FUT or FUE hair transplant: how to choose?

Un chirurgien et son assistant en train de faire une greffe capillaire
Patients suffering from baldness are well aware that hair transplants are the most suitable surgical solution to correct their hair problems in a permanent and aesthetic way. However, when they start to do some research online or discuss it with their surgeon, they realize that they have to choose between two hair transplant methods: the FUT hair transplant and the FUE hair transplant.

The differences between FUT and FUE hair transplants

The difference between FUT and FUE hair transplants is not the result: it will be natural and definitive and will take about a year to stabilize. In both cases, the doctor takes hair follicles from the area spared by androgenetic alopecia, which he then injects into the bald area(s).
The main difference between the two grafting techniques is the method used to extract the hair bulbs. To perform an FUT graft, the surgeon must first extract a strip of scalp from the occiput, which he then cuts into micro-grafts or mini-grafts. When performing an FUE graft, he extracts the grafts follicular unit by follicular unit using a micro-punch measuring between 0.8 and 0.9 millimeters in diameter.
How to determine which method is best suited to the patient’s needs?

What criteria should be considered?

Consultation pour une greffe de cheveux

The chosen technique will depend primarily on medical criteria, although some practical criteria may also be taken into account.

Hair characteristics

During the consultation, the doctor carefully examines the patient’s hair characteristics. This includes measuring:
  • density and number of hairs per follicle: both transplant techniques are possible, regardless of the hair density and number of hairs per follicle.
  • the diameter of the hair: when patients have fine hair, a FUT transplant is sometimes recommended because the “density effect ” is inferior with the FUE method.

Size of the area to be corrected

The surgeon will measure the size of the area to be corrected during the pre-operative clinical examination. An FUE transplant is the most appropriate solution for small or medium baldness, since up to 2,000 grafts can be harvested in a single session. On the other hand, if the alopecia is diffuse or very advanced and the patient’s hair supply allows it, then the doctor will recommend an FUT transplant, since this technique allows the extraction of up to 4,000 grafts in a single session.
It is possible to correct a large alopecia with the FUE technique, but it requires several sessions. On the other hand, if the alopecia is very advanced, the surgeon can perform both techniques in the same session. In this case, he uses the FUT method to remove the grafts from the occiput and the FUE method to remove those from the temporal areas. The combined use of the FUT and FUE procedures increases the size of the donor area by 30-50%.

Scalp flexibility

Scalp flexibility – also known as “laxity” – is another criterion that must be taken into account when considering an FUT graft, as insufficient laxity will make it difficult for the donor area to heal. Scalp flexibility is assessed during the preoperative clinical examination. If the results are insufficient, then he may recommend an FUE graft rather than an FUT graft.

Type of hair

There are no particular contraindications for patients of European and Asian origin to either FUE or FUT transplants. However, the FUT technique is strongly recommended for patients with curly hair. These hairs have the particularity of curling under the capillary dermis and strip extraction can significantly reduce the risk of a bad extraction.

The scarring process

If the patient scars poorly, then the surgeon will prescribe an FUE transplant. The procedure is minimally invasive. The wounds resulting from the extraction of follicles measure less than a millimeter in diameter, so they heal easily.
Contrary to popular belief,  FUT transplants can be considered in cases of difficult scarring. In this case, the surgeon simply uses cosmetic surgery techniques to make the scar as discreet as possible. In fact, the scar is no more than one millimeter high and blends perfectly with the hair.

Shaving

In case of a minor baldness, both transplant techniques can be used without shaving. However, if the baldness is significant, the FUE procedure will involve shaving all or part of the scalp. The FUT method is frequently recommended to patients, especially women. Since the development of the FUT technique for long hair by Dr. Pierre Bouhanna, it is no longer necessary to shave the donor and receiving areas. As a result, fewer sessions will be required to graft the same number of implants without shaving.

Patient sensitivity to pain

The procedure is completely painless, regardless of the grafting technique used, as long as it is performed under local anesthesia. The surgeon may even prescribe an ointment to make the anesthetic injection painless for the most sensitive patients. On the other hand, the FUT technique often causes discomfort and tightness in the donor area after the procedure. However, these are mild pains that can be managed with paracetamol and do not last more than three days. The FUE transplant being less invasive, it causes less post-operative pain.

Patient availability

The FUE procedure is longer than the FUT transplant, simply because the extraction of grafts is done follicular unit by follicular unit. Between 3 hours and 3 hours and a half are needed for 1,000 grafts and between 5 hours and 6 hours for 2,000 grafts. The patient stays between 2 and 5 hours in the operating chair for a FUT graft, depending on the size of the area to be re-densified.
You can contact the CMCC if you want more information on FUE or FUT transplantats at 01 84 83 14 00 or make an appointment by clicking here.