Follicular Unit (FU) Hair Transplantation

Follicular unit hair transplantation (FU) terminology can be confusing. FU is the nomenclature to describe the manner in which hair grows from the scalp. Hair naturally grows from the scalp in bundles or units, also known as follicular units. When these units are grafts, then it is a Follicular Unit Hair Transplantation. There are two methods of obtaining FU’s.

The first method to obtain FU’s has began in the early 1990s. The scalp tissue is harvested by removing a strip of tissue 4-8 inches in length in the back of the scalp. This is the strip method. The strip of tissue is then put under a microscope and the FU’s are dissected out of the strip. Unfortunately, some hair transplant facilities, do not use microscopes, causing more transection. The FU’s are then transplanted into the targeted balding area called the recipient area. It is important to note that the hair harvested is transplanted into the scalp the same way it grows out of the scalp, in follicular units, so it has a very natural appearance.

follicular unit hair transplantation

Natural feathered appearance

Unlike the old round plugs that looked unnatural and “doll-like”. The natural feathered appearance is beneficial for hair transplants in the hairline. It is acceptable to transplant the entire scalp using this technique. This will make the entire balding area from the hairline through the crown appear natural. However, note that it will appear wispy without multiple hair transplant sessions. If use of FU’s are exclusive, without MFU’s in a large hair transplant session from hairline through the crown, the process will require about twice as many hair transplant sessions to reach the same appearance of density.

Follicular Unit Extraction (FUE) technique

The second method of obtaining follicular units is the Follicular Unit Extraction (FUE) technique. This method and the above method is the same process AFTER the tissue harvest process. In other words, both methods are transplanting FU’s. The difference lies in the harvesting technique. The tissue harvesting uses a linear incision to create a strip of tissue.  Then, under microscopes, careful dissection of the FU’s from the strip occurs.

The FUE method utilizes a punch to extract the FU’s directly from the scalp, thus the name Follicular Unit Extraction. However, the FUE method usually results in more transected tissue compared to the strip method. The instruments used for FUE are the Harris SAFE System, NeoGraft instrument, and the ARTAS. Dr. Arthur Zacco’s preference is the Harris SAFE System as he feels there is less transection of viable hair follicles.