We hear this question very often, not only from our patients during consultations, but also from our young colleagues arriving for trainings in Tsilosani Hair transplantation Institute and even on hair transplant conferences from experienced doctors as well. Taking in account our experience (we use FUT method since 1998, FUE method since 2003, BHT method since 2006 and Long Hair Transplantation method since 2011), we can say that there is no direct answer to this question. Even more, we think that subject is incorrectly stated. Today it is impossible to give dominance to any of the above listed methods, as every of them have its positive and negative sides together with indications and contraindications.
FUT - Follicular Unit Transplantation (Strip) Method is the basic method in hair restoration surgery. In case of strip method donor material is taken from the permanent zone (the area in the back) as an ellipse shape skin. Advantages of this method are:
- Speed - FUT (Strip) method gives an opportunity to the experienced and multitudinous surgical team of harvesting and transplanting big amount of grafts faster, in a 3-4 hour lasting procedures rather than during FUE and BHT methods.
- In case of need FUT surgery allows us to transplant more number of grafts in a single session then in case of FUE surgery.
- FUT method gives an opportunity to harvest more optimal number of grafts from the same donor area then FUE.
- In case of having same donor density, FUT method gives possibility to more optimal use of donor zone in nape area, compared to FUE method. It is possible to harvest much more grafts with several FUT sessions. For example: In case of high scale hair loss (Norwood VI-VII classes) it is possible to harvest 7000-12000 grafts from patients permanent donor zone using several FUT sessions, when in case of FUE method only 4000-6000 grafts.
- Transection of follicular units using FUT method is minimal and during use of contemporary tools (open donor technique, stereomicroscopic graft preparation) for donor tissue harvesting and further processing by experienced surgeon and surgical assistants is lower than 3% (meaning that in every 100 hair roots only 3 of them are transected). In case of FUE method, this number is several times higher.
- Survival rate of transplanted FUT graft (follicles) is well researched and according to opinion of most of the authors is much higher (nearly 100%), compared to FUE method. It is clear that, using FUE procedure there is much more risk of trauma for the grafts during harvesting and implantation processes compared to FUT procedure, as FUE grafts are naked and have less connective tissue around. Although, many authors think, that FUE grafts have same survival rate as FUT grafts. A. Tsilosani’s research in 2004 “Survival Rate of FOX grafts” was the first paper in the world which showed, that FUT and FUE grafts have same survival rate.
- And finally, as FUT method includes mostly surgical assistant’s work force, cost is cheaper compared to FUE procedure.
The only disadvantage of strip method is a linear scar which appears on the back of the head on the same area from where donor strip is harvested. Though, our method of the donor wound closure based on trichophytic closure scar is not noticeable. The area from where the donor strip is harvested is hardly observable, but in case of short haircut or shaving of the head, it becomes noticeable (see photos).
One more weak side of FUT procedure is little bit uncomfortable postoperative period (numbness, low pain and feeling of stretching in nape area, also limitations on physical exercises during 2-3 weeks appear to be additional shortcomings of the method).
Follicular Unit Excision (FUE) is minimally invasive method of hair transplant when individual FU's are removed directly from donor area without slits and sutures.
- No linear scaring can be regarded to be main advantage of FUE method. Formatted scaring micro dots and depigmentation after FUs excisions are less detectable in case of shorter haircuts styles or even on totally shaved head.
- FUE method is less invasive compared to FUT method, as a result postoperative discomfort after FUE surgery is much more less.
- In case of low donor density in nape area, using FUE method, it is possible to harvest grafts from different parts of the body (beard, chest, legs and pubic)-with BHT method.
- During FUE procedure, grafts consist higher amount of follicles, compared to FUT method. Reason for this is that surgeon always targets multi hair FUs (containing 3-4 hair roots). Dr. J.cole’s research papers showed, that hair/graft ratio during FUE procedure done by experienced doctor’s is nearly 3, when in case of FUT method this indicator is 2 on average.
