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BackgroundMale androgenetic alopecia (MAGA) has been one of the most common reasons for hair consultation, which affects more than half of men under the age of 50. Recently, follicular unit extraction (FUE) megasession has been an attractive treatment option for patients with severe AGA. However, compared with hair transplant surgery by traditional FUE or follicular unit transplantation (FUT), a megasession lacks a suitable surgical design solution for Asian high‐grade AGA patients. Therefore, we introduced novel principles for surgical design into FUE megasession for Asians.ObjectiveThe goal was to investigate the naturalness of hair, patient and doctor satisfaction level, and safety assessment of FUE megasession with the specific surgical design, to explore a novel technique for an efficient, satisfactory, and safe FUE megasession procedure.MethodsThirty‐six Asian male patients with AGA in Hamilton Grade V–VI were enrolled in the research. All participants underwent FUE megasession treatment with the specific surgical design. The investigators observed the patients' general conditions, surgical information, naturalness of hair, and patient and doctor satisfaction level and adverse reactions.ResultsBefore surgery, the average age of patients was 36.8 ± 9.6 years, and average duration of disease was 8.3 ± 3.8 years. During surgery, we harvested an average of 3705 ± 383 grafts. Recipient density ranged from 30 FUs/cm2 to 50 FUs/cm2, and the total operation time was 10.6 ± 0.9 h. After surgery, patient‐rated Likert score for naturalness of hair was as high as 4.72, and the doctor rated 4.61. Patient satisfaction score was up to 4.64, and the doctor scored 4.75. No serious side effects occurred in the study.ConclusionFUE megasession with the introduced surgical design is a satisfactory treatment option for patients with high‐grade AGA in Asians, with few side effects. The application of the novel design method can effectively lead to relatively natural density and appearance in one operation. Due to its remarkable effect, high satisfaction level, and few postoperative complications, FUE megasession with the introduced surgical design has great potential for Asian high‐grade AGA patients.