Objective To compare the grafting effects of shaven and non-shaven occipital follicular unit extraction (FUE) combined with beard FUE in patients with severe androgenetic alopecia. Methods Clinical data of 83 male patients with grade Ⅳ or above androgenetic alopecia (AGA) admitted to Xi’an Beilin BOTUS Medical Beauty Clinic from January 2023 to March 2025 were selected for retrospective analysis. All patients received beard FUE combined with occipital FUE. According to different methods of occipital extraction, patients were divided into the control group (shaven FUE, 54 patients) and the observation group (nonshaven FUE, 29 patients). The beard graft volume, total graft volume, occipital graft volume, follicular survival rate at 1 year after operation, donor-site healing and scar formation, patient satisfaction were compared between the two groups, and stratified analysis was further performed according to alopecia grade. Results There were no statistically significant differences in total graft volume, beard graft volume, occipital graft volume and follicular survival rate between the two groups (P >0.05). There were no statistically significant differences in primary healing of donor site, punctate hypopigmentation of beard donor site, and visible scar in occipitaldonor site between the two groups (P >0.05). There was no significant difference in patient satisfaction between the observation group and the control group (100.00% vs. 98.15%) (P >0.05). Stratified analysis by alopecia grade revealed statistically significant differences in total graft volume, beard graft volume, occipital graft volume and follicular survival rate among different alopecia grades (P <0.05), among which grade Ⅴ patients obtained the largest graft volume. Conclusion Shaven occipital FUE and nonshaven occipital FUE combined with beard FUE achieve comparable outcomes in terms of graft volume, follicular survival rate, scar rate and patient satisfaction. Alopecia grade influences transplantation outcomes. Grade Ⅴ patients gain the maximum benefit, while grade Ⅶ patients have limited donor resources leading to lower total graft volume and slightly decreased survival rate. Surgical modality should be selected according to individual clinical conditions.