This question, answered by Coalition surgeon Dr. Alan Feller, was asked by a member of our Hair Restoration Social Community and Discussion Forums:
Do you think in the future follicular unit extraction (FUE) will fully take the place of strip surgery or do you think FUE will just be used as an added alternative?
I never thought that FUE could replace follicular unit transplantation (FUT) because of the trauma associated with FUE compared to strip.
FUE grafts undergo three detrimental forces that strip grafts just don’t:
1. Torsion- Twisting to the point of graft fracture
2. Compression- crushing
3. Traction- pulling apart.
Unfortunately, to date, there is no way to obtain a graft via FUE without experiencing these three forces. Some of the instruments I’ve developed minimize the forces, but don’t eliminate them. Some devices made by other doctors also minimize, but don’t eliminate.
Also, even if one could completely eradicate the three detrimental forces, the havoc large or multiple FUE sessions play on the donor area can be considerable.
After, say, 1500 grafts, the holes begin to coalese together to form one massive subdermal scar. Even though it may not be very noticable to the eye, the damage is done and it can and will limit the ability to obtain more follicular unit grafts in the future: even if strip is then utilized.
FUE definitely has its place, but only for small procedures or as an adjunct to strip surgery. I felt that way back in 2004 when this video was made, and I still believe the same today. Nothing since has convinced me to change this view.
Sure, there are some great FUE results out there, and I’m proud to have contributed to that number, but percentage-wise, FUE doesn’t hold a candle to the consistency of strip results.
The gold standard of hair transplant surgery is, and remains, quality strip surgery performed by an experienced surgical hair restoration team with a great track record. And nowadays there are plenty such clinics dotting the globe.
Dr. Alan Feller