The International Society of Hair Restoration Surgery (ISHRS) has updated the terminology of the hair transplantation method known as FUE from Follicular Unit Extraction to Follicular Unit Excision. The ISHRS explains that this change is driven by the need to emphasize the actual surgical aspect of the procedure, especially among patients in countries where the term "extraction" has non-surgical implications. The group says it has already received worldwide support and acceptance from hair restoration surgeons.

"The purpose of clarifying that surgical graft removal with FUE involves excisions of hair and tissue is to make this terminology more scientifically, clinically and surgically accurate," says Ricardo Mejia, MD, ISHRS Board Member and Chair of the Ad Hoc Committee on Issues Pertaining to the Unlicensed Practice of Medicine, in a news release. "When performed by qualified, properly trained hair restoration surgeons, hair transplantation is a safe and highly effective procedure to correct hair loss. However, it is a cosmetic surgical procedure and any attempt to downplay the significant surgical aspects of FUE to appear less invasive is misleading, and potentially dangerous, to patients."

According to a member survey conducted by the ISHRS in 2017, a total of 635,189 surgical hair restoration procedures were performed worldwide in 2016—a 60 percent increase from 2014. There are two commonly known methods of donor hair graft harvesting—one is known as follicular unit strip or ellipse harvesting, and the other is the method now known as follicular unit excision (FUE).  The latter has become increasingly popular worldwide, often buoyed by aggressive marketing campaigns emanating from medical device companies seeking to sell their surgical tools which assist with the FUE harvesting technique. The ISHRS survey found that the majority of ISHRS members (92.5 percent) reported performing follicular unit excision (FUE) on their patients, and members often allow patients to choose the type of donor harvesting method they prefer.

During a follicular unit excision (FUE) procedure, the small, naturally occurring hair bundles (also known as follicular units) are individually excised with a micro punch and moved from the permanent donor area to the area of hair loss. This highly specialized technique has gained popularity over the years because it does not involve stitches or leave a linear scar. Rather, full thickness holes are created—often many thousands of them. These holes or wounds are left open to heal with small round scars or speckles, and the creation of open wounds constitutes the surgical nature of the procedure.

Dr. Mejia explains that over the past 15 years, the term "extraction" has been used to minimize the surgical nature of this surgery in order to imply a non-surgical procedure that only involves "extracting" hairs, as if they were being plucked out of the scalp without surgery. This misleading messaging has given rise to the worldwide expansion of follicular unit excision (FUE) surgery being performed by non-medical and unlicensed personnel—essentially spawning a black market for hair transplantation that has resulted in cases of serious cosmetic damage with scarring and hair loss, infections and even deaths.

"As the world's leading authority on hair loss treatment and restoration, the ISHRS feels a responsibility for consumer education which supports patient safety, promoting truth in advertising, as well as to educate patients about all surgical and medical options available to them," says Dr. Mejia. "Amending FUE terminology is one more way that we can inform patients about the true surgical nature of the procedure so they can make better decisions about their choice of physician and treatment—and avoid inadvertently paying to have surgery performed by someone not licensed to practice medicine."

The ISHRS has created a consumer education site, which provides a list of questions patients should ask when seeking a physician, http://www.ishrs.org/article/consumer-alert.