Follicular Unit Extraction
Follicular Unit Extraction (FUE). The medical indication for the FUE procedure is in those who have a very tight donor area, such that you could not remove a 1-cm wide strip. This was the method originally used by Dr. Elliott back in the 80s to provide small grafts for hairlines. Below are photographs of a hair transplant done with the plug method, using 4-mm plugs throughout the center and back of the head, and one and two hair 1-mm plugs for the hairline. As you can see, it looks pretty good and almost as good as today's hairlines. The patient here is from 1988. The disadvantage of this method in hairlines, in those of Nordic origin, very small white circles may be seen at the base of the hair on close inspection.
BEFORE 1991
AFTER 2006 - 7 PROCEDURES OVER 15 YEARS
BEFORE
AFTER
AFTER
AFTER
In practices such as Elliott Clinic, where every effort is made to keep the donor scars to a very thin line in the 1-2-mm range, and to repeatedly go in the same place so there is always just one scar, there is no advantage to the FUE method unless you plan to shave your head. Those who plan to shave their head should not have a hair transplant.
To quote Dr. Bill Rassman in the May/June 2004 issue of the Hair Transplant Forum International, "Because the main advantage of FUE is the elimination of a linear donor incision, it's ironic that donor scarring is the major limitation to successful FUE. Although the individual scars of FUE are small, the cumulative scarring from hundreds to thousands of open wounds, left to heal by secondary intention, is significantly greater than from a linear incision. The small white donor scars may not be visible through normal length hair, but it is disingenuous to represent that scarring doesn't exist. The fine white scarring can be seen if the scalp is clipped or shaved, a style that is increasingly common today. The major consequence of this scarring is the decreased yield in future FUE sessions. Successful FUE depends upon tactile as well as visual cues, and scarring in the donor area significantly diminishes the sensitivity of the former. The scars in a previously harvested donor area make it significantly more difficult to extract intact follicular units without transaction. The scarring process alters the angle of the follicles,as well as the feel of the dermis. This can be appreciated both in the vicinity of a linear scar, as well as in the area of previously extracted grafts."
Note below the scar line on the back of patient, Scott McGuire. Scotty has had three procedures, with each time the donor being taken in the same place. You will note that this scar is only about 1-mm to 2-mm wide, and if you add up the total surface area of this scar which has produced 3000 grafts, you will find it is less than the surface area of 3000 1-mm circles. Thus, the old axiom that there is no free lunch proves true here once again. If you are going to take grafts out of a head, you are going to have some small scars. The trick is to get the scars as small as possible, regardless of which method you are using. Remember that small scars will not show unless you shave your head, and if you wish to shave your head, don't have a hair transplant.