Follicular Unit Transplantation or FUT is a procedure in which after shaving a thin strip of hair from the donor site, that strip of skin containing healthy hair follicles is removed from the scalp under anesthesia. The follicles from the strip of skin are removed under a microscope. These follicles are then implanted either individually or in small groups depending area of the recipient site.
| FUT | FUE | |
|---|---|---|
| Scarring | Linear | Dot-Scars |
| Cost | $5 per Graft | $6 per Graft |
| Lifetime Graft Availability | 5000-8000 Grafts | 3000-6000 Grafts |
| Graft Survival | 95% | 85% |
| Shaving | No | Yes |
| Max Grafts Per Session | ~3500 | ~2500 |
| Procedure Time | Shorter | Longer |
Follicular Unit Extraction or FUE involves shaving a large the donor area and then under anesthesia extracting individual graft follicles using a small circular extraction tool.
The graft follicles after they have been prepared following either FUT or FUE are then implanted into the recipient site in exactly the same way. The only difference between these procedures is in the method of extraction.
With respect to scaring at the donor site, FUE has a clear advantage, but cutting edge (no pun intended) techniques in FUT sutures performed by Dr. Milchak are closing the gap. FUE leaves dot like scars at each of the extraction sites, caused by the extraction tool used. Since these scars are distributed evenly over a large region, they might not even be seen unless the hair is almost shaved as they are otherwise well disguised by surrounding hairs. A highly trained provider will use the smallest possible extraction tool that will not transect the follicles, leaving smaller scars than less experienced providers who must use larger tools to avoid transection.
FUT scars are linear, typically going across the back of the scalp horizontally. Historically these scars were much more noticeable than FUE scars, and would require the surrounding hair to we worn a bit longer than FUE to fully disguise the scar.
To mitigate the appearance of scarring, Dr. Milchak has adopted the new technique of trichophytic closure. Using this technique, hairs surrounding the extracted strip are actually able to grow through the scar. Naturally, the scar will still be present, but because the site of the excision has uninterrupted hair, it is far less noticeable. Thanks to this closure technique, the hair can be worn much shorter without the scar being noticeable when compared to more conventional methods of closure offered by other providers in the area.
Combine Ringpfeil Dermatology's new scar prevention procedure with FUT to make the scar almost completely invisible. Our new method has proved to be incredibly effective at preventing noticeable scar formation. This scar prevention procedure can be performed during the 10-14 day follow-up after the FUT procedure
FUT is generally a much faster procedure than FUE. With FUE each follicle needs to be removed one by one from the scalp with extreme caution to avoid transecting and killing the donor grafts. By contrast, FUT is much faster because the removal of the single strip is much faster than the individual extractions. Even adding in the time for the dissection of the follicles from the strip of skin under the microscope, FUT is still much faster.
FUT is also a much more cost-effective method than FUE. Because follicles can be extracted under the microscope under ideal conditions, FUT is much less labor intensive than FUE. FUT costs $5 per graft while FUE costs $6 per graft. Although this price difference might seem small, the difference can add up dramatically, it’s the difference between a 2,000-graft procedure costing $10,000 or $12,000. In those cases where many more grafts might be needed, the cost difference only continues to grow.
Only the strip of hair to be removed needs to be shaved. After trichophytic closure of the area, there will be no shaved area remaining. The donor area will be hidden by the neighboring hair and will not be noticeable.
FUE requires shaving of a quite large area of the scalp so that graft follicles can be extracted from a large distributed area. FUT by contrast only requires shaving the area which will be extracted. This means that a person can leave on the day of the procedure without having shaved the back of the head. Since FUT can be completely hidden by long hair, it has typically been a more popular option among our male and female patients with long hair as well as those receiving a transplant as a part of their MtF affirming regiment.
When many grafts might be necessary to achieve the desired appearance, FUT might become the only practical procedure. During both FUT and FUE, there will always be some follicles surrounding the extraction sites that are injured during the procedures. In the case of FUE, since these extraction sites are evenly distributed across a larger area, generally a greater number of total donor region follicles will be injured. FUT, because it leaves a thin line as apposed to many dot scars, can only injure far fewer neighboring follicles. The loss of neighboring follicles in FUE is usually completely unnoticeable since hair will not appear thinned until ~50% of follicles are not producing hair and to approach this number would require a many thousands of grafts to be extracted. However, when many thousands of grafts are necessary, this can be a concern and the reduced damage to neighboring follicles through FUT allows for a person to have a much larger stock of follicles they can transplant throughout their lifetime.
Again, because FUT only deals with individual hair follicles after the strip has been removed and under ideal conditions under the microscope, graft survival is much higher and few if any grafts will be transected. FUE as performed by even the best providers will struggle to match the level of graft survival made possible by FUT, as the FUE provider will rarely be able to completely avoid transecting a few follicles, even in straight hair.
