Current practices and controversies in cosmetic hair restoration.

BACKGROUND Hair restoration surgery has evolved into a scientifically based cosmetic surgical discipline over the last half century. A recent hair surgical technique to evolve, Follicular Unit Extraction (FUE), is a donor harvesting technique removing single "follicular units "one unit at a time" with a small round punch. OBJECTIVE Describe the origins, current practices and controversies in hair restoration surgery; and challenges in adopting donor harvesting with the FUE technique. MATERIALS AND METHODS The medical literature is reviewed in regards to the improvements in surgical hair restoration techniques. Publicly available direct marketing campaigns, promotional material, and Internet advertising of certain FUE devices are reviewed. RESULTS After two decades of technique improvement cosmetic outcomes with hair restoration surgery are observed with FUE and Follicular Unit Transplantation (FUT) techniques. Although FUT remains the gold standard in hair restoration surgery, FUE has clinically demonstrated comparable patient outcomes and satisfaction. Certain FUE device manufacturers market the illegal concept of expanding the hair technicians role hair restoration surgery. CONCLUSION FUE is a complementary and satisfactory donor harvesting method to FUT. The evolving trend for new or inexperienced surgeons to delegate partial or total surgical care and clinical oversight to non-licensed is discussed.