What is FUE?
Follicular Unit Excision is the surgical technique that refers to circumferential incision of the skin around the follicular unit bundle or group of hair follicles, for the purpose of extracting a full-thickness skin graft containing hair follicle(s), intradermal fat, dermis and epidermis.
What is the difference between Follicular Unit Excision and Follicular Unit Extraction?
FUE stands for Follicular Unit Excision. It was previously referred to as follicular unit extraction. Extraction in the purest form can be defined as “the action of taking out something, especially using effort or force.” In the early years, the key question for surgeons was: How do hair transplant surgeons remove the follicles? Hence, the word “extraction” was appropriately used. This term also provided a significant marketing advantage as it did not imply surgery and was advertised in 1995 as it is today as “no scalpel, no stitches, no scar.” All surgeries can leave a scar irrespective of technique.
The more accurate term for what we do today is Follicular Unit Excision because an Excision = Incision + Extraction
Over the past 20+ years, there has been less focus on true extraction techniques and more focus on the incision aspect of the equation to minimize damage and transection rates and to obtain a better-quality graft. We have seen an explosion in the variety of “incision techniques” using handmade punches from 18- and 19- gauge needles, and sharp, serrated, non-serrated, dull, hybrid, Upunch, trumpet punches, and more. A variety of automated devices have evolved to assist with the speed of incisions such as the S.A.F.E. SystemTM, ARTAS®, NeoGraft®, SmartGraft®, Vortex, PCID, WAW, Atera, 3 Step FUE, RotoCore, Mamba, and other international devices. These devices, as well as many manual punch handles, have the ability to limit the depth of incisions.
As we continue to evolve and develop better quality incision techniques, doctors continue to use inappropriate or misleading language. Simply put, it’s a bad habit. To be precise and accurate in our communication with patients, physicians should use the term “extraction” only when they are using techniques to physically manipulate and handle the graft to remove it from the body AFTER the incision is made. This can be done by suction, ATOE (Aid to Extraction), the one-handed or two-handed technique, wiping grafts out using gauze, or other techniques that safely avoid damage to the graft.
Hair transplant doctors are in the habit of using this term—extraction—and it will not be easily forgotten or changed. However, to use language in a precise, technically accurate way, Dr. Mejia of Jupiter, FL has written an article published in the Hair Transplant Forum advocating the change to Follicular Unit Excision. Excision embodies the true aspect of what Hair loss surgeons do both in the academic and clinical aspect as it focuses on the two aspects of the equation: incision and extraction.
In addition, physicians have a responsibility for truth in advertising. Over the past 15 years, the term extraction has been minimized by many across the world to imply a non-surgical procedure that only involves “extracting” hairs as if they were being plucked out of the scalp without surgery. We continue to see advertisements that promise “no scar” or that use phrases such as “harvesting grafts,” which minimize the procedure as if we are non-surgically gathering crops from a field. Given the worldwide expansion of this technique by non-medical and unlicensed personnel, the term extraction often is used to falsely mislead individuals so that the procedure can be performed by non-medical personnel and to justify these actions to the public and legislators.
This is why Dr. Ricardo Mejia proposed that hair transplant surgeons adopt Follicular Unit Excision as the new medical term. In a recent personal communication regarding the name change, both Dr. Rassman and Dr. Bernstein agree. Dr. Bob Bernstein noted, “Times have changed and it will give more clarity to the term FUE and hopefully be more respected for the surgical procedure that it is.” This concept has received worldwide attention and approval.
The International Society of Hair Restoration Surgery, the largest organized leaders of hair restoration surgery has adopted this new terminology and agreed that the above definition more accurately reflects the true nature of the procedure. It also prevents any type of misleading or fraudulent information that may be conveyed to the public. We consistently hear from leading physicians and textbook authors across the world that this updated terminology “makes sense,” and that they are already making plans to incorporate the new culture and terminology into future textbooks.