FUE vs FUT- Which one is right for me?

From punch hair transplant in the 1950s to mini and micro grafting to follicular unit transplant in the 1990s and then finally to Follicular Unit Extraction, hair transplant has come a long way [1].  If you have been contemplating the idea of undergoing a hair restoration procedure for quite some time, the terms FUE and FUT wouldn’t be new to you, but if you’re still trying to figure out which is the right one for you, then this piece might help in making the decision.

 

Follicular Unit Transplant

Follicular Unit Transplant or strip method involves a thin strip of tissue being removed from the back and sides of the head, followed by removal of individual removal of follicular units (grafts) from the strip through stereo-microscopic dissection. The grafts are placed in tissue storage solution until they’re transplanted. The edges of the wound are sealed leaving behind a linear scar.

FUT tends to give a higher hair yield (not always but most of the time) and this advantage especially comes in handy, when the patient prioritizes maximum fullness. The advantage stems from the precision of the stereo-microscopic dissection as well as efficient harvesting from a more selected area of the donor region.

Even if you have chosen to FUT as the procedure, you should try to look for a surgeon who is an expert in both the procedures, because sometimes a combination of FUT and FUE may be required. This especially becomes inevitable if;

  • No more strips can be harvested due to scalp tightness
  • There is a wider scar that now needs to be camouflaged

The graft quality is better for FUT since there’s more supporting tissue around the follicles and it definitely becomes an excellent choice for patients who aren’t concerned about a scar being there. Many patients don’t mind the scar because they keep their hair a little longer in the back, thus hiding the scar.  Also, FUT costs less than FUE, due to the time-intensive nature of the latter.

 

Follicular Unit Extraction

Contrary to FUT, where a strip is removed, FUE makes use of small circular incisions while harvesting hair follicles. The donor region, in this case, is larger than that of FUT, while the scars are smaller, round, and widespread. The advancement in technology has further given a boost to the procedure’s popularity with the help of automated systems and hand-held devices that have improved the precision of the procedure.

The main benefit of FUE is the absence of a linear scar, which in turn means a quicker recovery. This is a treat for patients who want short hair without having to think about hiding the scar. FUE comes to the rescue when;

  • There’s a risk of a widened scar
  • The scalp is lax or loose and doesn’t permit strip removal
  • The patient doesn’t want a scar at all.

Both the procedures yield high-quality results but have a separate set of indications. The choice is therefore made after a consultation in which the patient’s situation and condition are assessed by an expert. However, here are a few more basic factors that influence the choice

 

DONOR HAIR

Hair at the outer edges of the donor area has a higher probability of being lost over a period of time (balding process), whereas those in the mid-portion tend to be resistant. FUT utilizes strips from the mid-portion, while FUE has a broader region to work on, in terms of harvesting.

Bottom line- Some of the hair follicles harvested during FUE may eventually fall prey to balding

Not all hair follicles make their way to the phase of harvesting during FUE, only about 20%, compared to an entire strip harvested during FUT. In an attempt to collect sufficient hair grafts, the surgeon then tries to harvest from additional areas, in turn leading to thinning in the donor region

Bottom line- there are chances of thinning of donor region with FUE

FUE is all about making tiny incisions in the donor region, which are left open for healing, unlike FUT. While the incisions have the advantage of being small and not visible, they do distort the adjacent tissues and make the subsequent sessions more challenging.

Bottom line- scarring is confined and consolidated in FUT but widespread in FUE

 

 

SCARRING

The most basic and obvious difference between both the procedures is scarring. FUT leaves behind a linear scar that can very well be hidden by hair, but not if you have really short hair. FUE has no remaining linear scar behind, just tiny dots that aren’t apparent even with short hair.

However, a person with a previous FUT, if he/she decides to have another procedure, the strip removed in the second procedure gets rid of the initial linear scar and at the end of the procedure, there’s only one left. No matter how many times you go through it, there will only be one scar.  However, eventually, the scalp will be too tight and you won’t be able to do any more FUT procedures. This is not true for FUE, that instead keeps adding the dot scars for every additional FUE procedure.

 

 

GRAFT QUALITY

In FUT, hair is dissected microscopically and carefully from the strip, keeping the tissue intact after its removal from the scalp, giving high-yield grafts.

FUE, on the other hand, removes hair follicles one by one and during this, there’s a risk of cutting the follicular units since the direction of the follicle underneath the tissue can only be estimated. This places the units at a greater risk of being damaged during FUE. Therefore, if the cut is not deep enough, the unit may be taken out without the lower portion, resulting in damaged grafts and potentially a lower yield.

 This particular aspect has seen a lot of improvement with experienced teams who understand how to extract properly using the FUE techniques.  It’s crucially important to find an experienced hair transplant surgeon who specializes in both procedures and also who has a team that has decades of experience.

In a nutshell, whether you need to go for FUT or FUE is partly determined by your own choice and priorities and partly by the assessment of a surgeon who has enough clinical knowledge and skills to carry out both efficiently.

 

References

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2956961/