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A New Universal Follicular Unit Excision Classification System for Hair Transplantation Difficulty and Patient

Sanusi Umar1,2,3, Paul Shitabata2,4, Paul Rose5

  • 1Department of Medicine, Dermatology Division, University of California, Los Angeles, CA, USA.

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Summary

A new scoring system, the Sanusi FUE Score Scale, helps predict follicular unit excision (FUE) hair transplant difficulty. It considers hair curliness and skin type, aiding practitioners in assessing FUE performance for diverse patients.

Keywords:
African haircoiled haircurly hairdermisepidermisfollicular unit extractiongradinghair transplanthair typekinky hairscalescoringskin typestraight hairwavy hair

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Area of Science:

  • Hair transplantation surgery
  • Dermatology
  • Surgical innovation

Background:

  • Follicular Unit Excision (FUE) difficulty is often linked to hair curliness and subsurface angulation.
  • Patients with very curly hair are frequently denied FUE, overlooking intrapatient variations in graft attrition.
  • Existing practices do not adequately account for diverse hair and skin types in FUE candidacy.

Purpose of the Study:

  • To develop a novel scoring system for predicting FUE procedural difficulty.
  • To create the Sanusi FUE Score Scale (SFS Scale) based on donor hair and skin characteristics.
  • To assist practitioners in better predicting FUE performance across a spectrum of patient types.

Main Methods:

  • Developed the Sanusi FUE Score Scale (SFS Scale) incorporating hair and skin characteristics.
  • Assigned scores to three hair subtypes (straight-wavy, curly, coily-kinky) and three skin subtypes (thick/firm, soft/thin, medium).
  • Weighted scores based on global FUE practitioner assessments of difficulty contribution.

Main Results:

  • Thick/firm skin and coily-kinky hair were rated as most difficult for FUE by 92% of practitioners.
  • Medium skin thickness/firmness and straight-wavy hair were identified as least challenging.
  • The SFS Scale generates a final score range of 2-9, correlating to five grades of FUE challenge.

Conclusions:

  • A universal FUE donor scoring scale has been developed, accommodating diverse human hair and skin types.
  • The SFS Scale aims to standardize the assessment of FUE difficulty.
  • Further validation is needed to confirm the SFS Scale's predictive accuracy for FUE difficulty and patient outcomes.