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WHICH IS BETTER

FUE OR FUT ?

Although FUE and FUT are the 2 standard procedures in hair restoration currently, they both have different positive and negative consequences.

People, who are contemplating hair transplant as a remedy to their hair loss problems, often wonder which procedure is better than the other in terms of success rate, side effects, scar appearance, scalp comfort, and so on.

What is FUE hair transplant ?

Follicular Unit Extraction or Excision

FUE, Follicular Unit Excision, is a graft harvesting method done with a special medical tool to extract individual hair follicles one by one from the donor area to be transplanted in another area such as scalp, eyebrow, mustache, or beard.


The tiny, circular dot scars, about 1 mm, on the donor site created by the FUE will turn into scabs and will fall out on their own within 7-10 days as part of the healing process.


There are no sutures to be removed. When healed, these scars will look like white spots scattered around on the donor area.

What is FUT hair transplant ?

Follicular Unit Transplantation or Strip surgery

FUT, Follicular Unit Transplantation or strip surgery, is another surgical technique of harvesting hair grafts by cutting out a strip of hair on the donor area where the incision will be closed by stitches.


Each individual hair graft harvested is microscopically dissected into single hair follicles before being transplanted onto the recipient area.


The scar created by FUT looks like a sutured linear scar that may be covered by the surrounding hair.

What are the similarities of FUE and FUT ?

  1. Currently both FUE and FUT are standard hair transplant procedures.

  2. Both FUE and FUT are minor surgeries performed under local anesthesia; therefore patients usually do not feel the pain during the procedures.

  3. Both procedures create scars on the donor areas. The FUE scars look like white spots scattered all over while the FUT scars look like a sutured line.

  4. Both FUE and FUT are using the same grafting technique for transplanting the harvested hairs onto the bald area.

What are the differences of FUE and FUT ?

differences of FUE and FUT

To compare the FUE and FUT scars, these images of one of our patients who had both FUE and FUT procedures done simultaneously are used here for illustration purposes.

The main difference between FUT and FUE is the harvesting method.


With FUE, individual hair follicles are singly removed with a special medical tool whereas in FUT, a strip of hair follicles is excised from the donor area.


Though the only difference between the two methods is the harvesting technique, each of them has its own pros and cons that raised a question among the people considering hair restoration whether FUE or FUT is better for them.


To answer this question, let’s explore the good and the bad of these procedures in the following categories.

1.Success Rate. Done by skilled, artistic surgeon and staff, both FUE and FUT have about the same success rate of 90-95%

2. Scalp Comfort. Though patients do not feel the pain during procedures, FUE patients normally feel less pain after the local anesthetic wears off.

3. Price. The FUE procedure usually costs a lot more than the FUT procedure.

4. Risk and Side Effects. These are the 3 major cosmetic impacts to the subsequent hair transplantation(s) to be considered.

4.1 Scar Appearance

FUE scar

FUE procedure creates numerous tiny, circular (1 mm ), white dots dispersed on the donor area. With short hairstyles, they may be less visible.


Since the FUE procedure can be done in a smaller session than the FUT procedure, patients may need subsequent sessions. But the more grafts they need, the more of these white dots will appear on their scalps, the more visible they become.

FUT scar

To give you a clear picture, if one needs 2,000 grafts on the first session, that means one will have 2,000 of these white dots on the scalp. Then an additional 2,000 grafts are done on the second session, that means one will have another 2,000 white dots added to the existing scars from the previous session, for a total of 4,000 dot scars. Meanwhile the donor area will become thinner as a result. Over time, continued thinning in the donor area with the subsequent session may cause the FUE scars to become visible.


Compared to the dot scars, the FUT produces a linear scar that might be easier to notice on patients who wear very short hairstyles.


On the other hand, FUT method involves excising a strip of hair from the area where the existing scar was left from last procedure so it does not create an additional linear scar while there are plenty of surrounding hair can be reserved as future supplies if needed. Most FUT patients will always have only one scar no matter how many times they have the procedures done.

4.2 Donor Depletion

depleted donor hair supply from FUE

FUE can cause a rapid donor depletion on the donor site; on the contrary, FUT hardly creates this problem.


Due to the distribution of the FUE dot scars, the more grafts removed, the less density on the donor area becomes, the sooner the donor depletion sets in.

While the strip harvesting of FUT is confined in a small area of scalp and FUT won’t create any scars to the surrounding hair like FUE, the donor depletion issue does not usually happen under normal circumstances.


When donor depletion is the culprit for the subsequent session, the surgery outcome may not be as satisfactory as the previous one. The surgeon doing the subsequent session could be blamed for the poor result in this situation if the patient does not understand the underlying problem.


The surgeon should clearly explain this issue to the patient prior to the surgery and have them decide whether they want to move forward.

beard hair for scalp transplantation

Transplanting beard hair to head

Hair from other parts of the body may be used as an alternative option to donor hair from the scalp but it can be very costly.


Moreover, it does not usually give the natural looking as hair on the scalp does due to the differences in characteristic and quality such as the texture, the flexibility, the curliness, and etc.

4.3 Permanent Result

FUE non permanent result

SAFE DONOR AREA or SDA as shown here is an area in the occipital and adjoining temporal zones in which hairs are permanent by nature. These are the only donor hairs on the scalp that can be harvested for hair transplantation in order to achieve the optimum outcome. Any hair outside the SDA is not permanent.

Unfortunately not all hair done with FUE procedure will grow permanently. Some of which are more likely to fall out eventually and will not regrow whereas hair done with FUT procedure literally stays at bay for life regardless of the patient's heredity or severity of baldness. It may shed from time to time like the rest of the hair; however, it will grow back and stay with you for good.


With FUE procedure, the surgeon can randomly extract only 30-35% of hair in the SDA for the procedure, the remainder is left to cover the scars; otherwise, they will be visible. That said, the surgeon have to extract the rest of the needed hair grafts from outside the SDA which is not permanent and will fall out eventually without growing back. This is one of the reasons that make FUE’s long-term success rate not as promising as FUT’s.

Video of the inaugural lecture of the 25th World Congress Prague 2017of ISHRS. Dr. Tykocinski explains the main differences between FUT and FUE techniques

Now that you know the pros and cons of FUE and FUT, you can choose wisely which procedure is appropriate for you.

Recommendation

GO FOR FUE IF :

  • You plan, or have a profession— such as in military service or law enforcement— that requires you to wear short hairstyles.

  • You are not on a budget.

  • You have zero tolerance for pain.

  • You are o.k. with future hair depletion should you need a subsequent session. And you are also o.k. with the idea of using hairs from other parts of your body as an alternative donor hair to be transplanted on your scalp.

  • You are o.k. with losing some of your transplanted hairs, that are not permanent, for good.

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GO FOR FUT IF :

  • You do not always wear short hairstyles.

  • You are on a budget.

  • You can tolerate some pain.

  • You do want the hair transplant to stay with you for a lifetime.

  • You need a large mega session, 2,500-3,500 grafts, done all at once.

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