Compared FUT & FUE

FUT Operations

The hair transplant has been based for many years on the extraction of a strip of skin, which implies that a band of scalp (20 to 25cm long by 1 to 2.5cm wide) is extracted from the donor site using a scalpel which penetrates the dermis, severing nerves and vessels. Afterwards the area is sutured and requires a period of some 30 days for complete healing although sometimes there is a change in the sensitivity which remains for a few months and, in rare cases, remains permanently. Due to the damage caused to the nerves, a small percentage of patients may never regain complete and normal nervous sensitivity in the posterior part of the head.

Surgical Technique
The strip method is considered to be major surgery; therefore the doctor who performs the operation should be a surgeon and not a dermatologist or general practitioner. It is an invasive procedure which implies an incision of skin, nerves and vascular tissues in the rear occipital area of the scalp. The doctor who performs this procedure must be very skillful in

Extraction from the donor area
The strip which is excised from the posterior zone is transferred to the auxiliary staff whose job it is to cut and divide the scalp into follicular units (FU´s) with or without the help of a microscope, depending on the procedures adopted by that clinic

Follicular Damage
More than 30% of the follicular units from the donor may be damaged by the scalpel during extraction, and also during the microscopic dissection performed by the nursing or auxiliary staff

Extraction of the Follicular Units
In the strip method the surgeon requires the scalpel to cut deeply into the scalp, consequently severing nerves and vessels in the dermis. For this reason the patients often experience temporary numbness and in rare cases permanent numbness in the donor area

Post operatory sutures
After having removed the strip for the rear area, the wound must be closed with sutures and stitching. The pulling on this wound is our worst enemy when it comes to leave them undetectable. To help avoid this, we suture at two different levels: the first level is subcutaneous with absorbable material and the second level is external with non-absorbable material which is removed after a minimum period of 2 weeks. The surgical technique is fundamental if we want to avoid permanent scarring, colloids or marks left by staples. However, even though the technique is perfect, there is always the possibility of the above mentioned problems occurring as the surgeon cannot guarantee the end result as he is unable to continually control the care and pulling exercised on the area by the patient before definitive healing occurs

Post operatory recovery
Sports or gymnasium are forbidden for 30 days following the strip procedure. Any kind of movement which involves stretching the area behind the head (tying shoelaces, reading…) must be done very carefully so as not to pull on the wound

Quality of the donor follicular units
Unfortunately, in the extraction by strip it’s possible to cut or damage more than 30% of the follicles in the sides of the strip where the scalpel cuts deeply and blindly into the skin. Afterwards the assistants separate these units individually under the microscope to avoid later damage

Selecting donor follicular units
When the skin is removed from the rear of the head and placed under the microscope, the units are separated in function of how many hairs each unit contains (1 – 4). This is a disadvantage because we cannot choose which units are best for the recipient area. Designing a front hairline is not the same as adding density to the crown area. With the strip technique we have to use the
hair that is available independently of what the recipient area is

Control of surgical quality
Another unfortunate aspect of the method of extraction by strip is that the strip is dissected under microscope by the nursing staff. The potential problem is that the doctor doesn´t supervise this step and the auxiliary staff who are performing it. If not well trained, they can cause damage to a good percentage of the grafts before they are inserted. Therefore with this method it is fundamental that the team is experienced enough.

Exact control of the number of grafts
The total number of follicular units harvested with the strip technique depends on the size and follicular density of the skin removed by the surgeon. The number of grafts cannot be determined exactly when surgically removing the strip of skin. This method doesn´t allow for tests or follow up procedures. Macro sessions are possible but with the number of FU´s being limited by the scar

FUT Extraction from other areas of the body
This method prohibits extracting grafts from other areas of the body, depriving the patient of an enormous donor area. There have been scars left in the pubis area from strip procedures, but it would be unthinkable to make incisions in the thorax or limbs to obtain additional hai
 

