In brief FUE or fully Follicular Unit Extraction is a hair transplant technique that has been practised for around 10 years. The basis behind the technique is the use of a micro sized punch under the 0.85mm in diameter to that encompasses and removes a single intact follicular unit (FU) from the scalp donor. Due to the micro nature of this technique it requires a high degree of skill and understanding of anatomy compared to more traditional hair transplant techniques.

FUE has become more widely practised and demanded by the public, an obvious reason from both sides was the tools used were different from the traditional linear scar method and promised the possibility of no scars, something that all wanted to believe was possibly. We have written much about FUE, the pros and cons, how advances have been made in punch size, the type of punch used, the extraction pattern or harvesting protocols, anatomy changes, skin types, each make up integral aspects of this technique.




Follicular Unit Extraction in the pure form can provide the correct candidate with as good a result in terms of yield as conventional hair transplant techniques. Not just can it excel in yield but it can leave the donor looking as if no hair transplant has been performed. But FUE has limitations in who the technique suits and what it can achieve.



Punch Diameter should not really exceed 0.85 in almost all cases, and 0.75 is a viable diameter to encompass most FU hair sizes and calibre. Using small tools minimises the sign of scarring on the skin surface and minimises the chance of transecting/impairing peripheral FU. The mechanical aspect of the punch is also integral to the transection of the graft; mechanical/drill type design is faster for certain but more accurate and able to sustain the best quality of the donor? Manual punch is possible with the correct technique to feel the FU as the punch surrounds the FU, manual will create less torsion to the skin and to the surrounding skin and hair. Manual Punch is time consuming, harder and more demanding but it will deliver a lower transection rate and better quality grafts in experienced hands.

Harvesting protocols is vital when planning the surgery, FUE does not change the surface area size of the donor but it does remove density of hair, the more removed the thinner the donor becomes. How much it is possible to remove, 20,30,50, 60%, realistically if spread over multiple procedures around 30% maximum under good conditions with a average to higher starting donor density; above 30% will start to remove adjacent hair and leave larger “hair less” areas, possibly more visible scars and impair the donor if future procedures are required. Hair characteristics will also play a role in how much can be safely removed, some candidates’ hair angles make better candidates than others and some have a % of miniaturisation in the donor.

A good candidate is a loaded question and complicated to answer, but to break down possible candidates but not assuming one size fits all. Small hair loss candidates, hair line work for example, those with higher than average donor density, repair cases when the traditional technique cannot be used, also opening up chest and beard hair FUE extraction to people. Not everyone is suitable for FUE and indeed a hair transplant in general. Education and research is so important when deciding to have any hair transplant, ideally consult various doctors and speak and if possible even meet their patients.

The amount of grafts available using FUE is tied into the harvesting protocol, as said because the surface area remains the same but the density of hair drops over this surface. It is unlikely that FUE over one or multiple procedures will be able to provide the same graft numbers as the Strip technique, hence it is better used for lower hair loss stages, when treating NW4 and above hair loss stages then the candidate has to have better than average donor hair characteristics and should be aware that if/when hair loss progresses then a Strip procedure will probably be required. There are always exceptions to the rule and the designing of the hair transplant can allow for more coverage but may also have limitations. Again education is vital to understand the potential before jumping into a hair transplant.