Follicular Unit Extraction

Introduction

Follicular Unit Extraction (FUE) is a technique of hair transplant in which the units of hair follicles are extracted by a small round punch from an area of dense hair growth to an area of sparse hair. Each unit contains one to four hairs.

In a standard follicular unit hair transplant procedure known as strip surgery, a strip of donor tissue having hair growth is removed from the back of the head and is placed under magnification into individual follicular unit grafts. This type of surgery is more suitable for larger areas of baldness. About 3000 grafts can be transplanted at one time if possible. However, the scalp requires longer recovery time after this surgery and the scar formed across the scalp is large, but can be hidden by hair.

In follicular unit extraction, the surgeon can remove the hair follicle from the skin without causing damage with the specialized punch. In this method, the hair transplantation is non-evasive and healing of the scalp is also faster. A patient may show no visible signs of surgery within ten days.

The Surgical Procedure:

1. In this procedure, a special punch of less than 1mm diameter is utilized to extract hair from the scalp one at a time. This requires a complex multiple step process.

2. Initially, a small sharp punch removes the skin around a follicular unit. After this, another less sharper dull punch is used to go deeper into the soft tissues which are around the follicular unit. The dull punch is used here instead of a sharp punch as the direction and angle of the follicular unit below the skin is not visible and is usually different from the direction of the hair as seen on the surface of the scalp. Therefore, if a sharp punch is used below the surface of the skin it can cut the underlying follicular unit.

3. This dull punch envelopes the follicular unit and separates it from the surrounding soft tissues at the same time.

4. After the separation of underlying follicular unit from the surrounding tissues, the unit can be extracted. This is done by using a forceps that grips the hair above the surface.

5. The tiny hole thus created at the site of extraction takes some days to heal. Within a few days, this small wound contracts making the remaining scar very smaller and less noticeable.

6. Such tiny, white and round scars in a number of few hundred remain in the scalp of the patient. They are typically invisible to the human eye and may not be at all noticeable after the growth of patient’s hair.

Ideal candidates for FUE:

1. Follicular unit extraction is beneficial to patients in early stages of hair loss, as it can graft only about 500 – 600 units in one time.

2. Patients who wish grafting only to cover their hairline or temporal area.

3. It is also effective for people who require moustache and eyebrow replacement

4. Patients who wish to shave their heads.

5. Patients with realistic expectations regarding the results

6. Patients in good general health and sound mental status

Availability of FUE:

The FUE is an extremely difficult technique to perform for surgeons. Therefore, this new hair transplantation technique is only available with only a small number of surgeons.

Advantages of FUE:

1. Excellent results for moustache or eyebrow replacement

2. Ideal procedure for patients in early stages of hair loss

3. Can be used for patients who wish to shave their heads

4. Less invasive and no visible scarring as compared to strip surgery

Disadvantages of FUE:

1. Expensive procedure (about twice of strip surgery)

2. More time-consuming as only 500 to 600 grafts can be transplanted in a day

3. Risks of any surgery like bleeding and infection

4. Availability of procedure is limited

5. Less effective for large areas of baldness

6. Hair loss treatment programme is required for maintenance of results

7. Conservative treatment programme can also have similar results