Author Bio: Dr. Sanusi Umar MD is the author of this article.
Last Updated on May 7, 2021 by Dr Sanusi Umar MD
Definition – What is Follicular Unit Extraction – FUE: Follicular Unit Extraction (FUE) is a no-linear-scar surgical hair harvesting method used in hair transplantation that involves extracting a natural group of individual hair follicles one at a time directly from the patient’s head. Some have preferred the term follicular unit excision as a more accurate description of the surgical process. This minimally invasive procedure does not involve scalpels, thus avoiding linear scarring that often results from other transplants. During a hair transplant surgery, the surgeon usually extracts follicles from the head’s sides and back before implanting them into the balding or thinning areas. The main advantages of FUE are:
- No linear scars
- No stitches
- No scalpels or knives
- No Staples
- No stitches or sutures
- Faster healing
- Ability to carry a short hair cut
Type of FUE Hair Transplant Methods
Dr.UGraft™ is a revolutionary hair transplant system featuring a set of uniquely-designed devices that have completely changed the game when it comes to FUE …
There are currently two broad forms of Follicular Unit Extraction:
- Basic Follicular Unit Extraction: This is the simplest and most common form of FUE, where only the back and sides of the head are used for donor sources. These methods can reliably extract straight and loosely waved hairs. However, this classic FUE has limitations for extracting curly or tightly wound hair and for patients suffering severe balding. These limitations widely restrict the number of good candidates that qualify for the procedure.
- Advanced Follicular Unit Extraction: The advanced techniques like Dr.UGraft procedure have design advantages that makes it possible to reliably and consistently:
- Extract hair from the head as well as nape, peri-auricular areas of the scalp, neck, and all body areas
- Extract the most tightly curled hairs and even in thick scalp skins. Most individuals with tightly curled Afro-textured hair are not good candidates for basic FUE. Dr.UGraft advanced FUE tools and techniques consistently extract these types of hairs successfully. The following video Describes attributes of the Dr. UGraft – UPunch Rotor system:
Before The Era Of Linear Scar Free FUE Hair Transplant
Before the linear scar-free FUE method, doctors widely performed follicular unit strip surgery (FUSS) as the most popular form of transplant surgery. A surgeon cuts a linear piece from the scalp’s back or sides to utilize as a solid donor strip in FUSS. The strip is then microscopically divided by units to provide separate follicles for transplanting purposes. However, the surgery leaves behind a wide and long scar around the head’s base or side. Commonly known as “strip harvesting,” doctors considered FUSS the most traditional hair transplantation method until introducing no linear scar FUE. However, this method had severe limitations that have yielded perilous outcomes to many individuals seeking a natural-looking and permanent hair restoration solution.
Unfortunately, FUSS has several disadvantages for the patient. Extracting a full strip of flesh during the procedure permanently leaves behind a linear scar at the donor site. This scar does not fade over time. Unless the patient decides to conceal the scar by wearing a long hairstyle, the linear scar remains highly visible. Additionally, the invasive nature of strip surgery can cause possible nerve damage at the incision site. The nerves running across the incision are at a higher risk of being severed.
The Evolution of No Linear Scar Minimally Invasive Hair Transplantation
- So what is an FUE hair transplant? Restoring hair loss through transplantation originated in Japan in the early 1900s, but various temporary and surgical techniques have been developed throughout the decades. Originally, the procedure entailed the use of extensive 4-5mm punch tools. Oreintrich also reiterated this in the 1950s. These large punches created large pencil-head-sized scars on the donor site and a “pluggy” doll-like appearance on the bald areas.
- In the 1980s, Japanese Dermatologist Masumi Inaba introduced smaller punches in 1mm in the 4mm punches. This resulted in smaller wounds and smaller unit grafts. This can be considered the first description of follicular unit extraction, which was memorialized in a textbook written by Dr. Inaba.
- In the 1990s. Drs Willian Rassman and Robert Bernstein first coined the term follicular unit extraction, a dermatologic surgery Journal publication.
