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Pros & Cons of Follicular Unit Extraction

The following tables summarize the pros and cons of Follicular Unit Extraction (FUE):

Advantages of FUE

No linear scar in donor area

Important for those who wear their hair very short

Decreased healing time in the donor area

No limitations on strenuous exercise after the procedure

Less post-op discomfort in the donor area

Useful for those with a greater risk of donor scarring

Younger patients
Very muscular, athletic patients
Those with very tight or very loose scalps

Useful for repairing donor scars that cannot be excised

Provides an alternative when the scalp is too tight for a strip excision

Enables one to harvest finer hair from the nape of the neck

For use at the hairline or the eyebrows

Makes it theoretically possible to harvest non-scalp hair

Beard or body hair

Disadvantages of FUE

Follicular units in FUE are harvested from a much greater area of the donor zone compared to FUT

In FUT, all the hair is harvested from the mid-portion of the donor area where the hair is most permanent. This is done to maximize the yield of high quality grafts from the permanent zone. In FUE, to obtain a sufficient number of grafts, follicular units must also be extracted from the upper and lower portions of the donor region and these may not be as permanent. Therefore, over time, the hair transplanted from these areas to other parts of the scalp may be lost
Over time, continued thinning in the upper and lower parts of the donor zone may cause the FUE scars to become visible

Graft quality is not as good compared to FUT *

Greater rate of follicular transection (damage to grafts) compared to FUT
Grafts more fragile and subject to trauma during placement, because extracted grafts often lack the protective dermis and fat of microscopically dissected grafts
More difficult to capture the entire follicular unit – resulting in lower density
* This disadvantage is minimized with Robotic FUE

The maximum follicular unit graft yield is lower than with FUT

Lower quality grafts may not grow as well
Inability to harvest all the hair from the mid-permanent zone results in decreased numbers of grafts
The scarring and distortion of the donor scalp from FUE makes subsequent FUE sessions more difficult

With each subsequent session, the scarring in FUE is additive

For example, if the first FUE session is 2,000 grafts, there will be 2,000 tiny round scars. With a second session of 2,000 grafts, there will be a total of 4,000 scars
In contrast, with FUT, the first scar is completely removed in the next procedure. Even though the scar may be longer in the next session, with FUT, regardless of the number of procedures, the patient is left with only one scar

In large hair transplant sessions, the entire donor area must be shaved

This may present a significant temporary cosmetic problem for working patients or those in the public eye

“Capping” *

Capping occurs when the top of the graft pulls off during extraction
* This disadvantage is minimized with Robotic FUE

Buried Grafts *

This may occur during the blunt phase of the three-step technique when the graft is pushed into fat and must be removed through a small incision
* This disadvantage is minimized with Robotic FUE

Microscopic dissection may be needed in addition to the extraction

If the number of single-hair grafts is inadequate
To remove hair fragments

After large numbers of grafts are harvested, fine stippled scars may become visible due to thinning of donor area

The size of a single session is limited

Since the extraction process is slower than strip harvesting, large procedures may need to be performed over two days

With FUE, grafts are usually out of the body for a longer period of time compared to FUT

This runs the risk of sub-optimal growth
This problem can be mitigated by performing large sessions of FUE over two consecutive days

FUE is usually more expensive than FUT

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