If you have been considering a hair transplant surgery for some time now, you are most likely to have come across the FUE and FUT procedures, respectively. When it comes to FUE Vs FUT Hair Transplant, both the options are excellent and can help you achieve desired results. However, it is crucial to understand each of the process in detail to make a better decision.
What is FUE?
FUE or Follicular Unit Extraction process involves harvesting a larger number of hair follicular units from the donor site as compared to FUT. This maximizes the total availability of grafts. Additionally, the surgeon will make cuts for individual follicular units separately to ensure that the scars after the surgery are minor and less noticeable. Next, transplantation of the extracted follicles takes place to the balding spots. The procedure can be long and at times, the surgeon could split it into multiple sessions.
What is FUT?
FUT or Follicular Unit Transplantation process involves extraction of the donor strip with the help of a scalpel from the donor site. This donor site would usually be an area on the back and sides of the scalp. After extracting the strip, the surgeon would split it into individual grafts, comparably smaller than the follicular units. Next, the specialist will transplant small groups of follicles or individual units to the recipient areas. The process would most likely leave a linear scar, the width of which is unpredictable prior to the surgery.
Advantages of FUE and FUT
As the major advantage of FUE, it does not leave a linear scar and comparatively heals faster.
• The process is ideal for those who aim to get back to strenuous activities quickly without much downtime.
• The procedure is also advisable in cases where there is an increased probability of a wide scar or strip excision is not possible.
• In majority cases, patients end up choosing FUE simply because they do not want to deal with a linear scar although they could conceal it easily with their hair.
Likewise, with FUT, the main advantage is that it can yield better result though not always. This procedure is mostly suitable when the patient’s primary concern is to achieve maximal fullness. The surgeon makes this possible due to the potential to harvest from a certain area of the donor spot and the precision of stereo-microscopic dissection.
The Implantation Process
When it comes to Hair Transplant procedure through FUT or FUE, the surgeon makes small incisions in the thinning areas as soon as the follicular grafts are ready. The surgeon would then begin to strategically place the grafts individually with precision depending on the number of hairs in each follicle. This step enhances the density and naturalness of the recipient area. Additionally, it also maximizes the coverage on the scalp, which is crucial for the re-creation of the hairline.
FUE vs FUT w.r.t Scars
The availability of grafts can vary from person to person but there is a limited extractable amount possible in both the procedures. Still, in FUE, the number of possible grafts is usually higher as compared to FUT.
Hence, for people who are not comfortable with some noticeable scarring, Follicular Unit Extraction would be a better choice. Here are more differences:
• The scars from the FUE procedure are rather small whereas the FUT scars are linear.
• There is less noticeable scarring with FUE, as the incisions are small and not visible at all.
• They are scattered throughout the scalp making it hard to notice.
Just opposite, FUT has certain demerits, for instance:
• FUT scars are large-sized and localized, which makes them slightly more detectable.
• Multiple FUT follow-up procedures can increase the chances of wide scars.
• FUT can alter the direction of your hair growth. This change can occur after a single treatment process or post multiple procedures.
Besides, FUT also involves removing a wide area of skin that can make the quality of the hair to vary on both sides of the scar. For example, the hair would remain coarser above the scar as compared to the bottom. This contrast in coarse and fine hair, and alteration in the direction of hair growth would easily be visible, especially with a short haircut.
Choosing the best Hair Transplantation Method
At the end of the day, the decision would be yours depending on the insight your surgeon provides. The expert would help you by judging the classification of hair loss, the quantity, and quality of donor hair and the size of thinning spot. A technique most suitable for one patient might not suit the other and hence one needs to make an informed decision.
It is therefore wise to visit an experienced and efficiently trained surgeon in both the procedures and can provide you with an unbiased opinion for your betterment. This is where the experienced hair specialists at Darling Buds would prove fruitful to your cause.
IN SUPPORT OF MY TECHNIQUE- FUE
No It does not!
