FUE Hair Transplantation

FUE is a method of hair transplantation that become popular because of its good results, hassle-free recovery and care after hair transplantation. Many patients believe that this method can produce natural-looking results with minimal scarring, thereby disguising others from noticing that the patient has undergone a hair transplantation. In this article, we will discuss the risks and costs of this hair transplantation technique.

What is FUE?

The follicular unit extraction (FUE) is a minimally-invasive hair transplantation technique because each follicular unit or graft is extract from the scalp. It is a common method used by hair transplant clinics and surgeons across the world to restore and solve baldness and hair thinning problems. In this method, grafts are extracted from the donor area which is usually the back of the head. However, grafts may be extracted from other parts of the body. The grafts are then inserted in the recipient area.

Background of FUE Method

Although first hair transplants were performed in Japan and the United States in 1900, the modern FUE method was only developed in 1990. Initially, the hair transplantation produced unnatural-looking results (“Hair Plug”) and were not e available in North America until 2002. Since it was first developed, this method has rapidly evolved and become the most widely used technique by hair surgeons at present.

FUE was developed from the traditional follicular unit transplantation (FUT) method. This method reduces scarring and gives a more natural-looking result. In addition, it can also reduce shock or trauma to the follicle, thereby increasing the survival rate of hair follicles.

How does FUE Method work?

Male androgenetic alopecia or male pattern baldness is mainly caused by genetic and hormones. Nearly 80% of men are affected by this type of hair loss as they enter puberty. Male pattern baldness is caused by hypersensitivity to dihydrotestosterone (DHT), a hormone responsible for hair loss. This hormone binds and weakens the hair follicles over time, causing the hair to die and eventually fall out.

The FUE method begins with extraction of hair follicles from the donor area that is resistant to DHT. These hair follicles are used to transplant at the balding area on the top of the head such as the receding hairline or the crown region. The transplanted hair follicles will continue to grow in the balding area for the rest of the patient’s life without being affected by DHT hormone.M


According to a hair transplant cost study, FUE method is slightly expensive compared to FUT method because it Is a time-consuming procedure. This method is therefore popular in low-wage countries such as Thailand or India.

FUE Hair Transplantation Procedure

FUE is a multi-step process for hair transplantation and takes hours to achieve high quality results. In some cases, it may take several days if a large number of grafts are required. The steps of the FUE method are as follows.

  • Patient’s head is shaved for easier extraction of hair follicular units, in which each hair follicular unit consists of 1-4 hair follicles.
  • The hair follicular units are extracted using a small, hollow needle by moving the needle in a circular motion which leaves small wounds.
  • The grafts are removed from the head using small forceps and then stored in a sterile solution until they are transplanted in the balding area.
  • Small incisions where the hair grafts are to be inserted are made in the balding area. These incisions are called recipient channels.
  • Individual grafts are inserted into the recipient channels using at special angled forceps.

FUT vs. FUE Method

Both FUE and FUT methods consist of the same three phases: extraction, storage and insertion. Both methods have similar storage and insertion steps, but there are significant differences in the graft extraction step.

In FUE method, hair follicles are extracted while FUT involves surgical removal of a strip of skin from the donor area. The strip of skin is then dissected into individual hair follicular units to be inserted into the recipient channels or incisions. A small, long wound is left on the back of the head which can be noticed with a short-shaved haircut. Therefore, this method is not suitable for patients who want to wear the hair short because the scar is noticeable. FUE is also the most popular technique for beard and eyebrow transplantation.

Unlike the FUE method, in FUT method, a large number of grafts can be transplanted in a short period of time without shaving.

Pros and Cons

Pros Cons
FUE is a minimally-invasive method where only small circular scars are formed after healing.
As the hair follicles are removed from the head one by one, FUE method is more time-consuming and may require multiple sessions to cover the affected area with the desired number of grafts.
The use of hair follicular units gives a very natural result as opposed to the use of larger grafts containing of more than 4 hair follicles.
In FUE method, a smaller number of grafts can be transplanted compared to FUT method.
FUE method results in increased survival rate of the hair follicles by reducing shock loss of the transplanted grafts.
In FUE method, patients have to shave their entire head, but FUT method does not require shaving. FUE is therefore no an ideal method for some patients.
FUE method makes it possible to extract a precise number of grafts, while grafts may be overharvested from the donor area in FUT method.
The cost of FUE method is higher than FUT method as it requires more labor and time.

Who is A Good Candidate for FUE Method?

FUE hair transplantation is suitable for people with large area affected by androgenetic alopecia or male pattern baldness. The surgeon must determine the degree of hair loss as well as donor area that is resistant to DHT for graft extraction.

People with certain hair types, such as curly, wavy, or thick hair can achieve more natural results than thin and straight hair because curly or wavy hair tends to look fuller. In addition, hair transplantation in people with dark hair color is easier compared to the procedure in people with light hair color.

