Identifying an individual follicular unit (FU) can be difficult when follicles grow at angles under the skin and “surface” in the midst of neighboring FUs. The identification of FUs is done by the surgeon using a loop or microscope. The identification, harvesting and transplanting of FUs requires the training and skill of a hair restoration surgeon. A recent development in surgical hair transplant surgery is to specifically use the FUs for transplantation. The FUs are removed from the donor site (usually on the back and sides of scalp) by using a harvesting technique that preserves the FU intact. One such technique is called single-strip harvesting ( FUT) and is done with a scalpel-like blade. Another method is called follicular-unit extraction (FUE). FUE is performed by using a punch-like “circular scalpel” to score the skin and mid-dermis to a level of about 2 millimeters around a follicular unit, then gently extracting the FU from within the scored circle.
The extracted FU may be used intact, or may be divided into smaller units for transplantation. Single follicular units are often used to fill in a hairline, multiple FUs to provide greater density in the center of the scalp. The FUs are transplanted into the scalp by inserting them into small slits incised into the skin and underlying tissue with a small blade or needle. There has been debate regarding the scarring left at the donor site by harvest of FUs. Single-strip harvest (FUT) leaves a single, fine incision that usually heals in a few days. Follicular unit extraction (FUE) leaves small holes 1 to 2 millimeters in diameter at the site of FU extraction. These holes are not stitched but are rather left to heal on their own. Proponents of the FUE procedure claim decreased or complete lack of scarring but depending upon size of punch used scarring occurs , minimum diameter of punch is .65mm which doesn't cause scarring .The choice of harvesting techniques should be made after discussion between patient and hair restoring surgeon.
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The availability of FU E hair transplantation expands the number of options a patient may consider for surgical hair restoration. Whether it is the best option for an individual patient depends upon the individual patient characteristics, including cause of hair loss, type of hair loss, likelihood of hair loss progression over future years, cost of procedures the patient may consider, and the patient's wishes for the “look” that he or she wishes to achieve from hair restoration.