Background <p>We previously described follicular unit extraction (FUE) for axillary bromhidrosis (AB). To enhance efficacy, we refined the technique into apocrine-pilosebaceous unit extraction (A-PSUE).</p> Methods <p>The A-PSUE technique is carried out by extracting the follicular unit with a 1.0 mm punch, followed by a circular excision of the dermal tissue connected to the extracted follicular unit using microsurgical scissors. The excised tissue is subjected to immunofluorescence histochemical staining to evaluate the apocrine gland marker, apolipoprotein D (APOD), and the eccrine gland marker, sodium-potassium-chloride co-transporter 1 (NKCC1). Postoperative complications were documented, and odor severity was assessed using the visual analog scale (VAS), along with patient satisfaction and re-operation willingness at 6 months postoperatively. A 12-month follow-up was further conducted to evaluate long-term efficacy, with observation of symptom changes across the summer season.</p> Results <p>Thirty-one AB patients were treated. The axillary pinholes healed within five days. No significant complications occurred, except for one case of scar hyperplasia. Histology confirmed abundant skin appendages, with numerous apocrine gland clusters staining positively for APOD and NKCC1. Significant improvement in odor symptoms and patient satisfaction was observed at 6 months, and the therapeutic effect remained stable at the 12-month follow-up.</p> Conclusion <p>The A-PSUE technique is an efficient, minimally invasive, and effective treatment for AB with a low complication rate.</p> Level of Evidence II <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>