Follicular Unit Extraction (FUE) hair transplantation began as a clinical offering in 2002. Since that time, this minimally invasive hair transplant surgery has grown to a market size of approximately $1.2 billion annually (48.5% of the total hair transplant business world-wide) and is continuing to grow rapidly. This growth is driven by a rapid expansion of the provider pool. New doctors, previous not in the business, have been entering the field and bringing with them, new patients from their own patient populations. The problems that they are encountering are similar to the historic challenges which are outlined in this article updated by the newer instrumentation that has evolved since 2002. Service organizations have arisen where non-professionals are performing the surgery for physicians unable to do so. This article summarizes the evolution of the FUE technology, which has not followed traditional new technological surgical procedures for training new doctors.