If we consider the fact that we can harvest up to 40% of the donor scalp over 2-3 sessions using FUE technique, a strip area which would yield an average 2500 grafts will yield around 1200 FUE grafts over 2-3 FUE sessions. So there is an availability of 40% more grafts from the area of the strip as compared to if we were to harvest that area of the strip only over 2-3 sessions (N.B.-not the whole scalp)
A fact that is not known to many people is that the strip scar can actually increase the area of the crown by downward displacement as the skin stretches and moves down somewhat when it is stitched. This area of expansion of the crown may be as great as 40% the area of the strip. The additional grafts that we may have been able to harvest with FUT would be used in the long term to cover this area which has developed not genetically but iatrogenically.
So the increased number of grafts we got by the strip technique is countered by a similar increase in the area of baldness.
Therefore it is an illogical and fallacious presumption that we get more grafts from FUT.
It is false to assume that in FUT we are utilising the extra loose skin in the harvesting. The loose skin is there for a purpose. You need it for neck flexion.
After all you can not offer cosmesis at the cost of body function!
2. Why is it that FUE is not reproducible in the hands of many surgeons, where as in the hands of a dedicated surgeon the procedure can be executed to such a level of finesse & excellence that rapid FUE harvest and other unique features can be a part of the procedure? Is it purely due to lack of training or something else?
FUE has a long learning curve longer than that of the traditional FUT procedure. FUE requires long hours of patient learning under high magnification. Once you take up FUE as a profession, you are married to it since it requires the whole day to accomplish if the doctor is doing the harvesting himself. Most doctors cannot-
- Use high magnification
- Sit for long hours in difficult postures
- They usually cannot leave their lucrative dermatology/ plastic surgery practice they are used to in favour of FUE which requires complete sacrifice of time and attention.
- Leave doing FUT procedure which gives them a lot of free time for other avocations. (A strip surgeon typically spends just one hour)
- Lastly, FUE learning centers are few. Since it is a new technique, most centers remain closeted with their technique and do not open their doors to those seeking FUE training.
FUT is currently the gold standard of surgical hair restoration. FUE is different from it only in the manner of harvesting. In the former, as strip of skin as wide as 2 cm at times and as long as the number of grafts needed is take whereas in the latter minute punches are used to individually extract follicles either manually or mechanically and with or without the assistance of a robot.
The main differences between FUE and FUT are five-fold-
- There are great FUT scars and there are great FUE scars but in general, and having performed both procedures passionately, there is no beating an FUE scar in experienced hands.
- Due to its minimally invasive nature, the recovery after FUE is faster and downtime lesser.
- Anagen Selective Harvest or the “Golden Harvest” permits the surgeon to cherry pick the most robust grafts for a better result.
- The donor site is limitless- restricted only by the bounds of one’s imagination.
- Dormant hair in the resting phase are lost in FUT. This akin to shaking a fruit laden apple tree. All apples fall off, whether ripe or raw. However if we pick the ripe ones with due care, the raw ones will bear fruit with time and not be wasted like in shaking the tree violently.
The above 5 have no place of rebuttal by even the most die-hard FUT surgeon. This is the reason only these differences have been stated. All other stated advantages of FUE over FUT are fictional and market driven.
4. What are the misconceptions about the FUE technique that may be misrepresented by those indulging in propaganda?
- There is no scar. (scar tissue is present after every surgical technique.)
- FUE gives better density (there is no difference in density in either technique if you have selected your doctor with due diligence)
- FUE can be done by novice surgeons if they use a particular machine. (tall commercial claims have done much disservice to the technique of FUE since it is the hands and mind behind the FUE tool that does the procedure. FUE is a greater skill than performing an FUT)
FUE is the harvesting of follicular units using refined miniscule punches which may range in size from 0.65-0.85 mm in internal diameter. The system used may be motorised or robotic. Manual FUE is waning in popularity due to slow pace of the procedure allowing just 500-800 grafts harvested in an 8 hour session. It is only the harvesting that is different in FUE, remaining procedure remains mostly the same.
6. What are the complications of hair transplant as a whole that may defame/bring disrepute to the procedure in general with catastrophic outcome?
Young surgeons falling to propaganda of companies selling their wares. There is a common misconception that some machines do all the work which is absolutely unfounded and spread by unethical companies. The complications are going to arise from a large number of FUE surgeons who are untrained and rely on these machines. It shall take another 2 years for establishing a standard of care in FUE technique.
