Follicular Unit Extraction (FUE) Explained

What is FUE?

FUE is a hair transplant technique in which a small round punch is used to extract units of hair follicles from an area of dense hair growth to an area of baldness. Each unit contains one to four hairs.
Though the abbreviation 'FUE'  is commonly known to stand for Follicular Unit Extraction, guidelines issued in March 2018 from the International Society of Hair Restoration Surgery (ISHRS) advised that the procedure would be renamed 'Follicular Unit Excision'.

How is it different from standard follicular unit hair transplantation (strip surgery)?

With strip surgery (the old fashioned way of transplanting hair, also known as Follicular Unit Transplantation or FUT), a strip of donor tissue is removed from the back of the head (where hair growth remains) and trimmed under magnification into individual follicular unit grafts. Strip surgery is usually more suitable for larger areas of baldness as up to 3,000 grafts can be transplanted at one time if there is an adequate supply from the patient. However, the scalp requires longer healing time post-surgery and a large scar will remain across the scalp which can be hidden by longer hair.
The specialised punch used in FUE allows the surgeon to remove hair from the skin without causing damage. The hair transplantation is non-evasive and therefore the scalp heals faster. A patient can often show no visible signs ten days after surgery.

The Surgical Procedure

The specialised punch, less than 1mm in diameter, extracts hair from the scalp one at a time. This is done by in a complex multiple step process. Firstly, a small sharp punch scores the skin around a follicular unit. Secondly, a small dull punch is used to go deeper into the soft tissue surrounding the follicular unit.
The reason for the use of a sharp and a dull punch is important in FUE. The direction and angle of the follicular unit beneath the skin is not visible and is often different from the direction of the hair on the surface of the scalp. Therefore if a sharp punch was used below the surface of the skin it might sever the underlying follicular unit. The dull punch, on the other hand, is more likely to envelope the follicular unit while separating it from the surrounding soft tissues. Once the underlying follicular unit is separated from the surrounding tissues it can then be extracted, usually by a forceps gripping the hair above the surface.
The small hole left behind after the follicle is extracted takes a few days to heal and as it does so the small wound contracts which makes the remaining scar much smaller and less noticeable. The patient often has hundreds of small round white scars which are typically invisible to the human eye after his or her hair has grown out.

Who is an ideal candidate for FUE?

People with mild to moderate levels of baldness will be suitable for FUE. The amount of hair transplanted was limited in the early days of FUE, but now up to 7,000 hairs can be extracted in one day - that would account for a fairly large area of hair loss or baldness.

Is FUE widely available?

FUE is becoming more widely available in the UK, although there are only a few reputable surgeons.

The Expert View

Senior hair loss specialist at the Belgravia Centre, Leonora Doclis, points out that the hair will continue to thin outside of the areas where hair has been transplanted; areas where DHT (the product in the body that causes genetic hair loss) is still active. Doclis says, “This procedure simply fills in the gaps. With any hair transplant technique it is necessary to use suitable treatments in order to retain the hair around the transplanted units, so with or without surgery preventative treatments are still necessary. Moreover, much of the time the same or better results can be experienced from the use of a specially tailored treatment programme, which can promote regrowth within three to six months meaning surgery may not be necessary. We usually advise giving the right treatments a go before deciding on any form of hair restoration surgery” adds Doclis.
For an idea of the results that an effective non-surgical treatment programme can bring, view Belgravia’s Hair Loss Success Stories.

Summary of the main advantages of FUE

• Ideal for moustache or eyebrow replacement


• Ideal for small sessions and for patients in early stages of hair loss


• Ideal for patients who wish to shave their heads


• Less invasive than strip surgery - with no visible scarring in the donor area



 
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Summary of the main disadvantages of FUE

• Costly


• Time-consuming procedure


• Surgical procedure so there are risks involved


• Only available from few surgeons


• May not be suitable for large areas of baldness


• Hair loss treatment programme required for maintenance post-operation


• Non-Surgical treatment programme may be as effective



 
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Further Information

If you would like to discuss your suitability for a hair loss treatment programme, contact Belgravia for a free consultation with a specialist. We can also advise you on the best and most reputable surgeons in the UK if you decide that you would prefer to go with the surgical option. To book an appointment, call 020 7730 6666 or message the centre. Alternatively, submit an online consultation from anywhere in the world and one of the clinic's advisors will contact you. The Belgravia Centre do not perform hair transplants but as stated above, hair loss treatments can often be a more suitable alternative.