FUT surgeons have always since the past one decade put forth their vociferous points of view about poor yield. If you state a lie a thousand times, it takes control of your rational senses and creates a doubt in the mind of the surgical hair restoration researcher, the potential FUE client. The most respected surgeons in hair restoration surgery are still FUT surgeons. This is because they have been trading their wares for a longer span of time; FUE surgeons on the contrary have been in FUE practice only the duration of the existence of the technique and that is not too long ago. It is mostly junior surgeons who started doing FUE full time around 5-10 years back. A handful of surgeons like me who were FUT (strip) surgeons before, converted full time to FUE, taking the Big Leap of Faith.
So as a community we are relatively new.
The reason such jaded arguments are finding ground in the hair loss domain is not long to seek- it is due to the fact that FUE is a demanding speciality where the surgeon has to spend most of his time with the patient. I know very few surgeons like me do the harvesting and other important parts of the FUE procedure themselves, not leaving it to the technicians. No-one who has a running practice would like to risk it by taking the Big Switch. So to stay relevant, one has to argue the advantages of your own technique and the chief argument that will hurt is that ‘FUE gives poor yield’.
I would like to counter this misconception thus-
- When FUT surgeons say FUE gives poor yield, who are they comparing with? You have to compare your FUT yield with the yield of the better FUE clinics and not your own FUE skills for fairness' sake.
- How much time in harvesting the FUT grafts is spent by surgeons? What is their strip harvest time? What is the time spent for slivering the strip and dissecting the grafts? Does the doctor do the slivering and dissection of grafts? Or their technicians? Is this their best practice? In FUE I do the entire harvesting myself- dissection and graft preparation. So why does this make my technique inferior.
- When a strip is harvested, how many hair in it are in the phase where they will withstand transfer following dissection?
- Can the telogen/catagen hair that are essential components of any strip be dissected safely and transplanted?
- If no, how many such hairs are wasted?
- Do they grow back?
- What is the ratio of good grafts available to the hair that cannot be transplanted and are confined to the bin? We all know that around 15% of hairs in the scalp are in the growing phase (also in the strip) and hence difficult to dissect out from the strip while slivering it.
- If not, is this not far greater a wastage than the 2-5% transection of grafts in FUE technique?
- Do FUE transected grafts grow back? Yes they do since they are transected within the body (in vivo) and not outside when the strip is out of the body (in vitro).
- Moreover, when we take the strip from the back of the head, to relax the edges of the resultant wound, we undermine the skin around and stitch the 2 ends in close approximation. The skin that moves in to close the edges without tension has to come from somewhere. Or is this new skin added? Where does it come from? Does it come from the crown region of the scalp? So, is it not a fact that to close the strip, the area of the crown expands by as much as the area of the strip? Will we need more grafts to cover this larger area of expanded crown?
Does this decrease the permanent zone from which permanent grafts are taken for FUE?
How then can we argue that FUT gives greater yield? Answers to these questions are only common sense!