There are only two methods to surgically extract follicular grafts from the scalp:
F.U.E and F.U.T.
F.U.T. is a general term that means Follicular Unit Transplant. This term is commonly used when speaking about the Strip Excision technique of harvesting donor hair grafts.
F.U.E. is a form of FUT that uses Follicular Unit Extraction to harvest donor grafts. With FUE, grafts are extracted individually from the donor area using a small ‘punch”
FUE Method (Punch Extraction)
Human hairs grouped together on the scalp in naturally occurring follicular bundles or families called follicular units. These groupings consist of one to four hairs. Individual groupings (FU’s) are extracted using a surgical punch-tool. The punch tool is positioned over the hair shaft where it emerges from the skin, then aligned with the direction of the hair growth and inserted, creating a round incision
This method can be challenging because it is difficult to see the graft through the scalp, which makes it tricky to align and position the punch and to judge the depth required to excise the graft. When FUE is performed manually, tools with smaller punch diameters can be used so that each graft unit can be more precisely matched. The incidence of transection may be higher using FUE than using FUT, but is very dependent on the experience and surgical skill of the performing surgeon
Whether grafts are extracted by FUE or FUT, they are processed under HD microscopic cameras and HD LED Screens to prepare each unit for transplant. It is essential that the integrity of these grafts remain undisturbed during the dissection process.
The grafts are planted as units, so if a graft contains three hairs when it is extracted, all three hairs will remain together when it is planted.
Although Medical Hair Restoration Clinic has been slow to jump aboard the FUE “bandwagon”, we never wanted to provide FUE procedure with results that were ‘mediocre’.
We have spent the last 2 years researching the various FUE techniques. We have looked all the various FUE methods including manual punches, power punches and even the Artas robot.
The best technique -in our opinion – and by a large margin, is the automated power punch.
We are now performing FUE procedures routinely.
FUE stands for ‘Follicular Unit Extraction’ and is a hair restoration procedure involving the transplant of one’s own hairs from one area of the scalp to another. It is a minimally invasive treatment, and involves
- No sutures
- No staples
- No cutting (although a small biopsy like punch of skin is removed)
Individual follicles, or groups of follicles, known us “Follicular Units” are removed directly from the donor area without the need to cut a strip. The grafts are then transplanted into areas where the patient desires more hair to create a natural looking hair line and/or add density to areas of thinning.
Consistent and natural results
The FUE method was developed in order to stop exposing patients to risks such as large scars, pain and excessive swelling. It also eliminates problematic, unnatural looking, “pluggy” transplants.
(Reasons to choose a FUE hair transplantation)
- No risk of visible scars even if you have short hair.
- Donor area (where hairs were removed) appears unchanged
- More hairs per graft
- Natural hairlines
- Extremely quick recovery after treatment (days instead of months)
- No deep wounds, nerve bundles remain intact
- Less severe swellings after the treatment
- No need to use a scalpel
- No need for stitches
- Less invasive with less post operative discomfort and faster healing
- Local anaesthesia (like a visit to the dentist)
- The patient can drive home himself after the treatment
- The result is very natural and not recognisable as a hair transplant
The follicular unit extraction technique (FUE), avoids the linear donor site incision. Instead, each graft is harvested one at a time with tiny 0.8 1.2 mm round Cole punches which usually heal as essentially undetectable dots( lighter spots) on the scalp.
Many of our patients are able to shave their heads without any visible scars. In order to obtain these grafts, usually the back and sides of the head are required to be shaved. We also can perform the “long Hair” FUE method where only setions of the scalp are shave, keeping the hair above long to camaflague the area later.
The patient typically lies face down (prone) for the first hour or two hours. We are able to harvest 1000 grafts from this are. Should the patient require additional grafts, these can be obtained from the sides of the scalp, allowing our experienced team to harvest as many as 2000 or more FUE grafts in a single-day procedure. Each graft contains one to three, and sometimes even four hairs, This gives the most natural results.
With smaller procedures of 700 or less grafts, the entire head does not need to be shaved, instead narrow “bands” of hair can be shaved permitting the overlying longer hairs to conceal these donor
Follicular Unit Extraction (FUE) Overview
Follicular Unit Extraction (FUE) is a method of extracting, or “harvesting,” donor hair in a follicular unit hair transplant procedure. In FUE hair transplant surgery, an instrument is used to make a small, circular incision in the skin around a follicular unit, separating it from the surrounding tissue. The unit is then extracted (pulled) directly from the scalp, leaving a very small open hole of 0.8mm – 1.2 mm
This process is repeated until the hair transplant surgeon has harvested enough follicular units for the planned hair restoration. This process can take one or more hours and in large sessions, may be accomplished over two consecutive days. The donor wounds, approximately 1-mm in size, completely heal over the course of 3 to 7 days, leaving tiny white scars buried in the hair in the back and sides of the scalp, which are almost undetectable.
