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What Is Your Opinion on Doctors Performing Only FUT or Only FUE?

June 22nd, 2015

Q: It seems that some doctors offer only FUT and others only FUE. What is your opinion on that?

A: Both FUT and FUE are excellent techniques, but have different indications. To deliver the best care for our patients, hair restoration physicians should have expertise in both procedures, and they should offer both in their practices.

The main advantage of FUT is that it typically (but not always) gives the highest yield of hair. Therefore, when the patient’s primary goal is to achieve maximum fullness, FUT should be performed. There are many well described reasons for this, including the precision of stereo-microscopic dissection and the ability to efficiently harvest from a more select area of the donor zone, but these are beyond the scope of this brief commentary.

The main advantage of FUE is no linear scar. Therefore, when the patient’s primary goal is to be able to wear his hair very short, FUE should be performed. FUE is also indicated when there is an increased risk of a widened scar or when scalp laxity does not permit a strip excision. The patient may sometimes chose FUE simply to avoid the stigma of a linear donor scar.

There are situations in which both procedures are useful in the same patient. For example, FUT may first be used to maximize yield, but then, after several sessions, the scalp may become too tight to continue to perform FUT, or the donor scar may become wider than anticipated. In the former case, the physician can switch to FUE to obtain additional grafts; in the latter case FUE may be used to camouflage the scar of the FUT procedure.

It is tempting to see the world in black and white, and it is easiest to learn and train one’s staff in just one hair transplant technique — but medicine is never so simple. Developments over the past twenty years have given us two excellent hair restoration procedures. We should offer our patients both.

Read about FUE Pros and Cons

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Posted by Robert M. Bernstein M.D. on June 22nd, 2015 at 3:08 pm

Compared to Manual FUE, Does Robotic Transplanted Hair Grow Faster?

March 24th, 2014

Q: Does transplanted hair grow faster after robotic FUE?

A: There is no difference in the rate of growth between manual FUE verses robotic FUE. However, with robotic FUE, the actual growth should be better due to less transection, i.e., less damage to follicles during the harvest.

In general, one can expect transplanted hair to start to grow within two to five months with the transplanted hair taking on its final appearance after approximately one year.

Read more about Robotic Hair Transplant surgery

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Posted by Robert M. Bernstein M.D. on March 24th, 2014 at 3:18 pm

If I Was Told That I Am Not A Good Candidate For An FUT Procedure Can I Have FUE?

March 5th, 2014

Q: At one time, I was told my donor area was not sufficient for an FUT hair transplant procedure. Does this also mean I’m not qualified for a FUE procedure either?

A: Great question. You are not giving me quite enough information to answer your question specifically, so I will answer in more general terms. If your donor hair supply was not good enough to do FUT (i.e. you have too little donor hair and too much bald area to cover) then most likely you will not be a candidate for FUE either, since both procedures require, and use up, donor hair. That said, if don’t need that much donor hair, but the nature of your donor area is such that a linear FUT scar might be visible then FUE might be useful.

An example would be the case in which a person has limited hair loss in the front of his scalp, has relatively low donor density, and wants to keep his hair on the short sides. In this case, FUT would not be appropriate as you might see the line scar, but we might be able to harvest enough hair through FUE to make the procedure cosmetically worthwhile. Remember, with low density neither procedure will yield that much hair to be used in the recipient area.

Another example is an Asian whose hair emerges perpendicular from the scalp so that a line incision is difficult to hide, i.e. the hair will not lie naturally over it. A third example is where the patient’s scalp is very tight. In this case, the donor density might be adequate, but it would just be hard to access it using a strip FUT procedure. In this case, FUE would also be appropriate.

From these situations, one can see that the decision to perform FUE vs FUT, or even a hair transplant at all, can be quite nuanced and requires a careful evaluation by a hair restoration surgeon with expertise in both procedures.

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Posted by Robert M. Bernstein M.D. on March 5th, 2014 at 10:38 am

Why Recommend FUT Not FUE If I Have No Linear Scar?

March 1st, 2013

Q: If I have no linear scar and I can exercise right away, why would you ever recommend FUT instead of FUE?

A: I advise FUT because the grafts are of better quality (less transaction and more support tissue surrounding the follicle) and because more hair can be obtained from the mid-portion of the permanent zone –- which is where the hair is the best quality and most permanent. For the majority of patients a linear scar buried in the donor hair is not an issue. Each patient has to weigh the pros and cons of each procedure when making a decision.

Read more about the Pros and Cons of FUE

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Posted by Robert M. Bernstein M.D. on March 1st, 2013 at 12:35 pm

Why FUT Hair Transplant For One Person, FUE For Another?

February 18th, 2013

Q: A while ago I saw you and you recommended FUT hair transplantation, but my friend came in and you recommended FUE. How come?

A: I think that both procedures are excellent, which is why I do them both. My recommendations are determined by the individual patient. His or her age, desire to wear hair cut very short, athletic activities, donor density and miniaturization, extent of hair loss, and potential future balding are all important aspects in the decision process.

