Follicular Unit Extraction (FUE) is a modern, minimally invasive hair restoration technique. Unlike older methods, FUE does not involve removing a strip of tissue, which addresses the concern of visible scarring. While no surgical procedure is entirely scar-free, FUE leaves a different, less conspicuous type of mark than traditional techniques.
How FUE Extraction Minimizes Scarring
The fundamental difference between FUE and older methods like Follicular Unit Transplantation (FUT) lies in the harvesting process from the donor area. FUT involves surgically excising a linear strip of scalp tissue, which requires an incision closed with sutures or staples, resulting in a permanent linear scar. FUE, in contrast, extracts individual follicular units one at a time directly from the donor area. This is achieved using a small, specialized cylindrical punch tool, typically between 0.7mm and 1.0mm in diameter. Removing each unit separately avoids the large, continuous incision and the need for sutures, preventing the formation of the distinctive linear scar.
The Appearance of FUE Micro-Scars
The resulting scars from an FUE procedure are not linear but appear as tiny, circular, or punctate marks scattered throughout the donor region of the scalp. Each mark is a remnant of where a single follicular unit was extracted by the punch tool. These micro-scars are generally less than a millimeter in diameter, making them smaller and more dispersed than a continuous linear scar. Initially, extraction sites appear as small red dots that form scabs, healing quickly within a few days to a week. Once healed, the scars often present as tiny white or hypopigmented dots, or in some cases, show hyperpigmentation, appearing darker than the natural skin tone.
Factors Determining Scar Noticeability
The visibility of FUE micro-scars depends on surgical technique and patient biology. The size of the punch tool is a factor; a smaller punch, such as 0.7mm, creates a less noticeable scar than a 1.0mm punch. A surgeon’s skill is also influential, ensuring units are extracted cleanly and spread evenly across the donor area. Patient factors include hair color contrast and preferred haircut length. Scars are more apparent if the patient has dark hair and light skin, increasing the contrast with the typically lighter scar tissue. Additionally, extracting too many grafts from a small area, known as over-harvesting, can cause the donor region to appear patchy or thinned. The primary risk for visibility occurs when the hair is cut extremely short, such as a buzz cut.
Treating and Concealing Visible FUE Scars
For patients who find their FUE micro-scars noticeable, several effective options exist for concealment and treatment. One popular non-surgical camouflage technique is Scalp Micropigmentation (SMP), which involves tattooing tiny dots of pigment onto the scalp. The pigment is matched to the patient’s hair color to replicate the appearance of short hair follicles, blending the scars with the surrounding hair stubble. Allowing the surrounding hair to grow longer is another approach, as hair growth over the donor area naturally hides the small, scattered scars. In cases where scars are prominent or raised, surgical scar revision can be performed. This may involve a subsequent FUE procedure where healthy hair grafts are transplanted directly into the scar tissue to conceal the area and improve skin texture.