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Differences between FUE and FUT

Alopecia is a common problem that has always affected men and women, fortunately medicine has evolved over the years being able to offer an effective solution against common baldness. 

The best treatment to recover the fallen hair is the hair graft, each clinic uses a different method of hair surgery, the most recognized are the FUE technique and the FUSS-FUT-STRIP technique. 

We will explain what are the main differences between the FUE and FUSS-FUT method.

differences technique fue fuss

What is the difference between the FUE technique and the FUSS technique?

The main difference is the method of extraction of follicles, in the FUE technique follicular units are removed one by one according to demand (1, 2, 3, 4 and 5 hairs), while in the FUSS-FUT technique follicular units are removed after extracting a band or strip of skin with hairs from the occipital area, using a surgical instrument: the scalpel.

Surgical material used in hair surgery

In the implantation of follicles with FUE technique, the IMPLANTER is used, a professional surgical instrument with a diameter of 0.7 and 0.9 mm. 

The implantation helps to define the inclination and orientation of the hair (it does not leave fibrosis, the result offers greater hair density thanks to the proximity of the grafts).

While hair surgery with FUE method the scalpel is used directly, a strip of skin is cut to subsequently remove the hair follicles.

The difference in cutting is that in FUE is circumferential incision and in FUT linear incision. 

linear. Higher degree of fibrosis, lower density and greater distance of follicular implantation.

Method of extraction and patient recovery

Another difference between the FUE technique and FUSS- FUT-SRIP is that, in the FUE method, follicles are extracted one by one, using microsurgical tools of less than 1 millimeter in diameter. Follicle extraction is simple, painless and the area heals in 2 to 4 days. There is no risk of nerve damage.

While in the STRIP-FUSS method, a band of scalp (20 to 25 cm and 1 to 2.5 cm wide) is removed from the donor area using a scalpel that penetrates the dermis cutting nerves and vessels.

Subsequently, it is sutured and a period of about 30 days is required for complete healing, although sometimes, an alteration of sensibility persists for some months due to the damage produced in the nerves.

Alternatives to obtain more follicles (more hair)

In the FUE method, hair can be obtained from all over the body. Many patients have excess body hair which makes it easier to graft it to the scalp. 
Body hair is used to increase density in posterior areas of the head, it is never used in the frontal line.

In the STRIP or FUSS method it is not possible to obtain hair from the whole body with this method, depriving a huge donor area. 

Scars have been made in the pubis, but it is unthinkable to make incisions in the thorax or limbs to obtain additional hair.

Follicular damage that may occur

With the FUE technique no follicular unit is damaged during extraction. If for any reason the hair surgeon decides not to remove the follicular unit that had been chosen and incised with the micro-scalpel, it will continue its normal growth as it did before.

With the FUSS technique, more than 30% of the follicular units in the donor area may be damaged by the scalpel at the time of extraction and in the microscopic dissection performed by the nurses or assistants.

Degree of invasiveness

The FUE technique is not considered an invasive surgery. In fact, it is a minor surgery. The hair surgeon must be specialized and highly experienced in order to be able to remove the follicular units intact. FUE is the least invasive method.

On the other hand, the FUSS strip technique is considered a major surgery, it is an invasive procedure that involves a cut in the skin with section of nerves and vessels in the occipital (posterior) part of the scalp.

Quality of follicular units

Thanks to the FUE hair transplant method, the quality and strength of the grafts removed are better than those extracted with the strip technique. The follicular units come out cleaner when removed one by one than when they are separated under the microscope.

Continuing with the differences, in the FUSS - FUT method of hair surgery here the extraction of the strip can cut or damage more than 30% of the follicles in the lateral zones of the strip where the scalpel affects the depth of the skin since it is a blind cut. Clearly the quality of the follicular units is better if extracted with the FUE method.

Selection of follicular units in FUE and FUSS - FUT technique

In the selection of follicular units with FUE technique, it allows us to select the follicular units that will provide greater hair density. This means that you can receive more transplanted hairs for the number of grafts calculated. For the restoration of the frontal line we use follicular units of 1 hair.

When we already have the line restored we will use follicular units of 2, 3 hairs to densify the back of the line. In the crown and parietal area follicular units of 2, 3 and 4 hairs are used.

In the selection of follicular units with STRIP-FUSS-FUT technique, a 20 cm long by 1 cm wide strip is cut.

If we take into account that the average density ranges between 55 to 60 follicular units per cm2, between 1000 to 1200 follicular units will be extracted.

Explained in another way, a patient with low follicular density could not be removed more follicles, with the cutting measures indicated, for that it would be necessary to extend the cut, thus producing a larger unsightly scar.

This is a disadvantage because we cannot choose the most useful units for the recipient area.


What is the difference in quality of the follicles extracted with the FUSS - FUT and FUE method?

The care of the grafts is maximum since the surgeons are the ones who are directly involved in the whole surgery. The hair surgeon extracts and places all the follicular units.

Another unfortunate aspect of the strip extraction method is that the strip is passed to the supporting medical team for dissection under the microscope. 

The potential problem is that the hair surgeon does not control this step and the assistants who divide these follicles, if they do not have enough experience and practice, can damage a good percentage of the grafts that will later be placed. With the strip technique it is essential to have a well experienced team.

What is the difference between FUSS and FUE in the number of follicles implanted per day?

With the FUE method it is possible to implant 1200 to 2000 follicular units in 1 day and 2000 to 3600 follicular units in 2 days.

Our only limit is the availability of hair in areas of the head and body.

The specialist doctor decides the exact number of units removed, extracting them one by one. 

In the FUSS method 1000-2000 follicular units can be implanted in 1 day.

Limited by the area, by the size of the skin strip (bigger strip, bigger scar) and by the follicular density of the strip.

Smaller number of follicular units of 3-4 hairs.

The total number of follicular units harvested with the strip technique depends on the size and follicular density of the piece of skin cut by the scalpel. The number of grafts cannot be known exactly when the surgical specimen is removed. It does not allow testing, nor does it allow consecutive procedures to be performed.

Differences between FUSS - FUT and FUE technique in the postoperative period?

With the FUE method the extraction stitches heal in a few days and are completely undetectable without using any stitches. There are no external influences to the healing as the incisions are less than 1 mm.
The FUE technique allows the patient to play sports and lift weights 15 days after the procedure. The waiting period is only to allow the transplanted follicular units to create roots in the recipient area. The donor area is of no concern. At 48-72 hours there is no trace of scab. At one week there is no wound sequelae.
With the FUSS method the wound needs to be sutured with stitches. The strip method requires no sports or gym for at least 30 days after surgery. 
Due to the result of the suture by the scalpel cut, it can cause problems in the future by an unsightly scar.
These are factors that do not only depend on the surgeon. A surgeon can never guarantee the final result because he cannot control the care and traction he exerts on the patient before the wound heals definitively.

Which hair transplant technique leaves visible marks?

Clearly the FUSS technique brings with it the disadvantage that the area where the tissue is removed is marked by a scar. This scar will not be seen if the hair is left long, but if you prefer to wear it short it is quite visible. 

While with the FUE method there is no mark or scar from the surgery, which allows you to wear your hair very short without visible marks.