Advantages of FUE (vs. FUT/Strip)

• Important for those who wear their hair very short where the scar may become visible
• Important for those who have a history of keloids, thickened or stretched scars

• The small holes that are created with FUE will heal in much a shorter period of time than the linear FUT-strip scar.

• With a FUT-strip scar, strenuous exercise soon after the procedure can lead to the scar widening. The small holes created from the FUE procedure do not widen and are not affected by exercise after the procedure.

• With FUE there is essentially no discomfort after the procedure

• Younger patients
• Very muscular, athletic patients
• Those with very tight scalps
• Those with a history of keloid scarring or poor healing

• If a patient has previously undergone a FUT procedure and has a widened donor scar, an FUE procedure can be performed to transplant hair into the scar to help camouflage it.

• If a patient has previously undergone one or more FUT procedures, there may not be enough scalp laxity for another FUT strip to be harvested. In this case, an FUE procedure can be useful.

• For use at the hairline or the eyebrows

• Beard or body hair

Disadvantages of FUE (vs. FUT/Strip)

• In FUT, all the hair is harvested from the mid-portion of the donor area where the hair is most permanent. This is done to maximize the yield of high-quality grafts from the permanent zone. In FUE, 5x the area needs to be harvested for the same number of grafts as FUT. Therefore, to obtain a sufficient number of grafts, follicular units often need to be extracted from the upper and lower portions of the donor region and these may not be as permanent. Therefore, over time, the hair transplanted from these areas may be lost.
• Over time, continued thinning in the upper and lower parts of the donor zone may cause the FUE scars to become visible.

• Greater rate of follicular transection (damage to grafts) compared to FUT. This difference may be exaggerated in patients with very fine hair.
• FUE grafts are often more fragile and subject to trauma during placement, because extracted grafts often lack the protective dermis and fat of microscopically dissected FUT grafts. In part, this is due to the fact that, in FUE, the grafts are separated from the surrounding tissue by the punch, but are still attached at the bottom.

* These disadvantages are minimized with Robotic FUE.

• Lower quality grafts may not grow as well
• Inability to harvest all the hair from the mid-permanent zone results in decreased numbers of grafts
• The scarring and distortion of the donor scalp from FUE makes subsequent FUE sessions more difficult

• For example, if the first FUE session is 2,000 grafts, there will be 2,000 tiny round scars. With a second session of 2,000 grafts, there will be a total of 4,000 scars.
• In contrast, with FUT, the first scar is completely removed in the next procedure. Even though the scar may be longer in the next session, with FUT, regardless of the number of procedures, the patient is left with only one scar.

• This may present a significant (although temporary) cosmetic problem for working patients or those in the public eye
• It can take 10 days to two weeks for one’s donor hair to grow to camouflage the small holes created in the FUE procedure.
• Exception: For small and intermediate size FUE cases (up to 1600 grafts), Long-Hair FUE may be an option. With this technique, the entire donor area of the back and sides of the scalp does not need to be shaved. On the day of the procedure, the surgeon lifts up the hair, clips a long thin band of donor hair, then extracts follicular units from this limited region of the scalp. After the procedure, the patient simply combs down their hair to cover the donor zone. With Long-hair Robotic FUE, patients can resume their work, or daily routine, soon after their hair restoration procedure.

• Capping occurs when the top of the graft pulls off during extraction

* This disadvantage is minimized with Robotic FUE.

• During FUE, the graft is pushed into fat and must be removed through a small incision

* This disadvantage is minimized with Robotic FUE.

• In an FUE procedure, if there are not enough 1-hair grafts harvested, (to treat the hairline, temples, eyebrows etc.), then these must be obtained by microscopically dissected larger grafts.
• To remove hair fragments generated from the FUE harvest

• 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, the line is placed in the mid-portion of the permanent zone and 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 (or below) the fringe of hair. In the less likely scenario of the donor hair actually thins significantly, both the line (of FUT) and the dots (of FUE) may become visible.

• The harvesting steps of the FUT procedure are “performed in parallel.” This means that after the donor strip is removed from the scalp, the grafts are dissected by a number of dissectors working simultaneously. And this is done at the same time that the doctor is creating the recipient sites.
• In contrast, in an FUE procedure, the grafts are harvested one-by-one, thus taking a much longer period of time. Since site creation cannot be performed while the grafts are being harvested this also adds to the length of the FUE procedure. As a consequence, FUE is a significantly longer procedure than FUT for an equivalent number of grafts. At times, large FUE procedures are performed over two (consecutive) days.

• This runs the risk of sub-optimal growth
• This problem can be mitigated by performing large sessions of FUE over two consecutive days. Pre-making recipient sites also minimizes this problem, since once the graft harvesting is completed, the grafts can be immediately placed in the pre-made recipient sites.

• This is mainly because FUE is a more time consuming procedure. With Robotic FUE there is the additional cost of the more expensive technology.