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FUE-HD offers Precision, Flexibility, and No Linear Scar
Last Updated: 6 Nov 2025
Hair transplant surgery involves extracting healthy hair follicles from a donor area ( usually the back of the head ) and relocating them to areas of thinning or balding. FUE is a minimally invasive hair transplant technique where individual hair follicles are extracted one by one from the donor area using a small, circular punch. This method requires no linear incision or stitches.
FUE-HD is our innovative approach with the objective to minimize graft damage and donor depletion. In recent years many centers advoate long hair FUE and Non-Shaved FUE. Each technique has its advantages and disadvantages.
The 1st Generation FUE was introduced as an alternative to strip harvesting in FUT. Follicular units were directly punched out one-by-one from the donor scalp. It is a modification of the old school Punch Graft used by Dr Orentrich, except a 0.8 to 1.0-mm diameter smaller punch was used instead of a 4mm biopsy punch.
1. Limited Number of Grafts unable to achieve High Density Grafting
2. Risk of graft transection (damage) during extraction.
3. Unsightly Donor Areas ( Dotting, Thinning, and Mottling ) if overharvesting
4. Long Surgery Time and Slow Recovery
5. Expensive
6. Potential for over-harvesting in the donor area
To overcome the above drawbacks, various technical modifications were developed over time. Each emphasizes on the various aspects :
FUE-HD is one of such technique variations to overcome the drawbacks of traditional FUE. “HD” stands for High Density. We combined and modified the European and USA FUE techniques to accommodate for high density implantation. The incisons are smaller with less bleeding and trauma to the recipient site. This markedly reduces the downtime, and patients can resume normal activities just after a few days. Our system also combines the latest bio-technology.
Graft transection is the main drawback in FUE. In 2017 a new punch 0.8mm in diameter was developed with a wider opening in the shape of a funnel. This punch design reduces transection of the follicle during harvesting especially in Asians with thicker and longer hair follicles.
A smaller punch would leave even a smaller graft but at the expense of getting lesser stem cells for rejunveration.
After learning Dr John Cole ( USA ) CIT System, Dr Umar ( USA ) U-System, Dr Devroye ( Belgium ) WAW System, Dr Trivellini ( Italy ) Mamba Device, and many other technique and devices in the last 14 years, we feel that the human touch is as important as any latest technology.
We combine both manual and automatic extraction to cater for different skin texture and hair characters.
Patients might not have enough donor hairs to cover all balding scalp. We overcome this common problem by implanting good hairs along the hairline and parting side only. These hairs can be combed over to allow for a larger area coverage without exhausting all donor resources. Patients can always return for a second procedure to extend the coverage. Results in Class V to VI are impressive.
This innovation is called “Key Area Transplant”. We first presented this approach in 2010 ISHRS Annual Scientific Meeting in Bahama, and in 2025 CAHRS Meeting in China.
In 2018 we had developed a new technique using both hands for excision and extraction simutaneously to reduce the graft harvesting time. This so-called “Double Gun Technique” was first presented in the 2008 ISHRS Annual Scientific Meeting in Montreal, Canada,
In 2018 the ISHRS FUE Committee re-named it “Sequential FUE Technique”. Our technique is currently used by many doctors in Europe, and published in Dr Sam Lam’s FUE textbook.
In 2018, we presented our “Double Gun Technique” at the ISHRS Annual Scientific Meeting in Canada — a breakthrough method using both hands for simultaneous excision and extraction.
The ISHRS FUE Committee later renamed it “Sequential FUE Technique” and recognized us as the first in the world to describe it.
With our skill we are able to cut a 3 or 4-hair follicular unit longitudinally into 2 intact halves. One half is removed for re-implantation as usual, while the other left behind to regrow.
Studies had shown that the remnant can regenerate completely. This technique has the potential to generate two hair follicles from one follicle with consistent results and preserve the donor area.
Grafts outside the body has a limited survival time and must be implanted ASAP. We have abandoned the use of implanters as they produce more tissue trauma by squeezing the graft into a metal tube, and with a bigger wound.
Instead we use forceps to grasp the upper hair shaft. The graft is directly inserted into a snug-fit holes. This is a 1-step procedure without the need to touch the roots or to squeeze the follicle into a metal tube of an implanter. The incisons thus created are smaller, allowing for denser packing.
The final result of hair transplant depends on how many grafts actually re-grow after the procedure. Damaged hair follicles may not produce new hair. Our FUE -HD combines the followings to enhance graft survival :
• ATP Energy Spray and Storage Solution
• Low Level Laser Therapy
• Tricomin Copper Peptide Hair Solution
When compared to traditional FUE, the FUE-HD further minimizes graft trauma thus delivers better quality of grafts and consistency in survival. Lesser grafts required also means a lesser cost.
The target is to harvest 2,500–5,500 hairs within 2–4 hours depending on donor density, followed by implantation within 2-3 hours. One-Day session is preferred to reduce risk and pain, and the additional trauma would disrupt blood supply.
Hair follicles are fragile and irreplaceable. Once depleted, they’re gone. Therefore they must be treated like mini-organs. The primary objective of FUE-HD is to reduces “ H-Factor ” ( human error ) and “ X-Factor ” ( unknowns risks ).
Even if hair cloning or cell multiplication are available in the future, it won’t be cheap. It is more practical to properly utilize your limited number of permanent hair follicles and avoid wastage.
Scars happen, but smaller extraction punch leaves tidy and almost invisible scar. FUE-HD uses ultra-small 0.8mm punches and direct implantation to :
FUE-HD prevents patchy or moth-eaten donor sites by :
FUE-HD is currently the technique used in over 85% of our hair restoration cases. It may be particularly suitable for the following situations:
Unlike FUT, which involves a linear incision and sutures, FUE-HD uses small punch extractions without scalpels or stitches. This typically results in less post-operative discomfort and a shorter recovery period.
Patients who keep their hair very short (e.g., buzz cuts, fades, or cropped styles) often choose FUE-HD because the small extraction sites heal with minimal visible scarring, avoiding the linear scar associated with FUT.
The use of fine punches ( 0.8 mm ) in FUE-HD reduces tissue trauma and may lower the risk of noticeable scarring or keloid development, which can be important for individuals with sensitive or reactive skin.
In cases where donor hair is limited, FUT may leave a visible scar even when hair is worn long. FUE-HD distributes extractions more diffusely across the donor area, helping to preserve the natural appearance of the scalp.
For younger individuals or those needing only a modest number of grafts (e.g., a few hundred), FUE-HD avoids the permanent linear scar of FUT. In select cases, the procedure can be performed without fully shaving the donor area.
Patients who have previously undergone strip surgery, or who have tight, thin, or scarred scalps that make FUT unsafe or impractical, may still be candidates for FUE-HD as an alternative approach.
In a typical FUE-HD session, we extract between 2,400 to 3,600 hairs, depending on donor hair density, scalp characteristics, and target area.
conditions of use
Information provided on this website is for educational purposes only and is not intended as medical advice. It should not be interpreted as promotional material or as claims of superiority over other techniques or providers.
Individual results may vary, and no outcome can be guaranteed. Always consult with a qualified healthcare professional before making any decisions about medical treatment.
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Our practice adheres to guidelines established by leading international organizations in Hair Restoration.
International Society of Hair Restoration Surgery is the leading global medical association that establishes international practice standards and patient safety protocols.
The American Board of Hair restoration Surgery represents the highest standard. To maintain rigorous certification requirements the physician must demonstrate surgical expertise.
Worls FUE InstituteI serves as the premier educational body focused exclusively on Follicular Unit Extraction methodology. The institute ensures consistent application of safe FUE.
