Follicular unit extraction is a minimally invasive procedure for performing follicular unit hair transplantation. However, unlike the predominant follicular unit transplant procedure, in which a strip of donor tissue is removed and dissected under magnification, the FUE procedure uses a small punch to extract each follicular unit one by one.

Both the strip excision and FUE procedures create 1, 2, 3, and 4 hair follicular unit grafts that are then transplanted into the balding area in the same manner. The primary difference between these two procedures is the technique used to harvest the follicular unit grafts.

Comparing the Strip Excision procedure to the Extraction (FUE) procedure

The common strip excision method of performing follicular unit hair transplantation involves surgically excising a thin horizontal strip of bald resistant skin from the donor area.

Strip Excision Procedure 

Donor strip being excised

Incision sutured together

Hair combed down after suturing

This donor area is then sutured together. These sutures (either stitches or staples) are then typically removed about ten days after surgery. Some physicians use dissolvable sutures so that no removal is needed.

Patient’s donor area 2 months after surgery

Once this linear incision is fully healed the patient is left with a thin horizontal scar in the back of the head. This scar is typically hard to detect since the surrounding hair conceals it, even when the hair is cut short.

To view a video of an actual strip excision surgery.

How the FUE Procedure is performed

With the Follicular Unit Extraction or FUE procedure 1, 2, 3, and 4 hair follicular unit grafts are carefully extracted one at a time using a tiny punch of one millimeter or less. Often the surgeon requires the patient to buzz cut a portion of their donor area so that they are able to see the patient’s scalp.

The follicular units are extracted

The follicular units are extracted by placing the punch around a single follicular unit and cutting a small circle through the skin around that follicular unit. The follicular unit is then gently pulled up and away from the loose tissue underneath the skin.

The small hole left behind after the follicle is extracted then heals over the following week. Normally this small round incision contracts as it heals making the resulting round scar smaller than the size of the 1mm punch that made the incision. The FUE patient ultimately ends up with hundreds of small round white scars, which are normally not detectable once the patient’s hair grows out.View a video of an actual FUE surgery.

To Extract or to Excise, that is the question.

Advocates for the relatively new FUE procedure claim that this procedure produces less noticeable scarring and no tightness or numbness in the donor area since no donor tissue has been pulled together and sutured. Many patients and physicians find the claim that FUE produces less visible scarring to be debatable.

Some physicians and patients also have concerns about the relatively new FUE procedure, such as the lack of formal studies regarding the percentage of follicles that may or may not be transected during the sight unseen extraction process.

In addition, since the physician must personally extract all follicles, one by one, the FUE procedure is very physician dependent and thus very expensive. The FUE procedure also requires considerably more time in surgery to move a given amount of hair to the balding area.

The standard strip excision procedure has the advantage of utilizing a collaborative team to carefully create the grafts once the donor tissue is removed in a strip. This collaborative approach enables a well trained staff to do sessions of 2,000 to 3,000 all follicular unit grafts in a single day. This team approach enables a patient to get a much larger number of grafts/hairs in one sitting at a much lower cost per hair than with the FUE procedure.

However, some believe that despite being relatively costly the FUE procedure may be appropriate for patients who have very limited elasticity in their donor area or who only need a small number of grafts.

In the 80's hair restoration surgery as a hair loss solution evolved dramatically, as the large punch grafts were gradually replaced with a more refined combination of mini and micrografts. This "combination mini micrografting" hair transplantation procedure no longer used the punch to extract the bald resistant grafts. Rather a strip of bald resistant hair was surgically removed from the back of the head and then trimmed into mini and micrografts.

Typically the minigrafts (4-8 hairs) were used to create fullness and density, while the one, two, and three hair micrografts were used to create a refined and feathered hairline in front. This combination procedure also normally used more grafts, several hundred grafts per session, rather than the approximately 50 to 200 large grafts of the original punch graft procedure.

Follicular Unit Hair Transplantation (FUT) the "Gold Standard"

The 90's saw the gradual introduction of a very refined surgical procedure hair loss solution now known as "follicular unit hair transplantation" or "FUT". This exacting and labor intensive procedure transplants hairs in their naturally occurring one, two, three, and four hair "follicular unit groupings" in which they grow naturally.

To create such natural follicular unit grafts, which mimic the way hair grows naturally, typically requires the use of high powered magnification. Such magnification enables the surgical technicians to properly visualize the follicular units in the donor tissue. They are then able to isolate them and cut them into 1, 2, 3, and some times 4 hair follicular unit grafts.

The Age of Natural Hair Transplant

Critical to the ultimate success of the follicular unit hair transplant procedure was the introduction of the binocular microscope by Dr. Bobby Limmer of San Antonio Texas in the late 1980's. Dr. Limmer found that by using the microscope he and his staff were able to successfully isolate and trim the naturally occurring follicular units into individual grafts.

