In the field of hair transplantation, we distinguish between two techniques, FUT and FUE. The main difference between the two lies in the way the follicle units are extracted. In an FUT, the strip technique is used, by which a strip of the scalp with hairs on it is taken from the back of the head, with its hair follicles subsequently being extracted. Using FUE, individual follicular units are extracted directly from the scalp.
The dominant feature of both techniques is the extraction of the smallest natural hair groups, the so-called follicular units, or FUs for short. Each of these anatomical units generally consists of 1 - 4 hairs. Both techniques - FUT and FUE - make use of these natural units.
The extraction method is one of the most important and decisive factors in any hair transplant. The focus is not on extracting as many grafts as possible, but on the quality of the hair roots, as they play a decisive role in determining whether the grafts take root.
FUE & FUT: the donor area and scarring
The two extraction techniques - FUE and FUT - differ with regard to the scarring left in the donor area. Whereas strip extraction (FUT) will leave a narrow linear scar on the back of the head, all that can be seen after an FUE transplant are micro-scars looking like little dots.
The appearance of the scar in the donor area is therefore a criterion for patients wanting to wear their hair very short. As scarring differs from patient to patient and is also dependent on the type and number of previous and future transplants, the in-depth and well-prepared consultation of a hair surgeon is an absolute "must". Special closure techniques such as trichophytic closure are beneficial for obtaining minimum scarring after FUT strip extraction.
Dr. Katona and his staff are of the highest caliber of professionalism with the perfect blend of friendliness. I feel you need to really educate yourself before committing to these sorts of decisions and he put me at ease with both his knowledge and presence. Dr. Katona has my HIGHEST recommendation!
Dr. Art Katona during surgery
FUE & FUT: the survival rate of follicular units / grafts
A meticulous approach exercising utmost care is a prerequisite for any medical treatment. This is especially true for the extraction of hair follicles and their subsequent survival rate.
Extracted grafts are vulnerable to dehydration. Extracted FUs waiting to be implanted are kept in a physiological solution corresponding to the human body environment. When being processed under the microscope, they are always kept damp.
Generally speaking, grafts extracted vie FUE are much more sensitive, as the extraction technique leaves much less protective tissue around the hair follicles. This ultimately leads to a slightly lower survival rate. Damage to healthy hair follicles influencing their survival rate, as well as a worse rooting rate, are possibilities in both techniques when the work is not performed in an optimal manner.
FUE & FUT: implanting the grafts
Even when optimally extracted, grafts can still become damaged during transplantation. This in turn will mean that a lower number of grafts actually take root.
The incisions in the recipient area, into which the extracted and prepared grafts are implanted, also play a major role in any transplantation. Incisions are best made with scalpels or blades specifically adapted to individual patients – so-called customized blades. Using these, the hair surgeon can match the width, length, depth and angle of the incisions with the direction the patient’s hair grows in. The right incisions also help the grafts to quickly connect up to blood vessels and nerves, having a major influence on their survival rate and making the transplant look natural.
FUE & FUT: healing
The level of pain felt is dependent on a patient’s sensitivity to pain. Transplantation is always done under local anesthesia and is therefore in general completely pain free. One effect of the local anesthesia when using FUT is a feeling of tension on the scalp. This is however generally only minor and will disappear after a few days. Healing after FUE treatment is faster than after FUT and generally free of pain. A temporary numb feeling, which could last for several months in case of FUT, does not occur with FUE.
The swelling in the transplantation area or possibly around the forehead and eyes is dependent on the FU density / size of the area treated or on the number of transplanted hair roots. It occurs with both methods and generally lasts for 6 – 8 days.
FUE & FUT: conclusions
Both techniques – FUE and FUT – have very good success prospects, but: there is no one best or right method – each method has its own pros and cons.
The decision on which extraction method to use should be individually weighed up in consultation with the hair restoration surgeon. There are many factors needing to be taken into consideration. A hair surgeon must be in a position to assess future natural hair loss, the quality and density of existing hair, and in particular the hair structure. He must also be able to calculate the number of grafts needing to be extracted to fulfill a patient’s wishes, discuss alternative forms of treatment such as a medication-based therapy, and explain to the patient the pros and cons of each technique. In addition, comprehensive tests need to be carried out before any recommendation for any one extraction method can be issued.
An FUE is best for patients wanting to avoid a linear scar at all costs, and for younger patients only requiring minor treatment. Moreover, FUE is the right choice when transplanting body hair or when corrective / reconstructive hair surgery is involved.
FUE is also good for patients with (very) little donor hair, as well as for patients with a tendency to extreme scarring or patients wanting to wear their hair very short. Patients with a Norwood V or VI diagnosis should choose a combination of FUE and FUT to attain the highest possible number of donor hairs.
Though both extraction techniques basically allow the same number of hairs to be extracted, there is one major difference. In an FUT, under good working conditions, 4000 – 5000 FUs can be extracted in one operation session. The corresponding figure for FUE is 3000 – 3500 FUs. Using the FUE technique, a second operation is generally needed to achieve the same number of FUs. This can only take place some 6 months later.
Dr. Art Katona is certified by the American Board of Hair Restoration Surgeons and a ISHRS Fellow, a distinct honor bestowed on select doctors worldwide. Dr. Katona’s approach earns him praise from his many patients. His work has been featured in publications such as Chicago Tribune, Inc., USA Today, ESPN, CBS Sports, Fox Sports, The Rich Eisen Show, Modern Luxury and more.
