Follicular Unit Extraction (FUE): Everything You Need To Know in 2018

Follicular Unit Extraction (FUE) is the most popular hair transplant method. It has many benefits over older methods such as FUT (and hair plugs), but is it the right option for you?

In this post, we’ll introduce you to FUE. This will include a look at how FUE compares to other transplant methods, how it’s performed, how much it typically costs, and the benefits of its use.

What Is Follicular Unit Extraction (FUE)?

Two individual hair grafts after extractionFollicular Unit Extraction (FUE) is a hair transplant method that involves the removal and implantation of individual hair grafts on the scalp.

This method was first introduced in the late 1980s, however, it didn’t grow in popularity until the 2000s.

A History of Hair Transplant Methods

With the first successful hair transplant completed in 1822, hair transplanation has come a long way.

Over the years, the methods have been modified to offer a more natural look and a more positive experience.

Hair Plugs and Punch Grafts

In the earliest years of development, punch grafts were the hair transplant extraction method of choice. These grafts would then become “plugs” when implanted into the scalp.

While technically effective, this was a rather painful procedure. Additionally, the finished results were less than stellar. Besides this, though, plugs were used commonly for more than 20 years.

Mini/Micro Slit Harvesting

As an improvement over punch grafts, mini/micro slit harvesting involves the extraction of a strip of hair from the donor site. A slit is then made in the recipient area, and the strip of hair is implanted.

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There are a few downsides to this method, though. Foremost, slit harvesting results in a linear scar within the donor site. This can be uncomfortable and disfiguring, and it reduces the areas in which surgeons can extract hair.

(Learn more about hair transplant scarring here.)

In addition, the risk of infection increases. This is because the wound is larger and requires proper stitching.

Follicular Unit Transplantation (FUT)

Follicular Unit Transplantation (FUT) is a modern technique with a more natural outcome.

The harvesting process is the same as mini/micro’s, where a strip of hair is removed from the donor site. However, the similarities between the two methods ends here.

Once the strip has been removed, the surgeon will then dissect it into individual grafts under a microscope. Each of these units will have a few hairs, and these will then be implanted into the recipient site one by one.

FUT does have some downsides similar to mini/micro. Foremost, the scarring. However, the overall look is much more natural and this makes it popular among hair loss sufferers.

Follicular Unit Extraction (FUE)

The most advanced technique used today is FUE. As mentioned, this involves the extraction of single hair units and their one-by-one placement onto the scalp.

Showing how FUE works

While commonly completed by hand, there are more advanced tools being developed for FUE. One is the ARTAS System, a robotic system that analyzes each individual unit and then performs the extraction. This is controlled by the surgeon and technician.

FUT vs. FUE

As the two most commonly used methods today, it’s important to understand the key differences between them. This will help you to make the most informed decision should you choose to undergo the procedure.

A comparison between FUE and FUT
Source.

In simplest terms, both FUT and FUE transplants are implanted in individual grafts. This reduces scarring in the recipient area, and also speeds the healing process. However, the method of extraction from the donor site is quite different.

In FUT procedures, a traditional slit extraction is used. This means a strip of hair is removed from the donor site, and the surgeon then uses a microscope to dissect the strip into individual grafts.

On the other hand, FUE involves individual graft extraction from the donor site. This takes quite a bit more time, but it also reduces the risk of scarring and infection.

Who Is a Candidate for FUE?

As with any hair transplant surgery, there are people who make better candidates for FUE than others. These requirements will vary by surgeon, but let’s take a look at the most common candidacy requirements.

Men With Norwood Stage 3 Loss and Above

Hair loss at any stage can be devastating. However, most surgeons will only perform transplant on patients with Norwood stage 3 loss and above. Why?

The Hamilton-Norwood scale of hair loss. Source.

Hair loss, especially caused by Male-Pattern Baldness (MPB), occurs over a period of time. And, while a general pattern of loss is followed, the loss itself can be quite unpredictable. This is especially true when hair loss has just begun.

(Are you not sure where you fall on the Norwood scale for hair loss? Learn more here!)

