Overview of the different FUE (Follicular Unit Extraction) Hair Transplant possibilities

During the so-called FUE procedure, hair is being removed one by one from the “safe zone” – the so-called “donor zone”. The donor hair is resistant to the hormone dihydrotestosterone (DHT) that causes hair loss. The follicles are then carefully prepared and treated before being placed back into the scalp.
Even if it is removed from the safe areas and placed where hair was lost due to DHT, the follicle will remain resistant to its effects and be permanent hair.

What is a Follicular Unit?

A follicular unit is the term that describes the natural groupings of hair found on every human scalp. Each follicular unit will have one to four hairs each.

How is FUE Performed?

Dr. Lupanzula is renown for his skilful manual FUE and his “doctor only” approach, where you can be sure that only the doctor himself will extract the follicular units in the donor area.

The follicular units are being removed after the administration of local anaesthesia.
A knife cylinder punch of 0.8 to 0.9 mm in diameter is used to extract each follicular unit from the safe area in the back and on the sides of the head.
Our technicians then carefully prepare the extracted units and check them for possible damages. The intact follicular units are then reimplanted into prepared sites in the recipient area of the scalp.

In contrast to the so-called STRIP procedure, follicular units are being harvested in a pattern that makes the detection after the procedure almost impossible, seeing that the holes are tiny and extraction is scattered. Thus, scarring is limited and almost invisible to the eye.
FUE benefits

  • as soon as 10 days after surgery the donor area is virtually undetectable
  • minimal, almost invisible scarring
  • less painful than FUT
  • fast recovery

FUE disadvantages

  • labour intensive
  • higher cost

Follicular Unit Extraction hair transplant surgery is performed in various ways depending on which clinic you choose but the basic underlying approach is the same.

The current trend in hair transplant surgery is for technicians or assistants, and not for the doctors themselves, to perform the scoring and extraction of the follicular units as well as to make the incisions and place the grafts. This approach is more commonly found in countries where medical regulations are not as stringent as in the United Kingdom or Western Europe. It is a business model that allows the clinic to perform multiple surgeries per day, meaning that the clinic can make more money. The doctor that owns or manages the clinic simply oversees the work being performed but has very little, if any, surgical involvement.

Dr. Lupanzula does not believe in this business model. He believes that the doctor should be the only person performing the surgical steps during a hair transplant. Allowing medical technicians or assistants to perform surgery is not only dangerous, it is also often the reason the surgery fails to give the desired results. Dr. Lupanzula is one of the few hair transplant specialists worldwide who performs all of the surgical aspects of the procedure himself.

There are various ways in which the grafts can be harvested during a FUE procedure:

fue-hair-transplant-manual-punch-systemEach follicular unit is being extracted individually by hand using a surgical punch. The circular cut is about 3.5-5mm deep and 0.8 to 0.9 mm in diameter, depending on the patient’s follicular physiology.
Through application of traction to the graft, the follicular units break free from underlying tissues and is then harvested.


  • full control of movement by physician
  • minimal, almost invisible scarring
  • the success depends highly on the knowledge and skill of the physician performing the operation – if you choose wisely, this is a clear advantage


  • manual rotation can be fatiguing for the physician
  • time consuming
  • higher cost
  • the success depends highly on the knowledge and skill of the physician performing the operation – which can clearly be a disadvantage as well
fue-hair-transplant-motorized-punchMotorised versions of manual punches have either a sharpened or blunt tip that is used to harvest the grafts. The motorised punch still allows the surgeon to have full control , however, it has the clear benefit of being less fatiguing as the rotating movement that is usually done by hand is done by the handheld device.
Given that during a hair transplant often a couple of thousand grafts are harvested the motorised punch is often used alternately with the manual surgical punch.


  • faster than manual FUE
  • less fatigue of physician


  • heat produced by device can potentially damage follicles
  • inexperienced physicians may misjudge the power of the device and cut too deep or damage the follicle
  • if used incorrectly the fast twisting motion can have a wringing effect that could potentially dry the follicle out and thus harm it
vacuum-assisted-fue-machineVacuum FUE is a method whereby a motorised punch has a tube system attached that automatically suck the follicular units out of the scalp of the donor area. The grafts then travel through the tube into a reservoir with a saline solution.
The same device is then used to create recipient sites and the grafts travel again through the tubes to then be placed in the prepared incisions.


  • faster than manual FUE
  • less staff needed
  • lower costs
  • manufacturers claim higher yield


  • follicles can easily get damaged
  • violent extraction may cause desiccation (drying) of grafts causing follicles to die
  • often used by physicians that are not specialised in hair transplantation
robot-fue-hair-transplantRobotic hair transplant surgery is used for follicular unit graft harvesting as well as recipient site creation. Currently the only robotic FUE system available is ARTAS®.


  • faster than manual FUE
  • less experienced physicians needed


  • cannot extract grafts from all areas of the scalp
  • larger punch size
  • hence larger and more visible extraction scars in the donor zone
  • higher cost than manual FUE due to high initial investment into buying the robot
  • cannot be used on light hair as the robot detects the pigment and light hair is not pigmented enough
  • higher transection rate