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Follicular Unit Extraction vs Strip Excision – Which is Right for You?

The prospect of losing one’s hair is a frightening and emotionally disturbing experience for most people facing hair loss. Luckily, in today’s world of scientific and technological advances, you don’t have to suffer in silence and accept your condition as inevitable. Modern medicine offers a variety of hair restoration options for both genders, including the advanced methods of follicular unit extraction and strip excision.

How does your hair grow?

Hair growth occurs in the living portion of your hair – the follicle, which anchors each hair into the skin. The hair bulb forms the base of the follicle. It contains living cells which divide to create the visible part of the hair – the shaft, composed of dead, keratinized cells.

Contrary to popular belief, hair doesn’t grow as individual strands, but rather in groups of 1-4 hairs called follicular units. Each follicular unit has its own nerve, muscle and blood supply, surrounded by a band of collagen. For this reason, follicular units can be regarded as tiny anatomical and physiological entities.

Which types of hair loss require treatment?

The general medical term for hair loss is alopecia. Hair loss affects both genders and can be temporary or permanent. Temporary hair loss can be triggered by pharmacological, dietary, stress-related and pathological factors. Once the underlying cause is corrected, the hair gradually grows back.

In male and female pattern baldness (androgenetic alopecia), hair loss is permanent and without treatment. According to statistics, 40% of men will experience noticeable hair loss by the age of 35. Although to a somewhat lesser extent, androgenetic alopecia also affects women, mainly after menopause. The main culprit for this type of hair loss is DHT (dihydrotestosterone) synthesized from the male hormone testosterone in the testicles, prostate and ovaries.

Elevated serum levels of DHT cause shrinkage of hair follicles and subsequent hair loss. Androgenetic alopecia is attributed to a combination of genetic, endocrine and environmental factors. Although it doesn’t require treatment in a strictly medical sense, many people seek treatment for cosmetic and psychological reasons.

Advanced hair restoration methods

Hair transplant surgery is an effective way to treat hair loss. If done skillfully and successfully, this hair restoration method yields permanent results. Six to nine months after the procedure, the majority of patients experience up to 60% of new hair growth.

Today, the most commonly used surgical hair restoration techniques are follicular unit extraction (FUE) and strip excision,subtypes of the follicular unit hair transplantation (FUT) method.

Both approaches have their advantages and the choice mainly depends on the extent of baldness, time of onset and the patient’s desires and budget, after a thorough consultation with a hair transplant specialist.

Follicular unit transplantation basics

As the name suggests, the procedure involves transplantation of follicular units, obtained through dissection of small strips of donor scalp. These hair-bearing strips are excised from the back of the scalp, referred to as the permanent zone, where hair is more resistant to balding.

Since follicular units are regarded as distinct anatomical entities, the best way to achieve a natural look and maximize hair growth is by preserving the integrity of follicular units during dissection, harvesting and grafting. The transplants mimic normal hair growth and are impossible to distinguish from natural hair.

Strip excision method

This is the standard approach to follicular unit hair transplantation. Although partly overshadowed by the popularity of the minimally invasive FUE, the traditional strip excision is still a widely used hair transplant option. This technique involves surgical removal of small strips of hair-bearing scalp from the donor area.

The follicular units are then carefully dissected out of the strip under a microscope and subsequently grafted onto the balding areas. If two or more strip procedures are required, they should be performed at least nine months apart.

Follicular unit extraction

Follicular unit extraction is regarded by many as the most advanced and sophisticated approach to hair restoration. Unlike strip excision, FUE doesn’t involve use of scalpels. Instead, an instrument is used to harvest each follicular unit directly from the scalp.

The harvesting process is demanding and time-consuming since each follicle has to be extracted individually and with extreme caution. On the plus side, this results in faster healing and minimal scarring which becomes virtually undetectable in a matter of days.

Choosing between FUE and strip excision

These two methods differ mainly in the follicle harvesting. In FUE, hair follicles are extracted directly from the scalp, whereas in strip harvesting the excised piece of scalp is dissected into many individual units.

FUE is the method of choice for smaller hair transplants, such as hairline restoration in the early stages of hair loss and for patients with little donor hair. It is also the preferred option when strip excision is not advisable, if the scalp is too tight or has existing damage from previous strip excisions.

Compared to strip excision, FUE requires less time to recover after the surgery. In FUE, the patient’s donor area can be expanded to include other body parts (beard, chest, abdomen). FUE can also be used to cover scars from previous strip excisions.

Strip excision leaves a linear scar which can stretch over time. Therefore, FUE is recommended for people who prefer to wear their hair very short, due to the absence of linear scars.

FUE and strip harvesting can also work in synergy. This way, several thousand grafts can all be extracted during a single session. In both methods, the level of surgical expertise determines the quality of the final result.


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Published on May 5, 2015

By Advanced Hair Restoration