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
Long-term, if the donor area narrows, the scarring may become visible

  • Both FUT and FUE produce donor scarring; FUT, in the form of a line and FUE in the shape of small, round dots. With FUT, the line is placed in the mid-portion of the permanent zone and in FUE the dots are scattered all over the donor area. If a patient becomes extensively bald (i.e. the donor fringe becomes very narrow), the line of FUT will generally still remain hidden, whereas the dots of FUE will be seen above the fringe of hair. In the less likely scenario of the donor hair actually thinning significantly, both the line (of FUT) and the dots (of FUE) may become visible.
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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