What is the real difference between FUE and FUT Hair transplantation and what is the marketing misinformation?

Ok, first let's establish our terminology. FUE refers to follicular unit extraction which is the individual surgical extraction of follicular units. FUT refers to the removal of a hair bearing strip of tissue that is then dissected into follicular units.

For the past twenty plus years the stated "Gold Standard" in hair transplantation has been microscopic follicular unit transplantation (FUT) where an experienced hair surgeon removes a "strip" of hair bearing tissue from the back "donor" area and then sutures the donor area back together leaving a narrow linear scar. The hair bearing strip is then carefully dissected under binocular microscopes by a team of highly trained technicians separating the naturally occurring follicular unit bundles of 1-4 hairs.

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While the microscopic dissection process is being performed the surgeon begins making tiny slit incisions on the top of the patients scalp where there is hair loss, replicating the natural flow of the hair pattern. By the time the "recipient" sites are made and follicular units have been created and sorted the physician and technicians begin inserting the newly harvested hair grafts into the recipient sites, establishing healthy blood flow back to the grafts as soon as possible to assure full and healthy hair growth.

Over the past few years Follicular Unit Extraction or FUE has gained popularity - both earned and misrepresented.

FUE hair transplantation is actually based on the old "plug" technique performed in the 1970's and 80's where a surgeon would use a manual or mechanized tool to extract a cylinder of skin with hair follicles. The difference is that today FUE's are very tiny .7mm to 1.2mm in diameter and contain a single follicular bundle rather than the large 4mm  plugs which contained multiple follicular units and created the dolls hair "pluggy" look.

Is FUE a scarless procedure?

Because FUE grafts are so small they leave a virtually invisible scar once the scalp heals in a few days. This has led to the marketing of FUE's as a scarless procedure which is not entirely accurate.

All surgical procedures leave a scar, it is how visible the scar is that can create a problem. FUE scars are so small that they are virtually undetectable with the human eye. They are still there and with proper technique and spacing will never be detected.  But, because FUE's require proper spacing to be undetectable the number of grafts that can be safely removed during a hair transplant procedure is greatly limited. The procedure is also more time consuming as each follicle is individually extracted. If too many grafts are taken in an area scarring and hair thinning in the donor area can occur.

What is the Difference between FUE, NeoGraft and ARTAS?

There is a great deal of confusion among the general public between the procedure of follicular unit extraction and the tools that assist a surgeon in performing FUE hair transplants. FUE's can be performed manually or with various mechanized devices. The mechanized devices are basically powered drills that spin the tiny punches. Two of the most well known devices are NeoGraft Hair Transplant System and Artas Robotic Hair Transplantation.

NeoGraft is a European device that provides automation by cutting the graft and through suction pulling the cylindrical graft from the connective fatty tissue at the bottom of the graft. Some physicians have reported graft damage from the section and therefore use the device without suction. It is also reported that since the NeoGraft company markets primarily to physicians with no prior hair restoration experience that the physicians can hire teams of hair transplant technicians who often perform the entire procedure for the physician. The International society of Hair Restoration surgery (ISHRS) has issued a consumer alert regarding this practice.

If the grafts are excised by an experienced surgeon with a anatomical understanding of hair follicle angles and hair density NeoGraft can be a very effective and efficient method of extracting FUE's.

Artas Robotic Hair Transplant system is a very sophisticated and expensive device that performs a 3-D mapping and analysis of hair follicles in the donor area. Both Artas and NeoGraft have been FDA cleared to be used to perform FUE hair transplantation. Both the Artas and NeoGraft devices have not demonstrated improved graft quality or hair growth than other manual or electrically powered FUE devices. Artas is also more limited in number of grafts extracted and time to perform the procedure.  Currently there are no demonstrated improvement in transplant results when FUE is performed by a properly trained hair transplant surgeon.

What is the difference in results from FUE and FUT?

When properly performed there is no measurable difference in hair growth and naturalness. FUE provides a patient who wants to keep their hair very short in the back the peace-of-mind that no linear donor scar will be visible. FUT on the other hand is a more time and volume efficient procedure that harvests more grafts, more efficiently in a single hair transplant session. When the donor is closed properly the linear scar is so thin that it is not visible unless the scalp is shaved.

So what procedure is best for me?

The only way to determine which surgical technique is best for you is to consult with an experienced hair surgeon who offers various surgical options. During your consultation your doctor will evaluate the quality of your donor area, your degree of hair loss, age and cosmetic goals and will discuss the benefits and options available to you.