For his part in pioneering the use the microscope in graft dissection and the follicular unit procedure Dr. Bobby Limmer was awarded the "Platinum Follicle Award" by the International Society of Hair Restoration Surgery in 1996. Many physicians now fondly refer to him as the "Godfather of Follicular Unit Hair Transplantation".

Dr Bobby Limmer

Dr Bernstein

While Dr. Limmer pioneered the use of the microscope in trimming follicular unit grafts, it was Dr. Robert M. Bernstein, in collaboration with Dr. Bill Rassman, who pioneered and advanced the concept of large sessions of all follicular unit grafting. These large follicular unit sessions enabled patients to achieve both naturalness and density.

Dr. Bernstein, who coined the name "follicular unit hair transplantation", tirelessly advocated for its adoption in ground breaking articles and lectures that are today recognized as benchmarks in the advancement of this procedure. Click to read these ground breaking hair restoration articles and papers.

In recognition of his many contributions in both conceptualizing, pioneering and advocating "follicular unit hair transplantation", Dr. Bob Bernstein was awarded the "Platinum Follicle Award" by the International Society of Hair Restoration Surgery.

Over time the merits of this refined but difficult to perform procedure became accepted and the follicular unit hair transplant procedure has become acknowledged by most hair restoration physicians to be the "Gold Standard" for surgical hair restoration. Click here to see video of a Follicular Unit Hair Transplant procedure.

Some feel that hair restoration surgery has evolved to its highest degree now that it relocates hair exactly as it grows naturally. However, even the "Gold Standard" in hair transplantation has continued to evolve by becoming even more "ultra refined".

Today some leading hair restoration surgeons, including all members of the Coalition of Independent Hair Restoration Physicians, perform an ultra refined follicular unit hair transplant procedure using very tiny incisions that enable them to safely "dense pack" tiny grafts when appropriate. This ultra refined follicular unit procedure is a hair loss solution that enables patients to achieve cosmetic density in a given area after only one surgical session.

Chosen by Patients and Peers for meeting the highest standards.

This Learning Center is sponsored by the Coalition of Independent Hair Restoration Physicians.

This elite group of independent surgeons have been carefully selected by patients and leading physicians and are committed to providing Ultra Refined Follicular Unit Hair Transplantation.

This minimally invasive hair restoration procedure enables patients to achieve very natural and dense hair growth after only one surgical session.

Coalition members agree to have their results openly critiqued and reviewed on the world’s most respected online patient based community - the Hair Restoration Network. Learn more about the high standards Coalition physicians must meet for membership.

Find an an elite Coalition Physician in your area and consult for free about how to restore your own natural hair.

Nioxin is an excellent product including both a shampoo and conditioner formulated specifically for men and women with thinning hair."> While neither the shampoo nor conditioner hasn't been proven to have any effects on DHT (the hormone responsible for male pattern baldness); Nioxin's ability to strengthen follicles and energize cellular activity can improve the overall health of your scalp and hair. Nioxin therefore may have the ability to delay the effects of hair loss. For best results, use both the shampoo (refered to as Nioxxin Shampoo Scalp Cleanser) and conditioner (referred to as Nioxin Scalp Therapy) in conjunction with one another.

Nioxin Scalp Cleanser's cooling properties refreshes and cools the scalp promoting maximum cleanliness and freshness. Because of this, Nioxin shampoo, especially when combined with the conditioner also significantly reduces scalp itchiness and tenderness after hair transplant surgeryin both the recipient and donor areas.

Nioxin Scalp Therapy is an excellent volumizing scalp and hair conditioner that moisturizes and improves your hairs' natural resilience, while promoting a healthy scalp environment for optimal hair growth. Nioxin Conditioner is the perfect conclusion to the Nioxin Shampoo Scalp Cleanser.

Nioxin Scalp Therapy's minty fresh cooling sensation literally refreshes and cools the scalp promoting maximum cleanliness and freshness. Because of this, Nioxin also significantly reduces scalp itchiness and tenderness after hair transplant surgery in both the recipient and donor areas.

We strongly recommend using Nizoral shampooevery 2 or 3 days in conjunction with Nioxin. Its active ingredient ketoconazoleat 2% concentration has proven to be a moderate DHT inhibitor and has growth properties approximately as effective as Rogaine2%.

Developing Realistic Expectations:

Men and women sometimes suffer from hair loss for different reasons. Thus, diagnosing its cause is necessary to facilitate and promote proper treatment.

