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Not Your Father’s FUT – How Advancements Have Refined This Classic Procedure

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Not Your Father’s FUT – How Advancements Have Refined This Classic Procedure

Male Hair Restoration,

The follicular unit transplantation (FUT) or “strip” method of hair transplantation tends to be considered antiquated by many who are considering hair restoration surgery. Consumer preference for the follicular unit excision (FUE) procedure has increased over the years for a number of reasons – some of which are misconceptions based more upon marketing than fact. However, refinements in the procedure have greatly reduced the early drawbacks, and may be the better option, depending upon one’s circumstances.

The FUT was a breakthrough technique when developed and introduced in the mid-1990s, providing a significant aesthetic improvement over the “mini-grafting” and “micro-grafting” methods then prevalent. These tended to create the unnatural telltale corn row, doll hair, pluggy-looking results associated with hair transplants of yesteryear.

As Dr. Marco Barusco – Founder and Chief Medical Officer of Tempus Hair Restoration – explains in his video – “Is FUT or Strip Surgery a Thing of the Past?” – on his YouTube channel, Hair Loss Medical Advice, the FUT is performed by removing a finger-width of scalp, with the lower and top edges of the incision brought together and stitched. This results in a pencil-line linear scar across the back of the head that is concealed by hair. A haircut with #3 or #4 clippers on the back and sides of the head usually completely conceals the donor scar.

“The suturing technique that we use is sort of like a baseball stitch,” says Dr. Barusco. “It’s called the running suture. Basically, there are knots on the ends and then just little loops bringing the tissue together. Almost immediately, the lines practically disappear. The stitches that we use now are dissolvable, so you don’t have to even come in to the office to have them removed. The hair will curtain over, completely concealing the stitches. The typical patient assumption about the FUT is that it will be aggressive and painful, and leave a huge scar that they will not be able to cover. This is not true.”

The Difference Between FUT and FUE Procedures

The FUT procedure involves harvesting a very small strip of hair and skin from the donor area, then placing it under a microscope to be prepared for implantation as hair grafts. Also known as a hair implant or follicular unit, a hair graft is a cylinder of skin and hair that encompasses the hair follicle, the sebaceous gland (which secretes sebum – a lubricating oily matter – into the hair follicles to lubricate the skin and hair), the arrector pili muscle (a microscopic band of muscle tissue which connects a hair follicle to the dermis), and the papilla – or bulb – of the hair. A hair graft includes all of these structures. Each follicular unit graft can contain one to three (or even four) hair follicles. Our blog post – “An Up-close Look at Hair Grafts” – covers this topic in greater detail.

The FUE involves harvesting follicular units from the scalp individually with a small diameter round punch. As Dr. Barusco explains in his YouTube video – “Are There Advantages of FUT Over FUE?” – “They need to be harvested with good quality and without trauma. These hairs – these groups of hairs – are harvested individually with a little punch, and the difference between that and the FUT is that you don’t have to take these grafts to the microscope to be dissected. We take them there just for quality control to see what they look like, but they are somewhat harvested ready to be implanted.”

Unlike the fine linear scar of the FUT, the FUE leaves circular dot-like scars, which are also easily concealed. Therefore, unscrupulous hair transplant clinics may claim that the FUE is “scarless,” which is false. Our blog post – “Is the FUE Procedure Right for You?” – covers this technique in greater detail. 

How Did the FUT Come to be Considered Outdated?

Advertising by some hair transplant clinics creates the misleading impression that the FUT leaves unsightly scars. These types of ads are intended to scare prospective patients away from FUT surgery so they only consider the FUE procedure – which perhaps is the only type the surgeon offers, or prefers performing. Such surgeons also may heavily promote FUE because they have a robotic device that harvests follicles. Dr. Barusco provides his insight as to the serious risks such devices create in hair transplantation surgery in an informative article we encourage you to read here. In addition, the media actively spreads the fallacy about FUT being an outdated technique, as most articles about hair transplant procedures are written by those who have no background in this area of medicine.

“Many times, it’s portrayed as if it’s the only – or the best – solution for a hair transplant procedure,” says Dr. Barusco. “I don’t agree with that. The FUE technique does not work for every single patient, for a variety of factors. Strip surgery is still a great technique. I perform both, and don’t have a preference, so I can tell you which one is better for your particular situation.”

In fact, the FUT was the better procedure for Dr. Barusco’s own hair transplant, having undergone four FUT surgeries himself. “I still have a lot of donor hair left. If I’d had an FUE, my donor area would probably be much weaker.” Why? Dr. Barusco compares the situation to that of resodding a bare area of lawn with patches of turf taken from other areas of the lawn. “If you do enough of that kind of harvesting, you end up having holes, and that’s what can happen with the donor area.”

