Manual FUE Hair Transplant

Many people have may have heard of a relatively new technique in hair transplantation called the FUE method. FUE stands for Follicular Unit Extraction. Basically the “Uni-Strand” TM and FUE are similar in that the doctor and his staff take the hair from the donor area by removing each hair follicle, properly called a follicular unit, one at a time. Each follicular unit is taken out with a small punch. The advantage to this method is that the doctor does not actually have to make a cut in the donor area. The healing is faster and there is no need for stitches. This has led some doctors to say that there is no scar since there is no linear cut.

The FUE technique has been a welcome addition to the hair transplant technology. However, it does have limitations. First of all, it does leave very small scars in the donor area. These scars are usually too small to be seen even with a very short hair cut. Secondly, there can be a high transection rate of the grafts. Many potentially healthy grafts can be lost this way. Also the technique is labor intensive and it can take almost all day just to remove thousands of grafts. It is also more costly than the “Uni-Strand ®” method. For the right patient, with the right needs in good hands, it can be a very valuable technique.

How it works

In this hair restoration procedure, a 0.7 mm punch is used to make a small circular incision in the skin around the upper part of the follicular unit. The unit is then extracted directly from the scalp.

Because FUE does not leave a linear scar it is used for patients who want to wear their hair very short, less than a # 1 on your clippers.

FUE’s main limitation, when compared to “Uni-Strand ®”, is that it is less efficient in harvesting hair from the donor area. We find it is best reserved for patients that do no require large areas to be transplanted or with minimal hair loss requirements.

FUE, in fact, is a type “Uni-Strand ®” where the follicular units are extracted directly from the scalp, rather than being microscopically dissected from a strip that has already been removed. To say it another way, with “Uni-Strand ®”, individual follicular units can be obtained in one of two ways; either through single strip harvesting and stereo microscopic dissection, or through FUE. The finished result where the hair is transplanted will appear identical.

The table below summarizes the pros and cons of Follicular Unit Extraction. Vs. the “Uni-Strand ®” method.


  • No linear scar. This is important for those who wear their hair very short or who are intending to shave their head from time to time.
  • Useful for those with a greater risk of donor scarring.
  • Ideal for repairing donor scars that cannot be excised.
  • Provides an alternative when the scalp is too tight for a strip incision.
  • Enables one to harvest finer hair from the nape of the neck to be used at the hairline or for eyebrows.
  • The FUE method makes it possible to harvest non-scalp hair from beard or body hair.
  • Most useful when a limited number of grafts are needed.


  • Maximum follicular unit graft yield is lower than with “Uni-Strand ®” method. This is due to the inability to harvest all the hair from the mid-permanent zone.
  • The scarring and distortion of the donor scalp from FUE makes subsequent FUE sessions more difficult.
  • Greater follicular transection (damage) compared to “Uni-Strand ®”
  • Greater patient variability in those who are good candidates compared to “Uni-Strand ®”
  • More difficult to capture the entire follicular unit.
  • More difficult to obtain a natural distribution of follicular units.
  • For efficiency, the largest follicular units are targeted, but these may not be ideal for the hairline.
  • Grafts are more fragile and subject to trauma during placing since they often lack the protective dermis and fat of microscopically dissected grafts.
  • Microscopic dissection may still be needed if the number of single-hair grafts is inadequate to remove hair fragments
  • Grafts harvested from outside the donor area will not be permanent.
  • After large numbers of grafts are harvested, fine stippled scars may become visible due to thinning of donor area.
  • Size of session is limited.
  • Requires multiple sessions to equal the size of a single “Uni-Strand ®” session. FUE also takes longer to perform.
  • More expensive than “Uni-Strand ®” session
  • Possibility that problems could occur with buried grafts. This happens during the blunt phase of the three-step technique. When the graft is pushed into fat and must be removed through a small incision


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