FUE is the ideal hair transplantation method for people who don’t require a large number of grafts and prefer to keep their hair short. FUE method is suitable for people with Norwood scale stage 1–4 and is more effective in older patients compared to FUT method due to its minimally invasive procedure and shorter recovery period.

Unlike FUE, FUT is suitable for people who need a large number of grafts, especially when the donor area has less hair, as it doesn’t make the hair around the donor area look much thinner compared to FUE method.

Possible side effects

  • Risk of infection: Like other operations, FUE hair transplantation pose a risk of infection as it leaves open wound. However, the risk is low as FUE is a minimally-invasive procedure and blood circulation in the scalp is high.
  • Bleeding: After FUE hair transplantation, patients may experience slight bleeding due to multiple incisions in the scalp where gauze can be applied to initially stop the bleeding in that area.
  • Scar pain: After hair transplantation, some patients may occasionally experience pain in the scar area caused by extraction and insertion steps.
  • Swelling: Patients may experience swelling on the head, especially around the forehead and eye area, which disappears within a few days.
  • Scab formation: Small scabs may form in the donor and recipient areas where these scabs fall off after 2
  • Itching, stiffness, and numbness: Patients may experience temporary stiffness and numbness immediately after surgery.
  • Hair shedding: During graft extraction and storage in a sterile solution, the hair follicles lack blood supply and therefore may cause hair shedding after hair transplantation. However, this side effect will only last 1-6 weeks, after which new growth starts.
  • Shock loss: Some patients may experience shock loss which is hair loss near the recipient area as a result of tissue injury. However, it is only a temporary condition.

Further Developments of The FUE Method

With the increasing popularity, it is not surprising that FUE method has been constantly developed using new technologies to increase its efficiency and capabilities. Therefore, technological development is an important step for the hair transplant transplantation industry.

Direct Hair Implementation (DHI) method is a significant development of FUE method. As its name suggests, Implanter Pen, a special tool is used to extract the hair follicles which are then implanted directly into the scalp without any incisions required. In this method, the grafts are removed from the scalp and the blood supply in a very short period of time, resulting in a very high survival rate

ARTAS robotic hair transplant method is also developed from FUE method. This method uses ARTAS robot to extract, collect and implant the hair grafts in order to reduce manual errors in the procedure. However, this method is suitable for a minority of patients because it does not work for those with curly or light hair color. This is because the machine may not detect the hair follicles. This method is rarely used in hair transplant clinics due to the expensive price of the machine.

NeoGraft is a semi-automatic hair transplantation method developed from FUE method and has become increasingly popular in North America. In this method, a special wand-like instrument is used to extract the hair grafts with suction rather than manual extraction by a surgeon. Therefore, it can reduce graft extraction time and scalp injury, resulting in higher survival rate of hair grafts.


Does FUE method give permanent results?

Permanent results can be achieved when FUE hair transplantation is performed correctly. This is because the hair grafts are extracted from donor area that is resistant to DHT, a hormone responsible for hair loss. Therefore, there is no subsequent shedding as a result of the DHT effects.

FUE or FUT method, which is better?

There is no better method as it depends on the degree of the hair loss problem of each patient.

Does transplanted hair become thinner?

The grafts taken from the donor area are resistant to DHT, a hormone responsible for hair loss. This means that they will not fall out and will not become thinner as a result of hormones. However, it can fall out for other reasons like normal hair.

What is the success rate of FUE method?

The success rate of FUE hair transplant depends on the skills and expertise of the hair surgeon. If it is performed correctly, the success rate is 90% or more.

How much hair grafts are required in FUE method?

According to the 2020 International Society of Hair Restoration Surgery’s census, the average number of grafts required for each hair transplantation is 2,083 grafts.

Dr. Suthida Arayametee

– Doctor of Medicine, Chiang Mai University

– Grad.Dip.Clin.Sci.(Radiology), Chiang Mai University

– Diploma in Practical Dermatology, Cardiff University, UK

  • Certificate of completion: Fundamental of Platelet Rich Plasma (PRP) Therapy Training Course
  • Certificate of attendance: Implanter Workshop for Hair Transplantation, Faculty of Medicine Siriraj Hospital
  • Certificate of Completion: Medical Weight Management Specialist, School of Antiaging and Regenerative Medicine, Mae Fah Luang University
  • Certificate of attendance RELIFE Master Network Module 3 Advance Workshop for Thread Lifting (Definisse Free Floating)
  • Certificate of attendance Mid-Face Correction & Enhancement using thread, botulinum toxin, filler Workshop by No 1 Trainer
  • Certificate of attendance: RELIFE Master Network Module 2 Advance Workshop for thread Lifting (Definisse Double thread technique with 23-cm-thread)
  • Certificate of attendance: 9th ITCAM Hands-on Cadaveric Dissection of Toxin and Filler Injections and Thread Lift
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