The FUT may be the preferable option for the following types of patients:

  • Those who need a large number of grafts moved during a single surgery.
  • Those who will require multiple surgeries to reach their goal.
  • Those who will require additional hair transplant surgeries over time.
  • Women – However, not every woman experiencing hair loss is a good candidate for a hair transplant.

Combining the FUT and FUE Procedures to Achieve Maximum Coverage in One Surgery

Although the FUT and FUE are different procedures, they can be used in tandem. Among his many contributions to the hair transplantation field, Dr. Barusco is known for pioneering the combined FUE and FUT technique, which is designed to treat advanced hair loss during a single surgery as opposed to several with a one-year waiting period between – as is typical. This procedure allows patients to achieve their ultimate goal in less time, with one procedure versus many.

Be aware that this is an advanced procedure that should be performed only by surgeons and teams with a significant amount of experience in this specific technique. For this reason, selecting the right hair restoration practice is essential to achieving a good outcome.

Make an Informed Decision and Choose Your Surgeon Wisely

As we hope you’ve learned, the FUT is still a solid option that may be the appropriate procedure for your type of hair loss and/or hair restoration goal. But whether your hair restoration surgeon recommends a FUT or FUE as your better option for a successful result, keep in mind that the success of any hair transplant procedure ultimately depends upon the experience, skill and integrity of the surgeon. Dr. Barusco’s long list of accomplishments, his notable artistic ability and his successful surgical team make Tempus Hair Restoration a renowned practice. Contact us to schedule your free virtual consultation. Dr. Barusco conducts every consultation himself, giving you the opportunity to learn your options in the comfort of your home – or any location, on any internet-enabled device.

Dr. Barusco conducts consultations in English, Spanish and Portuguese. For your greater convenience, Tempus Hair Restoration offers a two-night complimentary hotel stay to out-of-town clients who travel 100 miles or more to our Port Orange, Florida, surgical center. No matter how far the distance, we welcome the opportunity to help you on your hair restoration journey!

Is the FUE Procedure Right for You?

General, ,

If you are starting to explore your options for hair restoration treatment, you’ve doubtlessly heard about the Follicular Unit Excision (FUE) procedure. Developed in the late 1980s, this procedure has been refined over the years and is now perhaps the most in-demand hair transplant technique. But just because the procedure is popular doesn’t mean it’s right for everyone. Factors such as age, degree of current and expected hair loss, quality and quantity of the donor hair, etc., are all factors that need to be taken into account. Nor does it mean that every clinic offering the FUE is experienced in treating hair loss.

As we at Tempus Hair Restoration always say, knowledge is power. Our goal is to educate people about the causes of hair loss, hair restoration treatments, hair transplant procedures and qualities to look for in an experienced, ethical hair restoration surgeon – as well as how to be your own advocate as a patient. When people start their search with the clinics and practices that heavily advertise, they run the risk of going with the procedure they already have in mind based upon how that procedure has been promoted – whether or not it’s best for their particular type of hair loss – or being steered into the procedure the doctor is most familiar with – again, regardless of the patient’s individual situation.

While the FUE achieves excellent results for many people, learning more about it can help you be better informed when you schedule a consultation with a hair restoration specialist. It is important that you, the consumer, ask the right questions of the practice you are considering for your surgery, and that you check the doctor’s credentials and experience in the specific field of hair loss and hair restoration surgery.

What is Follicular Unit Excision?

Performed under local anesthesia, FUE is a surgical hair transplant technique in which follicular units in groupings of one, two or three hairs are individually extracted from the back of the head (donor area) using small circular punch blades instead of a scalpel. The grafts are then transplanted to the thinning or balding areas of the scalp. Once the desired number of grafts are obtained, the donor sites are left to heal without suturing.

One aspect of the procedure that can be a downside is that it requires the donor area be shaved in order to harvest each graft. For many, this can be a difficult, embarrassing process because of appearing in public with a half-shaved head. Some patients may have to take time off work in order to allow their hair to grow back.

For this reason, Dr. Marco Barusco – Founder and Chief Medical Officer of Tempus Hair Restoration – developed the innovative No-Shave FUE, which completely conceals harvested donor sites immediately, allowing patients to resume their regular activities with very little downtime. As with every hair transplant procedure, scheduling a consultation is necessary for Dr. Barusco to determine if you are an appropriate candidate for the No-Shave FUE.

