Which Surgical Techinique Should I Choose FUE or FUSS

10/5/2018 7:37:30 PM

Today, modern hair restoration offers two distinct donor harvesting surgical techniques that are proven to provide excellent patient results. However, the pros and cons have been heavily debated in the hair restoartion community and on hair loss forums. In this article, we will go over the limitations, physicial restrictions and discuss in detail the pros and cons for each procedure.

Follicular Unit Strip Surgery (FUSS)

Hair restoration has evolved from the "barbie doll" and "corn row" hair plugs of the 80's and early 90's. FUSS or strip surgery is now an ultra-refined techinique that uses micro-surgical blades which enable hair transplant surgeons to make micro-incisions and "densely" pack up to 40-60 follicular units (fu) per square centimeter (cm2). FUSS or strip surgery, is a surgical techinque that involves a hair transplant surgeon removing a strip of donor tissue from the sides and back of the scalp where hair is genetically resistant to the effects of dihydrotestosterone (DHT), DHT is the main catalyst for androgenic alopecia (genetic hair loss). The donor tissue is then dissected under high magnification and trimmed in to their natural groupings of one (1), two (2), three (3) and four (4) hair follicular units.

Follicular Unit Excision (formerly known as Follicular Unit Extraction FUE)

FUE is a minimally invasive surgical techinque that involves a hair transplant surgeon using a small punch between the sizes of 0.7 and 1mm in circumfrence. The surgeon uses the small punch to extract each follicle one by one. Both surgical techinques use 1,2,3 and 4 hair follicular unit grafts to transplant in to the balding area (recipient site).

Comparison between FUSS and FUE

The primary difference between FUSS and FUE are the methods of donor harvesting. However, there are different physical limitations that exist between each procedure that a prospective patient must be cognizant of before having surgery. Both surgical techinques rely on finite donor supply thus, careful planning must be employed by the surgeon prior to performing surgery. Generally, more grafts can be harvested through FUSS because a large donor strip can be removed in one surgical session without compromising the donor site. However, due to the nature of FUE typically less grafts can be harvested in one surgical sesion for a multitude of factors such as donor density, graft transection, surgical fatigue etc. Conversley, strip surgery relies on scalp elasticity to remove donor tissue thus, the more surgeries and individual has means the less elastic their scalp will be until they can no longer support strip surgery.

Maximizing Hair Transplant Results by combining FUE and FUSS

Both procedures offer ultra-refined follicular unit transplantation however, it is recommended that patients with extensive hair loss maximize their donor supply with strip surgery first, until they no longer have scalp elasticity or are "stripped out" and then use FUE to obtain every viable follicular unit in their donor site. With that said, even patients with extensive hair loss may choose to only use FUE or FUSS however, they will not be able to obtain as many overall grafts as they would if they opted for both procedures. In conclusion, no procedure is better than the other and both procedures have their place in modern hair restoration. 


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    All Articles by Melvin Lopez

    Melvin is an Associate Publisher and Forum Moderator for the Hair Transplant Network and the Hair Loss Learning Center. He is a 3-time hair transplant patient, having received over 5,000 grafts via FUE. He has thousands of helpful posts on the popular hair restoration network discussion forum. Melvin writes articles, moderates the hair loss forum, and creates YouTube videos for the Hair Transplant Network YouTube channel. View Melvin's impressive hair transplant journey HERE.