Why FUE scar area is 10 times bigger than FUT's?

With FUT, if we removed 1 cm by 20 cm donor strip for transplant, we will close the wound so it will shrink to 0.1 cm or even smaller.  The total scar area is 0.1 cm by 20 cm=2 sq. cm.

With FUE method, to harvest the same amount of hair we need to punch out 1 cm by 20 cm donor skin.  Because the wound is leaved open after surgery, if we punch out all hair in the area then it leaves no hair to cover up the donor site.  In order to cover up the punch scar, we have to punch out from an area of at least 5 to 6 cm wide and 20 cm long.

The total scar area in FUE is 20 sq. cm in this case.

So the FUE scar area is ten times bigger than FUT.

Most of the time the FUE punched scar will get bigger in the future. The tighter of the scalp the bigger the scars becomes. The scars are permanent so will stay there forever.

Donor Site Safe Zone

Professor Unger studied 328 men aged 65 years or older and determined the safe donor area (safe zone).
When you are 80 years old, 80% of the chance that  your safe zone at occipital area is only 7 to 8 cm wide, at lateral and posterior area only 5 cm wide.
If grafts harvested are not in the “safe zone” then hair at that area are not permanent hair. When the surrounding hair loss or even get thinner, thousand of scars will appear and extremely difficult to cover up. 

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.

FUE Scar with Keloid

A keloid, sometimes referred to as a keloid scar, is a tough heaped-up scar that rises quite abruptly above the rest of the skin. It usually has a smooth top and a pink or purple color. Keloids are irregularly shaped and tend to enlarge progressively. Unlike scars, keloids do not subside over time.

This is a photo of a patient who had keloid and received FUE procedure.

What kind of hair style can I have with FUT surgery?

Since the FUT scar is a linear scar, so even these kinds of hair style can cover up the the scar.

With FUE surgery, thousand of small hypo-pigmentation scars will show.

Cutting Grafts Under the Stereoscope

As part of our dedication to excellent quality hair transplants, NHT Medical Center uses the latest state-of-the-art MANTIS stereoscopes, which provide our skilled surgical technicians with detailed visibility when cutting the grafts. This follicular removal technique provides the greatest number of grafts, as well as the least damage to the hair.

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.

FUT surgery-donor site with suturing

Photos taken immediately after donor removal and suturing




Immediately after FUT surgery, no sign of surgery visible from donor site.

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.    

FUT Scar

Our FUT Scars

FUE Scars

FUE don’t produce linear scar but create thousand of punch scars. To transplant same amount of hair, the scar of FUE will be 10 time more than FUT because FUE wounds are leaved open, so they will keep the same size but FUT wound are closed and almost of the time it will be reduced to 10% or less.  







More about FUE Scars

Photos taken immediately after FUE surgery

Photos taken immediately after FUE surgery.

For FUE, hair at donor site will be shaved completely for FUE procedure. The punch scars is over the safety zone. There are no way the hypopigmentation scar will be covered by donor hair completely in the future.

Case Study #2 -Norwood Class 6

Case #2- Total Increased Density: 35%
One Surgery:		Hair Regrowth Medication: Yes
Coverage Area:	60 cm2
Donor Area:	23 cm2
Density:	35%
Graft Number:	1510 grafts

We added 30% density to zone 1,2,3,4.

For zone 5,6, we recommend the patient to use the FDA approved oral medication, Finasteride (Propecia) to slow down his hait loss progress and maybe grow some new hair for his vertex area.

Case Study#1 -Norwood Class 7

Case #1- Total Increased Density: 30%
One Surgery:		Hair Regrowth Medication: Yes
Coverage Area:	88 cm2
Donor Area:	28 cm2
Density:	30%
Graft Number:	1690 grafts

We added 30% density to zone 1,2,3,4.

For zone 5,6,7, we recommend the patient to use the FDA approved oral medication, Finasteride (Propecia) to slow down his hait loss progress and maybe grow some new hair for his vertex area.

The after surgery photos are taken two years after the procedure.

From 2014 ISHRS Meeting -Is a glaucoma drug the next treatment for hair loss?

ISHRS 2014 Meeting

Is a glaucoma drug the next treatment for hair loss?

Professor Valerie A. Randall, PhD, FIBMS, FSB

Professor of Biomedical Sciences, Centre for Skin Sciences, School of Life Sciences University of Bradford, Great Britain, U.K

Hair Loss causes significant negative effects on the quality of life of affected individuals. This occurs in every culture due to hair’s importance in human social and sexual communication across the world. As common as alopecia is, treatments are very limited and vary in their effectiveness. Current treatments involve cosmetic wigs or hairpieces to surgical techniques. The main medical therapies in current use include hormone action modifiers for androgen-dependent hair loss and non-hormonal treatments for other alopecias.

