You would have certainly heard a lot about FUE and FUT, especially if you are looking to get a hair transplant in the near future. While you will certainly find a lot of information about both, it would be prudent that you understand the intricacies of both, before deciding which one would be most suited for you.
In this two part article, we will be looking at everything you need to know about follicular unit extraction and follicular unit transplantation.
The purpose of any hair restoration process would be to ensure that there is a full head of hair and that it looks as natural as possible. Over the past decades a lot of improvements have been made in this field and it was understood that the smaller and more precise the grafts, the better the results would be.
The main difference between follicular unit extraction or FUE and follicular unit transplantation or FUT is the manner in which the follicular units are extracted. In FUT, an entire strip of hair is removed and then the individual hair follicles are extracted. In FUE, individual hair follicles are extracted directly from the scalp.
Each of these procedures utilises the smallest units of hair groups, which are normally known as follicular units, and each unit normally consists of single to four hairs. In addition, both these techniques concentrate more on the quality of the hair roots, as opposed to the number of hair extracted. If the roots are destroyed during the extraction process, there is little chance that the hair will eventually take up and grow well.
In FUE, the method of extraction is with punches, extracting individual follicles, and ensuring that the roots are intact. There is also lesser damage to the skin of the donor area.
The Scarring in the Donor Area
Since the extraction techniques are different it is natural that the scars left behind will also be different. In FUT, the strip method is used, which is why a linear scar, although narrow will remain visible. However, by managing the length of the hair, the scar can be easily concealed. In the FUE process, since the hair is extracted individually, there might be some spots in the donor area which are usually not noticed with naked eye.
The Utilization of the Donor Hair
There is only one disadvantage when it comes to hair extraction in FUE – there is a limit to the number of hair follicles that can be extracted. Only a small section of hair from the donor area can be harvested. This means that not all hair can be removed in one go, even though there might be sufficient hair in the donor area.
In the FUT method, however, a long strip of hair is removed, from the middle part of the donor section. Since the entire section has been removed, therefore, all the hair from that section can be utilised. The section from the strip has been removed, is normally sutured together, which is why there is linear scar. The hair that is leftover from transplant is then redistributed in the donor area, which helps cover the ‘wound’.
There is actually much lesser hair to utilise in the FUE method, as compared to the FUT technique. Many a times, in order to compensate, doctors choose to harvest hair follicles from the lower and upper margins of the donor area. However, there is always the chance that such hair might not be of the finest quality. This is why the FUE method would not be advisable for someone who needs a larger area of the scalp covered.
Healing process of the donor area
In FUT, since an entire strip of hair is removed, there is an open and obvious wound. In order to ensure that there is no infection, the wound is immediately closed and stitched up, using an appropriate kind of suture. While there will be a linear scar left, it can easily be hidden by choosing a proper haircut and length of hair.
However, in FUE, the small puncture wounds that are created to harvest the hair follicles are left open. While there are no issues due to the scars and you can easily wear hair short.
In order to truly appreciate how far the domain of hair transplant has actually come, it is crucial to understand the history.
It would be hard to believe that the very first hair transplant had been done in the late 1930s! As a matter of fact, in 1939 and then in 1942, Okuda and Tamura of Japan discovered that hair used from the back side of the head, could actually be utilised to handle the loss of pubic hair. Women in Japan had to take part in certain public bathing rituals and this often led to loss of pubic hair. The very first transplant proved to be quite effective and it showed that hair harvested from any part of the body, would thrive on any other part too.
However, hair transplant the way we know it, started evolving in 1950s with the innovation brought about by Norman Orentreich, a famed dermatologist from New York. He started working on cases of androgenetic alopecia and found out that the hair harvested from the back of the head could be transplanted into areas which showed balding. More importantly, he discovered that this newly transplanted hair would not fall. He named this phenomenon ‘donor dominance’, which meant that hair that had been taken from an area that showed minimal balding would be less prone to falling out, irrespective of where they are placed.
This was the breakthrough that the hair transplant world needed and it imbibed doctors and surgeons with a new zeal. Hair transplantation surgery then went through different changes starting with the large punch grafting to minigrafts and micrografts to finally evolve into strip or Follicular unit transplantation technique in 1990s. This was a breakthrough with excellent results cosmetically as the entire follicular unit was grafted ensuring better survival.
