FUE vs FUT? Myths and Other Components of a Transplant that Affect Yield

[Bill - Seemiller]

I posted the some of the below comments on another topic however, given the amount of attention donor harvesting is receiving, I'd like to garner your input on a couple of important facts.

 

Despite the common misconception, FUT and FUE aren't opposing hair transplant procedures. FUT stands for Follicular Unit Transplantation which is today's gold standard hair transplant procedure. Follicular units are hair groupings as they occur naturally in the scalp and typically contain 1, 2, 3 and 4 hairs. This has replaced mini-grafting (hair groupings containing more than one follicular unit typically ranging from 2 to 8 hairs) as the dominant procedure over a decade ago.

 

Follicular Unit Extraction and Strip Excision are two distinct sub-types of FUT that deal with how follicular units (typically referred to as grafts) are harvested from the donor area. Both harvesting methods produce follicular units and thus, falls under the larger umbrella/category of FUT.

 

Given the above, it's much more accurate to compare FUE to strip excision, since both donor harvesting techniques are sub-types of FUT.

 

You can read more about the above concepts by reading our recently revised content on "Follicular Unit Extraction" on the Hair Transplant Network and Dr. Ron Shapiro's article on "Understanding Hair Transplant Terminology" on our Q&A Blog.

 

Donor harvesting techniques (FUE versus strip excision) have certainly garnered a lot of attention and controversy. But donor harvesting is only one part of a hair transplant procedure. Other crucial parts of the procedure that affect yield (the percentage of transplanted hair that grows successfully) that are seldom discussed and not as popular include:

 

1. The handling of grafts outside of the body

2. Storage solutions for grafts if/when appropriate

3. Placement including various placement devices

 

Donor harvesting could produce healthy follicular units but if any of the other 3 components (4 if you include post-op care) to a hair transplant aren't performed properly, grafts can be crushed, damaged and/or dehydrated producing poor yield.

 

So while discussing and debating donor harvesting techniques is popular, I'd like to hear people's thoughts on the other critical components that can affect yield and the overall hair transplant results.

 

What is your opinion?

 

Best wishes,

 

Bill

[Bill - Seemiller]

I believe the true reality of an ongoing debate between FUE and strip excision (two distinct donor harvesting techniques performed in FUT procedures) lies in the donor area and concerns about scarring. The other components I've listed above won't affect the donor area nor do they deal with scarring. However, I felt it was important to mention as "yield" is often discussed only as a result of strip excision versus FUE when donor harvesting is only 1 of many components of a hair transplant procedure that can affect yield.

[Bill - Seemiller]

Any thoughts on this topic?

[Spanker]

As far as placement inside the slits, I think it is more about who is doing it than what they are using. Dr. Konior used two sets of very sharp angled tweezers when I saw him placing. I think that the yield during placement has mostly to do with the handling of the grafts during the excision and placement (not causing trauma) and the patient's physiology.

 

 

 

I think storage solution is something that is kind of elementary regarding highly regarded doctors. I don't think it is a closely guarded secret and I think everyone is on an even playing field in this area. These doctors have conferences and share ideas, information, etc.

 

 

FUE grafts could be more vulnerable due to the fact that there is less tissue surrounding the follicle. This means that the can dry out fast (I don't really think this is a big problem) and that they are subject to more trauma when pulling a more trauma in placing as well because there is less room for error when handling them.

[Mickey85]

I'm not exactly sure on which method forces the grafts out of the body for longer. With FUE a surgeon can extract 500 grafts and then make recipient sites and have them implanted but the process of obtaining 500 grafts is not exactly fast. Strip allows the grafts to stay in the native environment(albeit with no new blood flow) until they are separated but the grafts to be implanted last may be out of the body for longer especially in megasessions. I really can't make the call on that but it is something to think about and maybe ask. FUE grafts tend not to need cutting as the punch is pretty small as it is so time may be saved there. Again, I'm just throwing factors out there.

 

Holding solutions.. Saline solution and Acell are two that I have heard of. There are proponents for Acell out there but not sure if there is a general consensus.

 

Placement.. Either the Choi implanter or using a blade. Maybe a blade would allow a tighter fit but could make it harder for graft insertion? The Choi implanter is not without controversy either. Lorenzo's method of implanting would surely leave the grafts out of the body for much less time as he can do the recipient sites and implanting in one go. Just my thoughts.