The topic of FUT versus FUE is one of the most popular in the surgical hair restoration field. Discussions about harvesting techniques often draw passionate supporters and dissenters from both sides of the aisle. It can quickly become heated and passionate. FUE is seen as more advanced and older than FUE. FUT users are quick to point out the shortcomings of FUE, such as lower yields, greater damage to donor regions, exaggerated marketing claims and unregulated processes. FUT “versus FUE” is a far too simplistic way to frame the issue. Both techniques have merits and places and should be discussed. It is generally easier to give impartial information on FUE and FUT by those who are able and have performed both. When deciding whether FUT or FUE is right for you, the following should be kept in mind.
Number of Lifetime Grafts
There is a limit to how many grafts one patient can remove from the donor area in their lifetime. Patients who have experienced hair loss, or those in their twenties, should keep this in mind. Each graft must be treated as if it were gold. For long-term success with hair transplant surgery, it is important to use these grafts efficiently and harvest them properly. The best way to get the most lifetime grafts is to start with FUT and use strip harvesting prior to switching over FUE. Perform subsequent strip harvests, removing any previous scars with each surgery to ensure that only one incision line scar remains. Then do FUE in areas not used by strip harvesting. Patients can then use their whole donor area efficiently. FUE is a great way to reduce the number of grafts that a patient can use from their donor area. This is especially true for large FUE sessions. FUT is a better option for patients suffering from advanced hair loss and young patients who have undetermined patterns.
Growth Yield
Although research is limited and results can vary, most FUT and FUE surgeons agree that FUT grafts are more resilient and consistent than FUE grafts. This is often due to the increased graft trauma in FUE extraction and the less protective tissue that FUE grafts require during transplantation and the crucial post-op period.
Donor Scarring
Scarring is a common side effect of hair transplant surgery. Scarring is not possible with “scar-free” surgery. Any clinic that claims scarring-free surgery is possible is intentionally misleading. FUT results in a scarring line in the donor area. It is dependent on physiology. Typically, it is a fine line of 1-2mm. Hair grows above, below and through it (for those who use a trichophytic closure). The incision line can be seen at a depth of 3/8 th inch. Patients typically reach a #3 on a buzzer. Small “dots” are left by FUE throughout the donor area. These scars are usually 1mm in diameter and can be concealed if the excision sites have been spread out and the patient has good skin/hair characteristics. The scars tends to heal lighter than natural skin tone so patients with lighter skin and darker hair tend to heal well. The dot scarring can usually be reduced to a #2 on a buzzer (or 1/4 of an in) FUE scarring can be more obvious if larger sessions are done. These cases can result in visible scarring, which can cause a more “patchy” or thinned donor appearance. FUT and FUE scarring may be treated with grafting or pigmentation camouflaging, if necessary. Patients must be aware that they will have visible scarring after hair transplantation. There is no way to “shave your head” once the donor area has been removed.
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