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A comparison between strip harvesting and FUE hair transplants – Part 2

We continue our comparison of the hair restoration surgical procedures of strip harvesting versus FUE.

In strip harvesting, doctors take strips of hair-bearing tissue from part of the head, dissect out individual follicular units and place them in the bald or thinning areas of the scalp.  FUE – follicular unit excision involves doctors taking follicular units with one to four hairs directly from the donor area and transplanting them elsewhere on the head.

In this second article of the three-part series we will talk about graft survival, graft placement and graft numbers. 

Graft Survival

Debate exists over the rate of survival using FUE versus strip grafts. There is some concern that since FUE grafts may have very little tissue surrounding them, they are less likely to survive. Such grafts are more prone to dehydration, which has been shown to be a major cause of diminished graft survival. The lack of tissue surrounding the hair follicle is often a result of “pulling” on the graft to remove it. Because there is added manipulation in trying to remove a graft this may also contribute to diminished survival.

Current techniques and instrumentation allow FUE to be performed with a chance of harming follicles to the same degree as strip harvesting given proper operator experience. In FUE the follicles may be damaged due to improper angulation of the dissecting device or insertion too deeply. In strip harvesting, grafts may be damaged in making the initial skin incisions and subsequent dissection of the tissue. The use of the microscope for dissection of the donor strip should limit damage rates to 1-2%. Grafts created with strip harvesting generally have a greater amount of surrounding tissue and fat. This will decrease the chance of dehydration and allow for greater leeway in manipulation of the grafts during placing. FUE grafts have less surrounding tissue are sensitive to dehydration and handling effects.  Studies indicate with the careful attention to these details, the graft survival between the two harvest methods are equal

Placing of Grafts

Care must be taken to implant all grafts while decreasing the risk of follicle trauma and dehydration. FUE grafts are more susceptible to these risks, however the use of special instruments such as implanters and inserters have minimized these risks.

Perfectly harvested grafts may be damaged during the placement phase and fail to grow. Trauma and graft drying are well known factors that may occur in inexperienced hands and will impact graft survival. Regardless of how grafts are harvested, there is a considerable amount of artistry and technical expertise necessary to place them to produce an excellent or even acceptable result. The surgeon must be able to create an aesthetic “blueprint” for graft placement, determining the distribution of 1, 2, and 3 hair grafts. Hairline design is obviously important, as is the grafting plan over the rest of the scalp.

Number of grafts per session

In general most physicians who perform FUE hair transplants cannot do as many grafts in a single session they can with strip harvesting. With strip harvesting, sessions of 2000-3000 grafts are very common and some physicians frequently perform sessions in excess of 4000 grafts. There are, however, exceptions and some physicians, routinely performing FUE, report similar in excess of 2000 grafts.

Read more on strip harvesting and FUE transplants here.

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