All patients who are candidates for FUT are candidates for FUE.
However, FUE has widened the horizon of surgical hair restoration by allowing the surgeon to look beyond the traditional donor sites.
Golden Harvest refers to Anagen Selective Harvest.
Anagen Selective FUE grows better hair. The hair in FUT which are in regression phases have a high chance of going into dormancy after the surgical assault. Hence the density obtained after FUT is less than after the Golden Harvest procedure. of FUE in which only hairs in the anagen phase are selected.
FUT surgeons have always since the past one decade put forth their vociferous points of view about poor yield. If you state a lie a thousand times, it takes control of your rational senses and creates a doubt in the mind of the surgical hair restoration researcher, the potential FUE client. The most respected surgeons in hair restoration surgery are still FUT surgeons. This is because they have been trading their wares for a longer span of time; FUE surgeons on the contrary have been in FUE practice only the duration of the existence of the technique and that is not too long ago. It is mostly junior surgeons who started doing FUE full time around 5-10 years back. A handful of surgeons like me who were FUT (strip) surgeons before, converted full time to FUE, taking the Big Leap of Faith. So as a community we are relatively new.
The reason such jaded arguments are finding ground in the hair loss domain is not long to seek- it is due to the fact that FUE is a demanding speciality where the surgeon has to spend most of his time with the patient. I know very few surgeons like me do the harvesting and other important parts of the FUE procedure themselves, not leaving it to the technicians. No-one who has a running practice would like to risk it by taking the Big Switch. So to stay relevant, one has to argue the advantages of your own technique and the chief argument that will hurt is that ‘FUE gives poor yield’.
I would like to counter this misconception thus-
- When FUT surgeons say FUE gives poor yield, who are they comparing with? You have to compare your FUT yield with the yield of the better FUE clinics and not your own FUE skills for fairness' sake.
- How much time in harvesting the FUT grafts is spent by surgeons? What is their strip harvest time? What is the time spent for slivering the strip and dissecting the grafts? Does the doctor do the slivering and dissection of grafts? Or their technicians? Is this their best practice? In FUE I do the entire harvesting myself- dissection and graft preparation. So why does this make my technique inferior.
- 3.When a strip is harvested, how many hair in it are in the phase where they will withstand transfer following dissection?
- Can the telogen/catagen hair that are essential components of any strip be dissected safely and transplanted?
- If no, how many such hairs are wasted?
- Do they grow back?
- What is the ratio of good grafts available to the hair that cannot be transplanted and are confined to the bin? We all know that around 15% of hairs in the scalp are in the growing phase (also in the strip) and hence difficult to dissect out from the strip while slivering it.
- If not, is this not far greater a wastage than the 2-5% transection of grafts in FUE technique?
- Do FUE transected grafts grow back? Yes they do since they are transected within the body (in vivo) and not outside when the strip is out of the body (in vitro).
- Moreover, when we take the strip from the back of the head, to relax the edges of the resultant wound, we undermine the skin around and stitch the 2 ends in close approximation. The skin that moves in to close the edges without tension has to come from somewhere. Or is this new skin added? Where does it come from? Does it come from the crown region of the scalp? So, is it not a fact that to close the strip, the area of the crown expands by as much as the area of the strip? Will we need more grafts to cover this larger area of expanded crown?
Does this decrease the permanent zone from which permanent grafts are taken for FUE?
How then can we argue that FUT gives greater yield? Answers to these questions are only common sense!
We started doing the Combo technique in 2009 and called it FLUTE technique then. It was under the mistaken surmise that a combination technique will give more grafts. Many doctors in Brazil and India have built there practice today around this so called new 'innovation' because they are non full time hair transplant surgeons and do not have the long hours to spare for an FUE only technique; and also they are not FUE surgeons. We did a study a few years back on our previous Combo method patients and found that the technique increases graft requirements significantly. The FUT scar also gets twice as wider since scar contraction of FUE exerts a pull on the scar above and below it, thereby widening it considerably.