Which One Is Better For Me?
One of the most common questions I am asked today is whether to have FUT otherwise known as the strip harvest procedure or FUE otherwise known as follicular unit extraction. In this article I would like to address the advantages and disadvantages of each.
FUT is a procedure where donor hair is harvested by excising a small strip of hair from the back and sides of the scalp and dissecting the strip into individual follicles for transplantation into thinning areas of the scalp. Typically sutures or staples are used to close the scalp. I also perform a trichophytic closure which allows hair to grow through the scar further concealing it. The scar that usually results from this procedure is about 1-3mm in width and the length is determined by the amount of follicles harvested. In rare cases the scar can be larger due to infection or poor healing. In this procedure the hair can be left longer above and below the harvest region which allows the hair to comb down and completely conceal the donor scar immediately after the procedure. In follow up procedures every attempt is made to include the original scar in the new strip so that the patient only has a single scar in their scalp and not train track scars.
FUE is a procedure where a small drill ( usually between 8mm-1.1mm) is used to individually harvest one follicle at a time. This may be performed by hand with special tools or by machine with the new ARTAS system or Neograft machine. In order to harvest these follicles the hair must be shaved close to a #0 cut so it basically requires the patient to shave all the hair on the back and sides of their head. This procedure leaves tiny white dots where each follicle is harvested from and also decreases the overall density of the donor hair on the back and sides of the scalp.
The main advantage of FUE is that it should allow the patient to shave their hair down to a #1 or #2 cut, whereas with FUT typically a #3 or #4 cut is as short as the patient can go before the strip scar is visualized. When measuring the actual scarring caused by these procedures, the scarring in FUE is 7-10 times greater than the scarring from FUT. The main difference is that the FUE scarring is diffuse (scattered throughout the scalp) while the scarring from FUT is localized in the area of the strip. What this also means is that the patient’s “donor bank” that is the permanent hair on the back and sides of the scalp available for future procedures, is less when the patient begins with FUE as opposed to FUT. This is because with FUT a small strip is taken and the rest of the donor zone is unscathed. We can usually go back to the same area in the scalp multiple times, but if not, there is often space above or below the original incision to take a new strip. With FUE, you can only harvest so many follicles from the back and sides before the donor hair begins to appear too thin.
Because of the increased labor involved, FUE is typically about twice the cost of FUT.
Finally, there is a wide range of proficiency with FUE and not all physicians are well versed in the technique. Because of this, the results with FUE are much more variable than FUT and often patients experience lower growth rates with FUE versus FUT.
I instruct my patients that if you are destined to have a minor degree of hair loss over your lifetime and wearing your hair at a #1 or #2 hair style is important, then FUE is probably the correct procedure for you. But if you wear your hair at a #3 cut or longer and are likely to require a large number of donor grafts over your lifetime than FUT may be a better option.
There are many new companies today selling expensive machines to automate the FUE process. They market these machines as not even requiring the physician to operate them. All prospective patients need to beware of this and ensure that an experienced hair transplant surgeon is performing their procedure and not a technician. In addition, don’t believe the hype that these companies are advertising that FUE is scarless. It actually creates more scarring when measured per centimeter, the only difference is that it is pinpoint diffuse scarring as opposed to the linear focused scarring in FUT.