What is Follicular Unit Extraction?
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. In this hair restoration procedure, a 1-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. FUT is the process of transplanting one follicle/graft at a time, attempting to mimic what nature has designed. Most of the hair transplant procedure involve FUT. Both strip
harvesting method and FUE involve FUT.
Therefore, when comparisons are made between FUT and FUE, what is really being compared is the way the follicular grafts are obtained (i.e. strip harvesting and dissection vs. direct extraction). The harvesting method does have other implications for the procedure such as the transection (damage) rate, distribution of follicular units, number of grafts per session, post-op care and the total yield.
Because FUE does not leave a linear scar, it is used for patients who want to wear their hair very short. The procedure is also useful for those who have healed poorly from traditional strip harvesting or who have a very tight scalp. Possibly the most important application of this technique is to camouflage a widened linear donor scar from a prior hair transplant procedure.
Patients differ significantly with respect to the ease in which the units can be removed from the scalp, with extraction in some patients producing unacceptable levels of transaction (damage due to cut hair follicles). All patients considering FUE should be tested for the ease of extraction (the FOX Test) so that those in whom extraction is difficult, or who show significant degrees of transaction, can be identified in advance.
Patients undergoing a full Follicular Unit Transplantation procedure should also be tested for Follicular Unit Extraction at the time of surgery, in the event FUE may be needed in a future session. One such use might be the camouflage of the linear scar after the patient’s final FUT procedure. This testing is done routinely (at no charge) in our practice.
Three-Step FUE
A significant advance in Follicular Unit Extraction has been the addition of “blunt” dissection to the original technique of “sharp” dissection followed by extraction. This was described by Dr. Harris at the ISHRS in 2004. In this three-step technique, a sharp punch is used to score the epidermis (cut just the upper part of the skin) and then a dull punch is used to bluntly dissect (separate) the follicular unit grafts from the surrounding deeper dermis. The third step is the same, namely removing the follicular graft from the scalp using fine forceps.
At MHTA we use a proprietary dissecting instrument that allows us to efficiently perform this 3-step technique with minimal transection. The instrument is positioned around the scored upper part of the follicle and allowing the surgeon to remove the entire follicular unit from the scalp.
The advantage of this hair transplant technique over the original two-step process is that using a dull punch minimizes follicle transection (damage). As the blunt-tipped punch is advanced into the dermis, the follicles, which naturally separate deeper in the skin, are “gathered together” within the opening of the instrument, rather than risk the lower portions of the follicles being cut off. Another significant advantage of the new technique is that it increases the number of patients who are FOX positive and thus who are able to benefit from FUE.
A problem of the three-step technique, however, is a higher incidence of buried grafts. When a buried graft is identified, it can sometimes be extracted by applying pressure to the surrounding skin. If this maneuver fails, a small incision is made to enlarge the opening and facilitate the removal of the graft. If not removed, a buried graft can occasionally result in a small cyst that would need to be removed at a later date.
Another problem is that during the extraction attempt the epidermis and upper dermis may separate from the rest of the follicle. This phenomenon has been called “capping.” When this occurs, the lower portion of the graft can sometimes be grabbed and extracted. When this is not possible, the lower potion is simply left behind. In this case the wound will heal and the lower portion of the follicle should produce a new hair. |
