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

Q: It seems that some doctors offer only FUT and others only FUE. What is your opinion on that? — D.E., Portland, M.E.

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.

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