Follicular Unit Extraction: Origin and history

Follicular unit extraction (FUE) is a minimally invasive hair transplant technique that involves the extraction of grafts from the donor area and implanting it in the recipient area. It is a very popular technique worldwide. If you plan to get this treatment done , then you can check with various clinics to learn about hair transplants in New York.

 

FUE has evolved through many years of trial and research by many doctors worldwide to reach the efficiency it has achieved today. So, in addition to knowing hair transplant costs in New York, you would also like to know about its history and origin.

 

So it all started with an idea to try a surgical approach towards hair growth, and the earliest attempts to achieve this are credited to Japanese doctors. However, their work went unnoticed for a long period of time. The Americans tried to punch the rafting procedure as a surgical option for male pattern baldness years later. This is considered the first major step towards surgical hair restoration. The methods of FUE and FUT originated from these attempts. It was also observed that large-sized grafts could undergo central necrosis due to inadequate oxygenation, thus leading to a gradual reduction in punch size over a period of time.

 

A new concept of follicular units evolved in the 1980s, strengthening the need for smaller and well-delineated grafts to improve survival. This, in turn, encouraged the researchers to get larger grafts into smaller follicular units, thus paving the way for the FUT method. But this method produced a large donor scar which concerned those who preferred to wear short hair. Thus, the surgeons were forced to revisit the original punch grafting technique using smaller extraction devices.

 

With this knowledge, the surgeons of America, Australia, and Japan worked separately towards introducing their techniques before the modern world. All surgeons’ combined efforts helped develop the modern FUE technique, which led to a few modifications. These methods are now practiced across the globe.

 

The pioneers of FUE

 

Dr. Norman Orentreich is called the father of hair transplant surgery as he was the first in the modern world to demonstrate a punch grafting technique using a 4mm punch to extract grafts. This was done in the treatment of male pattern baldness. However, this technique had many pitfalls like unnatural appearance post-transplant, large and multiple donor area scars, and central necrosis of grafts.

 

The concept of Follicular Units was pioneered in the 1990s by Dr. Bobby Limmer, who demonstrated the stereomicroscopic dissection of strips into individual follicular units. Later in 1994, Dr. William Rassman discussed the possibility of revisiting Orentriech’s punch grafting technique and proposed modifying the methods such that the follicular units could be harvested directly from the donor area of the scalp without needing to cut a strip. This turned out to be a crucial point in the evolution of FUE.

 

Around the same time, a Japanese dermatologist named Dr. Masumi Inaba demonstrated a technique similar to modern-day FUE by using a two-step technique for graft harvesting. Meanwhile, Dr. Ray Woods in Australia worked towards a similar goal and publicly demonstrated his version of FUE named Wood’s Procedure. Much later, in 2002, Dr. Rassman and Dr.Bernstein published their work and coined the term Follicular Unit Extraction. This was considered a minimally invasive hair transplant procedure that used a 1mm punch to harvest individual follicular units, which were then passed partially into the dermis. The graft was thus extracted using forceps.   

 

This was the beginning of safe, cosmetically acceptable, and minimally invasive hair restoration. And this technique is now used worldwide. As the technique evolved, harvesting and implanting a greater number of grafts in a single session became possible. As more surgeons started performing this technique, it was getting difficult to cover larger areas of baldness due to the limited donor area. So few surgeons began experimenting with using body hair for scalp transplantation. These techniques have since been increasingly performed with good results, and this is how the process of FUE started and has been established as a safe and minimally invasive hair restoration transplant.

 

 

 

 

The new avenues

 

The surgeons later observed that using manual punches for extracting the grafts was time-consuming, and very few grafts could be extracted in a single session. So in 2004, Dr. James Harris introduced the Surgically Advanced Follicular Extraction system for hair extraction, a device that uses blunt dissection to isolate follicular units. It is available in both manual and motorized options which greatly increases the speed of the procedure. However, since blunt punches had disadvantages, Dr.John Cole used a sharp motorized punch and called the method the Cole Isolation Technique. This technique was also reported to increase the accuracy of extraction.

 

Conclusion

 

As a result of the wise leaps of various researchers worldwide, the FUE technique has progressed since its inception. The procedure is widely preferred by many patients as well as surgeons across the world due to the many advantages it has to offer.