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A comparison between strip harvesting and FUE hair transplants – Part 1

Years ago, experts started advocating a new way of performing hair transplant surgeries. Instead of the traditional strip harvesting– meaning that doctors would take strips of hair-bearing tissue from part of the head and place them elsewhere, the experts started advocating FUE hair transplants. FUE stands for follicular unit extraction, which means taking follicular units of one to four hairs instead of entire strips, and transplanting them elsewhere on the head. The “new way” has been slow to catch on. Many physicians have tried the FUE technique with varying degrees of success.

Here, we will begin a three-part series comparing various aspects of both methods.

In this article, we will review the Donor Area and Scar Formation. 

Donor Area and Scar Formation

Strip harvesting produces a linear scar. The appearance strip scar can be a significant concern for patients who wear their hair very short. The majority of patients who undergo strip harvesting have minimal scars that are easily concealed by the hair above the scar. In many instances, the scar may not be evident at all, except on careful inspection. There are, however, some patients who have scars that have widened, and there are also patients who have several scars from multiple procedures.

Careful planning by the surgeon can diminish problems with strip scars. By limiting the width of the strip taken, the surgeon can minimize the donor scar. To avoid multiple scars, many physicians who use strip harvesting employ a single scar technique, even if multiple procedures are performed. By utilizing careful dissection along the incision line, damage to hair follicles can be diminished. Closing under minimal or no tension can also help to avoid the widening of a scar. This allows hair to camouflage the scar and the hair growing through the scar can limit the stretching. Avoiding damage to the hair follicles along the incision lines is crucial in preventing the appearance of a prominent scar.

The primary rationale for the use of FUE hair transplants is that a linear scar is avoided. Several proponents of FUE say it does not involve cutting, is less invasive and does not result in scars. While a linear scar is not created, there are circular scars. The length of incision is greater with FUE than with strip harvesting.

“Cutting” is involved with FUE, and scars are created as evidenced by discolored “dots” visible when the hair is cut very short. These “dots” may be a scar reaction or post inflammatory pigment changes, particularly in darker skinned individuals.

With FUE, as more and more grafts are harvested, the area may appear moth-eaten. If grafts are taken too close together, there may be an appearance of a scar. In some patients, when large numbers of grafts are removed there can be a clear line between the areas that have been harvested and left alone. This is opposed to the strip technique where hair of similar density is brought back together at the suture line.

Read more on strip harvesting and FUE hair transplants here.

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