The next major development came in 2002 when Bernstein and Rassman introduced the concept of FUE or follicular unit extraction. In India, it was introduced by only a couple of doctors which included Dr. Kapil Dua & Dr. Aman Dua in 2007. This technique avoided the scar produced in FUT at the same time providing good results. Several modifications have been made to this procedure with the development of even a Robotic system by ARTAS.
While Orentreich did lay the foundation for hair transplant, it is now up to the doctors and surgeons to ensure that they utilise the donor area with care. While there is a lot riding on the density of the donor area, there is also a lot dependent on the skill level of the doctor handling the procedure. Harvesting the precise amount of grafts, ensuring there is no damage to the follicles, and implanting them with care and accuracy are all in the hands of the doctor. It is important that the doctor transplants the grafts, keeping in mind, aspects such as direction of normal hair growth and angle of the hair. It is also crucial that the doctor maintains the donor area, because should the need arise for more grafts, there should be sufficient available.
In the hands of a good doctor, any person can have hair that looks natural and can be styled as per individual choice!
We received an email from Hari, who wanted to know more about hair transplantation techniques, since he was considering one for himself.
Here are important parts of the information that we shared with him:
Thank you for writing to us with your query and here is the information that you were looking for.
In the simplest of terms, a hair transplant is a process in which, small section of hair, along with the follicles are carefully removed from the head and then transplanted into areas which have excessive hair loss or balding. The areas from which the hair is extracted is known as the donor area – this area can be identified only by a professional. Normally, the donor areas are the back or the side of the head. The bald area where grafts are implanted is the recipient area.
There are various techniques for hair transplantation which include,
- FUT (Follicular unit transplantation) Strip technique : Here, a strip of skin with hair follicles is taken from the donor area, which is then dissected into individual follicular units. This strip area is sutured and this leaves a scar at the donor site upon healing.
- FUE (Follicular unit extraction) : In FUE, the grafts are taken individually using special instruments from the donor site. This is a suture free procedure.
The extracted grafts are implanted in the same manner in both the techniques. Another new technique is DHT or direct hair transplant, a modification of FUE, in which the grafts are implanted immediately after extraction without much delay. The results are found to be excellent with this novel technique.
The actual transplant procedure involves two main steps – harvesting and transplanting. In the first process, follicular units or grafts are extracted by strip or FUE technique. These grafts can vary from two to three strands of hair or more, depending on the density and viability. The next stage is the actual transplant process, where in, the grafts are carefully transplanted into the recipient areas. This is done by making small holes or slits on the recipient bald area and then implanting the grafts into these holes.
As doctors, we are extremely careful about both processes – not only do we ensure that there is no damage caused to the donor site, we also ascertain that the transplant looks natural. For this, we place each graft in the same direction as the natural growth of the hair.
Doctor: Hair Transplant is the only successful, permanent & established treatment of baldness until the successful hair cloning is devised. At the same time, the method of implantation for even cloned grafts still may remain the same as hair transplant. Hair transplantation is a procedure in which hair from the back of the scalp is taken and transplanted in the bald area. Hair transplant has also changed its shapes from punch grafts to robotic hair transplant. But there are primarily only 2 ways in which the extraction is done the strip method(FUT) & FUE. Both techniques are very successful & followed worldwide. But it is not justified to state which is better as both have relative merits and demerits.
Fundamental difference between FUT( STRIP) and FUE technique lies in its extraction process.
|1||Method||Extraction of individual follicular units through small punches. No Sutures||Scalpel excision of donor strip with suturing|
|2||Scarring||Small scars are formed which are inconspicuous and get merged very well most of the times but not always especially if overdone||Linear Scar that may be visible if hair is trimmed /shaved|
|3||Donor Source||Scalp and Body||Back of Scalp|
|4||Quantity of Hair||Large session difficult (upto 2000 – 2500 graft)||Larger session (upto 3000 graft possible)|
|5||Natural Result||Yes, Permanent||Yes, Permanent|
|6||Recovery||Back to routine activity within few days||Suturing used healing over 10 days|
|8||Time Take||Moderate||Slightly Less|
|9||Pain||Not Painless. But anesthesia is given in such a way that it feels painless to the patient||Not Painless. But anesthesia is given in such a way that it feels painless to the patient|
|10||Preferred||Hair restoration of short hair/small number of graft or for patients that have undergone several STRIP procedures and their scalp has become too tight||Grade of baldness is higher and the donor area is not very good, strip technique is usually preferred|
FUE Hair Transplant
In the FUE approach individual hair follicles are extracted directly from the scalp and then transplanted in bald area. The scalpel or stitches are not required, resulting in significantly less down time, due to faster healing.
