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WHICH IS THE BEST HAIR TRANSPLANT PROCEDURE?

There are two categories in which a hair transplant procedure fall into, both are highly effective but use different techniques to extract the DHT resistant follicles from the donor area, the area at the back of the head. Extraction of follicles from the donor site is commonly known as ‘Harvesting’ and this can be carried out in two ways, via FUT (also known as Strip) or FUE.

FUT which stands for Follicular Unit Transplant uses a hair transplant procedure  technique which extracts of a narrow piece of skin from the donor site under local anaesthetic. Once removed, the strip of skin is dissected under powerful laboratory microscopes into individual follicular units in preparation for the hair transplant procedure.

FUE stands for Follicular Unit Extraction and refers to the technique via which a small round punch is used to extract units of hair follicles one by one from an area of dense hair growth to an area of baldness. Each unit contains one to four hairs. Extraction is directly from the scalp.

Once extracted the hair transplant procedure technique of implantation into the micro-incisions that have been made in the recipient area is identical. Follicles are planted one by one.

The FUT hair transplant procedure also known as Strip is more suitable to those who have large patches of baldness as up to 2500 grafts can  be transplanted at one time, if the patient is able to supply a good amount. This procedure takes longer for the scalp to heal and a scar is left across the scalp which can be hidden by longer hair.

The hair transplant procedure technique used in an FUE procedure means that the surgeon can remove hair from the donor area causing hardly any damage or disruption to the skin which then means the scalp can heal much quicker as the hair transplant is a noninvasive treatment. A patient can often show no visible signs ten days after surgery.

FUT SCAR BLADE 1

UK Hair Transplant Clinics - FUR Scar Blade 1

FUT SCAR BLADE 3

UK Hair Transplant Clinics - FUT Scar Blade 3

Patients requiring more than one hair transplant procedure to achieve the desired coverage should not be concerned with the unsightly appearance of multiple scars, the second procedure will in most cases begin with the opening of the original scar which will then be closed again once supplementary tissue has been taken.

Which Hair Transplant Procedure Is The Right One For You?

If the choice between FUE and FUT hair transplant procedure came down only to the nature of the scar all Patients would choose FUE. Unsurprisingly each technique has resultant characteristics which must be taken into consideration to make an informed choice.

1) Success Rate

The more intricate and time consuming nature of extraction that is required for FUE Surgery means that there is a greater likelihood of follicular transection – damage to the follicle that will prevent successful growth post implantation – during harvesting. Of the follicles that are harvested and implanted via FUE an average of 90% will successfully grow which in comparison to the 97% success typical of FUT follicle populations is three times greater the rejection rate. Visually the aesthetic impact is difficult to notice.

2) Achievable Harvest – Quantity of Grafts Extracted

The choice of hair transplant procedure technique may be heavily dependent on the ‘Donor Density’ or the number of follicles that may be extracted and thereafter implanted

As a rule Patients who require large scale implantation in one sitting must elect FUT as their extraction technique of choice in confidence that a yield of between 2300 and 3000 will be possible in a single sitting. Yields of over 3000 follicles are not unheard of if scalp elasticity is high as the availability of excess scalp tissue material is the determining factor in FUT yield. Conversely a Patient with a small skull and tigh scalp may only achieve a yield of up to 2200 follicles.

Put simply FUE extraction takes longer yet to ensure integrity and optimise successful growth the follicle cannot remain out of the donor site for any longer than a follicle extracted via FUT. The FUE option is viable to Patients who require generally no more than 2200 – 2500 grafts in 1 treatment. Cases towards the end of this scale may require 2 consecutive day sittings.

Patients should exercise extreme caution when dealing with Clinics who promise to extract and implant above 3000 follicles in one treatment, irrespective of whether the proposed treatment is over one day or two.