This method of donor harvesting, removing follicular units one-by-one directly from the scalp, is what differentiates the FUE hair transplant from a traditional Follicular Unit Transplant (FUT), where the donor hair is removed from the scalp in one thin, long strip and then subsequently dissected into individual follicular units using a High Definition (HD) camera-microscope and LED screens
After the grafts are harvested, tiny “recipient sites” are made in the balding area of the scalp using a fine blade custom cut blade according to the size of the graft. The follicular units are then placed into the recipient sites where they will grow into healthy hair-producing follicles. The creation of recipient sites and the placing of follicular unit grafts are essentially the same in both FUE and FUT procedures.
The difference lies in the appearance of the donor area and in the quality and quantity of grafts obtained with each technique.
Follicular Unit Extraction is an instrument and user dependent procedure; therefore, the type of tool used for this procedure as well as the skills and experience of the surgeon significantly affects its outcome. The development of increasingly better extraction instrumentation has closely paralleled the advances in the procedure.
The use of direct extraction to harvest follicular units was initially conceived by Dr. Woods in Australia as the “Woods Technique,” but he did not disclose the details of his procedure. The technique was first described in the medical literature by Drs. Rassman and Bernstein in their 2002 publication
FUE hair transplantation continues to evolve as more physicians learn about this procedure, gain experience with it in their practices and offer improvements to the technique.
Indications for FUE Hair Transplants
Because FUE does not leave a linear scar, it may be appropriate for patients who want to wear their hair very short. It is also an advantage for those involved in very strenuous activities, such as professional athletes, who must resume these activities very soon after their procedure.
The technique is also useful for those who have healed poorly from traditional strip harvesting or who have a very tight scalp. FUE transplants also allow the surgeon to potentially remove hair from parts of the body other than the donor scalp, such as the beard or trunk, although there are many limitations with this process.
Possibly the most straight-forward application of this technique is to camouflage a linear donor scar from a prior hair transplant procedure. In this technique, a small amount of hair is extracted from the area around a linear donor scar and then placed directly into it.
Some patients desire Follicular Unit Extraction simply because they heard that it is less invasive than FUT or is non-surgical. The reality is that both procedures involve surgery and in both cases the depth of the incisions (i.e. into the fat layer right below the hair follicles) is the same. The difference is in the type of incision made. In FUE multiple round incisions are made scattered diffusely through the donor area. With the FUT method there is one single, long incision in the middle of the donor area. FUE should be chosen if the multiple round incisions are preferred and not because the technique is “non-surgical.”
Since FUE harvesting requires a much larger area compared to strip harvesting (approximately 5x the area for the same number of grafts) in order to perform large sessions of FUE, the entire donor area must be shaved. This can present a significant short-term cosmetic problem for many patients. In contrast, with FUT using strip harvesting, the donor incision can be covered with hair – even with very large sessions.
On the other hand, because there is no linear incision with FUE, patients can resume strenuous activities and contact sports much sooner after the procedure.
FUE vs. FUT
Follicular Unit Extraction (FUE) and Follicular Unit Transplantation (FUT) are frequently compared as if they are two totally different, even competing, hair transplant procedures. Despite this common misconception, the difference between FUE and FUT is the method by which follicular units are removed from the donor area in the back and sides of the scalp. The remainder of the hair transplant procedure is essentially the same.
However, the harvesting method does have important implications for the hair restoration procedure as it will affect the total number of high quality grafts that can be harvested from the donor area and ultimately, the fullness achieved from the hair transplant. In general, the harvesting method of FUT via strip is superior to that of FUE for two main reasons.
1)The FUT procedure allows the surgeon to produce the highest quality grafts by isolating the follicle units with minimal trauma .
2)The FUT (strip) method enables the surgeon to best utilize the most permanent part of the donor area..
Because the differences between FUE and FUT are significant, the pros and cons of FUE hair transplant surgery should be considered when deciding which procedure is best for you.
FUE vs. FUT Hair Transplants
The following tables summarize the pros and cons of Follicular Unit Extraction (FUE) compared to Follicular Unit Transplant (FUT) procedures.
