Hair Transplants: FUE vs. Strip

[HARIRI]

Surgery

 

FUE Surgery: Minimally invasive. Follicles are extracted individually, leaving many tiny extraction sites. These follicles are re-inserted into the recipient area. Shorter recovery time.

Strip Surgery: Moderately invasive. A large incision is made and a long strip of hair-bearing tissue is completely removed. Follicles are dissected individually from this strip and re-inserted into the recipient area. Longer recovery time.

Cost

 

FUE Costs: 5-10 dollars per graft.

Strip Costs: 3-5 dollars per graft.

Donor Appearance

 

FUE Scarring: Thousands of tiny white dots interspersed throughout the donor area.

Strip Scarring: One long, thin linear scar that spans from ear to ear in a U-shaped pattern.

Other Considerations

 

FUE surgeries generally lead to higher transaction rates and, thus, lower yields. Although some surgeons claim that FUE surgeries actually have lower rates of transaction, this has yet to be demonstrably proven.

Strip surgery necessitates significant donor laxity (ability of scalp skin to stretch after strip removal). Without significant laxity, bald surface area can actually increase once a strip is removed and the scalp stretches to accommodate sutures.

New Developments

 

FUE: Mega-sessions (3,000 grafts or more) are becoming increasingly popular, although the feasibility of an efficient FUE mega-session is still under scrutiny. Body hair transplantation is now an option for individuals with limited donor resources since individual follicles can be extracted from any area of the body (legs, chest, etc).

Strip: The trichophytic closure method allows hairs to grow through scar tissue, reducing the appearance of strip scars. The use of ACell MatriStem Extra-Cellular Matrix products is also being investigated to reduce the appearance strip scars.

[MusoInOz]

Hey Mate!

Great write up if I may say...you seem to be almost collating the pro's and con's of each procedure to talk yourself into which one may be better suited? Would I be correct in assuming this? I know I have concocted very similar lists myself.

Cheer,

[HARIRI]

yeah bro, somehow you are true, i think with the yield superior of FUT. I learnt from other forums is to:-

 

All of these perfect results and outstanding pictures posted by hasson and wong plus rahal are all FUT outcomes, its more guaranteed. I aso heard from the FUE coordintator of Shapiro medical group (Jason) at hairlosshelp.com

 

" believe strip maximizes the available donor of a patient, especially those with extensive balding. Transection is lower, and the grafts are exposed to less trauma as opposed to fue where they are "torn" from the scalp. Fue is outside the body for less time, but because the grafts are removed one by one and are extracted roots un-seen, a greater chance for transection exists. I know there has been much discussion about the "safe zone" and available donor, but I am taking a conservative/less aggressive view"

 

if donor really valueable to us and knowing to our fathers are NW6 then FUT is the answer, unless your parents side are only NW3 OR below, then FUE is the best.

 

Trust me if your surgeon using trichophytic closure, you will barely see the scar. Thats why i decided to go FUT before posting this article.

 

Im just against underestimating FUE as still is great that even when they asked the which has better results, Mr Jason perfectly answered:-

 

"I think one thing that is overlooked is physician skill---- regardless of coronal/lateral,sagittal incisions, needles/blades---fue/strip--- the most skilled docs will consitently produce the BEST results-- we have seen this play out time after time. There is one thing that I believe in and that is incision size..... nothing can ruin a good hair transplant more than pitting or cobblestoning or ridging due to large incisions. I have heard people say--"Well, who cares about the scalp that much--- now that it is covered by hair, you can't see it."

WRONG. A hairtransplant encompasses managing the donor region, EACH INDIVIDUAL GRAFT, and making sure the recipient site is properly managed as well--- with controlling bloodloss, controlling depth control, avoiding transection of native hair, using the right sized incisions, and controlling angulation. "

 

That thread almost answered all of my doubts and confusion. Its all about the correct sized incisions and good handling of the grafts as what also Jotronic told me. Thanks Jason and Jotronic for the guidance.

Edited February 3, 2011 by HARIRI

[kathie47]

I've definitely heard that FUE results aren't typically as good as FUT but it really all depends on your needs. FUE is definitely the right choice for some. This is really great information though!

[HARIRI]

FUT is the best, no doubt, its just that many people arent aware of the new donor closure technique (Tri-closure).. will allow the hairs to grow towards the scar which will be almost invisible, I means whats the fuss, a small thin line in the back, no one cares about it, The front is what people look it unless you are a female.. lol.. Just a joke.

