You read all the time on the hair restoration forum to maximize the number of strip hair transplants and then go follicular unit extraction (FUE), in order to max out one’s available grafts. I often wonder how many patients actually go through with all that though. Or what % of patients is it even necessary for?
This is an excellent point. I have always disagreed with the “FUSS first” concept. A follicular unit is a follicular unit, whether it was harvested by follicular unit strip surgery or FUE. One of the several advantages of FUE is that we can spread the extractions over the entire donor area, and so minimizing the impact on any one area. Also keep in mind that strip excision changes the scalp architecture, and harvesting grafts (especially below the donor scar) with FUE is made more difficult after strip excision.
The only questionable benefit I can see to performing FUE after strip excision is the chance to try to cover up the strip scar with FUE grafts. However, the results of this are variable, and in many cases the strip scar does not have the vascularity to support the grafts. For this reason it is much better to avoid the strip scar than to plan on covering it with FUE grafts.
Dr. Mike Vories
Editorial Assistant and Forum Co-Moderator