Journal Club: A comprehensive review of evolution of advanced follicular unit excision systems

A recent review article published in the Journal of Cutaneous and Aesthetic Surgery, published by Scientific Scholar.

Initially, the application of the follicular unit excision (FUE) technique for hair transplantation faced a challenge due to a significant occurrence of hair follicle damage. However, advancements in techniques, punch designs, and tools have successfully addressed this issue. The integration of motorised equipment featuring rotation, roto-oscillation, oscillation, vibration, suction, and hydration has significantly improved the successful harvesting of grafts. More recently, the adoption of robotic technology for both graft extraction and incision is becoming increasingly common in the FUE procedure. Given the wide range of available devices and technologies, hair transplant surgeons may find it challenging to select the most suitable option for their specific practices. The advancements in techniques, punch shapes, and motorised devices have played a key role in reducing the rate of follicle damage and increasing the speed of FUE procedures.

Hair transplant surgeons often employ the FUE technique, making it essential for them to be familiar with the different available devices. An ideal graft harvesting system should possess several key attributes. It should operate at high extraction speeds while maintaining a zero transection rate to preserve the integrity of the grafts. The system should be multiphasic, allowing for smooth extraction of grafts from the scalp, beard, body, and long hair. Moreover, it should ensure proper sheathing of the grafts, particularly with a sufficient amount of tissue around the lower third for successful transplantation. In addition, it must be cost-effective, with minimal ongoing operational expenses, making it an efficient and economical choice for practitioners. As the quest for an ideal system continues, it is equally important to understand how these systems can be customised according to the unique hair and skin characteristics of each patient.

Ref: Chauhan K, Tandon M, Kumar A, Taneja N, Hamid SA. A comprehensive review of the evolution of advanced follicular unit excision systems. J Cutan Aesthet Surg. 2025;18:69-77. doi: 10.25259/JCAS_4_2024