The technique we use at the THT Center is called "Follicular Unit Transplantation" or "FUT". This is commonly referred to as the “Strip technique” and is different to "Follicular Unit Extraction" or "FUE"

FUE is a more recently developed modification of the standard FUT. In both techniques, the way the follicular units are planted into the recipient area is identical with both procedures resulting in transplant growth without "plugginess". The difference between the two techniques is in the method of how the hair is harvested from the donor area. Instead of excising a strip of hair, suturing the area together, then dissecting the follicular units under a microscope, the follicular units in FUE are removed from the scalp individually, one by one, therefore leaving no wound to be sutured and and no need for microscopes.

The follicular units are removed by placing a 1 mm punch around a single follicular unit and cutting a small circle through the skin around that follicular unit. The follicular unit is then grasped and gently pulled away from the loose connective tissue surrounding it underneath the skin. Once it is removed, no further preparation is necessary. It is ready for planting. The small hole left behind is left to heal in by itself, which it does over one to two weeks. This process is repeated hundreds of times until the desired number of follicular units are obtained. Rather than leaving a white, linear scar as with the standard FUT, the patient is left with numerous 1 mm round white scars. Proponents claim the advantage is less noticeable scarring and no tightness of the scalp (because no tissue has been brought together and sutured as in standard FUT).

Although good in theory, FUE does have some major drawbacks. One of the greatest is that not every patient's scalp is amenable to FUE. In these patients, the follicular unit tends to tear while it is being teased out of the skin and damaged follicular units will not grow as well, if at all. For this reason, frequent test procedures are recommended, to check whether the patient's follicular units remain intact during the extraction process. Another major problem is that it is difficult to perform large sessions. Extractions are slow and tedious and patients desiring large sessions may have to return to complete the procedure over several days rather than in a single day as is standard procedure with FUT.

The capacity for long term growth is also a theoretical concern. During extractions, the follicular units are gently torn from the underlying tissue. The deepest component of the connective tissue beneath the follicles tends to be absent in these grafts and it’s this absence that could possibly lead to weakening of the follicular unit over time. Additionally, since FUE is a new technique, hair transplant surgeons cannot be sure of the long term results.

ก่อนการปลูกผม ด้วยวิธี FUT หลังปลูกผม ด้วยวิธี FUT
Left photograph shows the back of the head of a transplant patient who has had one “FUE” session (approx 2,000 grafts) at an undisclosed clinic. As a result, the donor area looks visibly thinner after the procedure and the punctate “FUE” scars are also quite visible, especially here where the hair is relatively short." The right photograph is a close-up view of the same patient.
Patients should also be aware that they will get scars in the donor area either way. FUE leads to hundreds or thousands of tiny round scars in the back of the scalp. Whether this is preferable to a linear scar is debatable.

It is my opinion that standard FUT will remain the workhorse of most surgeons' practices, but that being said, there may be a small number of patients that could benefit from FUE. This would include patients with limited donor material remaining, due to tightness of the scalp, patients who tend to heal with wide scars after suturing, patients with loss of eyebrow or mustache hair that require follicular units of a particular size, or patients in the military who must keep their hair in the donor area very short.

The Advantages and Disadvantages of Follicular Unit Extraction

FUE’s main limitation, when compared to FUT, is that it is less efficient in harvesting hair from the mid-portion of the permanent zone. In FUT, the strip is taken from the optimal (central) part of the donor region so all the hair in this area can be removed and transplanted. After the strip is removed, the wound edges are sewn together.

ก่อนการปลูกผม ด้วยวิธี FUT หลังปลูกผม ด้วยวิธี FUT
Photograph 1. A patient about to undergo FUT/strip technique surgery. Photograph 2. Immediately after donor closure using the FUT/strip technique.

Photograph 3. The same patient approximately one year after surgery. The Donor scar has healed well and is very difficult to see.

In FUE, hair is extracted, but the intervening bald skin between the follicular units is not removed. Therefore, the surgeon must leave enough hair in the area to cover the remaining donor scalp. Consequently, there is considerably less total donor hair available, perhaps even half as much as with FUT. This represents a significant disadvantage, since a limited donor supply is the main factor that prevents a complete hair restoration in many patients. To compensate for the inability to harvest all the hair from the permanent zone, the surgeon may eventually be tempted to harvest hair from the upper and lower margins of the original donor area and risk the hair being of poor quality or being non-permanent.

In Follicular Unit Extraction, the wounds although small, are left open to heal, leaving hundreds to thousands of tiny scars. Although not readily apparent, this scarring distorts adjacent follicular units and makes subsequent sessions more difficult. This is an additional factor that limits the total available donor supply in FUE.

Although three-step FUE significantly decreases the amount of transection and damage during the extraction, the inability to fully access the mid-portion of the permanent zone, significantly limits the total amount of hair that can be accessed through FUE, rendering it a far less robust procedure than FUT for moderate to advanced balding.




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