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Comparison between techniques

Definition
FUE

Follicular units are removed one by one. The doctor chooses follicles depending on demand (1, 2, 3, 4 and 5 hairs).

STRIP OR FUSS

Follicles are removed by extracting a strip or hair skin strip from both sides of the head. We will need the scalpel.

Surgical instruments used Show punch
FUE
STRIP or FUSS
Hair cut
FUE
Patient with alopecia scale V, 1st Operation. Frontal restoration
Same days after the procedure
One year after the procedure, there will be a second procedure in order to restore the crown. There is no evidence of the hair transplantation at a glance.

Needs total or partial shaving. With the FUE technique there are no visible scars.

Our patients will be able to wear short hair with razor from nº 2 forward, it will vary according to native capillary density, healing, skin color, hair color, number of follicles extracted in the intervention and successive interventions in each patient.

With the FUE technique, the patient will be able to choose the style that he wants to give to his hair at all times.

STRIP or FUSS

One of the bad things about this method is big scar. 

No matter how good the surgeon is, there will always be a scar on donor site. Even if it is a strip, it would be visible because hair does not grow there.

The patient who decides to use this technique won´t be able to have very short hair on donor site for the rest of his life.

Anesthesia
FUE

Local

STRIP or FUSS

Local

Type of incision for extraction
FUE

Cuts with punch/Incisions.

The part shown with the arrow is the only thing that penetrates in patient´s skin.

STRIP or FUSS

Cut with scalpel/Incision.

The glass slide of the scalpel cuts scalp skin in order to extract the strip.  

Extraction
FUE

Follicles are extracted one by one by using microsurgical tools (diameter range less than 1mm). Follicles extraction is simple and does not hurt. The area heals from 2-4 days. There is no risk of nerve damage.

STRIP or FUSS

A strip of the scalp is removed (20-25 cm and 1-2.5 cm wide) from donor site by using scalpel which penetrates on dermis and cuts nerves and vessels. 

Later it is sutured and it is needed around 30 days to obtain total healing although sometimes there is an alteration of sensitivity that lasts some months due to nerve damage.

Hair extraction from other areas of the body
FUE

We can obtain hair from the whole body.

Many of our patients have a lot of hair in their bodies and would be pleased to use it in order to replace lost hair in scalp.

Body hair is used to improve following density; it is never used on frontal line. Not everybody can be a good candidate for this, but it increases our treatment possibilities.

STRIP or FUSS

Hair can´t be donated from other places of the body. So, a huge donor site is wasted.

Scars on pubis have been done, but it is unthinkable to do then in thorax and members to obtain additional hair. 

Follicular damage
FUE

No follicular units are damaged during extraction. If the surgeon decides not to remove the follicular unit he had chosen and cut the scalpel, this unit will follow its normal growth the same way as before. 

STRIP or FUSS

More than 30% of follicular units from donor site can be damaged by the scalpel when extracting or when nurses and assistants cut microscope dissection. 

Invasion scale
FUE

Non invasive.

FUE is considered as a non invasive technique. In fact, it is minor surgery and is classified as a medical act. The surgeon needs to have special training so that he can extract follicular units very well. He will not to damage any of its elements either.

STRIP or FUSS

Invasive.

Strip is considered as major surgery, it is an invasive procedure because it needs cuts on the skin and nerve and vessel section in the back side of scalp. 

The doctor needs to have special surgical skills so that scars are undetectable. 

Quality of Follicular Units
FUE

 

The quality and strength of the grafts removed are better than those extracted with the strip technique. The follicular units come out cleaner, removing them one by one than when they are separated under a microscope.

STRIP or FUSS

We could cut or damage more than 30% of the follicles of both sides of the strip where the scalpel cuts the skin, since the surgeon can´t see where he is cutting.

Follicular unit selection
FUE

FUE technique let us select follicular units that provide more density, which means that more hair can be transplanted for each number of grafts.  To restore frontal line we use 1-hair follicular units.

When the line is restored we will use 2 or 3-hair follicular units. For crown and parietal area we will use 2, 3 and 4-hair follicular units.

STRIP or FUSS

This technique is based on extracting a 20 cm long and 1 cm wide strip. If we take into account that average density is around 55-60 follicular units per cm2, we could extract between 1 000 to 1 200 follicular units. That is, if the patient has low follicular density we won´t be able to extract more follicles (with those measures) so we would need to make a bigger cut and the scar would be more anaesthetic. 

This is a disadvantage, since we can´t choose the most useful units for recipient site. 

Quality control
FUE

Surgeons are directly implied in the whole surgery process, so graft care is very well looked. The surgeon extracts and places all follicular units. 

STRIP or FUSS

Another bad thing is that strips are in nurses´ hands for its dissection in the microscope, so the doctor can´t control this step. Also, if assistants are not well trained, they can damage a high amount of grafts. It is basic to have an experienced team. 

Number of follicles per section
FUE

1200 to 1500 follicular units in 1 day.

2200 to 3000 follicular units in 2 days.

We are limited by the availability of hair in donor sites of the head and body.

Since units are extracted one by one, the doctor decides the exact number he will extract. So, both doctor and patient are happy because they decide to do it step by step or in a row (due to economic matters, tests…).

It is not limited to one area. We can take hair from a larger area and even in patients who have less density we could extract more follicular units per session with this technique. 

Larger number of 3 and 4-hair follicular units. 

STRIP or FUSS

Around 1 000- 2 000 follicular units are taken 1 day. Limited by the area, strip size (if a larger strip is needed, there would be a larger scar) and follicular density of it.  

There is a smaller amount of 3 and 4-hair follicular units. The total amount of follicular units depends on follicular size and strip density. When we extract the piece we can´t know the exact number of grafts. It does not allow consecutive tests of procedures.

Implantated
FUE

Use of implanters. 

It lets the surgeon control the insertion angle and growth of new transplanted hair. We always have to follow natural angle and growing direction of the patient hair. 

(It controls the angle; there is no fibrosis, higher density and proximity of grafts). 

Read more about implanters

STRIP or FUSS

Use of glass slide of the scalpel. 

Higher scale of fibrosis, less density and larger distance of follicular implantation. 

That day after the postoperative
FUE
24 hours later fibrin has recovered all stitches.

Stitches heal in a few days and they are undetectable. There are no external influences that affect healing because wounds measure less than 1 mm.

STRIP or FUSS

After removing strip it is needed to suture stitches. Even in an experienced surgeon´s hands and not using staples, we could find future problems regarding unaesthetic scar. These are factors don´t  depend only on the doctor. A surgeon can´t guarantee final results because he can´t control the attention the patient pays at the wound before it heals definitively.  

Postoperative recovery
FUE

FUE technique lets the patient play sports and lift up heavy things after 15 days of the procedure. Waiting period is only to let follicle units grow roots in recipient site. Donor site does not worry.

STRIP or FUSS

The patient can´t play any sports or go to the gym at least for 30 days after the procedure. Any movements involving head flexion (to tie shoe laces, to read, …) must be done very carefully in order not to inflict traction to the wound.

10 days after surgery
FUE

After 48-72 hours there is no sign of scab. After one week, there is no wound. 

No scab and good healing.

STRIP or FUSS

Withdrawal of stitches.

Final result
FUE

1 year.

STRIP or FUSS

1 year.