As such, surgeons prefer to work with men with an established hair loss pattern.

Men With a Stable Pattern of Hair Loss

Alongside an established pattern, transplants are also most effective on men with stable (i.e. sustained) hair loss.

While a hair transplant can be used to renew your scalp’s appearance, it does not stop hair loss. If the underlying cause of the loss is not treated, then the hair loss will just return a few years down the line.

Fortunately, there are ways to get your hair loss under control. This means you can set yourself up to a successful transplant patient.

(Learn more about natural hair loss treatment methods here.)

So, when will a surgeon consider you “stable”? Again, this will depend on the surgeon. Six months to one year seems to be the common timeline of recommended stability, but your surgeon may be willing to perform the procedure earlier.

Men and Women With Trauma-Related Hair Loss

Whether you lost hair from a burn or other physical injury, a hair transplant may be a good way to regain your head of hair.

The reason trauma-related hair loss can be ‘treated’ with hair loss is because the hair loss isn’t genetic or otherwise ‘natural’. As such, there isn’t expected to be any future hair loss, and that gives you a good chance at achieving positive results.

As long as you have sufficient hairs for extraction (either on the head, or even elsewhere no the body) and your injury was treated properly, a transplant can be a good option.

How FUE Is Performed

FUE is a time-consuming process. However, surgeons have been working to perfect the procedure to both reduce time and increase positive benefits. In short, the procedure can be split into two major parts.

Part One – Extraction

Part one involves the extraction of the grafts, and there are two different ways this can be done.

Two-Step Procedure

  1. The punch is placed over the follicular unit. It’s then pushed in.
  2. Forceps are then used to gently leverage the unit free from its surrounding dermal structures.

Three-Step Procedure

  1. The punch is placed over the follicular unit. It’s then pushed in.
  2. The blunt end of the punch is then used to twist the unit, disconnecting it from the surrounding tissues.
  3. Forceps are used to gently pull the unit from its place.

The three-step procedure provides more accuracy. However, it does increase the risk of graft burying, and it also takes longer. This is why many surgeons still follow the two-step procedure in their practice.

Part Two – Implantation

Part two is the actual transplantation part, and it can also be done in two different ways.

Pre-Made Incisions

As the name suggests, this method involves the use of pre-made incisions in the recipient area. This is done by the surgeon or assisting physician.

These incisions are made after the units have been extracted, and the units are kept in a saline solution to ensure survival.

Once the incisions have been made, they’re placed individually into the pre-made incisions.

Stick and Place

Similar to the above method, the stick and place method of implantation is done after the follicular units have been extracted. The units are then placed in saline, and the surgeon prepares for implantation.

Depending on the surgeon, this is done in one or two steps.

The one-step method involves the use of an implanter pen. The unit is loaded into the pen, and the pen is then placed over the recipient area (in a predetermined implant location). The pen is pushed down, and the implant incision is made at the same time as the unit is placed.

The two-step method involves a needle or blade. An incision is made in the recipient area, and the preserved follicular unit is then immediately placed in the incision.

There are benefits and drawbacks to each method, but both are used frequently during transplants. Your surgeon will likely have a preference and use the method they’re most comfortable with.

How to Prepare for the Procedure

A hair transplant is a surgical procedure and, as such, there are a few things you’ll need to do to prepare. These preparations will ensure your procedure goes much more smoothly, and it will also increase the odds of success.

First and foremost, follow any recommendation given by your surgeon. For example, some surgeons will advise you to supplement with Vitamin C to boost your immune system. Other surgeons may advise you to quit smoking (or at least cut down). The majority will also prescribe an antibiotic to prevent the occurrence of infections post-surgery.

In addition, your surgeon should know about every medication, supplement, and herb that you take. You’ll be required to stop taking any blood thinners (such as aspirin), and you may have to temporarily cease taking prescribed medications (assuming it is safe to do so).

The night before surgery, you will be required to stop eating or drinking at midnight. You should wash your hair, and not use any product at all.

