What is Ultra Refined Follicular Unit Transplantation (URFUT)

Everyone suffering from androgenetic alopecia has an area of hair existing on the sides and back of the head which is unaffected by the balding process. This region is known as the “donor” area or site. Having calculated the amount of donor hair necessary for the hair transplant (using macrophotography and computer analysis) and having designed the hairline in conjunction with the patient, the hair to be transplanted is trimmed close to the scalp.

In Ultra Refined Follicular Unit Transplantation (URFUT), an intricate procedure in which HRBR is an expert, a thin strip of skin containing this hair is surgically removed from the donor area. Due to the flexibility of the skin of the scalp, the resulting incision can be stitched together again usually resulting in a fine scar which is covered by existing hair, even if it is short, and only detectable on close inspection.

The donor hair-bearing skin is then slivered into very small pieces and the hair follicles diligently dissected by highly skilled nurses and technicians, selected for their expert manual dexterity, using state-of-the-art stereoscopic microscopes, specifically the Nikon SMZ 800 model. Excess tissue and the collar of skin attached to the graft are removed to ensure that when the hair exits the skin from the transplanted area it looks completely natural. If this epithelium (skin) is not removed it can lead to complications such as pitting and/or tenting, which can result in an unnatural appearance.

The resulting grafts, known as follicular units because their integrity in the skin is maintained, are then carefully inserted in miniscule surgical sites made in the thinning or balding (recipient) areas of the scalp, using the Zeiss head worn Loupe KS microscope. The size, shape and angle of these incisions are key to the cosmetic outcome of the hair transplant and will have been meticulously mapped out in partnership with the patient prior to surgery. The transplanted hair behaves as it was programmed to behave at its origins and will normally grow naturally for the rest of one’s life.

What is Follicular Unit Extraction (FUE)

Follicular Unit Extraction (FUE) is another method of obtaining donor hair for transplantation.

A FUE hair transplant involves the removal of individual follicular units from the donor area on the scalp, one by one, without the need for a standard surgical (linear) incision. Instead, a blunt-tipped punch tool is used to extract the individual hair follicles from the scalp. This differs from Ultra Refined Follicular Unit Transplantation (URFUT) where a donor strip of skin is taken and the follicular units are microscopically dissected from that strip.

This procedure was developed as a result of some patients’ dissatisfaction with the appearance of the donor scar on the back of the head. However, with a proper surgical technique this scar should be virtually invisible in the majority of cases.

Following the removal of the hair grafts from the scalp the method of transplantation is identical in both techniques.

FUE: what about scarring?

FUE does result in scarring however the circular scars are usually more spread out across a larger area and for some patients that like to wear their hair short it is a preferable option as the scars can be less obvious in particularly short hair than the linear scar left from the URFUT procedure.

It should be noted that certain advertising by commercial FUE hair clinics has stated that follicular units can be extracted from the scalp with “no stitches, no scars, no pain”. As skin cannot be broken without leaving a scar, however small, this is completely false. It should be clearly understood that it is not possible to remove the hair follicle and its root from the scalp without leaving some degree of scarring or stippling.

How does FUE compare with URFUT?

Both techniques have their advantages and disadvantages, some of which are listed below for ease of reading;

  • For patients undergoing an FUE procedure usually the entire scalp must be shaved in advance of their procedure, for those undergoing an URFUT procedure only the area of hair to be removed is trimmed.
  • In an FUE procedure the graft yield is lower than with URFUT which means you get less donor hair for transplantation. This is because it is not possible to harvest as much hair.
  • In an FUE procedure the growth rate of the grafts is often lower as the accuracy of the punch tool used is not as good as a skilled technician using a microscope.
  • A stitch is required in an URFUT procedure; in an FUE procedure no stitches are needed.
  • For patients that like to wear their hair very short FUE may be the preferable option as the scars resulting from the FUE procedure may be less noticeable in very short hair as they are more spread out.
  • Should a patient decide to return for a 2nd or 3rd hair transplant procedure with the URFUT technique a skilled surgeon can remove the scar from the patient’s previous surgery however with the FUE technique this is not possible and new scars will always be created with subsequent surgeries.
  • Before any patient makes a decision as to what techniques they wish to choose, a consultation with a properly qualified consultant surgeon is essential.

For many patients the optimal treatment plan would involve the use of both techniques over the patient’s life and therefore it is important for patients to attend a clinic that can offer both techniques to them.


This tool is used to extract whole hair follicles from the scalp..

Donor strip

This patient (lower image) is a 26 year old man who had an FUE procedure performed at a commercial clinic eighteen months ago. Note the white, stippled and scarred areas on his scalp where the FUE was done. These scars are present all over the back of his head and would be visible if he cut his hair short. The patient also reported that the procedure was painful, despite the fact that FUE is often marketed as being painless.