Follicular unit extraction (FUE), also known as follicular transfer (FT), is one of two primary methods of obtaining hair follicles, naturally occurring groups of one to four hairs, for hair transplantation. The other method is called strip harvesting.
The follicular units obtained by either method are the basic building blocks of follicular unit transplantation (FUT).
Follicular unit extraction was first described in 1988 by Masumi Inaba in Japan, who introduced the use of a 1-mm needle for extracting follicular units.
Follicular unit extraction takes considerable time and expense to learn and to develop skills to a high standard.
The survival of follicular units upon extraction from the scalp is one of the key variables of successful hair transplantation. If follicular units are transected in the extraction process, there is a greater likelihood that they will not survive the transplant, and the hair transplant will fail. While FUT procedures using strip-harvesting of follicular units typically guarantees a large number of non-transected follicular units, FUE procedures can, and often do, transect grafts, rendering them useless in a transplant.
FUE harvesting of grafts may cause “pit” scarring, small, round, and typically white scars in the patient’s donor area where the grafts have been removed.
Follicular unit extraction generally has a quicker patient recovery time and significantly lower post-operative discomfort than follicular unit transplantation (FUT). Additionally the risk of long term nerve damage, leading to chronic numbness and/or pain in the donor area, is significantly reduced with FUE vs the strip (FUT) procedure. Additionally, FUE provides an alternative to FUT when the scalp is too tight for a strip excision and enables a hair transplant surgeon to harvest finer hair from the nape of the neck to be used at the hairline or for eyebrows.
However, with FUE, the follicles are harvested from a much greater area of the donor zone compared to FUT, estimated to be eight times greater than that of traditional strip excision so requires patients to have hairs trimmed in a much larger donor area. Follicles harvested from borderline areas of the donor region may not be truly “permanent,” so that over time, the transplanted hair may be lost. Due to the scarring and distortion of the donor scalp from FUE it makes subsequent sessions more difficult, and grafts are more fragile and subject to trauma during placing, since they often lack the protective dermis and fat of microscopically dissected grafts.