FUE — Extraction vs Excision — Why the Change?

A major change has been made in the world of surgical hair restoration — the popular follicular unit extraction (FUE) procedure, is now to be known as a follicular unit excision procedure.

Why the change now, thirty years after its initial introduction? Is it worth it to push this new terminology onto hair transplant specialists and patients alike? According to the experts in the January 2018 issue of FORUM, the official publication of the International Society of Hair Restoration Specialists (ISHRS), the answer is an emphatic and nearly unanimous yes.

What is FUE?

First things first. What exactly is an FUE?

As of 2018, the ISHRS Board of Governors agreed that follicular unit excision should be the official terminology for “the surgical technique that refers to circumferential incision of the skin around the follicular unit bundle or group of hair follicles for the purpose of extracting a full-thickness skin graft containing hair follicle(s), fat, dermis, and epidermis.”

Initially developed in 1988, the FUE has evolved into one of the most effective hair transplant methods on the market. Though surgeons may employ different harvesting methods, the general procedure is the same.

A surgeon excises each follicle individually while a technician may remove them from a donor area of the patient’s scalp. The removed follicle is then transplanted into a tiny hole on the balding area of the scalp.

The process often involves several thousand individual grafts and procedures typically take between 6-8 hours. After approximately 3–7 days of tenderness and mild swelling, most patients feel back-to-normal. Within about 4–6 months, patients should expect to see the first signs of new, natural hair growth in their formally balding areas.

Why Change Extraction to Excision?

Changing well-known medical terminology is never taken lightly. Asking patients and professionals alike to adopt new lingo can be complicated and confusing.

However, after years of performing the FUE procedure, specialists began to notice common issues with the term extraction. Many believed it made the procedure sound less invasive than it actually was, patients interpreted it to thinking hair were merely plucked out of the scalp rather than by thousands of small incisions made during the procedure.

By combining those two essential steps, the term excision was born—

Incision + Extraction = Excision

By changing extraction to excisions, hair restoration experts aim to:

Describe the FUE Procedure More Accurately

When a surgeon removes a donor hair follicle from the patient, they are doing more than pulling out a hair; they are precisely cutting, or punching out, a full thickness skin graft which includes epidermis, dermis and fat surrounding the fragile hair follicle(s). Therefore, an FUE is a legitimate and invasive surgery.

Licensed hair transplant physicians desired a way to emphasize that this an intense procedure entailing more than just a simple extraction of hair. By clearly acknowledging the incisions, patients should have more realistic expectations pre-, during, and post-op.

“The purpose of clarifying that surgical graft removal with FUE involves excisions of hair and tissue is to make this terminology more scientifically, clinically and surgically accurate,” Ricardo Mejia, MD and ISHRS board member said in an interview with MedEsthetics.

Discourage Frauds from Performing the Procedure

By officially making the FUE procedure sound less benign, licensed hair restoration specialists are hoping this will dissuade unlicensed frauds from performing the surgery.

As FUE has increased in popularity, there has been an explosion in clinics falsely claiming to be legitimate and knowledgeable FUE providers. Many succeed by advertising the FUE as a largely non-invasive outpatient procedure. With a gentle word like “extraction”, it can be relatively easy for an undertrained technician to sell it as such, minimizing or ignoring the need for a licensed hair transplant surgeon to be at the helm of the operation.

Patients should be aware that while technicians are essential to the labor intensive hair transplant process, it should NOT be performed exclusively by technicians because they are not qualified to perform surgery on the skin. Switching out the word extraction with excision makes it clearer that actual incisions are being made. By clearly acknowledging that FUE is an invasive surgery, professionals hope interested patients will take a closer look at whom they are choosing to perform the procedure.

Acknowledge FUE’s Evolution

Since debuting now over three decades ago, the FUE procedure has drastically evolved. As follicle-harvesting methods have been refined, experts have been constantly improving the procedure creating better results and less scalp damage. Recovery time, side effects and scarring have decreased tremendously when done properly by a trained physician.

An update to the name highlights the progress and innovations the FUE procedure has made by giving it a fresh new name to go along with its continued success.

What Does The Change Mean for Hair Restoration Specialists?

As of January 2018, ISHRS is immediately asking that all professional hair restoration specialists to begin using the term follicular unit excision at their practice.

The term “excision” itself describes the simultaneous process of making the incision and extracting the entire follicle. An “incision” only describes the actual cut, and the “extraction” the removal of the follicle.

For more information how to describe the FUE based on the new standards, read the January 2018 issue of FORUM.

What Does The Change Mean for Patients?

If you’re interested in having an FUE procedure, this new name will be valuable for two main reasons:

1. Honesty: As a patient, it provides you better insight into what the surgery actually entails. Ensure you do all of the proper research and find a certified hair restoration surgeon in your area.
2. Knowledge: By now knowing about the update, this is a great way to vet possible FUE surgeons. If they are up-to-date on all hair restoration medical standards and terminology, it’s a positive sign that they are current and well educated about their supposed specialty. Any hesitation or lack of understanding about the term “excision” should be an immediate red flag.
3. Integrity: Incisions and Excisions are done by physicians not technicians. As a patient, you should expect the very best medical care and you should know exactly who is doing your surgery and their qualifications.

Ultimately, changing the name of FUE procedure was made for the utmost transparency and understanding of this complex procedure. Hair transplant professionals hope this will be an essential step in providing patients with only the best, professional care with the incredible results they deserve.