Fue vs Strip

[hair leaving]

I am about to schedule a consultation with Dr. Konior and was trying to figure out the advantages and disadvantages of the two. Also is the recovery time faster with one vs the other and which one is more succesful?

[Fixed by 35]

I'm not a doctor, but in the meantime from what I know:

FUE leaves less scarring and is typically essential these days for a natural look at the front. It heals quicker but is more expensive.

Strip is an older method, still often used on the crown because it's cheaper and hidden by the FUE at the front (so natural look is retained).

A doctor will fill in the details and correct me where I'm wrong!

[hair leaving]

Since my hair line is receding i should try to go with the fue then?

[Winston]

I'm not a doctor, but in the meantime from what I know:

FUE leaves less scarring and is typically essential these days for a natural look at the front. It heals quicker but is more expensive.

Strip is an older method, still often used on the crown because it's cheaper and hidden by the FUE at the front (so natural look is retained).

A doctor will fill in the details and correct me where I'm wrong!

That’s completely incorrect.

FUE and FUT are both methods of extracting follicular units. Fue is a method where the doctor removes one follicle at a time from the back or sides of the head leaving, in many cases, a tiny white scar (1000 grafts=1000tiny scars). FUT uses the strip method where a strip of scalp is removed from the donor area in the back of the head and cut into follicular units under a microscope. In the end the follicles are the same but extracted differently so there is no difference in using FUE or FUT for hairlines except for cost and recovery time.
FUT is still the most performed type of hair transplant because of it consistent results.

[hair leaving]

Thanks winston as i see you took the time out to answer another post i had as well. Now my next question is which is more likely to work and have fue ht not worked?

[mattj]

It is often said that with FUE you are less likely to get full yield, meaning that some of the transplanted hairs don't grow, probably due to being damaged during the extraction process. Some FUE doctors have said this themselves so I'm sure there is some truth to it, but it seems to me that of the relatively limited number of cases I've seen (compared to strip), the results, especially from the crop of European FUE doctors, seem to be very successful.

You often hear FUE advocates talking as if the procedure leaves your donor area looking untouched, but I'd caution against this. I think the donor can often look quite ravished and the extraction marks fairly noticeable when the hair is shaved down. Obviously this will depend on the number of grafts taken and the individual's healing characteristics.

[CIT_Girl]

The strip technique is currently the most widely practiced form of hair restoration surgery. It involves the excision of a strip of scalp from the back and sides of the head. This strip is then dissected into smaller units and then further subdivided into individual follicular units under a microscope. Meanwhile, the open wound is closed with sutures or staples.

Despite its prominence, there are several drawbacks to the strip method. Most notably, this method leaves a linear scar in the donor area. It is difficult to predict the width of the scar you will be left with; contributing factors include scalp laxity, the skill of your physician and personal healing characteristics. With a strip scar, you will no longer have the option of wearing your hair short, or shaving your head, without the tell-tale linear scar being visible. Additionally, a strip procedure will cause irreversible changes in the donor area’s hair growth angles so, even with a longer hair cut, people may be able to tell you have had a hair transplant procedure.

The strip method of hair transplantation is a more invasive procedure that involves the use of a scalpel to remove a portion of tissue from the back of your head. Recovery can be uncomfortable with numbness, tightness and/or soreness for up to two weeks. Another drawback of this method is that it results in a scalp reduction in the donor area (as you are excising a portion of the scalp). This reduction in laxity can be uncomfortable, is irreversible and can prevent you from being able to harvest more donor hair if your hair loss persists in the future.


Follicular Unit Extraction (FUE) is a method of follicular extraction by which follicular units are removed individually from the donor area. With this technique, there is no need for a linear incision and, therefore, no linear scar. However, as mattj noted, FUE can leave its own type of scarring: immediately following a procedure, the patient will have small (<1mm) scabs where the donor hair was removed. These scabs will normally shed within a week though small red dots may remain. Depending on personal healing characteristics, these dots may remain red for a short period of time, turn lighter or be skin-toned and nearly invisible. However, FUE scars (usually called hypopigmentation) tend to be virtually undetectable due to the surrounding hair remaining (depending on how short hair is kept).

FUE is less invasive than the strip technique, as it does not require a large scalpel incision or sutures. This greatly decreases healing time in the donor region and greatly decreases any post-op discomfort. Patients can resume even strenuous activities the very next day following a procedure.

FUE provides an extended donor region from which your physician can graft from because they are not limited to a single strip of hair. With this method, your surgeon can extract hair from the nape of your neck or even extract body or facial hair. This ability also allows the physician to “cherry-pick” follicular groups which will yield the most optimal and consistent results. I would contend that yield rates for FUE and FUT are very similar (though this obviously depends on the characteristics that vary from patient to patient as well as the skill of the surgeon). FUE is not more likely to damage grafts during the extraction phase and, if anything, FUE transection rates tend to be very low (Dr. Cole's transection rate is consistently under 2 or 3 percent). Another point to note is that strip surgeons average 2 hairs per graft whereas, with the CIT method (Dr. Cole's proprietary method of FUE), Dr. Cole averages 2.9 hairs per graft. This means the patient is getting almost one hair more per graft of value for their money, or about 30% more hair in each graft. This sort of bonus can make the cost difference between strip and FUE negligible.

Regardless of the type of procedure you elect to have, the success of your procedure will ultimately depend on the skill of the surgeon you choose (and their skill in the method you select), and having realistic expectations and a solid long-term plan.

[ebutterg]

Fue v Strip

Edited for retraction

[Winston]

Thanks winston as i see you took the time out to answer another post i had as well. Now my next question is which is more likely to work and have fue ht not worked?

