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One of the most important decisions- choosing FUT or FUE

- Friday.March 22. 2019

FUT FUE Paul Gerrard Dr Sara Kotai Dr Jennifer Martinick

Dr Sara illustrates how hair follicles under the skin tend to diverge almost like a tripod.

In hair transplantation, choosing what type of procedure to have is one of the most important decisions a patient has to make. There are two harvesting techniques- FUT and FUE. Both are workable depending on the patient’s case and expectations.

In strip or follicular unit transplantation (FUT), a thin sliver of tissue is removed from the donor area in the back and sides of the scalp and the individual follicular units are cut from that strip via stereo-microscopic dissection by trained technicians. The wound edges are then closed leaving a single, generally fine scar.

In follicular unit excision (FUE), hair is harvested without the need to carry out the cut on the nape. Small circular incisions are made over a considerably larger area of the donor zone leaving tiny, round, white scars.

With the first technique, “you are cutting what you see and you’re seeing what you cut. FUT is all done under magnification. Therefore, naturally you’re going to get much better quality hair follicles to be implanted in a single session,” says Dr Martinick.

In the second (FUE), the excised follicular units are decidedly inferior, the choice of one or another is at the discretion of the doctor. While FUE can be appropriate for some people, it isn’t necessarily the best treatment for all hair loss patients. The only way of finding out the best treatment for a patient’s individual needs is through a consultation with an experienced hair transplant doctor.

Dr Martinick says, “The reality is the outcome- how it’s put together. The best outcome is a permanent, healthy and natural looking transplant.”

“Strip harvesting or FUT has been around for 50 years and it has reached its zenith. FUE has been around less than 20 years and it certainly needs further development.”

“At the moment an FUE graft does not survive as well as a strip harvesting one. You have a limited number of follicles [from the donor area]. You can’t get more once it’s used up, destroyed, dried out, whatever… they’re gone.”

Many physicians around the world have tried the FUE technique with markedly varying success. Over-harvesting causes serious degeneration of the donor area. Today we are seeing this problem far more often immediately after or more commonly after fewer years with aggressive FUE than we did in the old days of aggressive strip harvesting.

Although FUE does not produce a linear scar, it does cause thousands of tiny “crater-like” scars. Patients need to be told about this possibility and that, although they can wear their hair short, they may not be able to shave their heads.

It is important that the doctor has counselled extensively and is certain that the patient completely understands the benefits as well as the unknowable and the possible long term downsides that might occur.

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A real medical concern of large FUE procedure is how effective the body can sustain and heal multiple open wounds whilst not impairing the scar healing in the donor area and yield in the recipient area.

Dr Sara says, “With FUE, we’re getting a lot of hair deaths. You expect an average of 30 to 50 per cent less growth rate compared with the strip. The important follicles when you’re transplanting are the ones that naturally have three or four hairs because they’re going to give you more bang for your buck.”

“Unfortunately under the skin, they tend to diverge almost like a tripod. And so when we’re doing the punch to excise them, inevitably, something gets damaged along the way. You do get some collateral damage and you get only one or two hairs instead of three or four.”

Patients who opt for a larger number of FUE performed in one procedure has a greater risk the result will not mirror that attained through FUT.

“Internationally, and that’s sort of a standard result, is to get a 60 per cent yield when you’re doing FUE. And sure if you only had a little bit of baldness, a small area to cover, and a lot of donor hair, if you get a 40 per cent loss rate- not the end of the world. But when we’re trying to cover a huge area because of your extensive hair loss, you can’t afford to lose that 40 per cent.” says Dr Sara.

FUT has been extensively tested over decades and in the right surgical hands, the hair transplant patient can look forward to a healthy and natural looking hair transplant.