Glaucoma drugs are recently being researched for hair growth. They are used to reduce intraocular pressure, but seemed to stimulate eyelash growth as a side effect. Then came about Latisse (bimatoprost), previously a glaucoma drug that is now indicated for eyelash growth. Eyelash follicles differ from scalp hair as they specialize in the protection of the eyes. When bimatoprost was tested on isolated scalp follicles it showed increased human hair synthesis of organ cultures. It also stimulated hair growth in rodent pelage follicles. Bimatoprost appears to offer a new approach to stimulate scalp hair growth clinically. It is currently in phase 2 clinical trial in the US as a topically-applied treatment for androgenetic alopecia in men. Overall, increased understanding of the hair follicle function both in health and disease and careful observation of drug side-effects are leading to new approaches for therapies for alopecia.

From 2014 ISHRS Meeting -Aging Scalp and Gray Hair

Aging Scalp and Gray Hair

ISHRS 2014

Desmond J. Tobin, PhD, FSB, FRCPath.

Desmond J. Tobin is Professor of Cell Biology and Director of Centre for Skin Sciences at University of Bradford.

Although humans have over 5 million individual hair follicles on their bodies, most attention be it academic or commercial is focused on the paltry 2% of these that are distributed on our scalps. 

The hair follicle produces several different types of hair fiber during a normal lifetime. It is worth emphasizing that hair will grow up to 4 meters all  within the same single hair follicle. Hair growth rates also vary significantly during human aging and for different body sites. Indeed, when these are averaged for post-40 year old non-balding males, hair actually grows most rapidly and with greater individual fiber thickness in certain body sites in individuals during their 50-70 years of age. 

Increasing age can leave its mark on several phenotypic properties of the hair fiber. While the most visually apparent of these include hair thinning, hair loss, reduction in the rate of growth, pigmentation loss, aging can also affect change in the surface morphology of hair. The hair follicle is somewhat unusual however, in that some of its interactive cell systems appear to be non-essential for overall hair follicle survival. Indeed, strikingly gray and white hair follicles may paradoxically grow hair even more vigorously than their pigmented predecessors. 

Much of the recent research has focused on both the oxidative stress that appears to increase with aging and to which the hair follicle melanocytes appears especially sensitive, and the fate of hair follicle melanocyte stem cell capacity. This is likely to reflect significant differences in the epidermal and follicular melanocyte microenvironments.  The hair follicle may provide richer information in this context. Pre-proliferative, proliferative, differentiated, terminally-differentiated and ‘senescent‘ melanocytes all co-exist in the same growing hair follicle.

Is the latest technique the best technique?

With technology, the saying has always been: the latest, the better; like smart phones and new cars. However, this does not apply with hair transplantation. The human body is a very intricate and complicated system. Pharmaceutical companies invest years, billions of dollars, and multiple phases of clinical tests to develop the newest medications. But even with extensive research, the medications still get recalled occasionally.

Basically, a hair transplant is only a relocation of hair from the back of the head to the desired area. It’s a very easy and simple procedure. However, this makes it difficult to stand out from other clinics. In order to convince potential clients, you have to create something brand new and different. Something that is very convincing and feasible.  For example, laser hair transplants were very popular twenty years ago. At that time, lasers were the the latest invention. It was the best marketing tool which is why doctors spoke so highly of the many laser hair transplant advantages. However, they did not realize that the laser sealed the blood supply as well. When people discovered that laser hair transplants held very poor yield rates and results, a few years had already passed. A lot of donor hair was wasted and a great amount of damage was done. Currently, no one mentions laser hair transplants anymore. Scalp reduction, flap, extension, expansion and ultra slim dense packing claim to transplant more than 3,000 very slim SFU to qualify as being advantageous. However, body hair transplants and eyelash transplants went through that course and all failed. Concurrently, there has been a lot of improvement on hair transplantation. But so far it is still only a relocation of the hair.

The latest techniques on hair transplantation always have a different surgical approach.

A surgical trend like FUE is very convincing and catches the interest of a lot of patients. More importantly is how profitable it is for the doctors. Doctors concentrate on how to produce the perfect grafts but they overlook the more important aspect. How efficient can FUE use the donor area? After the first surgery there will be thousands of punch scars around the donor site. This is worrisome because scar tissues will have a big impact on the hair growth direction. What will be the quality of the grafts by the second surgery? If patients keep losing hair, how will they handle the thousands of scars that will show someday? What is the maximum donor area that can be used? No one currently has the right answer and no one dares to bring up the problems either.

For patients who choose the latest technique for hair transplantation, they are taking a lot of  risks. 

When you want to have the latest hair transplant surgery, you should always be very cautious and use your own judgement. I am sure the FUE technique will be one that will cause major problems in the future.

FUE was called "punch graft" 30 years ago, the only difference is that size of punch is reduced. The scars are smaller but still stay forever. 

FUT Donor Scar-Videos

You can barely see the donor scar from the videos.

FUT Scars

The scar on the donor site is nearly invisible with with Trichophytic Closure.

These photos below are taken on the suture removal days (10 days after surgery)