FUE Hair Transplant
Each hair follicle is extracted solely with precision thus, making it a more time consuming and labor intensive process. There is a hardly any complication and almost no scars are visible within a week.
The surgeons adopt the follicular unit that offers the most hairs per graft, and produce an optimal yield. Due to the non-invasive nature of FUE the scars produced during the transplantation process are so tiny that they can’t be detected by naked eyes. But after a week no scars visible.
A surgeon has to be proficient to perform both the techniques with perfection. A strip procedure limits the surgeon to use only the excised strip of scalp tissue, at that time the doctor is required to implement their artistry for adequate distribution to achieve optimum result.
FUE is an admirable technique for hair restoration of short hair or for patients that have undergone several STRIP procedures and their scalp has become too tight. At this moment, FUE is the latest and most refined approach to escape early stages of baldness. At the same time it is essential to understand the difference between the two methods.
FUT(Strip) Hair Transplant
In FUT (Strip) method, the grafts or hair are harvested along with skin or a thin donor strip of scalp along with hair is taken from back of head and its hair follicles subsequently being dissected into individual follicular units with the aid of special microscopes.
They are then placed in the balding region, where the surgeon has already made recipient sites.
Adopting FUT (STRIP technique) for hair transplant can be more attractive to some patients as it is economical despite knowing that it may produce linear scars.
A strip is usually preferred if higher number of grafts are required as more grafts can be obtained from a smaller area and protecting rest of the donor area at the same time.
If the grade of baldness is higher and the donor area is not very good, strip technique is usually preferred.
It is usually considered that the strip technique takes less time. However in the hands of an experienced FUE surgeon, the grafts can be extracted within the same time period or even less, at times.
Cost : FUT is cheaper compared to FUE due to the ease of doing the procedure. FUE needs special instruments and the surgeon has to be extremely skilled for doing the surgery at the right pace.
The decision for determining the most appropriate extraction technique can be determined after consultation with the hair restoration surgeon as he considers various factors including quality and density of existing hair, the future natural hair loss pattern, the number of grafts required, etc.. Extraction of hair follicles is not just the only criteria to be taken into consideration for a successful hair transplant as the surgeon should possess extensive technology, ability, experience and technique to perform the hair restoration process on a bald head.
At A K Clinic we are totally dedicated to our client satisfaction as we deliver what we commit to them. Our approach has guaranteed numerous happy clients over the years.
We receive numerous emails and phone calls each week, asking about which is better – FUE or FUT.
Here is a concise description and comparison of both procedures:
First of all, it is important to understand what each of the procedures is – while FUE stands for Follicular Unit Extraction, FUT stands for Follicular Unit Transplantation. In FUT, the technique utilised is the strip technique; wherein, a small strip of the scalp skin is removed from the back of the head and hair follicles from the same are harvested. However, in the FUE method, individual hair follicles are extracted directly from the scalp and then transplanted.
FUE Hair Transplant
For us, as doctors, the most important aspect is not only the technique but also how many grafts we can get from a donor area; rather, we are more concerned about the quality and the quantity of each hair follicle which can be harvested. The better condition the root is in, the greater the chances of it holding steady and growing properly.
Now let’s take a look at the other aspects and their comparison, in terms of FUE and FUT:
Number of grafts and density: A strip is usually preferred if higher number of grafts are required as more grafts can be obtained from a smaller area and protecting rest of the donor area at the same time. Thus if the grade of baldness is higher and the donor area is not very good, strip technique is usually preferred.
Speed of the surgery: It is usually considered that the strip technique takes less time. However in the hands of an experienced FUE surgeon, the grafts can be extracted within the same time period or even less, at times.
Survival rate of the follicular units: Carefully done, the grafts in either method can survive well, but there is a slight problem with the FUE method. The protective tissue around each follicle is much less in FUE, leaving the graft more susceptible to drying and hence dying. However, when carefully done with proper handling of the grafts, the rate of survival can improve drastically.
Scarring: The manner in which the scars appear are different in FUT and FUE – while in the former there will be a linear scar, in the latter, there will only be dots or micro scars. So, if someone is planning to keep their hair short, FUT would not be a great choice for them.