Whilst technically this is achievable Patients often find that the final result is sub optimal and falls far below their expectation for a number of reasons:

I. Over extraction leads to unsightly scar tissue when insufficient space is left between extraction sites to achieve the expected yield
II. Extraction of follicles from the ‘non permanent’ zone not only means that the transplanted follicles are still susceptible to attack and miniaturisation by DHT but are likely to suffer a premature death due to the trauma of transplant from an area which is not robust enough to withstand harvest.

UK Hair Transplant Clinics - Harvest Area
3) Yield – Quantity Of Grafts Required To Fulfil Treatment Plan

Patients with a healthy and substantial donor site may typically undergo three FUT treatments utilising one site resulting in one scar. Across three treatments it is usually possible to extract and implant between 6000 and 7000 grafts.

Patients electing FUE will generally yield no more than 5000 grafts over multiple treatments if they are to maintain the non scarring visual impact synonymous with FUE. A Patient attempting to harvest more than 5000 follicles via FUE would risk incision scar blending which can often have a worse visual impact than the scar that otherwise would have resulted from

4) Genetics – Predisposition To Balding

If there is evidence of severe balding – a Norwood 6 to 7 – within your family specifically towards the maternal side and if you do not envisage undergoing several procedures there may come a point in the future that you wish to shave your head to reduce the visual impact of aggressive progressive hair loss. At this point any scar from previous FUT treatment would become visible.

Therefore if excessive balding is prevalent in your family you may wish to consider taking medication to slow down the rapidity of miniaturisation. You may also be open to additional procedures to replace existing non permanent hair that will continue to be lost post transplant or micro pigmentation (tattooing) of the scar to minimise its appearance at a later date

5) Post Operative Appearance

The appearance of the Patient’s recipient site post treatment is identical in both cases. It is the appearance of the donor site directly following surgery that must be taken into consideration if discretion is to be assured. It would be difficult to detect that an FUT Patient had undergone surgery as the scar of the donor area is covered by the surrounding hair which may be left at the Patient’s normal length or slightly longer, it is not necessary to shave the donor area when electing for extraction via FUT.

Extraction of follicles via FUE however requires that the donor area be shaven in its entirety to a blade zero for maximum accuracy and yield. It is not uncommon for up to 12 days to elapse before the donor area loses all traces of scabbing and regenerates to a pre surgery appearance.

The below is an example of a FUE donor site before, four days and 1 month.

hair transplant procedure - FUE Donor Site
6) Cost

The extraction of consecutive individual follicular units that is FUE takes more time and typically a higher skill level and therefore costs more. Patients can expect procedures of up to 1500 grafts to cost in the region of £600 more than the equivalent FUT harvest with supplementary costs rising to over £1500 for procedures of 2000 follicles and above when the procedure is likely to be scheduled over 2 consecutive days.

7) Poor Scalp Elasticity

If your scalp laxity is poor which means you have a very tight scalp FUE may be the only option. A pre-determinate requirement of FUT is that sufficient loose skin be available for extraction and comfortable rejoining of the scalp. If there is not adequate loose skin at the back of the scalp extraction via FUT would not be possible.

8) Treatment Time

Extraction via FUE can only be performed by one clinician therefore the procedure takes longer than would be required for FUT. To provide perspective, a 1500 graft transplant via FUT would typically take up to 5 hours whilst the equivalent FUE procedure would be expected to run to 8 hours or above. For cases above 1500 grafts, FUE procedures will extend to two days whereas only one would be required for FUT.

9) Discomfort

The level of discomfort experienced is generally the same for both treatments with Patients classifying both FUT and FUE procedures as a 2 out of 10, with 10 being the highest level of discomfort. The main reason cited for discomfort was the injectable anaesthetic.

It could however be argued that with large FUE cases the discomfort is doubled as the administration of anaesthetic must be performed twice on each consecutive day.

10) Hair Styles

Fundamentally this is the most important consideration. Since the visual scar is the main difference between the two treatments the consideration of future hair styles may be the deciding factor.

If shaving your head is a real consideration in the future and if there is the possibility that the appearance of a scar at that time would make you feel uncomfortable then the obvious choice is FUE. Otherwise FUT is a very popular and successful treatment.

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