The technology in the hair transplant field has come along way especially in the last 15 years. The discovery of naturally occurring follicular units, and the ability to use a microscope to dissect hair into follicular units means that a hair transplant can be virtually 100% natural.

The most established follicular unit technology is the strip method. In the strip method, a strip of skin is taken from the back and sides of the head and then dissected into follicular units (grafts) and then placed into the thinning area into small holes. In experienced hands, the results can be spectacular. However, in a small percentage of cases the door scar did not heal well or widened. This led to the idea of transplanting hair into the scar to make it less obvious. The hair was harvested from the back and sides of the head one at a time by using a small punch biopsy so that it would not leave behind a very visible scar. This was the birth of the FUE (follicular unit extraction).

Initially the FUE was designed for small cases where only a few grafts were needed. With the FUE method you cannot see the root of the grafts until it is pulled out of the head. As a result, traditionally there is a high rate of transection which means the root of the follicle is cut and will not grow. This was considered acceptable since only a small number of grafts were needed. Since the FUE method leaves very small scars that are very hard to see, many doctors started promoting the FUE method as an alternative to the strip method.

The FUE has been promoted as a “scarless” surgery. This is not true. It is true that often the scars are so small that a patient can wear the hair very short. The technology for the FUE has evolved and now there are powered drills that help take out larger number of grafts in a more efficient manner. However, for reasons we do not understand, sometimes even when large number of “good ” FUE grafts are planted in a FUE transplant, many will not grow. I am sure that with time the technology will improve.

A word of caution about the FUE. It does leave a scar. If a hair transplant is done using 2000 grafts for example, then the patient will be left with 2000 little scars. This may not be a problem the first time. However, if a patient needs a second transplant with 2000 grafts, then he will have a total of 4000 little scars at the back of his head. This can leave the patient with a “swiss cheese“ look. Furthermore, it becomes more and more difficult to find “good grafts” amongst the scarring in the donor area when the FUE is used. Typically with the strip method one scar is all that is produced no matter how many surgeries.

Recently, a news show showed a new machine that takes out follicular units automatically using the FUE method. This new machine was marketed as being the “latest breakthrough” in hair transplant technology. In fact, the machine has been around for many years and was not considered a reliable method of doing the FUE. I know for fact that the company who makes the machine has improved the technology and that it is now at the 7th generation with the device. This is good news. Myself and other hair transplant doctors are waiting to see how well the machine performs before considering routinely using such as a device.

However, it seems that some doctors are now purchasing the new machine with the intent of performing hair transplants when they have little or no experience performing hair transplants. A hair transplant is a very delicate procedure that takes an entire team of people to perform. It takes a lot of practice and experience to do a good hair transplant.

There are many reputable hair transplant doctors who feel that it is not appropriate for non-experienced doctors to jump on the bandwagon and perform hair transplants because “the machine will do all the work”. If a machine could perform all the technical aspects of a hair transplant, you still need a doctor to plan and design the transplant. You can’t just put hair anywhere! You need to plan for future hair loss. A doctor needs to have the artistic skills produce a natural hairline and understand donor recipient ratios and density gradients. Think of it this way: there are air guns that will put nails into wood boards very quickly and efficiently. However, you wouldn’t let a machine build your house – you still need a contractor who knows how to build a house!

There is a time and a situation where any technology will serve you well. Make SURE you speak to an experienced professional who can offer the right technique for you!

* Additionally you can visit the International Hair Restoration Surgery website ( and read their position paper on the FUE method.