As one of the few docs who does FUE routinely in my practice, I think it is interesting that all sorts of new methods for automating the process are being introduced. There have been many iterations of these machines and while none has yet panned out perfectly, I do see some hope on the horizon! For those of you who are novices to the idea here is a comparison of the two techniques;
Traditional Follicular Unit Transplantation
The traditional FUT (Follicular Unit Transplantation) or “Strip” technique takes a thin strip of hair from the back and sides of your head. The two sides are brought back together leaving a thin line typically 1-2mm wide as the scar. Often, a “trichophytic closure” is used which allows the hair to grow through the scar, rendering the scar all but invisible. This scar is typically visible only if you buzz your hair shorter than a #2 on a pair of standard clippers (or if you shave your head with a razor.) It is typically NOT visible if you cut the hair at a #3 on clippers (or if you leave it even longer). This goes for wet and dry hair.
Traditional hair transplant methods result in stitches for about 7-10 days and obtain up to several thousand grafts per session. The surgery usually takes 8-10 hours (plan on being there the whole day although smaller sessions can end earlier). There is typically nothing visible in the donor areas (back and sides of the head), even immediately after the the procedure! Good surgeons typically charge $4-5 per graft giving it a variable price tag but usually in the $5-$13K range. (Cut-rate grafts are no bargain!) Most hair surgeons agree that this method is generally best for those looking for a single large session and as close to a full correction as possible in a single surgery.
Follicular Unit Extraction (FUE)
Follicular Unit Extraction (FUE) also takes grafts from the back and sides of the patient’s head individually. Depending on how the patient prefers it, you can either shave the whole head or small “micro-strips” can be shaved for optimal camouflage – but some level of shaving has to be done because the hair has to be short for effective removal. Normally Dr. Wasserbauer we will harvest an average of 1500-1800 grafts per session. The scars are small – about 1mm in diameter, and if you shaved the head they would look like little dots scattered all over the head. You actually have more scar area with this method, but since it is not in a LINE it is much harder to see!
FUE transplants take a full day as well (8-10 hours) and requires that the patient lies face down and on their side for long periods while the grafts are being removed. Recovery takes about 3-5 days and while there are no stitches, you do have a number of little tiny scabs all over your head which can be covered with hair (or just open if the patient can shave their whole head to start with.) If you shave your whole head, I like to compare the look to being hit with a shot gun, but it heals to a bunch of tiny little pink spots very quickly so amazingly, the patients who choose this option do not seem to mind! Surgeons who practice this technique typically can obtain 500-1000 grafts in a single session and charge $20 or more per graft. The range is large since the success of the procedure depends largely on patient variables that cannot be fully determined until the surgery starts. Most hair surgeons agree that this method is generally best for those looking for a single small session or several smaller sessions to achieve a full correction.
FUE Video Library
(“Strip” or “FUT”)
|Follicular Unit Extraction (“FUE”)|
|Average number of grafts||~2300 (range 500-4000)||~1800 (Range 500-2400)|
|Visibility of scarring||Linear scar visible generally when hair cut less than #3 clipper setting||Diffuse pinpoint scarring generally invisible down to #1 clipper setting but still visible on certain heads and if scalp is completely shaved|
|Total square area of scarring||2-4 cm2 (20cm X 0.1-0.2cm = 2-4 cm2)||56 cm2 [1800 X PiR2= 56cm2 where R = radius of typical FUE punch which is 0.1cm)]|
|MD Level of technical expertise needed to extract grafts||Low||High|
|Staff Level of technical expertise needed to assist with extraction and place grafts||Medium to High||High|
|Graft growth||95%+ expected||Unknown but early studies have shown the growth to be comparable. Grafts acquired with this technique can require more delicate handling (hence the high level of staff technical expertise needed)|
|Best for hair length||Short but not shaved (i.e. greater than #3 clipper setting) or long||Buzzed short (i.e. less than #3 clipper setting)|
|Depth of incision||1-4mm||1-4mm (note that this is just as invasive/deep as a traditional method incision)|
|Best for hair type||Any||Straight and darker are better but light or curly hair is not an absolute contraindication (meaning you can still do it but often the transection rate will be higher)|
|Best for skin type in donor area||20% elasticity or higher||Any elasticity|
|Anticipated density||20-50 F/U per square centimeter typically||20-50 F/U per square centimeter typically|
|Recovery time at donor area||7-10 days until stitches removed||3 days until healed, 10 days until hair re-grows enough to camouflage area|
|Recovery time at Recipient area||3 days – 7 days||3 days – 7 days|
|Time until you can resume strenuous workouts||Most MDs recommend waiting until after suture removal||About a week|
As a patient considering hair restoration surgery, it is difficult to sort out which of the current techniques; traditional “strip” surgery (often erroneously referred to as FUT) or Follicular Unit Extraction (often abbreviated FUE). Right now on the internet, much of the hype centers around FUE which is the latest technique to be adopted by hair transplant surgeons. New and exciting devices exist to perform this procedure and several of these device companies market directly to patients, further confusing the task of deciding which might be right for you!
The absolute best way to decide which method might be best would be to see your hair transplant surgeon and lay out your goals for your hair. Along with developing a long term plan for your hair, a well-trained and experienced hair surgeon can point out the benefits and risks of each technique and how it might fit into your goals. To that end, here is a side-by-side comparison of both techniques to help the layperson begin to tease out which method might be the best for them. Calculations and statistics cited are based on my own clinical data and experience from 2000+ cases. Hopefully, it will help clarify some of the confusing claims surrounding both of these techniques.