What’s New in FUE Technology?

One of the most difficult challenges during all hair transplant surgeries is to avoid damaging the follicles. After all, what is the use of the surgery if the hair follicles fail to grow? This problem has largely been resolved for the follicular unit grafting (FUG) or strip technique, because each graft is carefully dissected by hand, under a microscope with full visualization of each follicular bundle. However, preserving the follicles during a follicular unit extraction (FUE) procedure can be more problematic. Unlike the FUG method, an FUE procedure removes follicular units from the scalp individually. The orientation of each follicle cannot be seen from the outside, so the knife must pass through the skin blindly, cutting through some follicles while missing others entirely. This difficulty is even more pronounced in patients with extremely curly hair (like many African Americans) because their follicles grow in different directions and are easily missed by a small, sharp punch. Furthermore, after the cut has been made, tension must be applied to remove the follicles from the scalp, placing additional stress on the grafts and potentially causing further injury which will ultimately lead to poor growth. Although the accuracy of this blind cut can be improved with proper equipment, bright lights, magnification, and expertly guided hand-eye coordination, it is still far too easy to destroy living follicles during an FUE procedure.

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Many hair transplantation experts have attempted to make follicular unit extraction (FUE) procedures more efficient by improving the equipment that is used, and so not all punches are alike. Some may have smooth inner edges and sharp outer ones, while others simply have only one sharp edge. In fact, some sharp punches can do so much damage that dulling the punch actually aids in the final results. Most punches rotate automatically to better separate the follicle from the surrounding tissue, but this rotation can, in some cases, bend and twist the hair underneath the scalp, which may actually increase the likelihood that the punch will damage the follicle. The limitations of these various devices mean that all the variables for each patient must be determined by the surgeon performing the procedure, so the goal of many hair surgery centers has been to perfect equipment that more effectively complements the action of a skilled human hand.

The latest and most successful development in FUE technology, more advanced than either NeoGraft® or the new robotic devices, utilizes a punch that flares outward, like the bell of a trumpet, with only the outermost edge sharpened. Because it does not cut straight downward into the scalp and funnels around the hair shaft, this unique design has a far lower chance of damaging follicles that grow in different directions. The smaller punch also produces a smaller and faster-healing opening which may produce a smaller scar. Finally, the punch does not rotate, but instead gently oscillates back and forth with a motion not unlike that of a human hand. This preserves the natural shape of the hair follicle and prevents the shaft from curling back on itself underneath the skin. The resulting grafts are much less traumatized and look like those taken during a strip technique. When they are placed under the skin, one cannot tell the difference, but they enjoy a significantly higher survival rate than those obtained with other FUE techniques.

The success of any hair transplantation is ultimately determined by the skill and experience of the surgeon who performs the procedure, and many transplant surgeons feel that the best grafts are produced by the strip method. However, the strip technique is by far the most difficult to perform, and for patients of color and those who want to wear their hair very short (Marine style) the lack of linear incision may be preferable. Although there will always be a limit on how many grafts can be performed using the FUE method, with this new technology we can now say that it is running a closer second than it ever was before. Every patient has distinct, individual needs, and both the FUG and FUE techniques have different advantages and disadvantages. The hair restoration specialists at The Griffin Center of Hair Restoration and Research will explain the specific details of each approach so that you can make a well informed choice.