This comment, addressed by Coalition hair restoration surgeon Dr. William Lindsey, was shared by a member of our Hair Loss Social Community and Discussion Forums:

Does the “unpredictable nature” of follicular unit extraction (FUE) hair transplantation as compared to strip hair transplants pertain to a) yield or to b) the quality of the matured transplanted hairs, or both? In other words, if a given follicular unit survives the extraction and implantation process and, therefore, grows, should the hair(s) produced by that FU be of the same quality (robustness, diameter, characteristics, etc.) as if it had been extracted via strip? Or, rather, can the quality of the mature transplanted hair shafts be compromised as well? Also, in your experience, is the unpredictability of FUE attributable to a) damaging the root bulb during extraction, b) transecting the hair follicle(s) itself, or both? Something in addition?

Good questions. I think it’s some of several factors that cause hair growth to be more variable with FUE.

First, there is the extraction process; making the punch along the correct angle and not hitting the root bulb or slicing off part of the root bulb itself.  This is referred to as “blind dissection”.  Secondly, the extraction process, even when done most gently, certainly pulls on the root tissue way more than microscopic dissection of grafts from a strip. Third, there is more time out of the body for the early FUE harvested grafts. With follicular unit transplantation (strip), it’s maybe 30 minutes until the first grafts go in (takes me that long to make the slits), whereas with FUE we harvest for several hours before placing–and even though we keep the grafts cool and moist, it’s not like being back in the body.

Now don’t get me wrong, I think FUE is an excellent alternative to FUT for someone who:

  • Wants a crew cut without revealing a strip scar.
  • Has limited hair loss.
  • May have significant scar risks.
  • Acknowledges FUE may offer a more variable result than strip.
  • Realizes that follicular unit extraction will take longer and cost more than a strip case or,
  • Has depleted all the strip-able hair and wants an FUE repair or fill-in case.

Follicular unit extraction (FUE) is a fine option that works well. It’s just not as much of a “sure thing” as strip cases are and this site has its share of strip cases done at clinics that didn’t yield perfect results either.

Hair restoration patients need to know all of this prior to making a decision on how to proceed.

Dr. William Lindsey – McLean, VA


David (TakingThePlunge)
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.
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