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Which Technique First: FUT & FUE

sl

sl

BHR Clinic Patient Advisor
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1
#1
(For the sake of this topic we assume that both techniques are performed competently)

Deciding on a HT is a hard decision; the technique used will play a major factor in your long term happiness, goals and intentions. Both techniques have their pluses and negatives and so it is important to ensure you choose the correct technique for long term planning and getting the most out of your donor.

FUE, the donor surface area is opened to the maximum but that does not mean there are more follicular units (FU) to be taken in comparison to FUT. Every FU removed will reduce the density, the more removed can noticeably drop the density and impair the donor for future procedures, FUE or FUT. Assuming an average density around the safe zone of 80 FU cm2 if the extraction pattern is spread and no areas are over harvested around 4000 FU could be removed, this will drop the overall density down by around 30%, leaving a density near 60 FUcm2 in the donor, and this would then be considered low density on a virgin scalp.

To sustain the density in the donor FUE is better suited to lower graft numbers, with an educated extraction pattern, no over harvesting or partial shaving , then the density change to the scalp can be minimal, if the candidate has an average to good density to start with then around 1500 grafts can be removed and hardly affect the overall density. With more advanced patterns of baldness FUE starts to be less of an option over one or multiple procedures; grown out results of 3500 FUE plus grafts are not the norm and require very good donor characteristics. If high FUE numbers are performed in one procedure there is a greater risk the yield will not mirror that attained through FUT; a real medical concern of large FUE procedure is the effect on the body to heal multiple open wounds created in the recipient and donor area simultaneously and how effective the body can sustain and heal whilst not impairing the scar healing in the donor and yield in the recipient.

A possible exception to the FUE rule on larger hair loss pattern candidates is when there are limited goals, not looking for total restoration, lower density placement due to specific hair styling, or the €œ5 o €™clock shadow € look for those who want a high conservative hair line to frame the face and frontal area and intend to keep their hair short/shaved; but this is not the normal HT candidate and very important that goals and long term intentions are discussed and understood by the candidate and the doctor.

FUT will remove a hair bearing strip of tissue and therefore effectively the hair density has not changed significantly in the donor as the surface area is removed opposed to hairs removed from the surface area. The scalp laxity allows for a strip to be removed without causing any long term tension and over time the skin heals well. There are limits to how many times this can be repeated but in good conditions 2-3 times and with good skin healing attributes it will be able to englobe the existing linear scars to leave a single line rather than multiple wounds.

FUT removes a high concentrated number of FU from a relatively small area and they are removed still in their natural state of high density on the strip; 4000 grafts in one procedure is an achievable number in the majority of candidates unless the donor density or laxity is particularly weak. For long term planning and high NW stages FUT makes it easier to plan and cover with a good density the largest surface area possible. FUT does have the disadvantage of leaving a linear scar so more visible signs a surgical procedure has been carried out but the advantage of being able to move a greater number of FU either in one procedure or multiple procedures compared to FUE and still sustain a similar density as before in the donor.

Conclusion, the advent of FUE means no need to be left with a linear scar for a relatively small amount of grafts placed so from a cosmetic angle it allows the patient to have an HT with little to no obvious signs that a HT has been performed. FUE due to the technical demands of the procedure being labour and time intensive as well as the medical healing and yield concerns is better suited to smaller sessions for the majority of hair loss sufferers. If the pattern of baldness is high and the goal is to cover a large surface area with a natural looking density then FUT would be the sensible and obvious choice to achieve the best result for the candidate.

The combination of both techniques can be utilised to ensure the original scar quality healing is maintained and using FUE to maximise the donor extraction zone, whilst still allowing the potential for future surgery using both techniques if need be. Combining the two techniques allows the best attributes of both to be used, maximum movement of grafts and opens the donor zone, concentrated high number of grafts from FUT and harvesting outside the traditional safe zone with FUE. What has to be remembered though is with either technique they are both scalp/hair characteristic changing in their own way, hair is being removed and there will always be a consequence to this, be it loss of density or laxity or scarring.
 
janna

janna

Invaluable Member
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5
#2
Nice write up Stephen. I see you went to the school of Philb.....lol.

I appreciate his posts too.
 
sl

sl

BHR Clinic Patient Advisor
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1
#3
Thanks Janna..I've known him for 3 years, 5 surgeries and numerous emails so a lot has rubbed off during this time, but not at his level yet..
 
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Bigmac

Bigmac

Administrator
Staff member
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24
#4
Good post Stephen.

Very informative.

Heres a question,if someone has grafts placed into an existing scar,then later decides to have that scar excised,what are the survival rates of those grafts that are dissected and re transplanted again?
 
sl

sl

BHR Clinic Patient Advisor
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1
#5
HI BM, good question,

In essence there is no reason why the FU couldn't be removed again, obviously they have been moved once and re-positioned so dissecting the strip they are in would be fun for the cutter because they would not necessarily follow the same direction of the other hairs if any. Survival would be hard to guesstimate, no reason why a high percentage would not grow, the doctor removes grafts from the recipient many times that are sitting in pitting and ridging and places them in to scarring in the donor and they grow.
 
Bigmac

Bigmac

Administrator
Staff member
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24
#6
Thanks Stephen.

Would you say there is a limit on how many times a graft can be re implanted?
 
sl

sl

BHR Clinic Patient Advisor
Likes
1
#7
Hi BM

Personally I would not say there is a maximum number of times a graft can be replanted. Obviously each time it is extracted, handled and replanted there is a potential for transection etc so in theory there could be a finite amount of times just on probability alone.

But as long as the graft is in a good state on extraction then it should, in the right hands be okay for implantation. The tissue type is goes into could also be a factor in terms of scar tissue, pitting etc.

Bit like re-potting a plant, as long as you know what you are doing, you should get continued growth, but it's wise to limit this cycle as much as possible.














 
H

hairtech

member
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0
#9
Stephen... This write up is very intelligent and I have very similar opinions... Also, I agree with you in your answer to bigmac. A graft will survive if properly extracted, excised, cut, or what have you... This is evident because of plug removal and resdistribution in recent years.

Follicles are sort of like plants.