2210 follicular units

The acronym FUE stands for follicular unit excision

The FUE hair transplantation method is an extremely demanding, minimally invasive surgical procedure used to remove individual follicular units from the donor area, using special 0.75 to 1.20 mm cylindrical surgical tools (punches).

Actually, it is a microsurgical procedure of removing individual, small, hair grafts, which can contain one or more hairs, the epidermis, the dermis and a portion of the subcutaneous fat.

In recent years, FUE is the technique that has taken off in hair transplant surgery, worldwide. According to official ISHRS data, the number of hair transplants increased by 64% in the three-year period 2014-2017, with FUE leading the way.

History of FUE

Unofficially, the first FUE reference was made in 1995, by Australian doctors, Dr.  Wood and Dr. Cambell, as a Hair follicle single unit excision.

The first official report was published in August 2002.  Dr. W. Rassman and Dr. R. Bernstein published in the DERMATOLOGIC SURGERY the article "Follicular Unit Excision, Minimally Invasive Surgery for Hair Transplantation".

They also introduce the FOX test for the candidate’s evaluation. It helps the physician to evaluate the degree of difficulty of graft extraction, for each patient individually. In FOX test, the surgeon takes out a few (about 100) grafts from the donor area and then evaluates how many complete/incomplete follicular units are extracted.

The first official reference in Greek literature on FUE was made by Dr. Sotiris Theocharis in INFODERMA magazine (November - December, 2003 issue).

In the same issue (2003), Dr. Theocharis presented the first FUE hair transplant with 680 follicular units.

In 2004, SAFE SYSTEM was proposed by J. HARRIS to improve the FUE procedure and increase the percentage of patients with a positive FOX test.

The term is derived from the initials of the words Surgically Advanced Follicular Excision (SAFE).

What is the key tool used in FUE?

At the same time, as more and more doctors worldwide, adapted the FUE method, scalpels (used in STRIP method) were replaced by small cylindrical sharp tools of 0.75-1.20mm diameter, called punches, which is the fundamental difference between FUE and STRIP method.


In dermatologic surgery, punches were used as tools during skin biopsies with a diameter greater than 2mm.

However, punches used in hair transplants, before 1990, had a diameter of 5 mm.

Since 2002, punches have been widely used in hair transplantation surgeries, and particular in FUE, however their diameter, nowadays is 1 mm or even less.

The main features of the punches are: diameter, sharp edge position, thickness, type of metal, sharpness, shape.

There are 3 important parameters to the FUE punch:

  • the internal diameter (the distance between the inner boundaries of the punch)
  • the external diameter (the distance between the outer boundaries of the punch) and
  • the cross-section diameter (the distance between the cross-sections of the punch)

Technological developments in punch manufacturing, as well as the type of rotation and extraction and the follicular units determine the evolution of the method.

All over the world, there are available punches that promise ideal results. The candidate for surgery should be aware that the final choice for the punches to be used, belongs to the doctor.


Skin and Hair Transplant is a world class dermatology clinic with over15 years of experience in the field of FUE.

All these years, we follow six key steps, which we believe lead to an ideal result for each case.

These stages, as shown in the figure below, are:

A. Information - Evaluation

During clinical examination, the following points are evaluated by the doctor:

  1. The hair characteristics, meaning, the hair color, the thickness (diameter of the hair shaft), the type of hair etc. the trichogram (fu / cm2 - hairs / cm2 - mimiaturarization) and the direction of the hair, meaning its angle
  2. The skin phototype of the patient. Particular attention should be paid to the contrast between hair color and skin color (Fitzpatrick phototype III-IV)
  3. The trichoscopic analysis will give us clues for any presence of possible skin disease
  4. Determining the safe donor area

The ideal patient for FUE, as shown in the following slide, is the one with a healthy and dense donor area.

B. Donor area preparation

Preparing the donor area involves shaving of the area and local anesthesia. Three shaving methods are applied: full shaven, strip shaven, totally unshaven - long hair FUE.

