Differences: FUE - Strip
Now we are going to summarize the benefits of the new FUE technique, in which the use of scalpels and sutures, habitually used in the strip technique, are eliminated. We have 11 years of experience in hair transplant and we have performed many operations with the strip technique with excellent results. We have 11 years of experience in hair transplant and we have performed many operations with the strip technique with excellent results. However, we have always wanted to be at the cutting edge of technology. For that reason, during the last 5 years we have been investigating various methods of follicular extraction that avoid leaving a scar in the donor site, always a serious hindrance in this kind of surgery. But now we can announce that we have developed a revolutionary method called FUE (Follicular Unit Extraction) which offers many advantages over the old method by means of the strip technique. We have prepared this table to clearly explain the advantages of FUE over the strip technique.
Strip Technique
FUE Technique
Summary of the procedure The hair transplant has been based for many years on the extraction of a strip of skin, which implies that a band of scalp (20 to 25cm long by 1 to 2.5cm wide) is extracted from the donor site using a scalpel which penetrates the dermis, severing nerves and vessels. Afterwards the area is sutured and requires a period of some 30 days for complete healing although sometimes there is a change in the sensitivity which remains for a few months and, in rare cases, remains permanently. Due to the damage caused to the nerves, a small percentage of patients may never regain complete and normal nervous sensitivity in the posterior part of the head.
Summary of the procedure The extraction of follicular units (FUE) is currently the best technique for obtaining grafts from the donor area. The follicular units are extracted one by one using microsurgical instruments of less than 1 millimeter in diameter. The extraction process is straight forward, painless and the donor area heals over between 2 and 4 days. There is no risk to nerve tissue. It’s an excellent choice for patients who can´t afford to rest for 30 days while the scar heals correctly. There is never any scalpel or sutures used. As we have said, the FUE technique is minimally invasive and tolerable by the patient.
Extraction from the donor area The strip which is excised from the posterior zone is transferred to the auxiliary staff whose job it is to cut and divide the scalp into follicular units (FU´s) with or without the help of a microscope, depending on the procedures adopted by that clinic.
Extraction from the donor area Each follicular unit is delicately extracted one by one by the surgeon who uses magnifying lenses.
Follicular Damage More than 30% of the follicular units from the donor may be damaged by the scalpel during extraction, and also during the microscopic dissection performed by the nursing or auxiliary staff.
Follicular Damage The greatest benefit of the FUE technique is that there is no damage done to the follicular units during extraction. If, for whatever reason, the surgeon decides not to extract a particular follicular unit that had already been chosen and subjected to the micro scalpel, this follicular unit will continue its normal growth as before.
Surgical Technique The strip method is considered to be major surgery; therefore the doctor who performs the operation should be a surgeon and not a dermatologist or general practitioner. It is an invasive procedure which implies an incision of skin, nerves and vascular tissues in the rear occipital area of the scalp. The doctor who performs this procedure must be very skillful in
Surgical Technique The FUE technique is not considered to be invasive surgery. It is in fact minor surgery, classified as a simple medical procedure. The operating surgeon should have specific training in a recognized centre to be able to extract the follicular units intact and without causing damage to them.
Extraction of the Follicular Units In the strip method the surgeon requires the scalpel to cut deeply into the scalp, consequently severing nerves and vessels in the dermis. For this reason the patients often experience temporary numbness and in rare cases permanent numbness in the donor area.
Extraction of the Follicular Units The follicular units are removed with micro scalpels of diameters from 0.5, 0.75, 0.80 to 1.0 mm, depending on the number of hairs in the FU being extracted. This is a minimally invasive technique in which the patients feel no pain or changes in sensitivity in the donor area. The wounds are tiny and completely heal within in a few days.
Post operatory sutures After having removed the strip for the rear area, the wound must be closed with sutures and stitching. The pulling on this wound is our worst enemy when it comes to leave them undetectable. To help avoid this, we suture at two different levels: the first level is subcutaneous with absorbable material and the second level is external with non-absorbable material which is removed after a minimum period of 2 weeks. The surgical technique is fundamental if we want to avoid permanent scarring, colloids or marks left by staples. However, even though the technique is perfect, there is always the possibility of the above mentioned problems occurring as the surgeon cannot guarantee the end result as he is unable to continually control the care and pulling exercised on the area by the patient before definitive healing occurs.
Post operatory sutures The extraction points scar over in a few days and are completely undetectable and don’t need any kind of stitching. As the wounds are less than 1 mm, there are no external influences. After 24 hours fibrin will have covered all the extraction points. From 48 – 72 hours, there are no signs of scabbing. After a week there is no sign left of wounding.
Post operatory recovery Sports or gymnasium are forbidden for 30 days following the strip procedure. Any kind of movement which involves stretching the area behind the head (tying shoelaces, reading...) must be done very carefully so as not to pull on the wound.
Post operatory recovery The FUE technique allows a patient to practice sports and gymnasium just 8 days after the procedure. The waiting period is so that the transplanted follicles can grow roots in the recipient area. The donor area requires no further care.
Quality of the donor follicular units Unfortunately, in the extraction by strip it’s possible to cut or damage more than 30% of the follicles in the sides of the strip where the scalpel cuts deeply and blindly into the skin. Afterwards the assistants separate these units individually under the microscope to avoid later damage.