Sutures : In FUT, the wound is closed with sutures and this produces the linear scar. FUE, on the other hand uses <1mm punches for extraction leaving behind small micro scars that heals on its own. It is thus a suture less surgery
Healing: Postoperative healing is slightly longer with FUT and the stitches need to be removed after a week. Many people who have undergone the same have also spoken about a pull on their scalp, but this sensation disappears over a matter of a few days. The healing period is much shorter with FUE and normal activities can be resumed after a much shorter time. Not only is this treatment faster, it also causes minimal pain.
Cost : FUT is cheaper compared to FUE due to the ease of doing the procedure. FUE needs special instruments and the surgeon has to be extremely skilled for doing the surgery at the right pace.
Thus the final decision to go for an FUE or FUT depends on the patient preference and the skill of the surgeon. The other steps of transplant procedure like making holes and implantation of grafts remains the same in both techniques and needs to be done with great care for the best final results.
If you have ever wondered if your eye-brow is not in perfect shape, the below case report would be of interest to you.
Eyebrows are an important feature in facial aesthetics. Perfect brows define and give character to form a beautiful face. Brow hair loss can occur due to various factors like trauma, burns, over plucking, tattoos, alopeciaareata and other systemic diseases.Eyebrow restoration can be done in a similar manner as scalp hair restoration procedures, but certain factors should be given more emphasis.The direction and angle of a natural eyebrow is very importantandshould be replicated as far as possible.
In July 2014, a 30 year old Caucasian female approached us for restoration ofherleft eyebrow. The patient had a history of loss of brow hair initially due to overzealous plucking of eyebrows in her teenage years. Due to resulting thinning of her brows, the patient got a tattoo on the brow to try and mask the lack of hair, but was unhappy with the resulting look. This led to her decision to undertake a brow transplant in September 2013.She underwent restoration of both eyebrows by FUE technique but had no idea regarding the number of grafts transplanted. The end result was not satisfactory with abnormal directionofhairs especially over her left eyebrow (Figure 1,2,3).
Finally, the patient approached us asking for a restoration of the left eyebrow earlier this month.
Past & Personal history
Regarding the patient’s clinical history, there was no previous history of any medical ailments. Menstrual history was normal. Her diet and sleep were adequate. She was not on any medications.
CBC, BT, CT, PT, were within normal limits and HIV, HBsAg were negative.
We did a reconstruction of her left eyebrow by Revision -FUE technique. The plan was to transplant around 150 grafts (mainly single follicular units) as some were present already. These were taken from her occipital area. They were implanted by giving coronal slits on the brow. Great precautions were taken to make the slits and implant the hair in the laterally outwards natural direction of the eyebrowand not upwards as earlier. (Figure 4,5,6).The patient was happy as she got thick and full eyebrows.
Though requiring less number of grafts, eyebrow restoration is a very delicate procedure requiring great skill and artistic sense. Theangle and direction of the grafts placed should be perfect for good aesthetic results.
For those who find hair loss to be a difficult or a socially hostile situation, even simple styling of hair poses challenges and can prove frustrating. More severe the hair loss, more the stress and fretting leading to more hair fall, it’s like a vicious cycle. It’s difficult to say whether people suffering from baldness are perceived by others negatively or they themselves feel devalued. Their behavior then automatically begins to reflect their sense of self worthlessness. It is vital for men not to feel overwhelmed because if they do not show their lack of self-confidence then they are better able to cope with their baldness and be accepted by society at large. However, studies have shown that 60% of bald men have reported that they have been teased or ridiculed and hence the desperation to either hide the problem or prevent it from getting worse. Depression is another outcome of perceiving that baldness is unacceptable or that it is something to be ashamed of. This type of anxiety-causing outlook is harmful for overall health as the person may go into a shell and lose the zest for life.
All this can be revamped with a little bit of clear and straight-thinking. Sometimes thinning hair can be checked with certain medical supplements. Other times, the cause of stress needs to be diagnosed and eliminated. Looking at the sunny side, bald men are considered to be intelligent so they need not work themselves into a tizzy trying to prove they are on par with their peers or be jealous of their social success. Another alternative is to seek counseling from professionals who will guide you to take corrective action towards finding hairloss solutions. For instance, globally renowned surgeons at A K Clinics, Dr Aman and Dr Kapil Dua head a dynamic team of medical professionals who can ably assist you in your journey towards a new you. Directing you towards FUE, STRIP or mesotherapy, theses experts will empower you to lead a fuller life based on what will be the optimal technique for your needs. So you can be rest assured that you are not misled by tall claims, false promises or exaggerated, vague explanations about how each technique works. Check out akclinics.com or visit Mumbai, Delhi and Ludhiana centers for an appointment that can change your life.
