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Hair Transplant

May 9th, 2017

Q: Why go to a hair restoration practice that specializes in both FUT and FUE? — L.P., Bayside, NY

A: This is a great question, but the answer may be counterintuitive in today’s age of specialization. The answer is that you should always go to the practice that offers both. To deliver the best care, hair restoration physicians should have expertise in both Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE) techniques and should offer both in their practices. There are at least five good reasons why:

1. FUT and FUE are both excellent techniques but have different indications for use

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 harvest efficiently 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 choose FUE simply to avoid the stigma of a linear donor scar.

2. The same patient may benefit from both procedures

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.

3. There is a cross-over set of skills from FUT to FUE

To do an FUE procedure well, the follicular unit grafts that are extracted should be examined carefully under a stereo-microscope and, when needed, trimmed and sometimes subdivided into individual hair follicles (such as for hairlines, eyebrows, temples, etc.). Stereo-microscopic dissection is basic to FUT and is thus a skill that is second-nature to the staff of practices that regularly perform FUT procedures, so this critical step will not be hit or miss.

4. Practices that offer both procedures are usually more experienced

It is easier to learn and train one’s staff in just one hair transplant technique. In particular, FUE procedures require a smaller staff than FUT and, thus, many doctors entering the field of hair restoration surgery will perform FUE but not master the skill or make the commitment to hire and train the staff to perform FUT.

5. Better decision making

One could argue that if a doctor performed only one procedure but the patient needed the other, then he/she would refer the patient to a colleague. Although this sounds nice in theory, it is very rare for a doctor to refer a surgical case to a colleague if it is a condition that he actually treats. More likely, the doctor will convince the patient (and probably himself) that the procedure he offers is the appropriate one, although, as one can see from the discussion above, this may often not be the case.

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Updated 2017-10-05





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