Donor Harvesting – Follicular Unit Excision (FUE)

Follicular Unit Excision (FUE) is a method of extracting or removing the donor hair for the purpose of hair transplantation. Small, sharp circular punches are used to make a round incision in the skin around the follicular unit, separating it from the surrounding tissue. The follicular unit graft is then extracted or harvested from the scalp, leaving a small opening, which heals relatively quickly. This process is repeated until Dr. Gabel has harvested enough follicular unit grafts to complete the size of the planned procedure.

The FUE method differs from the strip method as the FUE excision sites heal in a random pattern of circular scars, which is easier to hide in patients who prefer to keep their hair very short. In FUE, various instruments are utilized to extract the grafts from manual hand-held devices, electrical rotary instruments, and in some practices automated robotic devices (Dr. Gabel does not opt to use robotic devices, preferring not to delegate the delicate process to machines). Currently, Dr. Gabel utilizes a variety of instruments, and tailors all efforts around maximizing the survivability of the transplanted hairs.

Since FUE does not leave a linear scar, this procedure may be more appropriate for patients who want to cut their hair very short in the donor area. It can also be utilized for those patients who have had prior strip procedures but no longer possess the scalp laxity to harvest more hair with an additional strip. It also allows the surgeon to harvest hair from other areas of the body such as the beard or chest. Lastly, in those patients who have had prior surgery, they may have enlarged scars in the donor area, which can be camouflaged by strategic placement of FUE grafts into the scar tissue.

In FUE, the donor area of the scalp is trimmed to 2 – 3 mm in length. Utilizing high-powered magnifying loupes, Dr. Gabel is able to visualize the exact angle and direction that the hairs exit the scalp. Depending upon the sized of the graft, Dr. Gabel will use a FUE punch ranging from 0.8 mm to 1.2 mm to harvest the grafts. After the incision is made, the grafts are gently removed and examined under the microscope to verify the quality of the extraction and remove any excess skin. The grafts are then placed into the slits with micro-forceps.

Follicular Unit Excision requires a highly skilled and experienced surgeon in order to perform the technique successfully (another reason Dr. Gabel refuses to delegate to robotic devices). Each graft must be extracted in the center of a very small 1.0 mm punch to avoid transecting and damaging the graft. Dr. Gabel is the most experienced surgeon practicing FUE in the Pacific Northwest, and he has been performing the procedure since 2004, when the FUE method was still in its infancy.

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