FUT graft and FUE grafts

Please see the two photos. The only difference is the FUT grafts have tissue around its follicles and the FUE grafts have no tissue. 

FUE is a blind procedure, the deeper the cutting, the more chance of dissection of the follicles. The standard method is to blindly punch through the skin then use a strong forceps to pull them out. This is the reason why there are no tissues are around the follicle level and the follicle is left exposed with no protection.

Dr. M Beehner’s Study about FUE and FUT

Below is  Dr. M Beehner’s  (3560 hairs/ follicles) study which was presented at the ISHRS annual meeting on Sep 2015.

Please see the two photos. The only difference is the FUT grafts have tissue around its follicles and the FUE grafts have no tissue. 

FUE is a blind procedure, the deeper the cutting, the more chance of dissection of the follicles. The standard method is to blindly punch through the skin then use a strong forcep to pull them out. This is the reason why there are no tissues are around the follicle level and the follicle is left exposed with no protection.

The impact to survival rate is 10-14 months after surgery- 

FUT 86% survival rate (765/890) vs FUE 61.4% survival rate ( 547/890).

The difference is 24.6 %.

We all know donor hair is limited, our worst nightmare is that we might run out of it someday .
Remaining concerns are, what’s the impact to the transplanted hair quality and the life of it? So far no one has done this study.    

Asian Hair

Asian Hair



Caucasian Hair

Asian hair is much coarser, lower density and thicker skin. Caucasian hair is thinner with higher density and thinner skin.For hair transplantation, the principal is the same for both hairs, but there are a few differences.

Compared to Caucasian hair, Asian hair tends to have a lot of tissue surrounding the hair, if we trim the graft too thin, it will automatically remove 10% to 15% of hair which is still in the resting phase.

Asian skin also has a tendency to bleed more; the technique of Anesthesia needs to be adjusted.
Asian hair graft is more difficult to implant due to its thicker skin, so experienced technicians is of extreme importance.

We have offices in Taiwan, Japan, and California. We are one of the most experienced clinics in the world when it comes to dealing with Asian hair transplantation!

For more detailed info, please read Chubby vs. Skinny Graft.

Paired Graft vs. Intact Graft

From July 2009 Dr. Michael Beehner’s report ~

One intact 2- hair graft: contain two single hairs follicular unit. This can also be cut into two 1-hair follicular units (paired graft). *paired graft=combine two grafts and insert into one slit.

One intact 3-hair graft: contain one single hair follicular unit and one two-hair follicular unit. This can also be cut into one 1-hair and one 2-hair follicular unit (paired graft).

BFU=Bi-Follicular Unit

Conclusion from Dr. Michael Beehner:

Intact follicular unit’s growth rate is better than paired grafts (93% vs. 70%)
3-hair follicular unit has higher growth rate than 2-hair follicular units. (99% vs. 83% on intact 2-hair graft, 49% on paired graft 1 hair+1 hair

Comments:
Intact follicular units and 3-hair follicular units are our modified follicular units (bi-follicular unit). Paired grafts are single follicular units. This is why our modified follicular unit (bi-follicular unit) has higher growth rate.
Another reason why we opposed to the paired graft is that the goal of hair transplant is to minimize the empty spaces among the grafts. When transplant same size of donor area and hair, paired grafts will increase the empty space.

The photo below shows the scalp skin. If you paired the blue circled hair into adjacent hair, the empty area will increase almost four times.

From another point of view, the intention of hair transplant is to use lesser amount of hair to cover a bigger area. But when you pair grafts, it covers less area. That’s against the purpose of hair transplantation.

Look at the picture above and imaging that if you paired all the hairs, the empty space becomes huge and unnatural. If you want to keep same space then we have to remove 50% of empty skin. Transplant area will be reducing to 50% smaller area.

Chubby vs. Skinny Graft

The more denser-packing, the more skinny grafts.

Here are the study results that I can find about chubby vs. skinny grafts.






Conclusion:

All studies show that compared to the chubby grafts, the growth rate of the skinny graft is decreased 15% to 33%.

Question: Exclusive use of single follicular units (SFU) seems to be the current norm, why does NHT insist on using mixed sized grafts?

Question: Exclusive use of single follicular units (SFU) seems to be the current norm, why does NHT insist on using mixed sized grafts?

Answer:
There are a number of reasons why many surgeons today use only SFU for hair transplants. Exclusively using SFU for hair transplants provides a more even "look" and fewer scabs immediately after surgery. As an additional benefit, surgeons can pack SFU more densely than modified follicular units.

However, there are three concerns:
1. Higher telogen (resting) stage hair loss due the process of thin graft preparation

Humans typically shed 60 to 100 hairs per day. These telogen stage hairs, or resting hairs, amount to 10% to 15% of our total hair at any given time. After about three months, the hairs re-grow and start the natural process over again. Telogen stage hairs are of concern for hair transplants because they are effectively invisible. In the process of preparing an SFU, the technician must trim off the tissue next to the SFU grafts possibly discarding the invisible hair inside the tissue. 10% to 15% of hair may be lost in this trimming process.

Photo: 10% to 15% of hairs are in Telogen Stage and are invisible.

2. Poorer growth rates when using thin grafts compared to "chubby" graft
Dr. Seager, Dr. Beener, Dr. Beeher, Dr. Reed and Dr. Raposio each conducted studies to compare the results of chubby and thin grafts. These studies found that re-growth rates for chubby grafts' are 20% to 51% more than the thin grafts. So far we haven't heard any report indicating that the thin graft's growth rates are better.

Photo: Thin follicular units-almost no tissue attached

Photo: Thin Follicular Units - tissues are trimmed off

Photo: Chubby Follicular Units

Photo: Chubby Modified Follicular Units

3. Cost to patient is almost double when using SFUs only

The cost associated with a hair transplant surgery is also an important issue. We work hard to earn our incomes - why should we waste it if we have a more affordable alternative to achieve our goal.

For example, here is a cost estimate for a typical SFU-only hair transplant for a hypothetical patient.
Assumes:

• A recipient area of 80 cm2
• A donor size of 40 cm2 needed for a 50% transplanted density
• Donor area contains about 100 FUs in one cm2
• Total grafts needed are around 4000 SFUs
• Total cost is around $20,000 at $5 per graft

In reality this surgery would likely cost much more than this estimate; in this calculation we didn't take into consideration potential hair loss during surgery or the growth rate.Remember that hair loss is a life long process. A patient needs to receive touch-up hair transplants once in a while to maintain a good "look". Over the longer term, the exclusive use of SFUs adds up to quite a sum!