Follicular Unit Extraction Enhanced

Introducing the Smart Harvesting Technique for Follicular Unit Extraction

Since 2002, the New Hair Institute has been developing a new harvesting method for perfecting Follicular Unit Extraction (FUE). In 2007, NHI physicians William Rassman and Jae Pak invented a new tool and technique that together minimize transection (amputation) of hair follicles performed with the FUE procedure. This is a completely different and superior approach from the prevalent FUE technology practiced today. We call this new smarter harvesting method the FUE² (Follicular Unit Extraction Enhanced)™.

Despite popular media hype and extensive marketing efforts by many doctors, patients (consumers) should understand that the standard FUE technique was never quite as good in harvesting the quality of follicular units that can be produced by careful microscopic dissection through the traditional strip method. Most patients have not been aware that significant damage to the harvested grafts is a common problem for many physicians performing FUE and this creates substantial waste of precious hair resources.

Grafts produced by the FUE² compare favorably with the best grafts produced by careful microscopic dissection from a strip harvest (the Gold Standard for graft creation since we published the classic article on follicular transplantation in 1995).

Above: Grafts harvested by FUE²

Above: Grafts harvested by strip procedure

The photos above show the comparison between the FUE² (top), and grafts harvested with strip dissection under careful microscopic control (bottom). Note the uniformity in both sets of grafts with a significant fat pad present at the bottom. The FUE grafts were removed with a 0.8mm punch. The entire follicular unit lies within the graft, presumably inside the outer root sheath. The large amount of fat around and below the grafts is substantial on both sets of photographs, showing the critical anatomical elements within each follicular unit.


Above: Grafts from another patient, harvested by FUE²


The production of quality FUE grafts has been a major challenge. In our hands, we have always qualified our FUE patients in the past by performing a limited FUE procedure (we called this the FOX biopsy). If damage to the hairs within all grafts extracted during this biopsy were under 5%, we felt that the patient could safely undergo an extensive FUE procedure. We still maintain that not all patients are FUE candidates, but with our new FUE² technology, far more patients will qualify.

Advantages of the FUE²

  1. Allows for the production of high quality grafts with less hair transection and trauma to the graft during the extraction process than with traditional FUE grafting.
  2. Allows for the preservation of critical anatomical elements of each follicular unit independent of the number of hairs in that particular follicular unit.
  3. Eliminates the problem of buried grafts frequently found with traditional FUE graft production, where grafts are pushed below the skin and can not be extracted, potentially causing a foreign body reaction at the point where the graft was buried.
  4. Allows the extraction of the entire follicular unit with potentially 1-4 hairs in a single graft, allowing for selective removal of the larger follicular units to produce more hairs per graft through smaller punches and with greater accuracy. It is important to recognize, however, that many people do not have high percentages of follicular units containing 3 or more hairs.
  5. Uses a punch size of 0.8-0.9 mm that keeps the wounds small enough to minimize potential compromise to the vascular integrity of the donor area.
    • The use of smaller instruments will minimize the size of the punctuate scars that are seen after healing is complete.
    • Smaller wounds will result in faster healing.
  6. For patients who have reduced donor densities due to poor hair quality in the donor area, selective removal of better, healthier grafts with more hairs per follicular unit can be performed. This should produce a higher hair yield in women with a poorer donor area and with less overall surgical intrusion than from traditional strip harvesting.
  7. For patients who have tight scalps, where traditional strip harvesting can be problematic, this is an ideal procedure.