Dr. Barusco has produced an informative video for his YouTube channel, “Hair Loss Medical Advice.” The video – “Be Careful with Practices Who Only Offer FUE Procedures” – deals with the issues that consumers typically don’t hear about.

Risks of Poorly Performed FUE Procedures

Two main factors in botched or poor-quality FUE procedures are the diameter of punches to harvest grafts and how close together the incisions are. This method leaves numerous small circular scars scattered throughout the donor region. When done properly, the resulting scars are less noticeable to the eye than a horizontal linear scar – as can be characteristic of the Follicular Unit Transplantation (FUT) procedure – when the hair is cut very short.

“Every time you take an FUE graft, the area where the follicle used to be will become a scar,” says Dr. Barusco. “So when people say there are no scars, there’s always a scar. But they should be so small that when you look at a patient from a distance, you won’t be able to see it. That is the principle of the FUE.”

One factor is the size of the punch used to harvest grafts. As Dr. Barusco explains, “There are different diameters of punches for different hairs or different hair calibers. So we need to make sure that we use the correct punch. Sometimes, either doctors are less experienced, or even the device itself that is being used has limitations on how small the punch can be, so you end up having bigger incisions and bigger punch diameters, which create more scarring.

“The second factor is how close together these incisions are. When you do FUE procedures, you want to spread them out far apart so you don’t have connecting incisions.”

When this occurs, Dr. Barusco notes that in addition to excessive, visible scarring, such a poor-quality procedure can make it impossible to harvest more grafts for future hair transplants. “We never want to sacrifice the entire donor hair of a patient for one procedure, no matter how much hair they need, so safety and good common sense is paramount here. So again, be careful about who you choose to perform your surgery. Do your homework.”

Not Every Practice Can Perform the FUE Hair Transplant – Watch Out for Technicians Performing Surgery

As Dr. Barusco’s video makes clear, not every practice can perform the FUE hair transplant and achieve aesthetically pleasing results that also preserve enough donor area hair for future transplant surgeries.

Regular readers of our blog will recognize the caution we frequently bring up. Many physicians have recently added FUE to their practice, but employ technicians – not surgeons – to harvest the hair follicles. Using non-medical technicians to perform hair transplant surgeries is becoming so prevalent that consumers have come to accept this as a typical, legitimate situation – which it is definitely not. These clinics gear their marketing and advertising to mislead the public into believing that technicians have a high degree of training and are just as capable as a surgeon to perform most – if not all – of the procedure. And that doing so allows them to offer hair restoration surgeries at a discount.

Don’t believe it. So serious is this problem that the International Society of Hair Restoration Surgery (ISHRS) – the world’s leading medical authority on hair loss treatment and restoration – has initiated a patient awareness campaign designed to help consumers understand why a surgeon is the only person who should be performing the procedure, and how to see through misleading marketing that makes technician-performed surgery seem safe and foolproof. Our blog post – “Don’t Let a Technician Perform Your Hair Transplant Surgery” – covers this issue in greater detail.

Dr. Barusco is a Fellow of the ISHRS. This is a distinction that is only given to those who achieve certain landmarks on teaching and leadership. Currently, fewer than 10% of the ISHRS members are Fellows. As such, Dr. Barusco and the Tempus Hair Restoration team are proud to help the ISHRS in this important mission.

Do Research, Ask Questions and Choose Your Surgeon Wisely

Another pitfall that those who are considering a hair transplant need to be aware of is the fact that some surgeons specialize in the FUE and perform that procedure exclusively. Those who are ethical inform prospective patients upfront. Others, however, may lead you to believe that it’s the best procedure for you, even if that is not the case. Also look for a practice dedicated to hair restoration, rather than a clinic that offers other cosmetic procedures.

Says Dr. Barusco, “Do your homework, look at the surgeon’s credentials, go to a few consultations before you decide, and make sure that whatever team you choose to do your surgery has your best interest in mind.”

Ultimately, choose your surgeon based on experience, results and integrity. Dr. Barusco’s long list of accomplishments, his notable artistic ability and his successful surgical team make Tempus Hair Restoration a renowned practice. Contact us to schedule your free virtual consultation. Dr. Barusco conducts every consultation himself, giving you the opportunity to learn your options in the comfort of your home – or any location, on any internet-enabled device. 

Dr. Barusco conducts consultations in English, Spanish and Portuguese. For your greater convenience, Tempus Hair Restoration offers a two-night complimentary hotel stay to out-of-town clients who travel 100 miles or more to our Port Orange, Florida, surgical center. No matter how far the distance, we welcome the opportunity to help you on your hair restoration journey!