- Dr. James Harris developed a sharp and dull dual punch system for FUE in which the shallow scoring of the skin using a sharp punch is followed by a deeper score using a dull punch to minimize follicular transection. Dull punches were an improvement, but the two-step technique was cumbersome, and the dull punches recorded a higher incidence of buried grafts.
- In late 2005 Dr. Sanusi Umar began developing a punch system that combines sharp and dull approaches in one punch. At this point, all FUE systems largely rely on head donor supply and could be classified as Basic FUE. In 2009 Dr. U patented the flared hybrid Dr. UPunch, which resolves many of the dull punches’ problems. As part of the Dr. UGraft system, the UPunch effectively harvested hair from the head successfully, nape areas, and all body areas.
- The extraction of curly Afro-textured hair continued to be a challenge to the FUE world, however. Dr. Umar found a solution by developing the Dr. UPunch Curl, which worked by a non-rotary plunge-action mechanism, thus beginning an era of non-rotary punches. The Dr. UPunch Rotor and the Dr. UPunch Curl are integrated into a Dr.UGraft Revolution Advanced FUE System unit. Dr. UGraft systems mark the era of Advanced FUE.
- FUE hair transplants and all head hair transplants restricted hair extraction to a narrow corridor in the middle of the back and sides of the head for fear of using impermanent hair if the patient were to progress to severe baldness. Dr. U described in a publication in the Aesthetic Surgery Journal the “FUE Shave Test” for screening patients and determining when to use hairs in areas outside the so-called safe narrow corridor. This opened up the ability to use hairs in the nape and temple areas in many patients. It expanded the donor potential of these patients and enabled finer nape hairs to craft more natural-looking hairlines, temple points, eyebrows, and eyelashes.
BASIC FUE Hair Transplant Methods and Their Techniques
All basic follicular hair extraction solely relies on head hair donor supply which is limiting on several fronts. It is performed using either a manual punch or a powered rotary punch device. Like a pen, manual punches are mounted on a holder and require the practitioner to execute rotation through precision.
There has been an attempt to increase speed in basic FUE procedures, including the suction devices or robotic punch devices for help. For instance, the Neograft FUE incorporates suction that pulls the grafts through a circuitous air drying vacuumed tube, with possibly deleterious effects on the hair graft. On the other hand, robotic devices like the ARTAS Robotic FUE, a pre-programmed robotic machine, perform parts of the hair follicle extraction process. However, robots typically require larger punches that cause larger wounds and scars in the head donor areas. Smaller punches in the robot would increase transactions, especially on the head’s sides.
ARTAS allows for minimal work by the surgeon during the extraction process in FUE hair transplants.
Advantages OF BASIC FUE Over Strip Surgery
Some of the benefits of basic FUE hair transplant over Strip Surgery include the following:
- Avoidance of the Linear scars
- Preserved scalp anatomy
- Less likelihood of Nerve damage
- Faster recovery
- Ability to cut hair short
Advanced FUE Methods Using Dr.UGraft
Dr.UGraft Advanced FUE Technique and Body Hair Transplantation
Advanced FUE practitioner Dr. Sanusi Umar revolutionized the FUE hair transplant process by developing the Dr.UGraft Advanced FUE system, enabling efficient body and head hair in hair restoration surgeries. Expanding FUE to include these donors provides a more promising hair restoration technique, even in extreme baldness cases. Dr. Umar’s patented, revolutionary Dr.UGraft Advanced FUE system creates a quicker process with little to no risk of damaging the donor grafts during extraction. His state-of-the-art, patented Dr.UGraft Advanced FUE system and Dr.UPunch tool have ultimately earned Dr. Umar a reputation as a world leader in FUE body hair transplantation.
