Which of the procedure is better for Hair transplant: Follicular unit extraction or strip hair transplant?
Follicular Unit Extraction or Strip for Hair Transplant?
Doctor Answers 21
FUE or Strip
FUG vs. FUE
FUE has one main advantage- the absence of any linear donor site scar, thus permitting the patient to shave his head if desired.
The downsides of the FUE procedure are several: typically a lower percentage of hair regrowth (for most patients an 80 to 85% rate of regrowth vs. 90plus % with FUG; higher cost; difficulty of obtaining a large number of grafts- anything more than 1500 or so requires 2 consecutive days of procedures; and the need to shave the head in the donor area.
However, FUE is still the procedure of choice for young men, men of African American ethnicity, those who have depleted their donor supplies from prior work, and those who wish to have the option of shaving the head.
FUE vs FUG
Both techniques have advantages and disadvantages. Below are the pros and cons of each:
Follicular Unit Extraction
- no linear scar on the back of the head
- almost limitless donor especially if body hair can be used
- time intensive sometimes requiring several days to complete a large case
- lower individual graft survival rate (75% vs 90%)
- cost usually 50% higher per graft
Follicular Unit Grafting
- more time efficient
- higher individual graft survival
- linear scar on the back of the head (usually not noticeable)
I don't think this is an issue of one being better or worse than the other technique, but rather a question of which technique is right for individual patient problems. I feel FUE is best suited to very young patients (teens or early 20's) with an unpredictable future pattern of hair loss, people who want to shave or cut their hair very short, and those who can't tolerate the risk of a scar. I still think FUG is the treatment of choice and the gold standard against which other techniques should be compared.
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Which procedure is best?
FUE or FUT
Earlier on, I performed the FUT technique as well as the FUE, however I began practicing merely the FUE technique using the manual punch in 2004 and have since that time performed the same technique. In my own practice, I have witnessed amazing growth rates in FUE that is equal and surpass those of FUT. In my own personal practice, I use the manual punch combined with a technique that I developed, the DES or Sequential Method. I believe that the manual punch creates less damage to the donor area, thereby increasing the donor capacity in a positive way. Furthermore, it is in my opinion the most effective method to achieve the best overall homogenization that allows for a natural look.
Donor Strip vs Punch technique
There is not golden standards in surgery including hair transplantation. We need to keep in mind that the donor harvesting is only One Step of the hair transplant procedure (six steps), each step is critical for a successful outcome of the surgery. I offer both donor harvesting techniques to my patients. The initial consult and visit is critical for learning patient's concerns, goals and expectations. I discuss with them about the pros, cons, side effects and complications of each donor harvesting and surgical techniques during my consult and I costumize my surgical plan and technique for each patient. Sometimes the strip technique is the best option, sometimes de punch technique (FUE) is the best option and sometimes both (combo technique), it depends of each particular case and patient.
Strip Surgery or FUE for Hair Restoration Surgery
Here are some guidelines to understand better this topic.
1. Most surgeons do either one of these techniques or are much better in one of them. Opinions of these surgeons may not necessarily reflect truths of current science.
2. There is a value to each surgical technique. Every patient needs to be analysed individually for the formulation of the best treatment plan.
3. Strip takes advantage of the skin laxity, where as FUE uses the extra density for individual harvesting of grafts. Since the principle behind each technique is different, frequently both techniques will be necessary to use the full donor capacity in a multi-staged surgical plan. The question then may be which one to choose first.
4. FUE is the current trend for hair transplants; thus it is impossible for a surgeon to speak against it, if he doesn't want to loose business. For this reason we will hear a lot about the disadvantages of the strip, but not FUE.
5. If we decide that both techniques will be necessary in the long run, then it may be wise to start with strip surgery first. Strip protects untouched donor area for FUE, but FUE uses the whole donor area.
6. In certain situations we may choose to do a FUT+FUE combined procedure. These are situations when there is a demand for a very high graft number, patients with limited donor availability, patients with previous surgery, patients with need of scar repair together with a hair transplant.
FUE leaves dots, Strip leaves a line
Follicular Unit Extraction FUE or Strip for Hair Transplant FUT?
Generally I prefer FUE for young patients, men who have thick hair that comes out at large angles, men who crop their very short, and also ones who need a very small number of grafts
Generally I prefer Strip or FUT if the patient has long and soft hair with no intention of a short hair cut and unable to shave their head for the procedure. Obviously these men also have no problem with a linear scar hidden with their hair at the back
In short the advantage of FUE is no linear scar, and the ability to choose more of the larger groupings of hair to create more density. With FUT, the advantage is more subtlety in the recovery stage and the ability to harvest thousands of grafts from the most central and dense part of the donor. It also generally cheaper
In short, its good to be able to offer both methods to best suit the individual patient. If the surgeon is equally adept at both then there should not be much difference in the cosmetic result of the hair transplant.