 

If you complain about grey hair and small scars, then go ask the bald guy. He would wish to have them both instead of what he has. Just chose a good Doc from this forum especially.

[scar5]

Any strip vs FUE discussion must point to a little (BIG) question about the telogen hair and their fate in strip transplants. At anytime, we all have, on average, about 10% of our hair in a telogen state. Telogen state is the stage in which the hair is detached from the bulb and is either waiting to fall out or has fallen out of the hair shaft. Then the hair bulb will wait 2-3 months before creating a new hair and the anagen stage then commences. We lose about 100-150 hairs a day through this process. In a strip transplant, the 'vacant' telegon follicles get thrown into the bin because the cutters cannot see them even with microscopes. It is an astonishing and embarrassing insult to all hair transplant consumers and forum readers that this phenomena is not discussed, especially considering the fact that FUE transection rates are continually, and critically, pointed out. This loss of hair amounts to up to 10% of your donor available hair - that's 400-500 grafts in a megasession!! This, obviously, has nothing to do with strip scars, and whether there are good or bad ear-to-ear scars.

 

Another is peripheral incision transection. It is simply impossible to cut a 60cm line across the scalp and not transect hairs. THe industry standard is said to be 5% - in other words, we try to kill only 5% of the hairs we pass along the road.

 

If any strip clinic wants to prove me wrong, I stand corrected. I by no means an FUE cheerleader as the same economic pulleys and weights that load the dice in strip also apply - just in a different way.

[TC17]

Unless I'm mistaken, I don't believe the "vacant follicles" get thrown away. I'm of the belief that the techs cut from looking at the follicle, and not the hair. I suppose what I'm saying is that even if you shaved your head down with a razor and then waxed your head to remove the hair, a clinic could still see the individual follicles from a strip and cut around those. Is that not correct?

[Guest Brad Limmer, MD]

Scar5

Loss of telogen hairs can be a problem with either procedure. Good news is of the 10% of your hair that is in a telogen state only ~10-20% of the 10% noted above (1-2 hair/100 hair) is actually in a near invisible state. So the risk is less than stated. So…per every 1000 hairs moved, you are probably looking at 20+/- hairs being next impossible to see. Remember, the telogen state last ~100 days total from beginning to end and during much of this time the hair can still be seen as it regresses and then regrow. It is also the reason why we tend to lean towards slightly chubby grafts vs. skeleton-ized grafts. The leaving of this extra tissue decreases the risk of losing a telogen hair as well as increasing over all survival of all hairs within the graft.

Brad Limmer, MD/jac

[scar5]

Any strip vs FUE discussion must point to a little (BIG) question about the telogen hair and their fate in strip transplants. .... This loss of hair amounts to up to 10% of your donor available hair - that's 400-500 grafts in a megasession!!

.

 

Dear Doc, so you say these figures are wrong because the hair stays in the follicle 'on its way out' and therefore the cutters can see them, well, 90% of them. Sounds fair enough, so I am happily corrected. but.....he said

 

But Telegen lasts, say a hundred days. Hair that is shocked from a transplant falls out in just two to three weeks, whether it is actually transplanted or native. So what are the chances that 90% of telegen hairs are waiting patently on op day, especially when the patient has diligently been doing his scalp stretching exercises? Anyway, I am glad you pointed the out that telegen hairs don't necessarily vanish immediately.

 

As for FUE being burdened with this problem, I don't think it's a fair comparison because an extractor would simply not see the vacant follicle.

 

Now about the peripheral linear transection. Some docs say they don't kill any on their way. Would you be willing to put a figure on that too?

[Michael5577]

I'd only get FUE for a thousand grafts or less. If you go with FUE, make sure you go to see the best surgeons. Dr. Feller probably qualifies as the best in the field.

[scar5]

Micheal, such a shame isn't it? I have to almost agree, mostly for the wrong reasons. Docs don't bother trying to improve FUE, (or they limit their exposure to risk through such investment) because there just isn't the incentive, when people beleive, naively or conveniently (or both) that only strip gets the 'real work' done and FUE is purely abjuct. (good for small jobs)

 

Fue is a pain in the ass for docs, and I don't blame them for 'appropriating' it "(It has it's place bla, bla", or even more cynical, "we let the patient decide") Perhaps, I would probably do the same with all the obedient consumers out there bragging about their scars being invisible only weeks or months after their transplants (their first transplants at that-many will have that scar re-visted).