The Nioxin product line is an excellent scalp and hair cleansing shampoo and conditioning therapy but is not proven to stop hair loss. Thus, we strongly recommend using Nioxin in conjunction with the "Big 3" (Propecia, Rogaine, and Nizoral.

To date, only surgical hair restoration is proven to grow hair in completely bald areas. You are invited to have a

Ingredients (Full List)

Nioxin Shampoo Scalp Cleanser: AQUA/EAU/WATER, TEA-LAURYL SULFATE, SODIUM LAURETH SULFATE, COCAMIDOPROPYL BETAINE, HYDROXYPROPYLTRIMONIUM HONEY, COCAMIDE MEA, PEG-150 DISTEARATE, PANTHENOL, GLYCOPROTEINS, POLY-SORBATE-60, POLYSORBATE-80, CYSTINE BIS-PG-PROPYL SILANETRIOL, HYDROLYZED KERATIN, ACETAMIDE MEA, PROPYLENE GLYCOL, ETHOXYDIGLYCOL, DIMETHYL ISOSORBIDE, COENZYME A, PANTOTHENIC ACID, PYRIDOXINE, CYANOCOBALAMIN, BIOTIN, FOLIC ACID, NIACIN, THIAMINE HCl, UBIQUINONE, ACHILLEA MILLEFOLIUM, ANTHEMIS NOBILIS, CAMELLIA SINENSIS, CITRUS GRANDIS, EQUISETUM ARVENSE, HUMULUS LUPULUS, MELISSA OFFICINALIS, MENTHA PIPERITA, PRUNUS AFRICANA, ROSMARINUS OFFICINALIS, SALVIA OFFICINALIS, SERENOA SERRULATA, SYMPHYTUM OFFICINALE, TARAXACUM OFFICINALE, THYMUS VULGARIS, URTICA DIOICA, SACCHAROMYCES LYSATE EXTRACT, PHOSPHOLIPIDS, SACCHAROMYCES/COPPER FERMENT, SACCHAROMYCES/IRON FERMENT, SACCHAROMYCES/MAGNESIUM FERMENT, SACCHAROMYCES/SILICON FERMENT, SACCHAROMYCES/ZINC FERMENT, PEG-23M, MELANIN, CITRIC ACID, SODIUM CHLORIDE, TETRASODIUM EDTA, DISODIUM EDTA-COPPER, SUPEROXIDE DISMUTASE, CI 42090/BLUE 1, PHENOXYETHANOL, METHYLPARABEN, PROPYLPARABEN, METHYLISOTHIAZOLINONE.
Nioxin Scalp Therapy: AQUA/EAU/WATER, CETRIMONIUM CHLORIDE, CETYL ALCOHOL, DICETYLDIMONIUM CHLORIDE, AMODI-METHICONE, TRIDECETH-12, LAURAMINE OXIDE, GLYCOPROTEINS, DIMETHICONE, SODIUM PCA, CYSTINE BIS-PG-PROPYL SILANETRIOL, PANTHENOL, POLYQUATERNIUM-11, ACHILLEA MILLEFOLIUM, ANTHEMIS NOBILIS, ARCTIUM MAJUS, CALEN-DULA OFFICINALIS, CAMELLIA SINENSIS, EQUISETUM ARVENSE, FRANGULA ALNUS, GERANIUM MACULATUM, HUMULUSLUPULUS, JUGLANS REGIA, LARREA DIVARICATA, MELISSA OFFICINALIS, MENTHA PIPERITA, PRUNUS AFRICANA, QUASSIA AMARA, ROSMARINUS OFFICINALIS, SALVIA OFFICINALIS, SERENOA SERRULATA, SYMPHYTUM OFFICINALE, TARAXACUM OFFICINALE, THYMUS VULGARIS, URTICA DIOICA, YUCCA FILAMENTOSA, PHOSPHOLIPIDS, DIMETHYL ISOSORBIDE, CETEARYL ALCOHOL, ETHOXYDIGLYCOL, CETEARETH-20, PROPYLENE GLYCOL, SACCHAROMYCES LYSATE EXTRACT, COENZYME A, PANTOTHENIC ACID, PYRIDOXINE, CYANOCOBALAMIN, BIOTIN, FOLIC ACID, NIACIN, THIAMINE HCl, UBIQUINONE, SACCHAROMYCES/COPPER FERMENT, SACCHAROMYCES/IRON FERMENT, SACCHAROMYCES/MAGNESIUM FERMENT, SACCHARO-MYCES/SILICON FERMENT, SACCHAROMYCES/ZINC FERMENT, MELANIN, TRIETHANOLAMINE, SUPEROXIDE DISMUTASE, CI 42090/BLUE 1, PHENOXYETHANOL, METHYLPARABEN, PROPYLPARABEN, METHYLISOTHIAZOLINONE.