Graft Excision in Hair Transplants - Bernstein Medical - Center for Hair Restoration
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By Robert M. Bernstein, MD

When Dr. Rassman and I coined the term Follicular Unit Extraction (FUE) in our 2002 publication “Follicular Unit Extraction: minimally invasive surgery for hair transplantation” we used the term to imply that this new procedure was less invasive than a traditional FUT/strip procedure ((Rassman WR, Bernstein RM, McClellan R, Jones R, et al. Follicular Unit Extraction: Minimally invasive surgery for hair transplantation. Dermatol Surg 2002; 28(8): 720-7.)), ((Bernstein RM, Rassman WR, Szaniawski W, Halperin A. Follicular Transplantation. Intl J Aesthetic Restorative Surgery 1995; 3: 119-32.)) Recently, FUE has been marketed by some practices as being non-surgical and this has given rise to the procedure being performed without physician participation (in some practices even without physician oversight).

The fact is that the FUE procedure is more than just the extraction of follicular unit grafts. The surgeon must first create an incision with a punch tool before the grafts can be extracted. The punch tool can be manually operated, automated or robotic. ((Bernstein RM. Integrating Robotic FUE into a hair transplant practice. Hair Transplant Forum Intl. 2012; 22(6): 228-229.)) The extraction can be performed with forceps or suction. This process of incising and then extracting grafts is a surgical procedure and is, therefore, better described by the word excision.

To avoid giving the erroneous impression that an FUE procedure is non-surgical, the term FUE will now be short-hand for Follicular Unit Excision. This better describes the two main components of an FUE procedure, incision (the separation of the follicular unit from the surrounding tissue) and extraction (the removal of the follicular unit from the scalp once it is separated).

OLD Terminology

FUE = Follicular Unit Extraction = the entire harvesting procedure

NEW Terminology

FUE = Follicular Unit Excision = incision (cutting) + extraction (removal)

It is important to note that this is just a change in terminology, not in the technique itself. The FUE procedure has not changed. The FUT/strip procedure and its nomenclature have also not changed. ((Bernstein RM, Rassman WR, Seager D, Shapiro R, et al. Standardizing the classification and description of follicular unit transplantation and mini-micrografting techniques. Dermatol Surg 1998; 24: 957-63.)) It is also important to understand that both FUE and FUT/strip refer to harvesting techniques and not to implantation of grafts into the recipient areas of the scalp (a process that is basically similar in both procedures).

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Q: I had an old hair transplant and I’m hoping to remove these plugs and of course am concerned how much additional scarring would result. I’m wondering if removal of the total hair plugs (which are perhaps 2 or 3 mm in diameter) by coring them out would result in a lot of additional scarring.

A: It will significantly reduce the scarring.

The reason is that the round disc of scar tissue at the bottom of the graft from prior plug hair transplants will be removed and the normal skin edges will be brought together resulting in a barely perceptible fine line scar.

See the Graft Excision in Hair Transplants page.

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