FUE Operations

The extraction of follicular units (FUE) is currently the common technique for obtaining grafts from the donor area. The follicular units are extracted one by one using microsurgical instruments such as manuel or micromotor punches of 0,6mm-1mm in diameter. The extraction process is straight forward, painless and the donor area heals over between 2 and 4 days. There is no risk to harm nerve tissue. It’s an excellent choice for patients who can´t afford to rest for 30 days while the scar heals correctly. There is never any scalpel or sutures used. As we have said, the FUE technique is minimally invasive and tolerable by the patient

Surgical Technique
The FUE technique is not considered to be invasive surgery. It is in fact minor surgery, classified as a simple medical procedure. The operating surgeon should have specific training in a recognized centre to be able to extract the follicular units intact and without causing damage to them.  

Extraction from the donor area
Each follicular unit is delicately extracted one by one by the surgeon who uses magnifying lenses.a  

Follicular Damage
The greatest benefit of the FUE technique is that there is no damage done to the follicular units during extraction. If, for whatever reason, the surgeon decides not to extract a particular follicular unit that had already been chosen and subjected to the micro scalpel, this follicular unit will continue its normal growth as before.

Follicular Damage
The greatest benefit of the FUE technique is that there is no damage done to the follicular units during extraction. If, for whatever reason, the surgeon decides not to extract a particular follicular unit that had already been chosen and subjected to the micro scalpel, this fExtraction of the Follicular Units

The follicular units are removed with micro scalpels of diameters from 0.5, 0.75, 0.80 to 1.0 mm, depending on the number of hairs in the FU being extracted. This is a minimally invasive technique in which the patients feel no pain or changes in sensitivity in the donor area. The wounds are tiny and completely heal within in a few daysllicular unit will continue its normal growth as before

Post operatory sutures
The extraction points scar over in a few days and are completely undetectable and don’t need any kind of stitching. As the wounds are less than 1 mm, there are no external influences. After 24 hours fibrin will have covered all the extraction points. From 48 – 72 hours, there are no signs of scabbing. After a week there is no sign left of wounding

Post operatory recovery
The FUE technique allows a patient to practice sports and gymnasium just 2 weeks after the procedure. The waiting period is so that the transplanted follicles can grow roots in the recipient area. The donor area requires no further care.

Quality of the donor follicular units
One of the most vital aspects of this technique is the quality of the units which are removed. We have found from our studies in previous years that the quality and strength of the grafts removed are better than those extracted by the strip method. The follicular units are much cleaner when removed one by one then by separating them under the microscope. This also helps to reduce wounding to the recipient area. Our surgeons have presented these studies in various seminars on hair transplants

Selecting donor follicular units
The surgeon selects the units required for the are being repopulated. For a front hairline, he will select mainly those follicular units with 1 or 2 hairs rather than those that have 3 or 4 hairs. On the contrary, when adding density to the parietal or crown area, the units chosen are mainly of 3 or 4 hairs, and always imitating the natural distribution of the hair. This choice is only possible when the units are extracted one by one. Today it is unthinkable to construct a front hairline with 3 or 4 hair follicular units as the result would not be natural

Control of surgical quality
Given that the doctor is directly involved in each step of the procedure, the quality control is optimum and the care taken of the grafts is maximum. The surgeon extracts and places all of the follicular units

Exact control of the number of grafts
The exact number of units removed is determined by the surgeon by removing them one-by-one. This allows us to perform surgery “a-la-carte”, where the surgeon and patient decide whether to perform the procedure in one go or perform it over several procedures “little by little” (usually for economic reasons, tests…). The macro sessions can be done over two or three consecutive days. The number of FU´s which can be removed in these mega sessions is large due to the amplified donor zone

FUE Extraction from other areas of the body
With FUE hair can be harvested from the entire body. Many of our patients have excessive body-hair and are happy to use it to repopulate the scalp. Body hair is used to augment density in the posterior region; it is never used in the front hairline. Many of our patients have body hair with an identical texture and growth pattern as in the scalp. Not everybody is a candidate, but it does increase our possibilities of treatment.