A comparison between strip harvesting and FUE hair transplants – Part 3
We conclude our three-part series, “Strip Harvesting versus FUE” in discussing a number of remaining issues between the two procedures.
In strip harvesting doctors take strips of hair-bearing tissue from part of the head and place them elsewhere, while with FUE – follicular unit excision, doctors take follicular units of one to four hairs instead of entire strips, and transplant them elsewhere on the head.
A somewhat different skill set is required for FUE harvesting. The surgeon must be able to align the small punch correctly, find the right depth and adjust the punch to account for changes in direction of the hair. The goal in hair restoration is to minimize damage to hair follicles whether it is in strip harvest or FUE as damaged follicles are less likely to grow. In strip harvest the follicles can be damaged during the removal of the strip or during the process of removing the follicles from the strip. During FUE, there is a heavy reliance of physician skill and the instrumentation being used to minimize follicle damage as the follicles are not seen as during a strip harvest.
FUE can be a tedious process and both patient and physician may experience fatigue. This can limit the amount of grafts that can be harvested in a single session.
The learning curve for FUE can be slow for physicians who are used to excisions with scalpels and unaccustomed to the use of punches. Working at a shorter focal distance can be tiresome and lead to neck problems.
The cost of FUE is usually significantly more than that for strip harvesting on a per graft basis. On average, the cost per FUE graft may be 25-100% greater than the cost of strip grafts depending on the clinic.
FUE can be very useful for harvesting body hair. In such situations the majority of follicular units are single hairs.
Small Number of Grafts
When small numbers of grafts are needed, FUE may be an excellent choice. It avoids a linear scar and the extraction sites can be easily camouflaged even with shorter hair.
FUE into Scars
FUE can be used to try to camouflage linear donor scars. The grafts can be obtained from the scalp or body hair, the beard being a very reliable source of good donor follicles. This is considered by many hair restoration surgeons to be an excellent use of this technique.
Combination FUE and Strip Harvest
Performing both harvest techniques in a single surgical session (even if over two consecutive days) is a method used to provide a patient with as many grafts as possible. For example, a patient may obtain 2800-3200 graft by strip harvest and an additional 1200-1800 grafts by FUE for a total of 4000-5000 grafts in a “single” session using two harvest techniques. It is generally accepted that for a patient to obtain as many grafts as possible from their donor area both FUE and strip harvest are needed.
It is generally accepted that the majority of patients having FUE experience less post-operative pain and have a shorter recovery time as compared to strip harvest. This is likely due to the fact that approximately 50% less skin in total is removed with FUE as compared to strip for the same number grafts and that the trauma is spread out over the entire donor area. However, there are some FUE patients that have significant pain for weeks following a procedure and strip patients that experience minimal, if any, discomfort.
Both procedures can cause ingrown hairs in the donor region that are self-limiting and rarely need intervention. Bleeding occurs with both techniques, but it is not considered a problem with either technique.
Strip harvesting and FUE are both acceptable techniques for harvesting donor grafts. Each technique has advantages and disadvantages. On a cost-benefit ratio, strip harvesting would seem to provide the most cost-effective procedure, however FUE is best suited for patients who insist on not having a linear scar. It may be an excellent choice for younger patients who may want to wear a shorter hairstyle at some time. FUE is the ideal choice for harvesting beard, chest, abdominal, leg and arm hair. FUE grafts are an excellent way to camouflage strip scars.