Read more about FUE vs. FUT

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Posted by Robert M. Bernstein M.D. on February 18th, 2013 at 11:47 am

After Hair Transplant, is Recovery Faster with FUT or FUE?

February 15th, 2013

Q: Is the recovery time a lot longer with FUT compared to FUE?

A: Cosmetically, the recovery for FUT is actually shorter, since the back and sides do not need to be shaved and the longer hair can completely cover the donor incision immediately after the Follicular Unit Transplant procedure. In large Follicular Unit Extraction procedures, the entire back and sides of the scalp need to be clipped very close to the scalp. It can take up to 2 or 3 weeks for the hair to grow long enough to completely camouflage the harvested area. Once the healing is complete and any redness has subsided, the hair can be cut shorter.

For strenuous physical activity, however, the recovery is longer with FUT due to the linear incision. This is a major reason why professional athletes or very physically active people prefer FUE. However, many business professionals prefer FUT hair transplantation as there is significantly less down time from work (for the cosmetic reasons discussed above).

Read more about the differences between FUT and FUE hair transplant procedures

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Posted by Robert M. Bernstein M.D. on February 15th, 2013 at 10:42 am

How Long Are FUT and FUE Hair Transplants Visible After Procedure?

November 13th, 2012

Q: How long are FUT and FUE visible after the procedures?

A: The recipient area is visible after both procedures for up to 10 days. The donor area in FUT is generally not visible immediately after the procedure. In FUE, the donor area must be shaved, so that will be visible for up to two weeks (the time it takes for the hair to grow in).

Read about what to expect after an FUT hair transplant

Read about what to expect after an FUE hair transplant

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Posted by Robert M. Bernstein M.D. on November 13th, 2012 at 9:46 am

Risk of Visible Scar Long-term, FUT or FUE?

July 10th, 2012

Q: What are the chances of the donor scarring being visible long-term in FUT compared to FUE?

A: Both FUT and FUE produce donor scarring; FUT, in the form of a line and FUE in the shape of small, round dots. With FUT hair transplantation, the line is placed in the mid-portion of the permanent zone, whereas in FUE the dots are scattered all over the donor area.

If a patient becomes extensively bald (i.e. the donor fringe becomes very narrow), the line of FUT will generally still remain hidden, whereas the dots of FUE will be seen above the fringe of hair. In the less likely scenario of the donor hair actually thinning significantly, both the line (of FUT) and the dots (of FUE) may become visible.

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Posted by Robert M. Bernstein M.D. on July 10th, 2012 at 4:14 pm

Which Is The Better Hair Transplant Technique, FUT or FUE?

May 31st, 2012

Q: I am so confused reading about FUT and FUE on all the blogs. Can you please tell me which is better, FUT or FUE? — M.T., East Brunswick, NJ

A: FUT (via strip) will give the best cosmetic results (more volume) since the grafts are of better quality (when using microscopic dissection, there is less transection and more surrounding tissue to protect the grafts) and better graft selection (the grafts can all be harvested from the mid-portion of the permanent zone).

In contrast, in FUE you need approximately 5 times the area. Because of this large donor area requirement, some of the hair must be harvested from fringe areas and thus the hair will be less stable genetically.

With subsequent FUT procedures we remove the first scar, so the patient only has one scar (albeit long). With subsequent FUE sessions we are adding additional scars, so over the long-term the cumulative scarring over large areas can present its own problems of visibility.

The main advantage of FUE is to have the option of wearing your hair very short (but not shaved). FUE is also appropriate for patients who are at risk for a widened donor scar (i.e., very athletic and muscular or with thin, tight scalps, etc.).

In my experience, Robotic Hair Transplantation is superior to other FUE methods in that it is much more accurate and more consistent. It enables the doctor to extract grafts with less damage than with hand-held instruments or other automated devices.

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Posted by Robert M. Bernstein M.D. on May 31st, 2012 at 4:25 pm

What Are Differences Between Follicular Unit Transplantation, Follicular Unit Extraction, and Ultra-refined FUHT?

March 21st, 2007

Q: What is the difference between the following ways of doing hair transplants: Follicular Unit Transplantation (FUT), Ultra-refined FUHT, and Follicular Unit Extraction (FUE)?

A: Please see the Bernstein Medical – Center for Hair Restoration website as it explains Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE) in detail.

In brief, with FUT, follicular units are obtained from the microscopic dissection of a donor strip that has been removed from the back of the scalp. In FUE, the doctor attempts to remove intact follicular units directly from the scalp via a small round instrument called a punch.

Ultra Refined FUHT (Follicular Unit Hair Transplantation) is term that Pat Hennessey uses on his Hair Transplant Network. It refers to using very tiny recipient sites, carefully dissected follicular unit grafts, and large hair transplant sessions in FUHT procedures.

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Posted by Robert M. Bernstein M.D. on March 21st, 2007 at 1:38 pm

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