Follicular unit extraction (FUE), also called follicular unit excision or follicular transfer (FT), is a method used to collect individual hair follicles from the donor area, usually at the back of the head. This process is done under local anesthesia using a small tool called a punch, which is about 0.8 to 1 mm in size. The punch makes a small cut around the top of the follicle, allowing the surgeon to remove the follicle directly from the scalp. FUE avoids leaving long, straight scars, which is one of its main advantages. It is one of two main methods for collecting hair follicles, which naturally grow in groups of one to four hairs. The other method is called strip harvesting.

In 2018, Mejia updated guidelines from the International Society of Hair Restoration Surgery. This change was made to better describe the procedure, which involves cutting around a full thickness skin graft (a piece of skin containing hair follicles) using a circular tool like a scalpel, punch, or motorized drill. The graft is then carefully removed and placed in the area where hair is needed. This update was necessary because new tools and techniques made it important to define the process more clearly. Some places had incorrectly described the procedure as simply plucking hairs, which misled the public.

Hair follicles collected by either method are the basic parts used in follicular unit transplantation (FUT). FUE was first described in 1988 by Masumi Inaba in Japan, who used a 1 mm needle to remove follicular units.

FUE requires time and skill to learn. The process begins by making a small cut around the hair follicle using a circular punch, which goes through the top layer of skin (epidermis) into the deeper layers (subcutaneous tissue) to free the follicle. A follicular unit is a full thickness skin graft that includes the epidermis, dermis, and fat. After cutting, the graft is removed using suction, forceps, or special tools and carefully stored until it is ready to be placed in the recipient area. Each follicular unit is removed one at a time, and care is taken to avoid cutting the hair’s growth cells or damaging the graft. Extra care is needed when using forceps to prevent crushing or harming the follicles, which could affect their ability to grow. Because of these details, FUE takes longer than traditional FUT, and many doctors can remove fewer grafts in a single day.

The survival of follicular units after cutting and removal is a key factor in successful hair transplants. If follicles are damaged during the process (called transection), they may not grow after being transplanted. While FUT typically provides more follicles that are not damaged, FUE often results in some damaged grafts, which may not work.

FUE is a surgical technique that may leave small, round, white scars (called "pit" scars) in the donor area. However, newer tools have reduced the number of damaged follicles. The choice of punch size depends on the patient’s skin type, hair structure, and the depth of the follicles. Punches can be used manually or with motorized tools. Oscillating machines allow FUE to be done without shaving the hair. FUE usually causes less pain and faster recovery than FUT and reduces the risk of long-term nerve damage, such as numbness or pain, in the donor area. FUE is also useful when the scalp is too tight for FUT or when finer hair from the nape of the neck is needed for the hairline or eyebrows.

However, FUE requires harvesting follicles from a much larger area of the donor zone than FUT, about eight times larger. This means patients may need to have their hair trimmed over a larger area. Follicles taken from the edges of the donor area may not last long, leading to possible hair loss over time. Scarring from FUE can make future procedures harder, and the grafts are more fragile because they lack the protective layers of fat and skin found in FUT grafts.