Paradigm Shift from Linear Strip to Follicular Unit Excision in Hair Restoration Surgery

December 2023 in “ Facial Plastic Surgery ”

Konstantinos Anastassakis

follicular unit excision FUE donor hair follicles hair restoration surgery graft injuries cosmesis

Studysummary This review discusses the widespread appeal and misconceptions associated with follicular unit excision in hair restoration surgery and reports no new clinical results; it highlights the technique's challenges and necessity for skilled execution.

Our plain-language summary. Not medical advice or a treatment recommendation. Consult a qualified healthcare professional before changing treatment. Full disclaimer

Follicular unit excision (FUE) is a method for obtaining donor hair follicles without a linear donor scar, making it ideal for patients who wish to hide signs of surgery. Over the past 20 years, FUE has become increasingly popular, driving the global market size of hair restoration surgery to new heights. However, FUE is often falsely advertised as "minimally invasive" or "scarless," leading to misconceptions among patients. Many clinics offer low-cost FUE surgery performed by nonprofessional technicians, which can lead to graft injuries as FUE is a blind technique. FUE presents unique challenges and potential long-term side effects if not performed correctly. The surgeon must have a thorough understanding of the FUE surgical technique to ensure consistent graft quality and favorable cosmesis of both donor and recipient areas. FUE requires dexterity, training, dedication, devotion, enthusiasm, cognitive clarity, scientific knowledge, experience, and an extended learning curve.

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3 citations , January 2021 in “Hair transplant forum international”

This study found that visual hair density is better correlated with hair count and shaft diameter, leading to the development of the Hair Diameter Index used in planning hair restoration procedures.

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12 citations , April 2020 in “Facial Plastic Surgery Clinics of North America”

This study reviews advancements in hair restoration surgery, noting that follicular unit excision significantly improves outcomes by enabling graft harvesting without scarring and reporting a graft transection rate under 4% when conducted with advanced equipment.

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8 citations , May 2019 in “International Society of Hair Restoration Surgery”

This review discusses the establishment of standard terminology for follicular unit extraction (FUE) by the ISHRS committee and reports no new results; the terminology is now widely accepted in hair restoration practices.

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10 citations , May 2019 in “Archives of Plastic Surgery”

In this study, postoperative pain was reported to be significantly less severe in patients who underwent follicular unit extraction compared to those who had follicular unit transplantation.

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4 citations , August 2018 in “Journal of Cosmetic Dermatology”

This study observed that actual harvested grafts in hair transplantation yielded more 1-hair follicular units and fewer 3-hair follicular units than originally estimated, with older age and multiple procedures limiting donor scalp harvesting.

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9 citations , January 2018 in “Hair transplant forum international”

This correspondence discusses issues related to overharvesting and challenges in measuring factors that impact donor coverage in hair transplantation procedures, but it does not report specific study results or outcomes.

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5 citations , November 2017 in “Hair transplant forum international”

This article reviews the basic principles and challenges of FUE hair transplants, highlighting techniques for improving graft quality and the importance of standardized procedures, but it reports no new clinical results.

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14 citations , March 2017 in “Plastic and reconstructive surgery. Global open”

In this study, various types of minor hair follicle damage were observed during follicular unit extraction, with paring and hair bulb injury being more apparent under microscopic examination.

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1 citations , November 2015 in “Hair transplant forum international”

This article introduces the authors and acknowledges a disclosed conflict of interest without reporting any new clinical findings.

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8 citations , September 2015 in “Hair transplant forum international”

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17 citations , May 2015 in “Aesthetic Plastic Surgery”

FUE hair transplantation using a micromotor is effective and gives natural results with few complications.

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45 citations , August 2013 in “Facial Plastic Surgery Clinics of North America”

This article reviews factors affecting follicular unit extraction, emphasizing the need to tailor procedures to individual patient characteristics, but reports no new experimental findings.

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10 citations , May 2012 in “Journal of Plastic Reconstructive and Aesthetic Surgery”

This article discusses various methods for minimizing and repairing strip scars from follicular unit hair transplants but reports no new clinical results.

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28 citations , July 2011 in “Journal of Plastic Reconstructive and Aesthetic Surgery”

This case report describes a serious complication of follicular unit extraction, where donor-site necrosis led to cicatricial alopecia, but was successfully treated with two-stage surgery using tissue expanders.

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16 citations , June 2009 in “Dermatologic Surgery”

This abstract does not contain research results or findings.

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27 citations , November 2008 in “Facial Plastic Surgery”

This article outlines the technical aspects, benefits, and challenges of follicular unit extraction for hair transplantation, but it reports no new clinical findings.

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15 citations , November 2008 in “Facial Plastic Surgery”

This review discusses the common issues with unnatural appearing hair transplants and presents potential treatment approaches, but does not provide new clinical results.

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27 citations , January 2006 in “Dermatologic Surgery”

This study found that the SAFE System may improve follicular unit extraction by reducing follicle transection rates and broadening patient eligibility, with only minor adverse reactions reported.

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This article reviews how new observations have revolutionized surgical hair restoration and highlights the logical applications and prior illogical judgments that delayed this advancement, without reporting new results.

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33 citations , September 1998 in “Dermatologic Surgery”

This article proposes a classification for small graft transplants that includes technical factors to improve communication and facilitate comparative studies, reporting no new clinical results.

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67 citations , September 1997 in “Dermatologic Surgery”

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