

A follicular unit (FU) is the small hair grouping that is naturally found on the scalp, first described by the histological studies of pathologist John Headington in 1985. When comparisons are made between FUT and FUE, what is really being compared is the way the follicular grafts are obtained (i.e. strip harvesting and dissection vs. direct extraction) rather than placed into the scalp. A follicular unit can consist of 1-4 hair shafts and, as a result, allows a more precise placement of hairs during transplantation than the earlier punch grafts performed by Orentreich.

Follicular Unit Extraction thus involves extracting and subsequently planting hair in their natural groupings (follicular units). The result is a natural-looking coverage of hair in the bald area and avoidance of linear or punch-graft-scarring in the donor area. Because the extraction wounds are tiny, they typically heal with cosmetically insignificant scars. This is a quantum leap from the widely practiced follicular unit strip surgery that acquires hair follicles for transplant from a linear piece of scalp, with a resulting wide and long scar that wraps around the head

The small hole left behind after the follicle is extracted then heals over the next few days. This tiny wound contracts as it heals making the resulting round scar smaller and less noticeable. The FUE patient typically ends up with hundreds of small round white scars, which are normally not detectable to the naked eye once the patient’s hair grows out

Follicular unit extraction enables the patient more hair grooming options including shorter haircuts without the fear of exposing a linear scar. The fear of exposing a linear scar is a concern for patients that undergo follicular unit strip surgery (FUSS); in most cases of FUSS, hair in the back and front must be kept long to conceal the linear scar, with anxiety about exposing the scar in windy and swimming situations. The FUE procedure minimizes visible scarring and achieves cosmetically aesthetic results via the tiny punch grafts

Advantages of follicular unit extraction over follicular unit strip surgery include:

    • Avoiding a linear scar .
    • Ability to cut the back and side hair short. In strip surgery, the hair on the back and sides is grown long to hide a scar, thus the top looks balder. With follicular unit extraction the hair on the back and sides of the head can be cut short, giving less appearance of baldness on the top.
    • Less chance of permanent nerve damage, which can occur in FUSS since a through-and-through cut in the skin is an integral part of the procedure (and nerves running across the cut are more likely to be severed).
    • Less chance of permanent nerve damage, which can occur in FUSS since a through-and-through cut in the skin is an integral part of the procedure (and nerves running across the cut are more likely to be severed).
    • Less invasiveness, less pain, and less recovery time.
    • Follicular unit extraction allows a wider area of the head for harvesting. The result is finer hairs (such as those found around the ears) that can be selected for hairline, eyebrow, eyelash and temple point constructions. In these areas, carefully selected finer hairs by advanced follicular unit extraction, such as the Umar Procedure, provide a more natural outcome than the strip method. It is impractical to obtain hair from around the ears using strip surgery or FUSS.
    • Strip surgery – FUSS results in the disruption of the anatomy and alignment of the hair and scalp architecture especially on the back and sides. Invariably the lower neck hairline is elevated and the hairline around the ears is also lifted. The hair flow is also disrupted. In extreme cases, the crown margin extends down towards the neck area.
    • Follicular Unit Extraction, enables the ability to harvest even more head donor hair after patients have maxed out their potential donor hair for FUSS. This is due to either scalp laxity limitations or further FUSS simply becoming impractical.
    • Advanced practitioners like Dr. Sanusi Umar can efficiently harvest beard and body hair using the follicular unit extraction technique to expand the donor supply for donor-depleted patients. This will repair cases of botched transplants, burn victims and severely bald patients who are considered poor candidates for hair transplantation due to lack of head donor hair.

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