Advantages of FUE (vs. FUT)
|No linear scar in donor area
Important for those who wear their hair very short where the scar may become visible
Important for those who have a history of keloids, thickened or stretched scars
|Decreased healing time in the donor area
The small holes that are created with FUE will heal in a shorter period of time than the linear FUT-strip scar
|No limitations on strenuous exercise after the procedure
The concern with a FUT-strip scar is that strenuous exercise soon after the procedure can lead to scar widening. The small holes created from the FUE procedure do not widen and are not affected by exercise after the procedure
|Less post-op discomfort in the donor area
With FUE there is essentially no discomfort after the procedure
|Useful for those with a greater risk of donor scarring
Very muscular, athletic patients
Those with very tight or very loose scalps
Those with a history of keloid scarring or poor healing
|Useful for repairing donor scars that cannot be excised
Eg:- If a patient has previously undergone a FUT procedure and has a widened donor scar, an FUE procedure can be performed to transplant hair into the scar to help camouflage it
|Provides an alternative when the scalp is too tight for a strip excision
If a patient has previously undergone one or more FUT procedures, there may not be enough scalp laxity for another FUT strip to be harvested. In this case, an FUE procedure can be useful.
|Enables one to harvest finer hair from the nape of the neck
For use at the hairline or the eyebrows
Disadvantages of FUE (vs. FUT)
|Follicular units in FUE are harvested from a much greater area of the donor zone compared to FUT
In FUT, all the hair is harvested from the mid-portion of the donor area where the hair is most permanent. This is done to maximize the yield of high quality grafts from the permanent zone. In FUE, to obtain a sufficient number of grafts, follicular units must also be extracted from the upper and lower portions of the donor region and these may not be as permanent. Therefore, over time, the hair transplanted from these areas to other parts of the scalp may be lost
Over time, continued thinning in the upper and lower parts of the donor zone may cause the FUE scars to become visible
|Graft quality is not as good compared to FUT
· Greater rate of follicular transection (damage to grafts) compared to FUT
· Grafts more fragile and subject to trauma during placement, because extracted grafts often lack the protective dermis and fat of microscopically dissected grafts
· More difficult to capture the entire follicular unit – resulting in lower density
|The maximum follicular unit graft yield is lower than with FUT
· Lower quality grafts may not grow as well
· Inability to harvest all the hair from the mid-permanent zone results in decreased numbers of grafts
· The scarring and distortion of the donor scalp from FUE makes subsequent FUE sessions more difficult
|With each subsequent session, the scarring in FUE is additive
· For example, if the first FUE session is 2,000 grafts, there will be 2,000 tiny round scars. With a second session of 2,000 grafts, there will be a total of 4,000 scars
· In contrast, with FUT, the first scar is completely removed in the next procedure. Even though the scar may be longer in the next session, with FUT, regardless of the number of procedures, the patient is left with only one scar
|In large FUE hair transplant sessions, the entire donor area must be shaved
· This may present a significant temporary cosmetic problem for working patients or those in the public eye
· It can take 10 days to two weeks for your donor hair to grow to camouflage the small holes created from the procedure
· Exception: For small and intermediate size FUE cases (up to 1200 grafts), Long-Hair FUE may be an option. With this technique, the entire donor area of the back and sides of the scalp does not need to be shaved. On the day of the procedure, the surgeon lifts up the hair, clips a long thin band of donor hair, then extracts follicular units from this limited region of the scalp. After the procedure, the patient simply combs down their hair to cover the donor zone. With Long-hair FUE, patients can resume their work, or daily routine, soon after their hair restoration procedure
|Microscopic dissection may be needed in addition to the extraction
· If the number of single-hair grafts is inadequate. In an FUE procedure, 1-, 2-, 3-, and 4-hair grafts are harvested; however, only 1-hair grafts can be used at the hairline. If there are not enough 1-hair grafts harvested, then the available grafts are dissected to create them.
· To remove hair fragments
|After large numbers of grafts are harvested, fine stippled scars may become visible due to thinning of donor area|
|Long-term, if the donor area narrows, the scarring may become visible
· Both FUT and FUE produce donor scarring; FUT, in the form of a line and FUE in the shape of small, round dots. With FUT, the line is placed in the mid-portion of the permanent zone and in FUE the dots are scattered all over the donor area. If a patient becomes extensively bald (i.e. the donor fringe becomes very narrow), the line of FUT will generally still remain hidden, whereas the dots of FUE will be seen above the fringe of hair. In the less likely scenario of the donor hair actually thinning significantly, both the line (of FUT) and the dots (of FUE) may become visible.
|The size of a single session is limited
· Since the extraction process is slower than strip harvesting, large procedures may need to be performed over two days. The FUT procedure is “performed in parallel” means that after the strip of scalp is harvested, the grafts are dissected by a number of dissectors working simultaneously. At the same time, the doctor is creating the recipient sites. In contrast, during an FUE procedure, the grafts are harvested one-by-one and site creation cannot be done while the grafts are being harvested. As a consequence, FUE is a significantly longer procedure than FUT for an equivalent number of grafts.
|With FUE, grafts are usually out of the body for a longer period of time compared to FUT
· This runs the risk of sub-optimal growth
· This problem can be mitigated by performing large sessions of FUE over two consecutive days. Pre-making recipient sites mitigates this issue to some degree, since once the graft harvesting is completed, the grafts can be immediately placed in the pre-made recipient sites.
|FUE is usually more expensive than FUT
· This is mainly because FUE is a more time consuming procedure.