Internationally acclaimed surgeons Dr Aman and Dr Kapil Dua conducted a hands-on FUE workshop at their Delhi centre, in collaboration with IPCA Laboratories to impart much-needed awareness and knowledge about hair transplants and various procedures. Their focus was on FUE through a series of an extraction, implantation and a lecture besides an observation case. Besides the ten doctors who attended the day-long event on Sat 7th Dec 2013; also present were Mr. Ashish Gupta, Vice president of Ipca Laboratories and Pankaj Pandey, Regional Manager alongwith Ms. Gopi – DGM Marketing.
Dr Aman and Dr Kapil Dua have acquired their expertise and honed their skills by staying updated with the latest global trends in their field. This has helped them to set benchmarks of quality and also share their acumen at seminars and workshops by demonstrating LIVE, and not just through impressive slides and hyped powerpoint presentations. It is through this dedicated approach that they have been able to carve a niche for A K Clinics as the best; with unbeatable qualitative solutions in haircare and skincare and in the process bringing India into the limelight for aesthetics and cosmetology.
How does cold laser therapy work when it is just a beam of light that stimulates healing? The scientific reasoning behind this is the light is absorbed by a living tissue, and then triggers biological reactions in the cells. When chemical substances are produced and endorphins released, there is less pain or inflammation and faster bone repair. So though, laser therapy is primarily used by the medical fraternity, it is also used by dermatologists for their procedures. Cold laser therapy is not painful because it does not burn the skin. As its name suggests, its ‘cold,’ it does not generate perceivable heat. It is extremely popular because it provides immediate results and at times may take even 6-12 sessions for visible effects.
Scientific research studies on laser therapy.
These reports verify the clinical value of laser therapy. While 2500 scientific research studies verify the clinical value of laser therapy, there are many people who are not aware of its benefits and therefore don’t consider it as a ‘preferred form of treatment.’ In fact, cold laser therapy is better than adopting alternative modalities such as electrical simulation or ultrasound; because they do not work towards tissue healing in any way. Laser therapy on the other hand causes tissue to strengthen. it is also safe to use though in certain instances, it involves use of special filtering glasses.
At A K Clinics, in India, we specialize in various forms of hair transplant from DHT, FUE, FUT to Mesotherapy and laser therapy. We have centers at Mumbai, Ludhiana, Delhi where trained medical professionals provide consultations and guidance to every patient, based on individual needs. Visit www.akclinics.com to get a glimpse into the fascinating world of hair and skincare and how it can help you lead a new life; one filled with hope and confidence.
Surgeons over the world claim it is the ultimate technology redefining hair restoration. Is it FUE? Or is it another technique which utilizes precision robotics and digital mapping to convert areas of thinning hair into those of lush growth. The doctor digitally scans the scalp, uses areas where hair is growing, removes it with the help of an advanced method that combines images and robotics and transplants the hair in the problem area. The implanted grafts then continue to grow just like any other normal, permanent hair. While patients can return within a day or two to their routine, it would take as little as a week for both areas (from where hair is taken and where it is transplanted) to look the same as before the treatment. Another nine months and the patient can begin to experience natural-looking hair. So is this wonder treatment preferred over FUE, which also boasts of of equally quick recovery? Or are they both the same thing?
FUE transplants use the NeoGraft machine which eliminates the painful invasive technique of hair transplants characterized by the traditional STRIP method, in which a strip of the scalp is surgically cut. Another advantage of the NeoGraft is that it harvests high quality follicles and therefore yields a low transaction rate. NeoGraft also involves fewer FUE Procedures Surgeons also recommend FUE to cover up linear scars which are a result of STRIP procedure.
For those undergoing unwanted stress due to baldness, it is advisable to consult experienced and knowledgeable specialists for sound advice. Veterans at A K Clinics have helped and guided many people through detailed and specific consultations as to which course of action would be the right one to follow. All our centres whether based at Mumbai, Ludhiana or Delhi provide this high level of expertise. This piece continues…