When a patient is considering a hair transplant, there are two main types of procedure: FUE or FUT/Strip. FUT stands for Follicular Unit Transplantation. This procedure involves the removal of a thin, long sliver of tissue from the donor area, which is generally located at the back of the head and the sides of the scalp. Individual follicles are removed from this one strip with a dissection process. Afterward, the wound edges are sealed, which leaves one scar (which is usually fine in appearance). Meanwhile, FUE stands for Follicular Unit Extraction. During this procedure, small and circular incisions are made over a larger portion of the donor area, and hair is harvested through these incisions, which leave behind circular scars.
In this post, we’ll discuss the advantages and disadvantages of each procedure type. Then we’ll explore the potential of combining the two techniques.
Main Advantages: FUE vs. FUT
When a FUT procedure is undergone, the largest advantage tends to be that it yields more hair than an FUE procedure. In many cases, the end goal of the patient is to have their hair restored to the maximum possible amount of fullness. If a large yield of hair is the most important factor to the patient, a FUT procedure is the best option. The dissection is done with stereo-microscopic and precise tools, which allow for more hair to be harvested from a selected part of the donor area.
Meanwhile, FUE procedures have faster healing times and don’t leave linear scars. If the patient is prioritizing quick recovery over everything else, FUE is the best option. This can include both strenuous activities and be wearing hair short. FUE procedures are also optimized for patients who have an increased chance of a wide scar. Sometimes the scalp is too loose to allow a strip excision to be performed, in which case FUE is the only procedure that’s possible.
When Can FUT and FUE Be Combined?
It is possible for the same patient to have both a FUT and FUE procedure. If you want to combine FUT and FUE, you should meet the following criteria:
- You can safely undergo both procedures (ie: you don’t have a level of scalp looseness that prevents the implementation of FUT)
- You are able to take extra time for recovery
- You do not intend to cut your hair very short very quickly
- You want the increased hair yield of both procedures as opposed to picking one over the other
There are also cases in which a patient might have started the hair transplant process intending to use only one procedure, but discovers partway through the process that they need to use the other procedure for the best results.
For example, a patient might undergo a FUT procedure for the sake of maximizing the donor yield from the first procedure or procedures. When subsequent sessions occur, the patient and surgeon may find that the scalp has reactively become too tight to yield any more donor hair. Alternatively, the donor scar might become wider than a fine line.
When the scalp is too tight, the physician has the option of switching to FUE procedures for the future sessions. When the scar becomes wider than anticipated, the surgeon might use an FUE procedure to harvest follicles that can then be implanted directly into the scar tissue, camouflaging it as part of the hair.
In another example, a patient might undergo an FUE procedure and find that the yield is lower than the doctor can work with. The patient might want to consider switching procedures either during the current session or when future surgeries are performed. The trade-off here is that he must trade a faster recovery time for a more successful donor yield.
Graft Quality in FUT and FUE Procedures
Regardless of the procedure you choose, your surgeon will prioritize the transplantation of high-quality grafts to allow maximum cosmetic benefits to be achieved. To obtain a high-quality graft, the surgeon will need to harvest from the most permanent area of the donor zone. These grafts must be undamaged and have a layer of protective tissue surrounding the follicles. This protective tissue reduces the risk of mechanical-related injuries during the insertion and keeps the grafts from drying while they’re outside the body.
Each procedure is done in a slightly different manner, though:
During FUT procedures, the first step is to remove the donor strip from the scalp. After this, stereo-microscopes are used to dissect and isolate the follicular units, all the while keeping the intact layer of protective tissue. This is a process meant to yield a number of different high-quality grafts, especially when the stereo-microscopic dissection is handled by skilled clinicians.
Meanwhile, during FUE procedures, surgeons extract follicular units one at a time rather than removing them in a strip. This does bring an increased risk of accidentally cutting the units while harvesting because the surgeon is only able to see the upper part of the hair follicle. Because of this, it’s more likely for follicular units to be harvested damaged or missing their protective membrane.
When the surgeon fails to make a deep enough incision, the follicular unit might accidentally be extracted bereft of the lower portion. Without the lower portion, the follicle has no guarantee of surviving the transplant. It should be noted, however, that robotic FUE procedures greatly reduce the risk of human error.
Dr. Jeffrey Epstein is one of the most successful plastic surgeons in the world and is a world-class hair restoration specialist in Beverly Hills and Los Angeles. You can learn more about Dr. Epstein’s work by visiting the Foundation for Hair Restoration website. If you have a query or would like to schedule a consultation, we’ll be happy to discuss your hair transplant options and schedule an appointment.