Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE)

These two procedures are considered state of the art by the majority of hair restoration surgeons worldwide.

Follicular Unit Transplantation

This procedure involves removing a strip of hair from the back of the head (the permanent donor hair) and dividing it under a microscope into “follicular units”.

This hair is then planted into small needle holes. About 60 or 70 grafts can be planted per square centimeter, allowing for a density that approaches that of naturally grown hair. When the procedure is done properly, it will produce a completely natural appearance. By "properly", I mean that the graft density is full, and that the hairline has been designed accurately and with aesthetic consideration. I had an FUT procedure done in February of 2006, and have provided some pre- and post-op photos of myself to show how natural this procedure can look on my website.

Many patients voice concern about the scar left across the donor site with this procedure. A new closure technique used by some physicians, called “Trichophitic closure”, allows the hair to grow through the scar, making the scar almost invisible.

If you go to my site at www.drrobertjones.com, you can see a diagram of how the Trichophytic closure technique works.

Follicular Unit Transplantation is the procedure suitable for most hair transplant candidates. In experienced hands, it will provide a completely natural result.

Follicular Unit Extraction

In 2002, I caught wind of a doctor in Australia who was performing hair restoration surgery without cutting a strip out of the back of the patient’s head. I called this doctor and asked him if I could visit and observe his practice, but he refused to have me. Curiosity got the better of me, so I started to experiment using different methods of removing grafts without a scalpel. I can remember the first attempt – it took me four hours to remove 75 grafts! Within a year I had perfected, and was performing, a technique whereby I could remove up to 1,000 grafts in a day. My notoriety grew as word spread of this new scar-free hair transplant technique, and soon I was teaching the technique to doctors from South America, Europe, America and Asia. I also had the privilege of showing doctors at major international conferences my technique, and now, doctors around the world are using it.

The concept is simple. Grafts are removed using a tiny punch, which varies its depth and angle according to the follicle. Once the punch releases the graft, it can easily be removed with forceps. The downside of this technique is that it requires a lot of work and practice on the part of the doctor, as removing the grafts can be quite difficult in some patients, and it requires the patient to buzz their head. (For women or men with long hair, you can get away with buzzing just a strip on the back of the head to use as a donor area). I have now performed enough FUE procedures that I can easily extract 1,500 to 2,000 grafts in one day, but it is an incredibly tedious and time-consuming procedure, and it is for this reason that it is so expensive – two to three times as expensive as an FUT.

Another advantage of FUE is the possibility of extracting body hair. When performing an FUT on a patient with a limited donor site, I often remove several hundred hairs from the body (chest, abdomen, back, etc.), allowing for more hair to be transplanted. It is a last resort for patients with minimal hair in donor sites on the head.

FUE heals very quickly. I have some photos on my site showing the healing over one week of the donor site with FUE.

FUE is not the answer for all patients, but it certainly has its place in modern hair restoration surgery.

Who should consider spending the extra money on an FUE procedure?

1. Patients who like to keep their hair shorter that 2 mm.

2. Patients who want eyebrow transplants where fine single hair grafts need to be selected for the best aesthetic result.

3. Patients who require the repair of a previous transplant’s scar using body hair FUE. I have used this with great success on a number of patients.

4. Patients who refuse to have strip surgery. Some patients simply don’t want to have a linear scar under any circumstance.

Dr. Robert Jones is a hair transplant surgeon just west of Toronto, Ontario, Canada. His practice is restricted to full time hair restoration surgery. He is president of the International Society of follicular Unit Surgeons, a member of the International Society of Hair Restoration Surgeons, and Board Certified by the American Society of Hair Restoration Surgeons.