C. Extracting Ways of Follicular Units during the FUE Method

The extraction of follicular units includes the punching. Depending on how the punch is implemented, there are three methods:

  1. The manual
  2. Motorized
  3. The robotics (artas robotic system).

The follicular unit can be extracted in four ways: with a single forceps, with two forceps, with a forceps along with a needle and using ATOE and GASTROVIECHO.

What is the best choice between manual or motorized?

In manual extraction,  better control over very thin skin types is achieved and there is a lower rate of possible follicular injury.

This process is considered most suitable although it is definitely more time consuming.

In motorized, the procedure is faster, and  better control is achieved because there is no need for circular motion or oscillation by the operating physician. When applied by a experienced dermatologist, there is a lower rate of possible follicular injury.

In every case, the best choice of the two methods, is a matter of the doctor’s medical experience.

FUE χειροκίνητη λήψη
FUE μηχανική λήψη

D. Hair follicles placement

This is probably the most important step. Hair Transplantation is not just a surgery, where follicular units are taken from one area to another for the quantitative improvement of the recipient area, but it is a creative and artistic medical practice, in which the critical points are as follows:

  • the natural looking outcome
  • the aesthetic harmony of the final result and
  • the satisfaction of the patient

After careful examination and evaluation of the recipient area, the placement of the follicular units can be executed in the following ways:

  1. by creating the slots and then placing the follicles with julliers forceps
  2. by creating the slots and then placing the follicles with implanters (Rainbow - Lion - KEEP)
  3. with simultaneous opening and positioning, with implanters (stick and place)

E. Restoration

The recovery stage is quite critical due to the time of 10 - 15 postoperative days which is required until the crusts are completely removed and the patient can return to his or her daily activities. During this time, the patient should follow the instructions given in detail and in writing.

F. Regrowth of hair

The regrowth stage of a hair transplant is an agonizing process for the patient. To be more specific, all follicular units gradually decompose and their regrowth takes about 9 to 12 months to be completed. During this time, Dr. Theocharis applies, where is appropriate, additional therapies in order to achieve safer recovery with medication such as minoxidil, finasteride or autologous PRP mesotherapy.

FUE motorized


FUE, an extremely demanding medical practice

In hair transplantation, the FUE method is a very demanding medical practice and it is considered a big challenge even for the experienced and well trained physician.

The hair’s anatomy along with the patient’s characteristics play an important role in this procedure.

More specifically:

  • The exit angle of the hair differs from the angle of the follicular unit.
  • The opening of the follicular unit (like flowers in a flower pot) below the surface


  • Determining the correct depth penetration is important so that the follicular units will not become detached or cut
  • In manual extraction,the selection of the correct mode in operating the device is critical (full rotation mode, oscillation mode, combination rotooscillation mode).
  • The detailed clinical evaluation before the surgery is of vital importance. The doctor examines the specific features of the candidate, such as skin elasticity, length of the follicular units, fibrosis and tethering.
Do you need to shave the donor area when receiving follicular units or not?

Yes, you need to shave the donor area in order to get follicular units more than 800 - 1000 as well as for safety reasons.

For fewer follicles, we apply strip shaven FUE (for example, 2cm wide shave), micro-strips shaven FUE (for example 1cm short shaving,), or totally unshaven FUE (for example, follicular units extraction without shaving).


Why do we choose FUE in the majority of our cases?
The hair transplant surgeon should be careful about
Advantages of fue method
The most common complications include the following
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Before & After


Our 25 years of clinical experience in hair transplantation, combined with our highly trained medical and paramedical staff, are a strong warranty for restoring androgenetic alopecia (of all types) and treating scalp diseases, achieving successful and natural looking results.

For the hair transplantations, we use the two basic techniques of FUE or FUT (STRIP) methods, or a combination of the two, depending on the needs of each patient.


28 Aristomenous str, 16674 - Glyfada, Greece

+30 210 9600930



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