Prospective clients usually ask about which is the best hair transplant procedure, once they conclude that surgery in general is the right course of action for them. Hair transplant surgery offers two main options: Strip Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE).

Strip FUT takes off entire patches of tissue from the donor area, harvests its follicles before implanting each of them onto the problem area. This method may have resulted in scarring during the first years that it was practiced, however methods have improved considerably and current practices result in less severe scars.

FUE is a more detailed process. The extraction as well as the implantation is on an individual follicle by follicle level. This method greatly reduces the risk and severity of scarring as compared to strip FUT. FUE also requires that the donor area and maybe even the entire scalp be shaved immediately before the surgery.

Strip surgery produces excellent results in most cases, however there is no denying that a FUE procedure is generally the most desirable method. It costs more than strip surgery, but the benefits such as reduced scarring make it worth the additional spend.

How much hair can be harvested using FUE?

It is more difficult to harvest through follicular unit extraction (FUE). There is a twenty five percent rule that represents the donor area on the sides and the back of the head. This area is one fourth of donor area or permanent zone and is distinguished from the original total hair count of the head. Up to two thirds to half of this donor area may be used as the maximum safe yield for FUE for a given period of time.

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This idea was derived from an article entitled “Hair Transplant Forum International”. To illustrate, say there is a total of 200,000 hairs or 100,000 follicular units located in the permanent zone. The twenty five percent rule allows you to harvest up to two thirds to one half of twenty-five percent of the permanent zone. This would total to about 16,667 to 12,500 hair units derived from the 25,000 units twenty five percent rule of the 100,000 follicular units in the permanent zone. This formula remains constant for the different densities of hair. Harvesting one out of two follicular units is the standard limit especially for those with lower density of hair.

On average, there are less than two hairs per follicular unit in Asians. This requires more follicular units to get about two hair FUE grafts. This might result in depleted looking hair on the sides and back of the head. Scarring may also be more noticeable because of this.

It is not recommended to harvest hair from the non-permanent area. They only have short-term benefits. The onset of aging and the natural balding process can greatly affect its effectiveness. Taking hair from the non-permanent area may also leave obvious scars. FUE should be confined within the permanent zone while respecting the twenty-five percent rule.

There is a case where a patient’s hair loss was greater than what was actually harvested from the permanent zone. The cause could probably be harvesting too many FUEs within a specified area in the permanent zone. It may lead to hair loss if the sessions are too close to each other. The blood supply may be affected which could potentially lead to necrosis and eventually, further loss of hair.

Harvesting should follow the twenty five percent rule in the donor area or the permanent zone. Sessions should be planned accordingly to avoid necrosis. FUE should be considered when doing long-term planning.

Strip surgery versus a FUE hair transplant