Unlike other FUE tools, Dr.UPunch tool completely avoids the added risk of buried grafts that other devices carry. While traditional straight punch grafts can cause trauma to the hair graft during extraction, Dr.UPunch angles away from the graft. It then creates a gentle pulling action of the graft for removal. Dr. Umar’s patented irrigation system then gently flushes any impacted grafts from the punch with no damage to the hair follicle. Dr.UPunch’s fluid irrigation system creates a final seal when the gentle pulling action separates the graft from the tissue.
Advantages of Dr.UGraft Advanced FUE Over Basic FUE Methods
Advantages of the UGraft over other basic FUE includes the following:
- The ability to utilize body hairs and head hair as donors allows Dr.UGraft Advanced FUE to have several advantages for patients and surgeons. Body Hair Transplant – BHT permits the use of donor hair from the beard, chest, stomach, arms, and legs, as well as the head and nape hairs for extraction. Expanding the donor pool to the body and the head can now restore hair in even the most severely bald or repair patients. Using finer hairs for the hairline and eyebrows in both situations where softness is desired makes for more natural-looking results.
- The ability to extract very curly hair from patients with African type hair in all patients using the UPunch Curl feature of the UGraft makes it a truly superior procedure. Basic FUE lack this ability.
VIDEO Explaining An Advanced Intuitive FUE Technology and Capabilities
For more information on Dr.UGraft FUE Products visit https://ugraft.com/If you’d like a free online consultation with Dr.U, fill out your information and pro…
The photo below shows a patient with curled African-type hair who failed basic FUE elsewhere but found hope in Dr. UGraft’s advanced FUE.
Now Known as Dr.UGraft Zeus – Skin Thickness and Transection is No Longer An Issue
Dr.UGraft’s newest upgrade referred to as Dr.UGraft Zeus, now includes a touch-screen interface that takes skin thickness into account as a leading contributor of hair transplant graft transection. Previously, hair restoration surgeons believed hair curliness to be the main problem. However, after performing countless procedures across patients of different ethnicities, Dr. U realized that skin thickness, not hair curvature was the number one factor to blame for high transection rates.
Certain patients with wavy (not tightly curled) hair experienced extremely high transection, compared to individuals of African descent. Dr.U noticed that this was due to differences in skin thickness. By overcoming this variable through improvements in his technology, he was then able to greatly lower the rates of surgical damage across his patients, regardless of their ethnic origins and hair curliness.
Poor Candidates For FUE
Some criteria that could exclude an individual from benefiting from FUE hair transplantation include the following:
- Those who lack quality heads, beards, or body hair. Patients in this category do not qualify for any hair transplant.
- Those with extremely curly hair or kinked follicles should only go to a clinic offering Intuitive FUE capable of navigating the subterranean course of the follicle.
- Those who have allergies to local anesthesia.
- Those who have bleeding or clotting abnormalities.
- Those with keloids or those with scar hypertrophy, an abnormal tendency to scar.
- The provider should counsel young patients under 24 for progressive hair loss, financial implications, and planning that considers their lifetime head and body hair donor supplies. However, this applies to practitioners of advanced FUE who can use hair from outside traditional head donor areas.
Who Should Perform FUE
The success of the FUE hair transplant surgery will ultimately rely on who performs the procedure. Follicular unit extraction requires an intense amount of labor and time. With this in mind, only a state-licensed FUE surgeon or an experienced associate with the same licensing should perform the procedure. Unlicensed surgeons are forbidden from performing this type of surgery.
Prepping for the Dr. UGraft Advanced FUE Hair Transplant Procedure
Patients who qualify for FUE and have chosen a qualified FUE practitioner should make it a point to know who would be performing different aspects of their FUE transplant procedure. Patients should also ask questions regarding the surgery process and obtain any pre-surgery instructions from the doctor. Your pre-surgical research and actions would carry far-reaching consequences and impact your overall surgical outcome immensely.
Patient’s To-Do List Before A Dr. UGraft FUE Procedure:
- Immediate after booking your surgery, make it a point to detail your written preparatory instructions given to you by the clinic. DO so with an eye for any preparatory instructions with time-sensitive mandates examples include when to start or stop certain medications, when, where, and how to shave or not shave.
