FUE or follicular unit extraction is a relatively new standard way to extract grafts from the donor region of the scalp as apposed to the primary standard procedure… the strip excision. The strip excision is where a physician takes a rather large strip of tissue out of the donor area, then technicians using microscopes further divide the tissue into follicular units. Follicular units are groups of hair follicles that range from 1 hair to as many as 8 hairs… the average hoovers around 3 to 4 haired grafts.
FUE was developed to try to work around the strip excision. Why? Because the strip excision has the potential for creating an unpredictable linear scar in the donor region. In years past, the strip scars put out by clinics ranged… in that a patient might get a pencil line scar, or the scars may widen to as much as 6cm in width. I personally have seen some of the worse scars in my lifetime. However, horrific scars have decreased overtime as clinics have become aware of this issue, and further technical developments(trichopytic closure) have curtailed the scar issue a great deal. This is speculation, though as there remains a severe scar issue in the wrong hands… and they do exist.
Moving onto FUE again, FUE is performed in a different way. A cylinder punch is utilized to cut around 1 or more follicular units. The cylindrical punch use in hair transplants is not a new technology. Cylindrical punches were used in the 80’s and 90’s but the only difference here was the fact that, the punch was 1.4-1.7mm in diameter. They called this shotgun punch holes after the donor area healed and scarred.
Fast forwarding to now, there was a re-introduction of the cylindrical punch back into the hair transplant industry by such popular FUE drs. as Dr. Woods, Dr. Rose, Dr. Jones, Dr. Harris, etc. The only difference here is the size of the punch.
The first re-introductions of the cylindrical punches was the use of .9mm up to 1.3mm in diameter. The average finally fell to around 1.0mm. Some clinics still today go above the 1.0mm punch but there is an inherent risk for a new phenomena in the donor region called “white dotting” AKA the moth eaten look, hypopigmentation, or just dotting. This can occur if the donor are is over harvested, and/or large punches are used and what occurs is a smaller version of the “shotgun” appearance.
A newer crop of punches surfaced in recent years and has become increasingly popular in its use. Clinics such as BHR (Dr. Bisanga), GHI (Global Hair Institute) and Dr. Harris, all prefer to use a small 0.75mm punch. or 75% of a 1mm punch. All three of these clinics(and there are more) have proven track records using this punch, producing good results in successive cases, and finally decreasing the scarring potential even more than in previous times. Dr. Bisanga also performed a research project that showed using larger punches can cause peripheral transections, or another phenomena called the halo effect. Dr. Harris pioneered his version of the 0.75mm punch using a two step process of scoring with a sharp punch and then blunt punching which is a form of blunt dissection. His theory is that less vasculature is damaged thereby less trauma… Most physicians prefer a sharp one step procedure and have become highly skilled and the sharp 0.75mm punch. Dr. Arvind (Dr. A) uses an even smaller punch or needle apparatus to extract single follicular units.
I hope this gives an overall quick introduction to FUE and i will ad more text and pictures soon. Please if anyone wants to add to this go right ahead.