This refers to a new technique developed in the early 2000’s, in which individual follicular units are removed from the donor scalp area or other parts of the body. This procedure is done by superficially cutting around the follicular unit with a tiny sharp punch and then using gentle traction or pulling to have the rest of the graft break free and come out. Some techniques feature a second cutting of the deeper portion with a duller instrument. This procedure is being refined further each year. It is a very tedious and time-consuming way to harvest hair, but in my opinion is invaluable as a back-up technique in two particular instances:
For use in camouflaging wide donor scars after they can be no longer narrowed by simple excision. This is particularly helpful for those with tight scalps or those in whom previous surgeons have tried excision and the scar remains wide. In such instances, one doesn’t want to add another linear scar, and so FUE is the best way to obtain the needed hairs to hide the scar without adding further horizontal scars.
For obtaining body hair when the the scalp donor sites are depleted. We have primarily used this in obtaining chest hair. There is virtually no evidence of scarring a few months after the procedure. Photos of this process are shown below.
I would like to close this section by stating once again that, for most patients, harvesting narrow elliptical strips of hair from the sides and back of the head is by far the most efficient and best way to obtain donor hair. As long as the surgeon is not too greedy or aggressive in the width of scalp taken or the size of the session attempted, the overwhelming great majority of these scars are very narrow and virtually undetectable even with hair length only a half inch long. Obviously, if someone wants to preserve the option of shaving their head some day, then proceeding with hair transplantation makes no sense, even with FUE, as after a great many of these tiny punch-outs, in many patients a slight “moth-eaten” appearance can still occur which is not entirely natural looking.
In summary, we think FUE has a valuable, but limited, role in hair transplantation and is a valuable procedure for us to be adept at performing, but that it will never be the preferred way to obtain donor hair for transplant procedures in general. It is simply too time-consuming, too tedious, and the surgeon and staff don’t have the same freedom and ability to cut perfectly sculpted grafts as with strips, in which case everything is carefully done under the microscope.