Quality of the donor follicular units One of the most vital aspects of this technique is the quality of the units which are removed. We have found from our studies in previous years that the quality and strength of the grafts removed are better than those extracted by the strip method. The follicular units are much cleaner when removed one by one then by separating them under the microscope. This also helps to reduce wounding to the recipient area. Our surgeons have presented these studies in various seminars on hair transplants.
Selecting donor follicular units When the skin is removed from the rear of the head and placed under the microscope, the units are separated in function of how many hairs each unit contains (1 – 4). This is a disadvantage because we cannot choose which units are best for the recipient area. Designing a front hairline is not the same as adding density to the crown area. With the strip technique we have to use the hair that is available independently of what the recipient area is.
UF,s 1 and 2 hair
Selecting donor follicular units The surgeon selects the units required for the are being repopulated. For a front hairline, he will select mainly those follicular units with 1 or 2 hairs rather than those that have 3 or 4 hairs. On the contrary, when adding density to the parietal or crown area, the units chosen are mainly of 3 or 4 hairs, and always imitating the natural distribution of the hair. This choice is only possible when the units are extracted one by one. Today it is unthinkable to construct a front hairline with 3 or 4 hair follicular units as the result would not be natural.
UF,s  3 and 4 hair
Control of surgical quality Another unfortunate aspect of the method of extraction by strip is that the strip is dissected under microscope by the nursing staff. The potential problem is that the doctor doesn´t supervise this step and the auxiliary staff who are performing it. If not well trained, they can cause damage to a good percentage of the grafts before they are inserted. Therefore with this method it is fundamental that the team is experienced enough.
Control of surgical quality Given that the doctor is directly involved in each step of the procedure, the quality control is optimum and the care taken of the grafts is maximum. The surgeon extracts and places all of the follicular units.
Exact control of the number of grafts The total number of follicular units harvested with the strip technique depends on the size and follicular density of the skin removed by the surgeon. The number of grafts cannot be determined exactly when surgically removing the strip of skin. This method doesn´t allow for tests or follow up procedures. Macro sessions are possible but with the number of FU´s being limited by the scar.
Exact control of the number of grafts The exact number of units removed is determined by the surgeon by removing them one-by-one. This allows us to perform surgery "a-la-carte", where the surgeon and patient decide whether to perform the procedure in one go or perform it over several procedures "little by little" (usually for economic reasons, tests...). The macro sessions can be done over two or three consecutive days. The number of FU´s which can be removed in these mega sessions is large due to the amplified donor zone.
FU Extraction from other areas of the body This method prohibits extracting grafts from other areas of the body, depriving the patient of an enormous donor area. There have been scars left in the pubis area from strip procedures, but it would be unthinkable to make incisions in the thorax or limbs to obtain additional hair.
FU Extraction from other areas of the body With FUE hair can be harvested from the entire body. Many of our patients have excessive body-hair and are happy to use it to repopulate the scalp. Body hair is used to augment density in the posterior region; it is never used in the front hairline. Many of our patients have body hair with an identical texture and growth pattern as in the scalp. Not everybody is a candidate, but it does increase our possibilities of treatment.
Scar One of the most unfortunate aspects of the strip technique is the scar that it leaves. It doesn´t matter how good the surgeon is, there will always be a scar in the donor area and, even though it is linear, it always be visible because there is no hair growth in the scar. The patient who undergoes a hair transplant with the strip technique rejects forever the idea of wearing their hair cut short in the donor area.
Scar With FUE there is no kind of scars whatsoever. Our patients can shave their head or wear their hair as short as they like, for the rest of their lives. With the FUE technique, the patient can choose their particular hair style at any time they want.
Healing time The first disadvantage of the strip technique is that, if considering a second procedure, the patient will have to wait some nine months for the donor area to completely heal and obtain sufficient elasticity in order to be able to safely remove a second strip. The strip method is not advisable for small sessions due to the risk of tearing the wound, colloids, infection, nerve damage or permanent numbness in the zone. A strip session should obtain the maximum number of grafts possible in one go. The patient will never be able to choose less intense sessions o even tests because every new scar increases the chance of the above mentioned risks occurring.
Healing time The FUE technique allows for the patient to tell the surgeon the exact number of follicles which he wants to transplant at that moment. This is an excellent benefit for the patient as he can plan the procedure and decide what will be the number of grafts allowed by his budget and agenda. Contrary to the strip method, the patient can ask for any number of follicles, greater than 100, to be transplanted at any one time. There is no difference in the healing, recuperation and risks between small and big sessions. The patient has complete control over his hair restoration from the beginning to the end. There are no time restrictions between sessions.
Maximum results The strip method also limits us to a maximum of 3000 to 3500 grafts (absolute maximum) in one procedure.
Maximum results The FUE technique allows us to extract as many units as we need. Currently we are extracting between 1500 and 2000 FU´s per day. We are only limited by the availability of hair in the donor areas of the head and body so mega sessions of 4000 units are actually normal in cases of extensive alopecia.
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Advanced Hair Transplant Clinic PIONEERS IN SPAIN Year 2003 FUE TECHNIQUE