 

I don't know whether you read the post you reponded to, but I was alluding to the loss of telegen hair in strip, just one of three major factors overlooked by punters going under the knife. Apart from peripheral linear transection (the cut collatoral damge) it is of course the scar that is what balding men do not need, especially if they are in their twenties. I saw a beautiful Dr. Wong scar on another forum a couple of days ago. The guy had (foolishly IMO) buzzed in an attempt to match the density of recipreinto the -in-doldrums to the donor area. Whilst it was beautiful, it was not a kind of beauty the public eye will appreciate. That guy will be fighting for his life in twenty years to cover that thing, or he will be like me, recently resigned, to just letting it show.

 

I never wanted to praise Armani, but they deserve credit for throwing away their scalpels and focusing on FUE. There is no doubt in my mind, that currently strip refelcts, in the current social-media, a better yield, but it need not be so, if patients and clinics are more honest and patients work out the kind of suitable and sustainable long-term plan to incorporate a number (say 5 or 6 surgeries for a NW5 28year old) of FUE. By sustainable I mean, giving the patient cover to retreat from the HT route throughout his life.

 

By the way, dot scarring should not be aan issue 'in the right hands'

[Guest Brad Limmer, MD]

The loss that people experience 10-20 days post op is not a telogen shed. It is more of an anagen arrest and shedding of hair as a direct result of the inflammation/trauma caused by the creation of recipient sites. While we currently try to minimize this by making sites that are 6-9 mm in size coupled with oral prednisone…shedding can still occur.

My father, Dr. Bobby Limmer, has seen some promising results (diminishing this shed) by using very dilute kenalog (cortisone) within the anesthesia we inject into the recipient zone to numb the area. While promising, we have not fully changed over our solution at this time.

Now without wading into the whole other debate on this thread…neither FUT w/ a trichophytic closure nor FUE is the panacea for all baldness. Each has pros/cons/risks/benefits that people need to understand. People also need to understand that, for most, baldness is progressive and that without medical management they most likely will continue to lose hair.

Truth be told…understanding that fact, planning for it and trying to prevent it might be more important than whether you choose FUE or FUT.

Brad Limmer, MD/jac

[scar5]

 

1. The loss that people experience 10-20 days post op is not a telogen shed. It is more of an anagen arrest...

 

2. (while we do everthing we can(scar5 words-))…shedding can still occur.....

 

3.Truth be told…understanding that fact, planning for it and trying to prevent it might be more important than whether you choose FUE or FUT.

Brad Limmer, MD/jac

 

Doctor,

 

Good discussion and good points IMO. Rarely these days, I actually learn two things that will definitely square me up coming into arguments/discussions in future. Namely, as you point out,

 

a) Telegen hairs do not immediately shed, and many are available in the strip, to be used on op. day. (I do question your optimism about numbers, especially nowadays given that patients are encouraged to do scalp stretching..but who am I...?). It was interesting though, that another poster assumed cutters can see vacant follicles when they can't. Hopefully, that poster took note too.

 

b) That the post-op shed, which is rapid and almost guaranteed (again your optimism impresses me, (see point #2 because saying it 'can' occur is somewhat of an understatement) but saying it is not a telegen shed but something else, which you term anagen arrest, must somehow acccount for something I've long wondered about; one which I've never seen satisfactorily answered, possibly due to my laziness, and this whether or not the 'clocks' in each follicle are reset to the their pre-op timelines. This suggests they are and partly explains why we get a rush of new hair 3-4 months post-op, then steady improvements, give or take a shed or two, for the next four or so months. Thanks for the info.

 

now I gotta address point number 3,

 

So we need drugs and we have to take this into account long-term, so much so that it might be more important than the FUE vs Strip debate

 

I can't relate to your attempt to separate the two of these things more because the FUE/strip debate and the drug thing go hand in glove. The former is of course, in 2011, on forums like these, just a bore, a turn-off and it is just a politically (and economically) unpopular topic. So be it, but I keep digging and discovering.

 

Anyway, the reason we need FUE is so we can retreat from the HT route when the drugs stop working or misfire. There is a chance they will work just fine for life and I think many strip punters, who start at NW3 or less, take that risk and enjoy the relatively lush results strip gives them for many years, but it is a risk.

The other reason we need FUE is because drugs don't create miracles and if you are a NW4 plus, you might be better of with a short, buzz (illusion-of buzz) type HT. Unfortunately this route is rarely explores, because the appropriation of FUE as a 'small job' fix-it, ancillary to strip. Instead it should be 5 small jobs planned together and ahead of time.

 

Edited April 27, 2011 by scar5
typos