Negative sides of FUE method are:
- FUE procedures are longer in duration compared to FUT cases, as harvesting process of grafts are accomplished one by one.
- Using FUE method we can harvest much lower amount of grafts, then by FUT method. FUE technique requires wider donor area of higher density.
- Transection rate of follicles in FUE cases is several times higher, compared to FUT surgeries and in worst case reaches 10-15% and more.
- FUE grafts are exposed to much more trauma, then FUT grafts, as a result they need much more delicate treatment by assistants while implantation process and presumably have lower survival rate.
- As FUE surgeries require mostly doctor’s work, price of the procedure is higher than for FUT surgeries. If FUE surgeries are very cheap it means that they are done by surgical assistants only and this is regarded to be violation of laws in all countries of the world.
Long Hair Transplantation - is the modification of FUT surgery. It means the transplantation of follicular units with long hair shafts (2-8 cm in length) and not with short hairs trimmed up to 2 mm.
Long hair transplant along all the advantages which are characteristic for FUT method (speed, opportunity of transplanting more number of grafts in one session, more chance of using optimal donor supply, low rate of follicle transection and highest rate of survivability) has additional positive sides:
- During ordinary hair transplant procedures (FUE&FUT) implantation of grafts are done according to the doctor’s experience and preoperative planning, but actually blindly: density and angle of recipient sites depends on surgeon's decision. Then surgical assistants are implanting the grafts in pre prepared holes from where the hairs are starting to grow after 3 month. How will the transplanted hairs grow and how good cosmetic result will be received after the hair transplant, doctor is able to estimate only based on his private experience. Neither doctor nor surgical assistants see the result – Hairs!!! They see only a recipient area covered with bloody red dots. In case of performing long hair transplantation doctor clearly sees the result of the surgery which will be got after the procedure is finished. Moreover, this method give chance to distribute the hairs more precisely, estimate the angulations and the density better and finally achieve an excellently natural cosmetic result.
- Long hair transplantation allows the patient to see and get the result of the surgery immediately. This is the moment when their many years dream comes true, it’s a huge wave of positive emotions, what is an ideal program for successful growth of transplanted hairs.
- Unnoticeable postoperative period is one of the most important advantages of long hair transplantation. Patient leaves the clinic with already finished hair transplant result, with combed hairs, without any bandages, hemorrhages, scabs and swellings. Often happens when our patients after the surgery are going straight on business meetings and nobody notices there any trace of the hair transplantation undergone just several hours before.
Other advantages of Long Hair Transplantation are the following:
- More precise estimation of the transplanted hairs regrows percent.
- Estimation of the optimal density of transplanted hairs in individual patient’s case.
- Possibility of patients involvement into the hair transplant process.
- In case of transplanted hairs poor grow patient more easily acknowledges the reasons.
- Interactive determination of the Ideal density using the concept of the satisfactory.
- Understanding the importance of maintaining the patient’s donor resources in order to achieve the maximum good result.
The disadvantage of long hair transplant is the same as for FUT surgery – a linear scar on the back of the head. But in case of using the modern technique of donor wound closure, so called – Trichophytic Closure, then the scar on the back becomes unnoticeable, especially in case of long hairs.
Long Hair Transplantation needs a high professionalism and a big experience of the surgeon and the surgical assistant’s team. Procedure is more labor consuming then other methods of hair transplant and adequately more expensive.
According to all above mentioned it’s absolutely clear that the FUT method is not suitable for patients predisposed to developing keloid or hypertrophic scars. Also for the patients who prefer a short hair cut style or often shave the hairs. For such patient more recommended is FUE method. If patient suffers from high degree of the male pattern hair loss (V-VII classes by Norwood classification) and want to wear a long hair style then FUT method is more preferable. In case when patient is more motivated on the natural appearance of the transplanted hairs or feels the importance of unnoticeable and easy postoperative period, planning to wear a long hair and also has the long hairs exiting on the nape area the ideal offer for him is a Long Hair Transplant. The indication of BHT is only a poor donor supply at occipital area and a high level of the male pattern baldness.