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.

Why we don’t offer FUE procedure?

Why we don’t offer FUE procedure?

Because we don’t think it’s your best interest!

Don’t listen to what people tell you! Take sometime, do your study seriously, ask questions, use your own intelligent and make your own decision.

Differences between FUT and FUE:

The only different between FUT and FUE is donor harvesting.

FUT uses blade and FUE uses punch. The recipient site transplant are completely the same.

Different tool used produced different result!

Comparison	FUE	FUT
Is it the latest technique?	no, it is the oldest punch graft but change the size of punch
Tool	punch	blade
Donor harvesting	blind	under direct microscopy vision
Wound treatment	leave open	closed
Scar	thousand of small punch scars	one linear scar
Scar distribution (in same length)	5 to 6 times wider	one line only
Total Scar Size	10 times bigger
Scar long term effect	permanent	permanent
For keloid patient	disaster-hard to treat thousand keloids	easier- only one scar to treat
Quality of graft	defect graft (no tissue around follicle)	intact graft (come with tissue around follicle)
Growth rate of transplantation	61.40%	86%	Read Dr.Beehner's study
Impact to 2nd surgery	huge-scar tissues change the hair direction	minimum- can use different donor area
Length of hair need to cover up the scar	1 cm	2 cm
Hairstyle options such as marine cut	no	yes
Price	Double

Why most surgeons prefer FUE?

  

FUE: need only one technician

FUT: need 3-4 technicians

Some surgeons do everything by themselves without hiring any assistance to save on business costs. It is for their own best interest, not yours.

In addition to the overhead expense, the surgery fee is double for the FUE technique. The incentive using FUE for physicians are simply irresistible. Especially for new physician who’s just starting his practice with only 3 to 5 surgeries a month. It’s difficult to start a business when you need to hire 3 to 4 technicians to assist.

ISHRS Warning

Learn from one hair transplant surgeon’s own experience.

Sharp Punch and Dull Punch

Hair alignment is different in and out of the scalp.

Using FUE procedure to punch the grafts is a blind procedure.

There is no way to see through the skin. Therefore, two types of punch (sharp and dull punch) are used to reduce the transection rate.

	Deep Level	Advantage	Disadvantage
Sharp Punch	shallow, only cut through skin	less transection	bare graft caping
Dull Punch	deep to whole follicle	punch out whole follicle	more transection

* Sharp punch only punch through skin, need to use two forceps to pull out the grafts.Because the tissue around the follicles didn’t separate, a lot of time follicle come out without any surroundings tissue,that we call bare grafts. Sometimes during pulling, only skin pull out,follicle still stay in the scalp, that we call capping.*Dull punch method,use blunt dissection to isolate the follicular units from the surrounding tissue.Require more experience and skill to perform, even the speed of punch is very important.

Punch Graft Correction

The 4 mm size grafts were transplanted more than 20 years ago. Everyone blames the big grafts for causing the pluggy look. I think the big graft is only the indirect reason for the pluggy look. The graft is too big to place close enough to each other.

The direct reason is too big of the spaces among the grafts. If we are able to fill in all the spaces then the pluggy look will disappear. It is unnecessary to remove the big grafts. By not removing the large graft, they will help to increase the density and make the final result easier to achieve.

Please study the photos, to observe two facts.
1. Please notice the huge spaces among the grafts.

2. The large graft has the original density. Within the 4 mm graft, the distance among the hairs is kept in their original density. The hairs are appropriately spaced. The size of the graft is not the problem; the hairs are in their original form and not squeezed into a smaller space. The problem lies in the fact that the grafts (also known as plugs) are spaced too far apart from each other and the space in-between the grafts accentuate the pluggy look.

Immediately after we made the slits

The goal is to fill in all the spaces between the punch grafts.

Please see Surgical Correction of ‘Plugginess’ in Hair Transplants
Published on Hair Transplant Forum International
January/February 2006 Volume 16, Number 1

Why We Don't Use FUE

When Dr. William Rassman first presented the Follicular Unit Extraction (FUE) method in 2002, almost every hair transplant surgeon criticized it as it taking us back to the old punch age. The FUE punch measured 0.8mm in diameter, much smaller than the 4mm original punch, and caused more transection than the older technique.

Over time Dr. Rassman convinced some surgeons to use his method. Dr. Jim Harris then improved the FUE punch to reduce the transection rate.

Let's evaluate the pros and cons of FUE.

The advantages of FUE:
1. No linear scar/minimizes scarring
2. Can use body hair as donor hair
3. Better for smaller surgeries (i.e. eyebrows, facial hair, touch-ups, scar cover-up)
4. For limited donor hair availability
5. For persons whom would like to wear their hair short


Rebuttal to Advantages:

#1-No linear scar does not mean no scar at all, it still leaves hundreds even thousands of small, round scars, whereas with the trichophytic closure method (discussed on 1/30/07 - Hair Can Grow Through Donor Scar), the linear scar is almost invisible.(as picture below)

#2-In Dr. Rassman's New Hair News volume 12, 2007 comment on body hair transplants, he stated: “in the live patient viewing, one doctor presented two patients who had body hair transplanted into the scalp. The aesthetic impact was negligible fuzz on the top of the scalp…Based upon what I saw, the value of body hair transplants to the scalp may only have experimental value in today’s surgical practice.”

#3-A small area such as eyebrow needs 300 to 400 grafts. With the strip method, we need a linear donor skin of 1 cm in width and 5 cm in length. When the hairs are shaved, it will show a 5-cm long fine scar. With FUE, it will show 300 to 400 small punched scar. Which scar looks more natural?

#4-With limited donor hair availability the small scars are even more visible.

#5-Extremely short hair leads to the possibility of FUE scars and linear scars being visible. Patient cannot shave his head with either procedures.

Further disadvantages of FUE:
1. Price
2. Time in surgery

FUE costs 200-300 hundred percent more than the strip harvest method and requires more time in surgery. I know one surgeon in Australia who takes one week to finish one patient. Is it worth the time and money?

Further disadvantage of FUE( compare to strip method)

*Quality of grafts can't compare this strips method.
FUE is blind punch method, strips method is cutting under microscope direct vision.
Which way will produce better guality of the grafts? And better result of regrowth?
* When hair loss progress, FUE patients will be converted to strips method's patients.
* After extensive FUE procedure, because of scars and lower density. The result of strips
method will be discount.

One hair transplant physician states that, "I have practiced FUE for the past five years. Most of my cases are strip FUT, but I perform an average of two FUE cases per week. Unfortunately, there are unscrupulous practitioners who advertise FUE as a scarless surgery and, therefore, many prospective patients present requesting FUE out of this expectation. Patients must understand that there are punctate scars. Granted, they are not visible when FUE has not been extensive, but can be readily detected when harvesting has been extensive and donor hair worn very short."