Follicular Unit Extraction or FUE is a method where individual follicular units are harvested directly from the donor area. The primary rationale for the use of FUE is that a linear scar is avoided. Several proponents of FUE market the procedure as a technique that does not involve cutting, is less invasive and does not result in scars (i.e., “scarless”). While a linear scar is not created with FUE, circular scars are created. A 1-mm punch is used to make a small circular incision in the skin around the upper part of the follicular unit, which is then extracted directly from the scalp.

It is important to point out that with FUE the patient’s hair usually must be trimmed quite short for harvesting. This is the case especially when large numbers of grafts are required. A way to avoid trimming all of the donor hair is to set up rows of short hair between rows of long hair. The short hair grafts can be harvested within the existing long hair. But again, this is only suitable when relatively small numbers of grafts are needed.

A different skill set is required for FUE harvesting. The surgeon must be able to align the small punch correctly. FUE is a tedious process and both patient and physician may experience fatigue. This can limit the amount of grafts that can be harvested in a single session.

The learning curve for FUE can be slow for physicians who are used to excisions with scalpels and unaccustomed to the use of punches for harvesting. The cost of FUE is more than that for strip harvesting on a per graft basis.