FUT vs. FUE
The topic of FUT versus FUE is one of the most popular in the surgical hair restoration field. Discussions about harvesting techniques often draw passionate supporters and dissenters from both sides of the aisle. It can quickly become heated and passionate. FUE is seen as more advanced and older than FUE. FUT users are quick to point out the shortcomings of FUE, such as lower yields, greater damage to donor regions, exaggerated marketing claims and unregulated processes. FUT “versus FUE” is a far too simplistic way to frame the issue. Both techniques have merits and places and should be discussed. It is generally easier to give impartial information on FUE and FUT by those who are able and have performed both. When deciding whether FUT or FUE is right for you, the following should be kept in mind.
Number of Lifetime Grafts
There is a limit to how many grafts one patient can remove from the donor area in their lifetime. Patients who have experienced hair loss, or those in their twenties, should keep this in mind. Each graft must be treated as if it were gold. For long-term success with hair transplant surgery, it is important to use these grafts efficiently and harvest them properly. The best way to get the most lifetime grafts is to start with FUT and use strip harvesting prior to switching over FUE. Perform subsequent strip harvests, removing any previous scars with each surgery to ensure that only one incision line scar remains. Then do FUE in areas not used by strip harvesting. Patients can then use their whole donor area efficiently. FUE is a great way to reduce the number of grafts that a patient can use from their donor area. This is especially true for large FUE sessions. FUT is a better option for patients suffering from advanced hair loss and young patients who have undetermined patterns.
Although research is limited and results can vary, most FUT and FUE surgeons agree that FUT grafts are more resilient and consistent than FUE grafts. This is often due to the increased graft trauma in FUE extraction and the less protective tissue that FUE grafts require during transplantation and the crucial post-op period.
Scarring is a common side effect of hair transplant surgery. Scarring is not possible with “scar-free” surgery. Any clinic that claims scarring-free surgery is possible is intentionally misleading. FUT results in a scarring line in the donor area. It is dependent on physiology. Typically, it is a fine line of 1-2mm. Hair grows above, below and through it (for those who use a trichophytic closure). The incision line can be seen at a depth of 3/8 th inch. Patients typically reach a #3 on a buzzer. Small “dots” are left by FUE throughout the donor area. These scars are usually 1mm in diameter and can be concealed if the excision sites have been spread out and the patient has good skin/hair characteristics. The scars tends to heal lighter than natural skin tone so patients with lighter skin and darker hair tend to heal well. The dot scarring can usually be reduced to a #2 on a buzzer (or 1/4 of an in) FUE scarring can be more obvious if larger sessions are done. These cases can result in visible scarring, which can cause a more “patchy” or thinned donor appearance. FUT and FUE scarring may be treated with grafting or pigmentation camouflaging, if necessary. Patients must be aware that they will have visible scarring after hair transplantation. There is no way to “shave your heads” once the donor area has been removed.
Donor Quality and Hair Characteristics
It is important to consider the hair characteristics and donor quality. Patients with healthy, dense donor areas are suitable for FUE or FUT harvesting. Patients with dense donor areas are less likely to notice a “thinning effect” from FUE harvest and can conceal scarring from either technique. Patients with sparse donor areas should be careful to assess their goals and choose the best option. Conservative FUE is sometimes more suitable for patients with sparse donor areas. This technique allows for the possibility to “skip” around and may make it easier to conceal FUE scarring than a straight incision in a thin donor region. These patients should remember that FUE is still limited in their overall graft count. FUT is still an option for patients who want more coverage and are willing to grow donor hair longer than the average length to hide incision lines.
A patient’s hair type can also play a part. Patients with thicker, more wavy hair tend to have stronger, larger and more solid follicular units. Patients with thicker grafts are more resilient to FUE than those with straight hair. These grafts have smaller, delicater and more forgiving follicular unit. This is not a guarantee that FUE will succeed. Patients with stronger follicular units may not be able to use FUE, while patients with weaker grafts do better. A large part of this is also due to the characteristics of the skin, both below and above the “surface”.
FUE and FUT are both modern harvesting methods that can yield excellent results. They should be performed by a qualified team, led by a hair transplant doctor, and for the right patient. FUT is best for patients with severe hair loss, or those who may require multiple surgeries. FUE is a good option for those who may only require a few grafts and have certain donor characteristics. They don’t need large procedures in highly visible areas and may prefer to keep their hair down on the sides. Both approaches should be discussed with patients.