Abstract
Follicular unit excision (FUE) is a very effective and valuable modality for obtaining
donor hair follicles using manual, motorized, or robotic devices to harvest individual
donor follicular units in situ without a linear donor scar or visible scarring making
it ideal for patients who wish to wear their hair short and hide signs of surgery.
Over the past two decades, FUE has become increasingly popular, and the rising demand
for FUE has driven the worldwide market size of hair restoration surgery (HRS) to
an unprecedented height.
FUE has revolutionized the HRS industry and offers excellent cosmesis and high patient
satisfaction. Unfortunately, a large part of the favorable appeal of FUE is due to
false claims that it is “minimally invasive,” “scarless,” or “not even surgery.” Most
patients opt-in for FUE due to these misconceptions, which are advertised by “black-market”
clinics offering low-cost FUE surgery performed by amateur, nonprofessional technicians
on unsuspected patients. The technique appears deceptively simple, and many neophyte
surgeons falsely believe that the learning curve of FUE is short because the barrier
of entry is low and no previous surgical skill is required. Nevertheless, injuries
on grafts are extremely easy to occur since FUE is a blind technique and can be minimized
only with excellent technique, which takes years to master.
FUE actually presents unique challenges for the surgeon and carries potential long-term
permanent side effects if not performed properly. The surgeon must have a thorough
understanding of the nuances of the FUE surgical technique to ensure consistent graft
quality and favorable cosmesis of both donor and recipient areas. Efficient FUE requires
dexterity, training, dedication, devotion, enthusiasm, cognitive clarity, scientific
knowledge, experience, and an extended learning curve.
FUE is an invaluable addition to the armamentarium of a hair restoration surgeon but
has to be judiciously performed.
Keywords
scarless FUE surgery - FUE graft transection - FUE megasessions - donor area depletion
- FUE overhavesting - FUE graft injury - motor-FUE - FUE surgery delegation
