Hair transplantation has come a long way since the early days of 4mm grafts and the doll-hair “plug” look of decades ago.
While we credit physicians back then with remarkable discoveries and pioneering techniques, there’s no doubt that transplantation is far more efficient and effective in the current era, with patient satisfaction higher than ever.
Now, the debate between Follicular Unit Transplant (FUT) and Follicular Unit Excision (FUE) is in the spotlight for hair restoration specialists and surgeons across the globe.
The techniques have some similarities and many key differences that patients and physicians should be aware of when deciding on a procedure. This article will highlight both methods’ pros and cons and discuss what types of patients are better candidates for each type.
The FUT method has been around since the mid-1990s when doctors discovered that removing a long, horizontal strip from the back of the head resulted in an impressive yield of quality follicles for the recipient area on the scalp.
This “strip surgery” method was a step forward from the previous micrografting techniques that surgeons used to extract small segments of follicle units from donor areas. The improvement meant better quality hair, a higher yield, and the ability to perform longer “mega sessions” with thousands of individual grafts over several hours.
Doctors using FUT also have a much better idea of how many follicles are required to ensure complete coverage of the recipient area, using advanced tools and models to stay on target.
The procedure involves a few major steps, starting with removing a designated strip of skin and the dissection of healthy follicle units. A team of surgeons select and process the best follicles to be implanted in the donor area.
With multiple technicians working at once, the head surgeon is able to graft hair to the donor area at a rapid rate with minimal damage to the hair. When fully recovered and regrown, the newly grafted hair looks natural and offers great coverage due to the high density of the chosen follicle units.
FUT does leave a thin, horizontal scar on the back of the head, which can take some extra time to heal, but if the patient allows hair to grow at least an inch in this area, the scar is virtually undetectable.
FUT post-op care is fairly manageable in terms of recovery and should not take more than two weeks to resume most normal activities. During the initial recovery phase, patients are advised to be extremely careful with both the donor and recipient areas to allow for complete healing.
Since FUT is more widely practiced worldwide, patients may also find a better price for this treatment than others.
FUT remains the most popular and well-known hair transplant technique, with plenty of evidence to show long-term effectiveness and permanence.
FUE is a relative newcomer to hair transplantation, combining older techniques with new technologies to gain some distinct advantages over FUT. The main difference between the two methods is in the extraction process.
While FUT relies on a single horizontal strip for the entire set of donor hair, FUE makes use of multiple small donor sites from around the back of the head.
Since surgeons draw hair from dozens of individual points around the donor area, they can be very selective in the patches of hair they choose. Some consider this to be preferable compared to the strip technique that gives surgeons less variety of follicles to draw from.
The instrument used to “excise” follicles from the donor area is a precise cylindrical blade that ranges between 0.8 and 1.0 mm in diameter. Surgeons will swap out various instruments during the extraction process depending on the width or depth of the follicles required.
As the follicles are extracted and set aside, techs will process the units with minimal transection and prepare them for implantation in the donor area. From there, the process is almost identical to the grafting phase of the FUT procedure, although the number and quality of the grafts may differ slightly depending on the patient and surgeon.
What is the main appeal of FUE? For many patients, it’s the attraction of the newer, more advanced technology that they want to experience for themselves. FUE is advertised as the latest and greatest transplantation method, even though not everyone is an ideal candidate.
FUE does come with reduced scarring in the donor area in terms of real advantages, although it cannot fairly be called a “scarless” surgery or “minimally invasive”. FUE procedures result in hundreds of tiny incisions in the donor area, each of which needs time to heal and may leave some sort of scarring in a patchwork pattern.
Still, the absence of the linear scar is enough to sell many patients on the virtues of FUE, especially if they want to wear a shaved-in-the-back hairstyle.
As mentioned, FUT has a few downsides that patients need to consider before moving forward with the procedure. Horizontal scarring is a concern for some people who want to wear their hair short in the back, and the recovery period is a bit more challenging and lengthier.
Some patients report that the post-op pain may be slightly worse in FUT recovery, but this can’t be measured objectively.
However, in nearly every other metric, FUT appears to still be the superior procedure compared to FUE. FUT has the edge with respect to growth rate, permanence, cost, and the viability of repeat surgeries.
It is also far easier to find a reputable and trusted surgeon to perform FUT than FUE, since the latter procedure has still not reached the mainstream for most clinics. This will equate to a better price for the customer who seeks FUT surgery in most instances.
Patients may run down the list of pros and cons between these two procedures and try to determine whether they would make good candidates for either one.
There are a few factors to consider when making this decision, and every case is unique.
Firstly, a patient should account for how much hair is already lost on the scalp and whether they expect to lose more at a similar rate. For those with a significant loss already, FUT is generally the better option because of the larger yield of higher quality follicles.
For patients who want a one-and-done solution for hair transplant, FUT tends to be the right decision. Mega sessions allow surgeons to transplant thousands of hairs in a single surgery and repeat sessions can also be performed over many years.
Some people are better candidates for FUE, on the other hand. These are patients with minor hair loss around the temples and the sides of the hairline, and who may not require a large strip of tissue to be removed from the back of the head.
Men and women who need fewer than 400 grafts, for example, might be perfectly satisfied with the results from FUE. If they require future surgeries, they can always go back to the same technique to harvest more hair from the area.
It’s important to think a few steps ahead when deciding on surgery of this magnitude and cost, and the best hair restoration doctors will help patients make the right call depending on their situation.
Factors like hair density, quality, and lifestyle all come into play when determining the best course of action, and only an experienced professional will have the skillset and insight to help patients make the best decision.
Surgery is also just one part of a comprehensive hair restoration strategy, which is why top physicians in the field are equipped with knowledge on things like medicines, supplements, remedies, and alternative therapies that can help patients restore their hair and keep it.
If there does come a time when another procedure or treatment change is needed, the patient will already feel comfortable with the clinic and informed about their diagnosis. This is a big advantage over a standard physician or dermatologist.
This is why men and women who notice hair loss should team up with a great hair doctor sooner than later to preemptively address the issue instead of waiting for too long.
The FUT vs. FUE debate goes on, although there’s no definitive winner for every type of patient. FUT will likely be a better choice for the majority of clients seeking hair transplantation, but FUE has its advantages that appeal to a certain segment of the population.
It’s important to be informed and updated on all the available options when considering these procedures, and a hair restoration specialist will help make the process as straightforward and painless as possible.
So you know a little bit more about the differences between FUT vs FUE. But you have so many other questions about hair transplants: Is it safe? Will it hurt? What kind of results can I expect? Hair transplantation is not a common topic of discussion. So, who do you turn to?
A successful transplant process starts with a consultation with a hair transplant expert who truly wants to understand your personal goals. Dr. Jae Pak of Jae Pak, M.D. Medicall is a board-certified physician and a hair transplant artist with 15 years experience. With a complementary background in engineering, Dr. Pak uses precision-like skill to bring his patients a natural and balanced hair line they can be proud of.
Schedule a consultation with Dr. Pak today and discover what hair transplantation can do for you.
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