FUE : The Best Hair Transplant Technique Ever?

FUE is the latest technique in hair restoration nowadays. Many novice clinics and physicians are offering FUE as the most advanced ultimate solution for hair loss. While, there are inherent advantage of FUE, which I have discussed before, proclaiming that FUE is 'always' the best is stretching the truth too far. The procedure has its own set of disadvantages, which must be brought to prospective patient's notice, before mutually deciding upon the technique of restoration.

One problem that FUE holds is the number of grafts that can be harvested in one session of transplant. Although, a larger number of grafts can now be harvested, the number is still not comparable to strip technique. The chief reason for this is technique itself. When performed properly and carefully, FUE is labour and technique intensive, and therefore lesser number of grafts can be harvested. Some clinics have now started using power tools and robots for follicular harvest. The main drawback of such practice is injury to surrounding follicles and high wastage of hair. Contrast this with strip, where larger number of grafts are taken out in same duration, because many qualified technicians can work simultaneously.

Proper Technique of FUE. Note use of small punch, minimal bleeding  and  limited harvest.
Also not that permanent hair zone is not breached.

Scarring is also an oft repeated marketing ploy with "FUE only" clinics. It is claimed as a "No Scar" technique. Rest assured, it is NOT so. Any cut in the skin will cause some scarring. The valid question, therefore, is visibility of scars. Which technique gives less visible scars? Here I agree with FUE proponents, that scars are less visible with short hairs in FUE after one session. On shaving or close trim, these scars can be seen as white dots in the scalp. They appear light colored because of removal of melanin (Hair pigment) and reduced blood supply in that area. After multiple sessions this can cause 'moth eaten' appearance in donor area, especially in dark skinned people.

Poor scarring after FUE.
Two sessions of 2500 FUs done at another clinic using Robotic Hair Transplant.

Some clinics even call FUE as non-surgical technique. This is also a bogus claim, as anesthesia, incision by small punch and physical removal of hair roots with forceps and placement in incisions can not be non surgical. FUE maybe minimally invasive surgery in respect to punch size used but overall invasiveness is only determined by the extent of the procedure and the harvesting protocol. Multiple incisions made on skin during FUE have a ripple effect on the surrounding skin. This can result in abnormal orientation of remaining hair and difficulty in future extraction.

Another common problem with large FUE sessions is that, one has to often go beyond the safe donor zone. By doing so we expose the potentially balding area to scarring. More importantly, one can implant temporary hair in bald areas, which are prone to hair fall in future. An experienced surgeon rarely makes such mistake but a novice may offer you many more grafts than are actually safe, just to seal the deal. Remember, more is not always better in hair transplant.

To summarise, patients should be clear that both strip technique and FUE are credible hair transplant techniques and both give good results when performed properly. Branding one technique as advanced just because its new is dangerous. Both have their pros and cons; and both have their own place in hair restoration.