FUE is said to be less consistent on average, but that could be because most doctors claiming to perform it don’t know what they are doing. If you go for FUE go with a surgeon who specializes in them like Dr. Cole. Check with the IAHRS to see who they recommend for FUE. Don't go with a clinic who lets assistants remove all of the grafts. I understand that this is a growing trend. You asked about Dr. Konior, I have only seen his results on this forum, but if he’s in the IAHRS he’s considered to be a top ht doc.

[CIT_Girl]

One thing these FUE docs and reps tend to leave out is that FUE results in far less total donor availability. So if you know you're going to need more than 3000 grafts in your lifetime, you better go with strip. After 3000, you risk patchiness - or risk extracting outside the safe donor zone. Only Shapiro group concedes that 3000 is probably the safe maximum. Strip on the other hand you have approx 8000 grafts to work with. And it's always better to start with strip then if you have to move on to to FUE because once you start with FUE it makes strip far more difficult. CITGirl and Cole always seem to ignore these very material facts.

Donor availability is not anymore limited with FUE than it is with FUT. With FUE, you can easily remove 4,500-7,000 and still maintain an acceptable level of coverage in most cases. Sure, if you have a shaved head, you may see areas of hypopigmentation after very large cases but I'm not convinced that this is any worse aesthetically than the strip scar(s) you would be left with after harvesting the same number via FUT. If you have a very large procedure, regardless of extraction method, your donor area will never look as pristine as an 'untouched' region but the cosmetic result, in my opinion, is definitely better with FUE.

Obviously, there's no "one size fits all" hair transplant procedure but I happen to find FUE/CIT to be the superior procedure. FUE/CIT leaves no linear strip scar, is less painful, requires a shorter recovery time, doesn't cause tightness in the scalp and is less invasive. With FUE/CIT, you always have the option to wear your hair short without worrying about the tell-tale strip scar being visible. On the other hand, FUT tends to be cheaper so if your primary concern is getting "more bang for the buck", and you don't plan on wearing your hair short in the future, FUT might be a good option for you.

[ebutterg]

Edited for retraction

[CIT_Girl]

You accuse Dr. Cole of ignoring “very material facts” but, to be fair, he has performed far more FUE/CIT procedures in the U.S. than any other doctor, and these procedures have been 90-100% of his practice since 2003. Other doctors may limit FUE procedures to 3,000 grafts but a lot of these self-proclaimed FUE doctors are actually relative novices when it comes to FUE: they only have a few years experience, they have limited instrumentation, and/or their offices aren’t primarily dedicated to FUE. Almost every doctor claims that they perform FUE but almost all have indicated they believe FUE is only for very small procedures, such as scar grafting. If you truly want to be the best at something, you have to believe that it works. Since he developed his CIT procedure, Dr. Cole has always viewed it as a stand-alone technique for all patients, superior to any other method out there. Dr. Cole has numerous patents and patent applications relating to FUE, and has developed all his own instruments for the technique (FUE instruments were non-existent when he started). We have a full-time engineer on staff to further the advancement of CIT, independent global licensees who were trained by Dr. Cole and many results on our website dating back to 2003. I think most people would concede that Dr. Cole is an authority on FUE.

The majority of purported FUE doctors may draw the line at 3,000 grafts, less than 20% of the 16,600 follicular units in the average donor region, but why? Maybe some doctors don’t like the drudgery or time it takes to perform larger FUE sessions; maybe they lack proper instrumentation or skill. Regardless, you can certainly take more than 25% of the donor area, and sometimes up to 50%, while still maintaining an acceptable level of coverage.

You reference “buckshot” scarring in your post. The fact is, some patients will heal flawlessly and some will heal with the small white dots (called hypopigmentation). We can’t predict who will get them and who will not, though lighter-skinned individuals tend to have better healing. We’re currently researching a possible solution whereby we apply ACell to extraction sites to see if it may alleviate the appearance of hypopigmentation. For patients who do develop hypopigmentation, they can simply grow their hair to 1 to 3 millimeters in length and it will be completely hidden.

In contrast, the second you have a strip surgery, you will have a scar and it will be visible if you shave your head: it will look like you had a surgical procedure on the back of your head. With your hair at 1 or 3 millimeters in length, the scar will still be apparent. Why discourage people from having a procedure that, in the worst case scenario, will require you keep your hair 1 to 3 millimeters long to hide a reduction in pigmentation, yet endorse a procedure in which you can never again shave your head?

Per your request, I’ve attached pictures of three procedures. In these photos, you can see the donor region of three different patients following a 5,000 graft surgery, a 5,700 graft surgery and a 9,200-graft surgery. The latter is shown as a close-up and wet since it was non-shaven. This patient’s hair is certainly not as thick as it was prior to having any procedures, yet this patient certainly wasn't disappointed in the cosmetic appearance of his donor region, particularly considering that his hair was completely restored using almost 10,000 grafts.

1. (5,000 grafts)

2. (5,700 grafts)

3. (9,200 grafts)

[Winston]

Very impressive pictures CIT girl. I certainly think it was inappropriate for ebutterg to accuse you or Dr. Cole of exaggerating your clinics ability to perform large FUE sessions. The proof lies in the results and it appears that you guys do a top notch job. I’m not sure if FUE is superior to FUT, that’s debatable, but I do think it’s a good option for a lot people and Dr. Cole is one of the best that I’ve seen online.

[CIT_Girl]

Well, thanks for your comment Winston...I know you're a veteran poster, very knowledgeable and well-respected on this board so that means a lot coming from you!

[bigmac]

Hi CIT Girl.

5000 grafts is an awful lot to extract via FUE imo,would it be possible for you to post the immediate post op pictures of the above patients showing the extraction sites and the area they were extracted from.
This way we can truly compare the the post op look.
Thanks bm.