Follicular Unit extraction or FUE as it is known is a relatively new technique of extracting grafts individually from the scalp. In this type of procedure a small round punch generally 0.6 to 1 mm in diameter is used to make a small circular incision around the follicular unit. These follicular units are then individually plucked from the scalp. This new procedure negates the need for a linear incision at the back and sides of the scalp with the inevitable scar that is produced.

Follicular Unit Grafting and Follicular Unit Extraction are sometimes viewed as being two totally different procedures. Follicular Unit grafting involves surgically removing a strip of skin from the back and sides of the scalp, this strip is then microscopically dissected into follicular units and these are implanted back into the balding areas of scalp.

FUE individually harvests these 1, 2, 3 and 4 hair grafts from the back and sides of the scalp. Each follicle after being extracted is examined under magnification and further trimmed of non hair bearing skin if required. And then re-implanted into tiny incisions in the balding area. So effectively once these grafts are out of the scalp the implantation procedure is exactly the same as it is for FUT.

So in effect when a comparison is made between FUE vs. FUT what is really being compared is linear strip excision (FUT) vs. individual graft extraction (FUE). As FUE does net leave a linear scar it is of particular interest for those who wish to wear their hair very short at the back and sides or plan to fully shave their head in their future.

• The donor region at the back and sides of the scalp is clipped down to 1-2 mm in length to allow the doctor to easily pinpoint which follicular units he will extract
• The donor area is aneasthetised to ensure a relatively pain free experience.
• The patient lies face down on a special operating chair that fully supports the head.
• The doctor using a powerful magnifier, extracts follicular units from the donor region one at a time using a small cylindrical punch and forceps.
• As each follicular unit is extracted, they are handed to the technicians who under the microscope will trim off any excess skin on the graft so they may be placed into the smallest incisions possible.
• The many small holes produced at the back of the scalp are then left to heal on their own.
• Once the doctor has extracted the required number of grafts the patient will change position and sit upright to allow the implantation to begin
• The follicular units are then implanted into the scalp one at a time into tiny needlepoint holes.
• Once all the grafts have been implanted the patient is free to go home.

For many years clients have been concerned about the linear scar that is produced by the strip excision method that is an integral part of the FUG procedure. However FUE’s primary advantage of no linear scar does bring with it, its own unique set of disadvantages.

• No linear scar
• Minimally invasive so shorter healing time
• No bandage required after surgery
• Allows a larger portion of the donor area to be harvested(does not increase the yield from a given area though)
• Best used in procedures that require a limited number of grafts
• Possible to use body or beard hair for transplantation if required

• Almost twice as expensive to achieve the same result as FUG.
• Absolute yield from given area is not as great as with FUG.
• Graft survival rate not as high as with FUG, due to the transection of grafts as they are extracted from the scalp.
• Those with curly or fine hair are generally not good candidates for FUE.
• Due to the labor-intensive nature of the extraction process, there are limits on how much can be achieved in one session and therefore multiple sessions are required to equal just one FUG.

In summary, the one disadvantage of FUG is the visible scar at the back of the scalp. However, with the advanced surgical techniques in use at our center, the reality is that over 90% of our patients have a scar that is 2mm in width or less and is easily camouflaged. This combined with the excellent and consistent growth rates of FUT means that FUT is yield equally good and consistent results.

That said FUE is a fantastic new advance and gives prospective patients an additional treatment modality to choose from.

Before and After

Eyebrow transplantation

Eyebrows form an important part of the framework for one’s face. They are important for facial symmetry and balance and, for many people, offer a valuable aesthetic aspect to attractiveness. Those who are unhappy with their eyebrows may be self-conscious about their appearance, which may be reflected in a lack of confidence.

Causes of Eyebrow Hair Loss

Loss of eyebrow hair can occur for a number of reasons. The most common cause is over-plucking and over-shaping. This typically occurs over a long period of time, similar to traction alopecia experienced along the hairline in women who continuously wear their hair in tight braids. The chronic pulling, plucking, and tension on the hair follicles will eventually cause them to stop growing.

Other times, eyebrow hair loss is simply genetic. Some families do not grow thick eyebrows. There are also medical causes such as thyroid disease and chronic anemia. Traumatic injury sustained from an accident, such as a motor vehicle crash, may also affect eyebrow growth. These are all common reasons seen in our practice on a regular basis.

Approach to Eyebrow Restoration

We address hair loss in the eyebrows similarly to that of the scalp. There are three main solutions:

• Medical stabilization
• Hair transplantation
• Camouflage

In regards to medication, there is Minoxidial to slow eyebrow thinning and help the hair regrow. They can provide favorable benefits for patients unhappy with the thickness of their eyebrows.

Those who desire a more elaborate solution can opt for a hair transplant. The procedure consists of placing mostly single hair follicles, but also strategically-located grafts which are slightly larger, in the desired area. Since every patient’s goal typically is to achieve a natural look, it is important that one consults an experienced hair restoration surgeon to perform this delicate procedure.

Following the procedure, camouflage agents such as makeup, micropigmentation (tattooing) and other cosmetic methods are helpful, but not always needed to complement the results of the procedure.