- The morning of the surgery, eat a plentiful breakfast. This will ultimately help with the anesthesia.
- Make sure to shampoo your scalp thoroughly. This procedure is considered surgical, so cleanliness is dire.
- Arrive at your surgery appointment promptly.
- If you leave out of the clinic area, it would be best to find accommodation near the clinic and arrive at your new place of abode at least 1 day before your surgery date.
- Wear open front shirts with buttons, so you do not risk dislodging your grafts when trying to dress or undress after your Dr.UGraft advanced FUE.
Dr.UGraft Zeus – A New Upgrade Based on Skin Thickness
The Dr.UGraft Zeus system represents an upgraded model which uses a central console with a touchscreen interface that includes a complete set of presets to adjust punch performance based on different skin thickness levels.
So why is skin thickness even important? Based on his experience performing hair transplantation on patients of all ethnic backgrounds, Dr. Umar discovered that skin thickness, not hair curliness is the leading contributor of hair transplant graft transection rates. By accounting for this variable, it is then possible to safely and successfully extract all hair types from the scalp and body without worry about hair curvature or hair follicle shape.
The Dr.UGraft Zeus represents a single system that can be used across all FUE surgery types.
VIDEO Explaining How to Research The Best FUE Hair Transplant Procedure For You
If you are considering FUE for your hair transplant surgery you may be curious to know what the overall experience is like. In this video, Dr. U provides a s…
Below are some of the processes a patient undergoing a Dr.uGraft FUE procedure should expect
Dr.UGraft FUE Hair Transplant Surgery Preparation
- After arriving at the hair clinic, the provider will take before-surgery photos to document a baseline in the areas marked for surgery.
- Surgical plans would be discussed in detail, cataloged, and all questions and concerns are addressed.
- Next, the provider will then shave the donor areas in preparation for surgery. For Basic FUE clinics, this will be the back or sides of the scalp. For clinics using BHT may shave alternative areas on the nape, beard, chest, arms, or legs.
- Once the transplant prep is complete, a blueprint reflecting the surgical plan agreed is drawn.
- Next, patients are given light sedatives orally and/or intramuscularly to alleviate anxiety.
- The patient is positioned depending on the planned surgery. Dr. U utilizes the latest surgical equipment (specialized surgical chairs and tables) that emphasize patient comfort.
- Next, administration of local anesthesia to the donor areas is performed.
- Dr.UGraft FUE is commenced.
No linear Scar Dr.UGraft FUE Hair Restoration Extraction Process
- Dr. U and his associates would first score around a group of follicles (using Dr.UPunch Rotor) one at a time to free each of their tissue attachments. This method is used for all patients except patients with tightly curled African type hair, in whom Dr. UPunch Curl is utilized.
- Next, using a jeweler’s forceps with or without gentle dissection aid using a hypodermic needle, the grafts are pulled out of the scoring area.
- The grafts are placed in chilled storage media.
- After all the grafts have been extracted for the day, preparations are made for the next step of implanting the grafts. Typically this would coincide with when the patient would take a lunch break.
The tiny wounds left behind in the follicular unit extraction process quickly heal and leave minimal traces behind.*
Dr.UGraft FUE Hair Transplantation Graft Implantation Process:
- After the extraction phase, Dr. U would proceed to numb the recipient area by local injection of a lidocaine-epinephrine solution
- Next, Dr. U would make slits in the recipient areas using costume-sized blades for graft placement. This is what determines the design of the final result
- Next, Dr. U’s qualified and well-trained medical assistants would place the grafts into the slits Dr. U prepared.
- To obtain the most natural-looking hairline, Dr. U directs his medical assistants to implant hair follicles containing a single hair follicle at the very front of the hairline. This allows him to build a gradual wall of hair. He then fills in the rest with units containing two to three hairs to provide density in the thinned-out area.
