Harvesting Techniques - Dr Rassman
FUT and FUE Compare
Patients always ask me, "Doc, should I have FUE or FUT ?"
One must remember that both FUT and FUE involve surgery. Those considering a hair transplant should therefore consult a hair transplant surgeon to learn about the advantages and disadvantages of these 2 methods. It is important to find a surgeon able to provide both techniques according to needs. Too often the opinion provided is bias as nowadays more than 50% of hair transplant surgeons know nothing about FUT. For the sake of covering their incapabilities they just bad-mouth FUT. Obviously they as doctors fail to observe the best interests of their patients.
Current trend worldwhile is FUE, as more inexperienced surgeons want to engage Hair Transplant as part of their services. Reason is simply that FUE requires less training, manpower, and facility. We maintain our view that both FUT and FUE techniques have advantages and disadvantages. The choice would depend on many factors as well as the wish of the patients.
| Technique | FUT | FUE |
|---|---|---|
| Good Candidate | Most are good candidates except those prone to have keloid or hypertrophic scar | • High donor density • Low hair-skin color contrast • Very tight scalp • Wants to keep hair very short |
| Unit for Transplant | Single or Double Follicular Unit | Single Follicular Unit |
| Harvesting Technique | A measured strip of hair-bearing skin is excised. The wound is closed with clips or suture | The follicle is punched out one by one using a 0.8-1.2 mm diameter sharp metal punch |
| Covered Area | Medium to large area of baldness | Small to medium area of baldness |
| Size of Graft | 0.8 - 1.8 mm in diameter Chubby Graft with abundant fat |
0.8 - 1.2 mm in diameter Skinny Graft with Minimal Fat |
| Number of grafts | Average 1,800 to 2,400 per session, up to 5,000 grafts in selected cases. | Average 1,200 to 1,500 per session, up to 2,500 grafts in selected cases. |
| Use of Permanent hair | 95 % Use | 75 % Use |
| Quality of Grafts | Grafts are removed under direct vision, thus less transection and better quality of grafts. Grafts can be cut to different sizes to meet different requirements. |
Grafts are blindly extracted with greater risk for transection and less fat, thus more susceptible to trauma and dehydration. Overall extracted grafts contain more 3-hairs and have a higher graft-hair ratio |
| Growth rate | 80- 90 % growth rate | 70-85 % growth rate |
| Manpower Required | 6 Staff Minimal | 2 - 3 Staff |
| Use of Microscopy | Mandatory | Recommended |
| Surgical Risk | Comparatively low with experienced surgeon | Comparatively higher : • Longer surgery hour • More Anesthetic injection required • Beware of inexperienced surgeon |
| Infection Rate | 0.2 -1 % | 0.2 -1 % |
| Pain | Less pain during surgery; more pain at donor wound the next few days | More discomfort during procedure due to long operating hours. Less pain at donor wound on the next few days |
| Removal of Stitches | Yes, after 5-7 Days | No Need |
| Shaving | No Need to Shave | Need to shave |
| Scar | Width of linear scar 1-4mm, covered if hair is worn 1cm long | Hundreds to thousands dispersed small white circular scars on close inspection |
| Thinning at donor area | No | Obvious if large amount of grafts are extracted |
| Scar Revision in Future | Easy, with SMP or grafting into scar | More difficult. Only option is SMP |
| Number of Sessions | Can achieve good result just in one session | May need more than one session to achieve the same result. |
Importance of Surrounding Fatty Tissue
They have 3 important functions :
• Prevent dehydration when out of body
• Protect the fragile follicle ( Dermal papillae )
• Contain Stem Cells which are required for regeneration of the follicle after transplant
Follicles By FUT has abundant fat and intact root, providing a good grip by forceps. There is no direct contact with the hair root during insertion. The overall graft survival is improved. Follicles By FUE on the other hand have less fat, more bleeding, and more transected roots. With less fat the forceps have to hold onto the hair root during insertion. More damage means less graft survival.
FUT-Strip technique creates linear scar, on average 2-3mm in width. Thus it can be covered by 1 cm of hair for cover-up in most situation. In FUE the linear scar seen in FUT is replaced by hundreds to thousands of white spots and thinning in donor areas.
The Fallacy of "No Scar"
All human tissues heal by scarring (fibrotic tissue). A doctor is telling lie if he/she promotes "scarless procedure" of whatever hair transplant technique. In fact. health organizations such as ISHRS and ABHRS have forbidden their members to use the following terms:
• “Scarless surgery”
• “No incision”
• “No cutting”
• “Non-invasive”
• “Pain free”
Unfair Comparison
Many FUE practitioners shows horrifying pictures of Strip_FUT scar, to compare with their pictures of FUE invisible scar. What they did not mention was that the Strip scar was from extracting over 3,000 grafts and the FUE just few hundreds. They should show pictures after removing the same number of grafts.
Patient's Factors
Each individual has a different skin characters, some are just more prone to more noticable scar than others. In general, patients with loose skin tend to have wider FUT scar. Patients with low hair density has more noticable white patches and donor thinning. So the choice of technique will depend on a lot of factor.
No Free Lunch
Scar is unpredictable. Obviously the more grafts you want, the more scar you'd have. Those intolerable of scar should not have hair transplant.
FUE has to shave the whole docor area, so it may longer to resume normal duty in case the patient does not want their colleagues to know they have a hair transplant. FUT would not have this problem as the incision is well covered by hair. That is why FUT is more welcomed by professionals who have a tight schedule.