I am 26 and considering hair transplant, I am so confused on doing FUT OR FUE? (photo)

Trying to find personalized medical advice on the Internet may lead to more confusion since you will only find generalized answers.  It is best to see a doctor for an examination and consultation and ASK the doctor in person about your confusion. If you want to keep your hair very short you may need to consider FUE harvesting.

Thank you for your question. You submitted your an image of the top of your scalp, state you’re 26-years-old, and trying to make a decision to do FUT or an FUE hair transplant procedure. You state you have friends who did FUEs who did not appear to have the most optimal outcome, so you’re looking for some guidance.
I can share with you how I counsel patients like yourself in my practice when it comes to hair loss management strategies. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. I am also the founder of TrichoStem™ Hair Regeneration Centers, a non-surgical system we developed to help people with male and female pattern hair loss which has been a significant alternative to hair transplant, particularly for people who are younger. I think it’s important to understand a couple of things as it is very challenging for people your age group to deal with hair loss.
The incidence of hair loss in different decades of life for men is referred to as the Rule of Decades: in your 20s, only 20% of men have hair loss, but as you get into your middle to later decades, your 50s and older, well then 50% have hair loss.
The challenge with hair loss in your age group and your degree of advanced hair loss is how to manage your hair loss before you move forward with a hair transplant. It is a common story I hear in our practice when people come to me somewhere in their 30s, and they’ve already had one or two transplants in their 20s. Unfortunately, the hair loss progressed, so they only have some isolated transplants. Those transplants are not anywhere close to enough to provide a significant amount of coverage, so they end up in their mid 30s and beyond not looking like they had a lot of hair, even though they underwent anywhere from 2 to 4 surgeries.
The challenge is to manage hair loss before doing surgery, which is very important. It’s also important to understand that hair loss is progressive, and having an early onset puts you in a more aggressive category. We developed a system based on our experience first doing hair transplant when we were trying to help our transplant patients get a better yield of their grafts, improve the healing of the donor area which was the strip method (FUT). What we got to see was thinning hairs in a lot of patients became thicker.
Move the clock forward now going on close to 8 years, I developed a system to address patients with male and female pattern hair loss. Further, I was also able to identify through a lot of challenges, obstacles, and setbacks that certain categories of patients have more aggressive hair loss than others. We developed a classification system with gender, age of onset, degree of hair loss, rate of progression, and other medical issues important to understand.
One of the things I would say to most of my young patients in their 20s is that almost by definition, having an early onset, it’s already hardwired in your DNA that you have a higher DHT sensitivity (dihydrotestosterone) which is one variable important in the progression of hair loss.  I counsel a lot of my patients in your age group to strongly consider taking a DHT blocker such as finasteride. People looking in the internet are very often afraid to take finasteride, but I try to put things in context of current clinical knowledge, and the fact this drug has been around since 1997. We try to put things in perspective and look at every patient individually, but I do routinely prescribe this drug as another tool to help slow down progression.
In addition, we also do a treatment called Hair Regeneration. What we’re doing is reactivating hair currently not growing  where the thinning hair has shorter growth cycles,, and the resting phases get longer, so fewer hairs are actually present; thinning hairs get thicker; and the prolongation of the hair growth cycle.
Occasionally, when we see our patients, we are seeing them in a snapshot, and there’s no way to know whether they’re in a stable or relatively stable phase of their progression, or whether they’re on their way down. Sometimes, a lot of these patients who are younger with more advanced hair loss, their thinning hair is almost, if not certain percentages, at the end of the growth cycle, and never to grow again, which means they can still progress before they stabilize, and before we can manage maximizing their growth cycles to as long as possible, and use a combination of a DHT blocker and injection is a way we are trying to help them combat a very aggressive DNA program.
It is important for you to think of stabilization and management before you do surgery. We have enough experience to know that a lot of people go through surgery at a young age will later regret it because they still progress, and they’re stuck with a look that doesn’t work very well for them. Think about this seriously before you make the decision between FUT versus FUE. There’s a mismatch between the amount of scalp that needs coverage and the amount of hair that’s available in your donor area. Yes, more aggressive or more ambitious patients will undergo body hair transplants which is a valid choice, but you should also think of how to maximize the lifespan of your existing hair for as long as possible to minimize and delay hair transplant. From my perspective,  that makes more sense than just doing transplant after transplant. I hope that was helpful, I wish you the best of luck, and thank you for your question.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

Both FUE and FUT (Strip) can provide excellent result when in the hands of a skilled surgeon and team who have mastered their craft, and both techniques can provide poor results if you do not choose a top clinic.