Follicular Unit Extraction Hair Transplantation (FUE): Factors That May Affect Hair Growth

Wed 23 May 2012

This comment, addressed by Coalition hair restoration surgeon Dr. William Lindsey, was shared by a member of our Hair Loss Social Community and Discussion Forums:

Does the “unpredictable nature” of follicular unit extraction (FUE) hair transplantation as compared to strip hair transplants pertain to a) yield or to b) the quality of the matured transplanted hairs, or both? In other words, if a given follicular unit survives the extraction and implantation process and, therefore, grows, should the hair(s) produced by that FU be of the same quality (robustness, diameter, characteristics, etc.) as if it had been extracted via strip? Or, rather, can the quality of the mature transplanted hair shafts be compromised as well? Also, in your experience, is the unpredictability of FUE attributable to a) damaging the root bulb during extraction, b) transecting the hair follicle(s) itself, or both? Something in addition?

Good questions. I think it’s some of several factors that cause hair growth to be more variable with FUE.

First, there is the extraction process; making the punch along the correct angle and not hitting the root bulb or slicing off part of the root bulb itself.  This is referred to as “blind dissection”.  Secondly, the extraction process, even when done most gently, certainly pulls on the root tissue way more than microscopic dissection of grafts from a strip. Third, there is more time out of the body for the early FUE harvested grafts. With follicular unit transplantation (strip), it’s maybe 30 minutes until the first grafts go in (takes me that long to make the slits), whereas with FUE we harvest for several hours before placing–and even though we keep the grafts cool and moist, it’s not like being back in the body.

Now don’t get me wrong, I think FUE is an excellent alternative to FUT for someone who:

  • Wants a crew cut without revealing a strip scar.
  • Has limited hair loss.
  • May have significant scar risks.
  • Acknowledges FUE may offer a more variable result than strip.
  • Realizes that follicular unit extraction will take longer and cost more than a strip case or,
  • Has depleted all the strip-able hair and wants an FUE repair or fill-in case.

Follicular unit extraction (FUE) is a fine option that works well. It’s just not as much of a “sure thing” as strip cases are and this site has its share of strip cases done at clinics that didn’t yield perfect results either.

Hair restoration patients need to know all of this prior to making a decision on how to proceed.

Dr. William Lindsey – McLean, VA


David (TakingThePlunge)
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.
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2 Comments so far:

  1. David Jones says:

    Hi Dr. Lindsey. Interesting comments about FUE. I think a good surgeon can overcome these issues though.

    I’m 4 months in an FUE procedure. I was at the Harley Street Hair Clinic in London – a practice which surgeons were not recognised in the forums but I saw Wayne Rooneys results and thought I’d give it a try. Four months in and I’m really thrilled with the progress – 80 yeild showing already and thickening up nicely.

    I actually think FUE is the superior technique (being more discrete) done properly albeit more expensive, it allowed me to return to an active lifestyle which FUT would not have allowed.

    Granted if you need 5000+ grafts done then you should probably start with FUT but I definately don’t think FUE should be discounted on the bases of your reasons alone and should stand up as a perfectly good approach in it’s own right.


  2. David aka - TakingthePlunge says:


    The above article was published on behalf of Dr. Lindsey and he does not directly receive comment notifications.

    Let me begin by congratulating you on your recent FUE and your happiness with the results thus far. While I do agree the FUE is a great option for many balding men, I disagree with your statement that FUE is “the superior technique” as this implies that it is better in all circumstances and under all conditions.

    Additionally, I don’t understand your comment that FUE allowed you to “return to an active lifestyle which FUT would not have allowed”. The vast majority of hair restoration patients today are still undergoing FUT and continuing to lead active lifestyles. Perhaps you meant to say that the recovery time was shorter, allowing you to participate in an active lifestyle more quickly?

    Our Managing Publisher Bill has had more than 9,000 grafts via FUT, which allowed him to return to his active lifestyle confident and with almost a full head of hair. Given his degree of hair loss, FUE would likely not have produced the same results.

    Best of luck and happy growing!


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