Follicular unit extraction (FUE) is the most advanced method of surgical hair restoration. Since FUE hair transplantation leaves a minimal scar footprint, it is favored over previous techniques that create unwanted linear scars. Hence, FUE is preferred by individuals desirous of wider hair grooming options, including close-cropped hair cuts. Currently, there is no standard method for predicting challenges in FUE hair transplantation and outcomes. One assumption is that FUE is very challenging to perform in curly or coily-haired patients, which leads to many curly-haired individuals, especially those of African descent, being inappropriately denied hair transplantation.

A New Scoring System Objectively Predicts Challenges in FUE 
In a recent publication in Clinical, Cosmetic and Investigational Dermatology, lead author Dr. Sanusi Umarof the Department of Medicine, University of California, Los Angeles and Dr. U Hair and Skin Clinic, Manhattan Beach, California, and their colleagues present a new scoring system to predict challenges in FUE. The paper titled “A New Universal Follicular Unit Excision Classification System for Hair Transplantation Difficulty and Patient Outcome” describes a grading method called the “Sanusi FUE Scoring (SFS) Scale,” which is influenced primarily by both the shape of the hair follicles and skin properties.

The Genesis of a Universal Scoring Scale for Hair Transplantation: An Odyssey through Human Evolution
According to Dr. Umar, “the notion that having curly hair always results in a complicated FUE surgery or failure is not true; In fact, FUE is easy to perform in many curly-haired patients. Conversely, some straight-to-wavy-haired individuals also present FUE challenges requiring specialized tools and skills to lessen the likelihood of surgery failure. Further, “This discrepancy is due to the varying combinations of hair and skin traits that influence the shape of the hair follicle and the extent to which the skin attaches to it. The large extent to which individual hair and skin traits have blended between human species owing to several millennia of migrations and admixing of genes has further complicated the issue. Even societies presently perceived as “homogeneous” result from the aggregation of several previously disparate phenotypic traits. Our FUE classification or scoring system accommodates this.”

How Does the Sanusi FUE Scoring (SFS) Classification System Work?
The SFS FUE classification system uses “points” determined by the patient’s hair type (straight, wavy, or curly/coiled) and skin type (medium, thin, or thick). The point total comprises the SFS score, grading the patient’s overall challenges to FUE hair transplantation.

This SFS classification suggests that FUE hair transplantation challenges are determined by the combined effect of the patient’s hair type and skin characteristics, including thickness, firmness or turgidity, and slipperiness. This suggests that hair transplantation will not be challenging for all patients of African descent or those with curly hair. Instead, hair transplant challenges are a nuanced subject not determined by racial, ethnic, or geographic stereotypes but by the objective assessment of individual skin and hair traits made complex by our social nature. Added Dr. Umar, “When we designed FUE technology with the understanding of this new paradigm, it resulted in an FUE device that is universally capable across all FUE scenarios in all individuals regardless of race, ethnicity, hair and skin type or location.”

With this new scoring system, hair transplantation challenges can accommodate for the diversity of human hair and skin types, an essential feature in evaluating outcomes.