Extraction and Implantation Speeds in Follicular Unit Excision: A Multicenter Retrospective Study of 612 Cases

BACKGROUND: Advances in follicular unit excision (FUE) have substantially improved procedural efficiency. However, real-world extraction and implantation speeds remain poorly characterized. OBJECTIVE: To describe typical FUE extraction and implantation speeds and identify factors associated with procedural speed variation. MATERIALS AND METHODS: Operative records of FUE performed by 8 surgeons across 5 clinics over 6 months in 2025 were retrospectively reviewed. Eligible procedures involved single-surgeon scalp-to-scalp FUE exceeding 1,000 grafts. Extraction and implantation speeds were measured during active surgical graft harvesting and placement. Associations between procedural speed and patient, procedural, surgeon, and device-related factors were evaluated using univariate and multiple regression analyses. RESULTS: Analyses included 612 FUE sessions across 526 patients. Mean extraction and implantation speeds were 725.7 and 697.6 grafts/h, respectively. Increased extraction speed was independently associated with larger case sizes, surgeon experience ≥1 year, and a dedicated graft-pulling assistant (all p < .001). Increased implantation speed was independently associated with multi-implanter device utilization (p < .001). Extraction speed was significantly reduced during revision cases (p < .001). Patient age and hair characteristics showed no significant association with speed. CONCLUSION: Real-world FUE extraction and implantation speeds approximate 700 grafts/h, providing a practical benchmark for operative planning and clinical counseling.