To FUE or not to FUE that is the question VS STRIP

Having worked as a Hair Transplant Consultant for 4 years, I field questions, myths, realities and wake up calls on a daily basis. I do so because I myself once looked in the mirror and saw hair loss and decided to get a hair transplant.

I am currently writing a series on hair transplant hairlines. However, I have been getting so many questions about FUE vs Strip, I wanted to post an article written by Dr. Ferreira regarding this. It is very informative and a must read if you are considering FUE or Strip. Enjoy!

I’m considering having a hair transplant, but when researching on the internet I have been getting conflicting opinions about FUE vs. having a strip hair transplant. I’ve been told that I need about 2500 grafts to fill in my hairline and about two inches behind it. Besides the obvious advantage of not having a long scar on the back of my head, are there any other advantages to going with FUE that justifies the added cost? My bottom line is to have more hair. If the scar is going to be hidden in the back by my own hair, I am not sure the cost of FUE is worth it unless there are some other advantages that I am not aware of. Thanks for your time.
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Your question is a good one and I think one of the most pertinent questions in modern hair transplantation. First, let’s get definitions out of the way. The ‘STRIP’ method is not an acronym. It means a strip of hair bearing skin is taken from the back and sides of the head. The strip is then dissected into follicular units (hair grafts) using a microscope which are then planted (placed) into tiny holes in the thinning area. By definition, the patient will heal with a linear scar. The scar is usually very fine and camouflaged with your own hair. FUE is an acronym which stands for Follicular Unit Extraction. In this method, a sharp punch instrument is used to remove individual follicular units (FU) right at the surface of the skin. The punch instrument can be powered or used by hand. The FUE method is marketed as ‘scarless’ surgery. This is NOT true. ANY time you cut skin you will heal with a scar. With the FUE method, the scars are created by punches which are about 1mm in size or smaller. Therefore, the scar will also be 1mm or less in size. However, because the resulting scars are often small dots less than 1mm , they are almost impossible to see even if the hair is cut very short. This can be a big advantage.

Here are the main advantages and disadvantages of both methods:
Strip:

1) The strip is still the gold standard for getting hair grafts. In the right hands very little hair is wasted because the roots of the FUs are visualized under the microscope. “Perfect” grafts can be trimmed to size.

2) The strip has been around for more than ten years and large numbers of grafts can be reliably harvested and planted with a high degree of success.

3) The strip is still the most time efficient and cost efficient way to harvest grafts.

4) You must assume that you will heal with a scar and that you may not be able to wear your hair below a certain length. One to two on a clipper is reasonable.

5) Future surgeries can be planned to remove the old scar so that the patient heals with only one scar.

6) The healing time means one to two days of taking prescription pain pills and then most patients do well without prescription medications.

FUE:

1) Grafts can be harvested with such small diameter punches that the resulting scars are very difficult to see even with a very short haircut.

2) The healing time is quicker than with the strip method.

3) It is hard to have control over the size and appearance of the grafts since they are “ plucked” out of the scalp without ever seeing the root of the follicle. Sometimes, the grafts are very skinny and they have to be handled very delicately. Many doctors who do a lot of FUE admit that sometimes they unexpectedly get poor growth with the FUE method. This is probably related to the quality of the harvested grafts.

4) The FUE method tends to be much more labor intensive and costly

5) Future surgeries are harder to plan after a large FUE session. For example, after a successful FUE session of 2500 grafts, you will heal with 2500 tiny little scars at the back of your head. If you have another hair transplant two years later, the doctor will have to “search” for the good grafts in and around the first 2500 FUE scars. This can be tough. If you are successful with the second FUE session, you will have 5000 little scars at the back of your head. It would be unlikely that you could wear your hair very short and not notice 5000 little scars.

There are some doctors who seem to be getting very good at harvesting large numbers of grafts with the FUE method. They report good success at getting the grafts harvested and good growth rates. Like many surgeries, the most important part of the surgery can be planning and selecting the right candidate. I believe that the FUE is great for small cases ; patients who have do not have worrisome need for alot more donor hair in the future; a patient with great genetics (no class 4 or worse in family) or an older patient. If you understand that the strip method will leave you with a scar and, that you will not be able to cut your hair too short, it is usually the preferred method if you include all factors such as cost etc. If you need 2500 grafts there are many reputable doctors who can do a good job for you with the strip method. It would be harder to find a doctor who can do a good 2500 graft FUE hair transplant.

I hope this helps.

Ironically, I just did a FUE case on a young man who had scars from a trauma earlier in his life. I will try and post his pictures soon.

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