HAIR TRANSPLANTATION: Hair transplantation has evolved a long, long way since it began in the early 1950’s. In 1939, a Japanese dermatologist, Dr. Okuda, published a revolutionary method in a Japanese medical journal of using small grafts that was similar to the way hair transplantation is performed today. FUE HAIR TRANSPLANTATION Follicular unit extraction or FUE is a hair transplant technique in which a small round punch (0.8 mm – 1.0 mm) is used to extract follicular units from a patient’s bald resistant donor areas. These follicular units are then transplanted into a patient’s balding areas. Given the time consuming and tedious nature of this procedure a physician is often limited to transplanting 1000-1500 follicular unit grafts in one day. The cost per follicular unit of FUE is also typically twice the cost of the standard follicular unit hair transplant (FUT) procedure in which a strip of donor tissue is removed from the back of the head and trimmed under microscopic magnification into individual follicular units. HOW A FUE HAIR TRANSPLANT IS PERFORMED? During the Follicular Unit Extraction or FUE procedure follicular units are excised one at a time using a tiny 0.8 mm – 1.0 mm punch. Typically the patient’s hair in the donor area where these follicular units are being removed is shaved so that the physician is able to see the patient’s scalp. The follicular units are extracted using a multiple step process. First a small sharp punch outlines the skin around a follicular unit. Then a small dull punch is used to go deeper into the soft tissue surrounding the follicular unit. Since the direction and angle of the follicular units beneath the skin can’t be seen and can often differ from the direction of the hair on the surface, a sharp punch if used below the surface of the skin will most of the time transect or severe the underlying follicular units. Once the underlying follicular units is separated from the surrounding tissues it can then be extracted, often by a forceps gripping the hair above the surface. 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,if performed correctly, which are normally not detectable to the naked eye once the patient’s hair grows out. WHAT IS FOLLICULAR UNIT EXTRACTION (FUE)? Follicular Unit Extraction (FUE) is a method of obtaining donor hair for Follicular Unit Transplantation (FUT), where individual follicular units are harvested directly from the donor area, without the need for a linear incision. With the FUE technique, a 0.8 mm to 1.0 mm punch is used to make a small circular incision in the skin around the upper part of the follicular unit, which is then extracted directly from the scalp. Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE) are sometimes mistakenly viewed as being two totally different hair transplant procedures. FUE, in fact, is a sub-type FUT where the follicular units are extracted directly from the scalp, rather than being microscopically dissected from a strip that has already been removed. To say it another way, in Follicular Unit Transplantation, individual follicular units can be obtained in one of two ways; either through single strip harvesting and stereomicroscopic dissection, or through FUE. Therefore, when comparisons are made between FUT and FUE, what is really being compared is the way the follicular units are obtained (i.e. strip harvesting and dissection vs. direct extraction). The process in the recipient area is the same. The main advantage of FUE is that it does not cause a linear scar. Therefore it is useful in patients who for one reason or another may in the future want to have their donor area very short. COMPARING FOLLICULAR UNIT EXTRACTION (FUE) TO THE STANDARD STRIP PROCEDURE While the FUE procedure has grown in popularity, largely due to the minimally invasive way in which follicular units are removed, the standard strip excision method is still the most popular hair transplant procedure. The standard strip excision method involves surgically removing a strip of scalp from the bald resistant donor area of the patient. The donor area is then sutured together. These sutures (either stitches or staples) are then removed about 7-10 days after surgery. When the linear incision is fully healed the patient is left with a thin undetectable scar in the back of the head. This scar is typically hard to see once the surrounding hair grows out. Both the FUE and the Strip Excision procedures have advantages and disadvantages: The strip excision procedure is more economical (typically half the price of FUE) and also enables a doctor to move much larger numbers of follicular units /hairs to the balding areas during a given surgical session. However, the donor area after a strip excision surgery will require more time before it is fully healed when compared to the FUE surgery. In addition, the FUE procedure, given its minimally invasive nature, does not produce one long linear scar but rather hundreds of tiny scars in the donor area that are often hard to detect. This has fueled interest in the FUE procedure with patients who are highly concerned about potential visible scarring in the donor area. However, given recent advances and care in donor closure techniques used during strip excision surgery, the linear donor scar created by the strip excision procedure is now often almost undetectable, even upon close examination. Thus concerns about visible scarring in the donor after strip surgery have diminished. This has made the additional cost and time requirements of doing the FUE procedure relatively less appealing.