Hair Transplant, Hair Restoration & Repair
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Bernstein Medical - Center for Hair Restoration

The following table details the advantages and disadvantages of Follicular Unit Extraction (FUE) compared to Follicular Unit Transplant (FUT/Strip) procedures. For an overview of the differences see FUT vs FUE.

Advantages of FUE (vs. FUT/Strip)

No linear scar in donor area

  • 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
Decreased healing time in the donor area

  • The small holes that are created with FUE will heal in much a shorter period of time than the linear FUT-strip scar
No limitations on strenuous exercise after the procedure

  • 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
Less post-op discomfort in the donor area

  • With FUE there is essentially no discomfort after the procedure
Useful for those with a greater risk of donor scarring

  • Younger patients
  • Very muscular, athletic patients
  • Those with very tight scalps
  • Those with a history of keloid scarring or poor healing
Useful for repairing donor scars that cannot be excised

  • 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
Provides an alternative when the scalp is too tight for a strip excision

  • 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
Enables one to harvest finer hair from the nape of the neck

  • For use at the hairline or the eyebrows
Makes it theoretically possible to harvest non-scalp hair

  • Beard or body hair

Disadvantages of FUE (vs. FUT/Strip)

Follicular units in FUE are harvested from a much greater area of the donor zone compared to FUT

  • 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
Graft quality is not as good compared to FUT *

  • Greater rate of follicular transection (damage to grafts) compared to FUT
  • 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

The maximum graft yield of FUE is lower than with FUT

  • 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
With each subsequent session, the scarring in FUE is additive

  • 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
In large FUE hair transplant sessions, the entire donor area must be shaved

  • 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” *

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

* This disadvantage is minimized with Robotic FUE

Buried Grafts *

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

* This disadvantage is minimized with Robotic FUE

Microscopic dissection may be needed in addition to the extraction

  • 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
After large numbers of grafts are harvested, fine stippled scars may become visible due to thinning of donor area
Long-term, if the donor area narrows, the scarring may become visible

  • 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 size of a single session is limited

  • 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
With FUE, grafts are usually out of the body for a longer period of time compared to FUT

  • 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
FUE is usually more expensive than FUT

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

To deliver the best care, hair restoration physicians should offer both FUT and FUE. For the reasons click: Why go to a practice that specializes in both FUT and FUE?

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Updated: 2017-09-19 | Published: 2017-06-09




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