Follicular Unit Extraction: Minimally Invasive Surgery for Hair Transplantation

    August 2002 in “Dermatologic Surgery
    William R. Rassman, Robert Bernstein, Robert E. McClellan, Roy B. Jones, Eugene W. Worton, Hendrik Uyttendaele
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    TLDR Follicular Unit Extraction (FUE) is a less invasive hair transplant method with minimal scarring, suitable for about 60% of patients, especially those needing fewer grafts and quicker recovery.
    In 2002, the document introduced Follicular Unit Extraction (FUE), a hair transplantation method that extracts individual follicular units using 1-mm punches, offering a less invasive alternative to traditional Follicular Unit Transplantation (FUT) with minimal scarring. The FOX Test, applied to 200 patients, determined that 25% were ideal and 35% were good candidates for FUE. Histological analysis of 10 patients' scalp biopsies showed no difference in hair growth phases between FOX-positive and FOX-negative patients, but FOX-positive patients had a thinner, more elastin-rich dermal sheath, suggesting the molecular composition of the dermal sheath affects the ease of extraction. FUE is suitable for patients with limited hair loss, requiring small sessions, or needing quick recovery, but only about 60% of patients were candidates, and it was practical for those needing fewer than 600 grafts. Despite its advantages, FUE has limitations, such as increased donor area damage, cosmetic issues, potential for more follicle damage, scarring, infection risk, and longer operating times. Walter Unger, MD, concurred that FUE should be limited to specific cases and is unlikely to replace FUT as the standard for most patients and doctors.
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