Possible Complications with FUE Hair Restoration Surgery
In general, the FUE hair transplant surgery carries little risks for good candidates. However, there some factors that can increase the chance of a complication. For instance, failing to do the proper research on the surgeon can have risky consequences. An inexperienced practitioner or someone who values quantity of grafts over quality may not provide the best results. The following a common side effects of the FUE procedure:
- Extensive work in the hairline and temples could result in transient facial swelling. This is typically a self-resolving phenomenon that could arise at about 3 days after the hairline work was done and would resolve without any treatment within 5-7 days of onset.
- Ingrown hair folliculitis is very coming in the donor areas (from transected hairs). It may also occur in the recipient areas at the onset of new hair growth.
Other side effects are elaborated in the consent forms
Dr.UGraft FUE Hair Transplant After Care
- Upon completion of the graft implantation. The medical assistant would review the discharge instructions.
- Patients must follow the post-surgery instructions carefully, especially to ensure the best results. Post-surgical guidelines include instructions for everything from showering, daily activities to exercising. The doctor will also prescribe a mild painkiller, antibiotic, and topical medication to help with any form of discomfort.
- Photos are taken, and the patient is discharged.
Hair Growth After Dr.UGraft Head FUE Hair Transplant: The Healing Process and Results
- The tiny wounds in the Grafted bald area would have scabs that should typically come off within 7-14 days.
- The head donor site continues to heal and is overgrown by the hair until signs of surgery become invisible to the public, typically within one week.
- The donor sites will typically go through a phase of shedding hair until around the eighth-week post-surgery.
- Patients will notice signs of growth by three-and-a-half to four months following surgery, usually maxing out after 12 months.
- However, for Up to 18 months after surgery, there could continue some improvement in growth, hair thickness, hair shine, and hair texture resulting in a better blend with the surrounding natural hair.
Follicular Unit Extraction FUE Hair Transplant Before and After Photos
Here are some examples. However, for a more extensive view of the results of Dr. UGraft FUE using only the head donors gallery, visit here.
No Linear Scar Follicular Unit Extraction FUE Hair Transplant Results Video
To view a more extensive video gallery of Dr. UGraft’s hair surgery results, visit here.
The Dr. U Hair and Skin Clinic is known for creating impressive hair coverage results for different hair conditions such as hair loss, repair, and other chal…
Follicular Unit Extraction FUE Hair Transplant Frequently Asked Questions:
Does Dr. Umar treat patients who live out of the Los Angeles area with linear scar-free follicular unit extraction Using The UGraft?
Yes. Dr. Umar has treated scores of patients from all over the world. If travel is a factor for a patient, Dr. Umar and his staff can design a treatment plan to minimize the required travel to his Los Angeles office. Moreover, the proximity to the LAX airport makes visiting his facilities quite convenient.
How much does a no linear scar FUE hair transplant cost with Dr.UGraft?
Cost varies from patient to patient, depending on the number of hair grafts needed for treatment. For patients who consider costing a major factor, Dr. Umar can help design a treatment plan that will consider the cost while still achieving great results.
I’ve been told I’m not a candidate for a hair transplant because of a depleted donor area on my head. Can Dr. UGraft FUE hair restoration restore my hair?
Chances are yes, even patients with depleted donor areas on the head can qualify for hair restoration with Dr.UGraft. Dr. UGraft procedure has a high degree of versatility and can utilize hair from anywhere it grows on the body. This allows Dr. Umar to develop a restoration plan taking into account the shape and number of other body hairs to restore a full head of thick, natural-looking hair.
Dr. U invites all patients to send him any questions they may have about hair restoration via FUE hair transplant through our Ask Dr. U online form:
- Umar S. Hair transplantation in patients with inadequate head donor supply using nonhead hair: report of 3 cases. Ann Plast Surg. 2011 Oct;67(4):332-5.
- Read more on the FUE Healing Process here
- View results of Dr. UGraft Follicular Unit Extraction using head hair donor alone here
- New York Times article on Dr. UGraft ‘s use of leg hair in transplantation