When going in for your procedure, you’ll want to wear loose, comfortable clothing. A button-down shirt is highly recommended, as you can remove it without fear of dislodging any follicles. In addition, you’ll want to arrange transportation for post-procedure, as you may be given a general anesthetic.

Of course, your doctor will provide you with their own list of recommendations. It’s necessary that you follow each as they’re laid out for best results.

The Side Effects of Hair Transplantation

Even though many hair loss sufferers receive positive results from the procedure, there are some side effects and risks to be aware of. In a 73-patient analysis, these included:

  • Postoperative edema (42.47%)
  • Failure of growth of transplanted hair (27.4%)
  • Sterile folliculitis (23.29%)
  • Wide donor scar (15.07%)
  • Bacterial folliculitis (10.96%)
  • Numbness/paresthesia (10.96%)

Other risks and complications include raised scar (8.22%), skin texture change (2.74%), pruritis/itching (1.37%), and excessive bleeding (1.37%).

Depending on your medical history, these risks may increase.

Even with these side effects a possibility, though, there are benefits to choosing FUE over other hair transplant methods.

The Benefits of FUE

As shown above, FUE is much more advanced than both punch grafts and slit harvesting. It’s also an improvement over another current method of transplantation, FUT.

Its main benefits come from the way in which the grafts are harvested. Single graft harvesting only causes a very small scar, known as pit scarring. These can be easily covered, and they’re nowhere near as disfiguring as the line scar associated with strip harvesting.

A donor scar as a result of hair transplant
A linear scar is a common occurrence after strip harvesting. However, FUE can provide similar results with NO noticeable scarring at all. Source.

Other benefits include:

  • Fast healing
  • Minimal pain/discomfort
  • Natural look

In addition, many hair restoration surgeons prefer this method because the potential donor site is much larger. Without having to worry about linear scarring, surgeons can pick from a number of more conspicuous sites on the scalp.

How Much Does Follicular Unit Extraction Cost?

As one of the more advanced hair transplant methods available, FUE is on the higher end of the scale. This is because the procedure takes considerable time, and it may need to be completed over a number of sessions.

One way that surgeons present costs is “by graft”. On average, this can fall anywhere from $4 – $8 per graft. But does how does breakdown by patient?

[one_third_first]Norwood Score[/one_third_first][one_third]Number of Grafts[/one_third][one_third_last]Cost (low – high)[/one_third_last]

[one_third_first]Norwood IIa[/one_third_first][one_third]800-1600[/one_third][one_third_last]$3,200 – $12,800[/one_third_last]

[one_third_first]Norwood III[/one_third_first][one_third]1200-2200[/one_third][one_third_last]$4,800 – $17,600[/one_third_last]

[one_third_first]Norwood IV[/one_third_first][one_third]1600 – 2600[/one_third][one_third_last]$6,400 – $20,800[/one_third_last]

[one_third_first]Norwood V[/one_third_first][one_third]2000-2800[/one_third][one_third_last]$8,000 – $22,400[/one_third_last]

[one_third_first]Norwood VI[/one_third_first][one_third]2400-3400[/one_third][one_third_last]$9,600 – $27,200[/one_third_last]

[one_third_first]Norwood VII[/one_third_first][one_third]2500-3600[/one_third][one_third_last]$10,000 – $28,800[/one_third_last]

If more advanced tools, such as the ARTAS System, are being used the price can be even higher.

Remember, these prices are just estimates. Not all surgeons charge “by graft”, and many cannot give you a solid estimate until you’ve been examined.

Is FUE Right For You?

If you’ve decided to undergo a transplant, you’re likely weighing the pros and cons of methods. However, only you and your surgeon can decide the right course for you.

Conclusion

For many hair loss sufferers, a hair transplant offers a confidence-boosting and all-around positive experience. However, it’s important to go into the procedure with your eyes open.

While I wouldn’t personally get a transplant, it may be the right choice for you. Though, I do recommend you take a look at more natural hair loss treatment methods before you decide. However, if you do go the transplant route, FUE is a good method with benefits over other advanced methods (including FUT) and less side effects than more traditional techniques.

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