Follicular Unit Extraction

Follicular Unit Extraction, or more commonly known as FUE, is a hair restoration method in which individual hair follicles are removed and transplanted to other locations on the scalp. This can be a desirable method because it leaves a tiny round scar about 1mm around

Ten years ago the use of follicular unit extraction (FUE) was advocated as an alternative to traditional strip harvesting of the donor tissue. The use of the technique has been slow to be accepted as a new standard. Many physicians have, in fact, tried the technique but with markedly varying success.

FUE technique is an alternative to Follicular Unit Transplant, or FUT, where donor hair is removed as a narrow strip of scalp about 10 to 15mm wide, and separated into individual follicular units under a microscope.

Follicular units (naturally occurring group as one, two, three or four) are extracted individually from the scalp/donor area and are placed in alopecia area. Unlike strip harvesting where the strip of hair is harvested and implanted in bald area, the follicular units are pulled/extracted from the place leaving a small pit in FUE.

Before extraction, the hair is trimmed for the benefit of doctor so he could work on the scalp efficiently. The extraction process will go on till the doctor extracts required follicular units for restoring the hair in the recipient area. As circular incisions are made and the graft is extracted, wound of the size 1mm or less in size leaves pit scars. But the healing process is quick and all the scars will not be visible once the hair grows back.

There will not be any linear scar that appears in FUT procedure. (Trichophytic closure method that we use in our hair clinic solves this issue too). The restoration method of follicular units which are extracted from the donor and then implanted in recipient area in FUE is same as in FUT. Under local anesthesia the procedure is conducted and is a simple out- patient procedure where the patient can leave home on the same day. With the help of stereo microscope the technicians arrange follicular units in groups. They check for any damaged follicles and dispose it and retain good follicular units that are to be implanted in the recipient area.

The incisions that are made in the donor are appearing as pits will contract and heal quickly. Once new hair grows the hair will hide the scars and are not visible. The transplanted hair may shed after few days as this is just a shock hair loss/shock fall out. This is a natural process and new hair will appear from 3-6 months after the surgery. Follicular unit extraction techniques are widely used in facial hair transplantations.

Donor scar visibility

Compared to a linear donor scar, the “mosaic” of dot scars created by FUE are preferred by patients who:

  1. Prefer short hair styles
  2. Are at risk for thickened donor scars due to excessive scalp tightness or laxity
  3. Notice scalp showing through their hair even with a longer style

Scalp Comfort

Multiple small round FUE incisions are spread out over a larger portion of the donor scalp compared to a single strip incision, so FUE patients experience:

  1. Less pain in the donor scalp
  2. Faster healing and no sutures or staples to remove
  3. Return to physical activity more quickly

Added Value

Scar management – FUE is an excellent method to disguise scar tissue that can’t be simply excised. Using FUE, bald scar tissue can be removed and replaced with hair bearing grafts.

Expanded donor hair supply – patients with excessive donor scars, scalp tightness, and/or patchy donor density have very limited options with traditional strip harvesting. FUE accesses areas that FUT can’t including upper and lower fringe of the donor scalp, beard and body hair for patients who have a shortage of donor hair

Fine hair can be harvested from the nape of the neck or temporal scalp for eyebrow and eyelash restoration.

Limitations of FUE

Hair Type – FUE is not as successful for patients with tightly curled hair because the curved “root” of the follicle is easily transected during extraction.

Graft quality – FUE often strips fat and other connective tissue from the lower portions of the follicle making the grafts more susceptible to damage from dehydration and physical injury during placement into the recipient sites.

Graft quantity – damaged graft rates are significantly higher for FUE compared to grafts prepared under a microscope with FUT. With the FUE method, the average number of hairs per graft is reduced due to difficulty removing the entire follicular unit.

Convenience – the number of grafts placed during a single FUE transplant session is limited due to the additional time required to precisely remove each individual graft. Larger sessions over 1500 grafts may need to be performed over consecutive days.

Financial – FUE is usually more expensive than FUT.

How It works

FUE or follicular unit extraction is one of the most modern and advanced methods of hair transplantation, which can assure you results which are completely natural. Unlike FUT or follicular unit transplantation, FUE is a far more sophisticated method, which is why there are very few clinics around the world, offering the same. In FUT, a strip of the scalp is removed from the donor site and hair grafts are harvested from the same. The area from where the strip was removed is then sutured back and this leaves a linear scar.

However, with FUE, there are no incisions, which means that there are also no sutures or scars. Via a suction like method, individual grafts are removed and are then almost immediately placed into the recipient site.

Here is a more in depth look at how an FUE procedure is done:

  1. The donor site and the recipient sites are demarcated beforehand. In case the donor site on the scalp will not yield sufficient grafts, other parts of the body, such as beard, chest and legs can also be looked at.
  2. The hair follicles or grafts are then extracted one by one from the donor site.
  3. The hair follicles or grafts will then be implanted almost immediately into the recipient site.
  4. The procedure is minimally invasive and leaves behind no scars, especially when done by an expert. In addition, the healing time is minimal and people are able to return to their normal lives in no time.
"F.U.E Surgery Steps"

Local Anesthesia

Slitting Recepient Area
Extraction of grafts

Implantation Of Graft


FUT or FUE. When carrying out a hair transplant the surgeon must ensure that the donor hair is only taken from the safe donor region. There are two surgical techniques by which hair can be removed from the donor area of a patient’s scalp. Follicular unit transplantation, FUT, and follicular unit extraction, FUE. In an FUT hair transplant a thin strip of hair is removed from the donor region. In an FUE transplant each hair graft is removed from the donor region one by one, using a punch tool. Regardless of whether FUE or FUT is used to remove the hair, the method for transplanting each of the grafts is exactly the same.

For patients undergoing an FUE hair transplant, in most cases the entire scalp must be shaved in advance of the procedure. For patients undergoing an FUT procedure, only the strip of hair to be removed is trimmed, allowing patients to return to their normal lives much more quickly, without others being aware they have had a hair transplant. As the FUE technique only allows a technician to take every second hair graft from the safe donor area, the yield of grafts is lower. As a result, many clinics are forced to remove hair from outside of this zone, which means as the patient ages, these transplanted hairs may thin and be lost.


  • No linear scar in donor area
  • Decreased healing time in the donor area
  • No limitations on strenuous exercise after the procedure
  • Less post-op discomfort in the donor area
  • Useful for those with a greater risk of donor scarring
  • Useful for repairing donor scars that cannot be excised
  • Provides an alternative when the scalp is too tight for a strip excision
  • Enables one to harvest finer hair from the nape of the neck
  • Makes it theoretically possible to harvest non-scalp hair


  • Follicular units in FUE are harvested from a much greater area of the donor zone compared to FUT
  • Graft quality is not as good compared to FUT *
  • The maximum follicular unit graft yield is lower than with FUT
  • With each subsequent session, the scarring in FUE is additive
  • In large FUE hair transplant sessions, the entire donor area must be shaved
  • Microscopic dissection may be needed in addition to the extraction
  • After large numbers of grafts are harvested, fine stippled scars may become visible due to thinning of donor area

  • Dr. Narendra Patwardhan, at Hair and Skin clinic, Bhandarkar Road, Pune is an expert Cosmetologist, Dermatologist, Skin Specialist and Hair Specialist and has expert knowledge and a great deal of expertise in Hair Transplants.