Follicular Unit Extraction (FUE) is the latest widely adopted practice in hair restoration. Traditionally, hairs to be transplanted are taken from a strip of hair at the back of the scalp. The hairs are then dissected out of he strip of skin nd hair. Follicular unit extraction involves removing each follicular unit to be transplanted individually, leaving only a small hole where the follicle used to be. The advantage of FUE is that involves minimal scarring and no chance of an unwanted large scar where the strip of hair would be removed. The small holes also feel much faster and with less pain and tenderness than the strip method. Sounds great, right? Well there disadvantages. The main disadvantages are that the cost can be twice as much due to it being more tmie and labor intensive as well as less donor hair available since the surgeon must leave some hair in between the hair follicles which are removed. Below is a more complete list of advantages and disadvantages.
Advantages
- No linear scar
- Important for those who wear their hair short
- Decreases healing time in the donor area
- Useful for those with a greater risk of donor scarring (Asians)
- Ideal for repairing donor scars that cannot be excised
- No limitations on strenuous exercise after the procedure
- Less post-op discomfort
- Provides an alternative when the scalp is too tight for a strip excision
- Extends the dimensions of the donor area (but not necessarily the total number of grafts)
- Enables one to harvest finer hair from the nape of the neck to be used at the hairline or for eyebrows
- Makes it theoretically possible to harvest non-scalp hair
- ex. beard or body hair
- Most useful when a limited number of grafts are needed
Disadvantages
- Maximum follicular unit graft yield is lower than with FUT
- Due to the inability to harvest all the hair from the mid-permanent zone
- The scarring and distortion of the donor scalp from FUE makes subsequent FUE sessions more difficult
- Greater follicular transection (damage) compared to FUT
- Greater patient variability in who are good candidates compared to FUT
- More difficult to capture the entire follicular unit
- More difficult to obtain a natural distribution of follicular units
- For efficiency, the largest follicular units are targeted, but these may not be ideal for the hairline
- Grafts are more fragile and subject to trauma during placing
- Since they often lack the protective dermis and fat of microscopically dissected grafts
- Microscopic dissection may still be needed
- If the number of single-hair grafts is inadequate
- To remove hair fragments
- Grafts harvested from outside the donor area will not be permanent
- After large numbers of graft are harvested, fine stippled scars may become visible due to thinning of donor area
- Size of session is limited
- Requires multiple sessions to equal the size of a single FUT
- Takes longer to perform
- More expensive than FUT
- Problems of “capping”
- This occurs when the top of the graft pulls off during extraction
- Problems of buried grafts
- This occurs during the blunt phase of the three-step technique when the graft is pushed into to fat and must be removed through a small incision or risked producing a cyst
