Quality and quantity of grafts in FUT vs FUE

[shai]

Can any practising surgeon or anyone senior member on the forum confirm or deny my findings (with reasons thereto please) . Please do bear in mind that this is a question regarding quality of grafts and NOT which procedure is better. I realize very well that both procedures are good depending on the patient's needs

 

Assuming similar skill levels/experience for FUE and FUT

 

1. A FUT transfer can have more people working simultaneously on extracting grafts as opposed to FUE which would lead to reduction in fatigue and human error resulting in better quality of grafts

 

 

2. A FUE extract is made blind since the dermal layer is in place and the hair is cut short which means it may be possible that the bulb is at an angle which the punch cuts into as it cannot be visually seen. A FUT extract on the other hand lays open the bulb which makes this a non possibility

 

3. The drill used in FUE can cause damage to adjacent follicles both because of heat generated via friction and close proximity to the graft being extracted

 

4. Thickness of follicular cells (fat grafts/skinny grafts) in FUE depends more on luck than skill . In other words a FUT extraction will result in more fat grafts than FUE 90% of times. This in part is similar to point 2 above

 

5. If any of the above points are true then apart from quality of grafts FUE results in higher transection than FUT , the percentage depending on skill level of the extractor. This last point is more about quantity than quality

[ArochaHair]

1. A FUT transfer can have more people working simultaneously on extracting grafts as opposed to FUE which would lead to reduction in fatigue and human error resulting in better quality of grafts

 

This depends on how many technicians work in the clinic. There are FUT clinics that also perform a lot of FUE and so these technicians will be used to examine and refine the grafts as necessary, regardless of the procedure being performed. If the FUE procedure is performed in an FUE only clinic, you are likely to have fewer technicians so when dealing with an equal # of grafts, it would be logical to assume more fatigue. But, most FUE only clinics aren't spending the same amount of time on the grafts as they do in FUT clinics because they aren't using microscopes to inspect and refine the grafts. In the end, it could be a toss up with regards to the fatigue factor.

 

2. A FUE extract is made blind since the dermal layer is in place and the hair is cut short which means it may be possible that the bulb is at an angle which the punch cuts into as it cannot be visually seen. A FUT extract on the other hand lays open the bulb which makes this a non possibility.

 

Yes and no. Both procedures are blind at the beginning because the scalpel that cuts the strip is also going in blind and potentially destroying some follicles. With FUE each extraction is blind but it is not uncommon for the majority of grafts to have a similar degree of angle so the first few test grafts, that most clinics will extract, helps to determine how the grafts are angled in general. If there is a strong variance then a larger punch will be considered but it's not a black and white issue.

 

3. The drill used in FUE can cause damage to adjacent follicles both because of heat generated via friction and close proximity to the graft being extracted.

 

The heat issue is non-existent. The punch is not in the tissue long enough to create enough hea for follicular death. They can damage neighboring grafts due to their promity, but this is a skillset issue dictated by experience.

 

4. Thickness of follicular cells (fat grafts/skinny grafts) in FUE depends more on luck than skill . In other words a FUT extraction will result in more fat grafts than FUE 90% of times. This in part is similar to point 2 above

 

I don' know where the number of 90% comes from but this too depends on the operator, the tool, and the goals. Some clinics want to have skinny grafts so they will use a smaller punch, as this also leaves a smaller scar, while some clinics will purposely use a larger punch to get fatter grafts and then they'll subdivide them after they're extracted. Same with FUT, some clinics will divide the grafts down to skinny grafts and some will use MUGS that have more fat. Luck has nothing to do with it.

 

5. If any of the above points are true then apart from quality of grafts FUE results in higher transection than FUT , the percentage depending on skill level of the extractor. This last point is more about quantity than quality

 

In general, FUE does have a higher transection rate but the difference in better clinics is so minimal that there is no cosmetic difference whatsoever. The problem with FUE is that there are more clinics than ever performing hair transplantation and FUE is the way in which the procedures are being carried out and this introduces the commodity factor in that these clinics have little to no experience with hair restoration and are taking it on as an adjunct to their existing practice where they perform tummy tucks and butt lifts. Expect very high transection rates in such establishments.

[shai]

Thanks for that. It was the kind of reply I was looking for

[mattj]

It's important to note that a clinic which performs FUT will be using microscopes while taking the follicles from the strip. Those microscopes will be put to use while sorting and inspecting the grafts during an FUE procedure. Through this process, the quality of the grafts can be established and transection will be kept to an absolute minimum.

 

Some clinics that have started to do FUE might not have invested in the microscopes that well-established FUT doctors already have.

[shai]

Thats true even from the first detailed answer I can make out that in most cases with equally experienced doctors both quality and quantity will be better in FUT maybe marginally so and at the cost of a scar but it will be better a yeild, at least at the moment. Having said that of late most FUE results seem excellent