Concentration and physical strength are essential for the long duration of hair transplant surgery. Because both the patient and the doctor must maintain certain postures for long periods, the importance of ergonomics cannot be understated. To review the devices, instruments, and techniques developed for ergonomic follicular unit excision surgery, to present our experience with various ergonomic modifications, and to evaluate the effectiveness of the related devices, novel concepts, and methods. We evaluated the scientific evidence supporting the ideas, methods, devices, and systems to help create a better ergonomic environment, and we investigated how these elements can be fine-tuned to improve efficiency when performing follicular unit excision graft harvesting. Through innovative methods, ideas, devices, and instruments, the authors achieved a high-quality ergonomic environment for performing follicular unit excision. Follicular unit excision is a widely used technique in hair restoration surgery. However, follicular unit excision is a very laborious and time-consuming procedure and mandates the best ergonomic conditions for both the surgeon and the patient. Therefore, it is crucial that the physician understands and appropriately adopts the various means and techniques to provide an ergonomic environment.