Patient Selection for Follicular Unit Extraction versus Linear Strip Donor Harvesting

Abstract

Follicular unit grafts can be harvested using two methods: strip follicular unit transplantation and follicular unit excision. Each method can generate outstanding results, but both are uniquely different with respect to the advantages and disadvantages they offer. Devising a sound surgical plan is instrumental to assure that a patient's short-term and long-term goals can be met, but creating the best plan possible for the graft harvest process is not straightforward. This paper will review the various advantages and disadvantages of each graft harvest method, along with their short-term and long-term ramifications, so as to provide insight into the process by which a sound surgical plan can be developed for any patient seeking surgical hair restoration.

Keywords

linear strip excision (LSE) - follicular unit excision (FUE) - surgical plan - safe donor area (SDA) - donor scarring - graft yield

Publication History

Article published online:
28 November 2023

• References

• 1 Cole J. Physicians sound off: FUT vs FUE. Hair Transplant Forum Int 2015; 25 (05) 185-187
• 2 Dua K, Uprety S, Dua A. Donor harvesting: strip dissection. J Cutan Aesthet Surg 2018; 11 (04) 190-194
• 3 Limmer BL. Elliptical donor stereoscopically assisted micrografting as an approach to further refinement in hair transplantation. J Dermatol Surg Oncol 1994; 20 (12) 789-793
• 4 Bernstein RM, Rassman WR. The logic of follicular unit transplantation. Dermatol Clin 1999; 17 (02) 277-295 , viii, discussion 296
• 5 Rassman WR, Bernstein RM, McClellan R, Jones R, Worton E, Uyttendaele H. Follicular unit extraction: minimally invasive surgery for hair transplantation. Dermatol Surg 2002; 28 (08) 720-728
• 6 Dorin R, True R. The advantages and disadvantages of follicular unit excision. In: Unger R, Shapiro R. . eds. Hair Transplantation, 6th ed. New York:: Thieme; 2023: 353-358
• 7 Gabel S. Megasessions: surgical indications and technical perspectives. Facial Plast Surg Clin North Am 2013; 21 (03) 419-430
• 8 Unger W, Solish N, Giguere D. et al. Delineating the safe donor area for hair transplanting. Am J Cosmet Surg 1994; 11 (04) 239-243
• 9 Pathomvanich D, Wong J. FUT fights back. Hair Transplant Forum Int 2015; 25 (05) 177-187
• 10 Josephitis D, Shapiro R. A side-by-side study of FUT vs. FUE graft availability in the same patients and its implications on lifetime donor supply and management. Hair Transplant Forum Int. 2019; 29 (05) 177-185
• 11 Keene S, Rassman W, Harris J. Determining safe excision limits in FUE: factors that affect, and a simple way to maintain, aesthetic donor density. Hair Transplant Forum Int. 2018; 28 (01) 1-11
• 12 Marritt E, Konior RJ. Patient selection, candidacy, and treatment plan for hair replacement surgery. Facial Plast Surg Clin North Am 1994; 2: 111
• 13 Cole JP. An analysis of follicular punches, mechanics, and dynamics in follicular unit extraction. Facial Plast Surg Clin North Am 2013; 21 (03) 437-447
• 14 Beehner M. Comparison of survival of FU grafts trimmed chubby, medium, and skeletonized. Hair Transplant Forum Int 2010; 20 (01) 1-6
• 15 Parsley WM, Perez-Meza D. Review of factors affecting the growth and survival of follicular grafts. J Cutan Aesthet Surg 2010; 3 (02) 69-75
• 16 Josephitis D, Shapiro R. FUE vs FUT graft survival: a side-by-side study of 3 patients undergoing a routine 2000+ graft hair transplantation. Hair Transplant Forum Int. 2018; 28 (05) 179-182
• 17 Unger WP, Unger RH, Wesley CK. Estimating the number of lifetime follicular units: a survey and comments of experienced hair transplant surgeons. Dermatol Surg 2013; 39 (05) 755-760
• 18 Wong J. Large grafting session. In: Unger R, Shapiro R. . eds. Hair Transplantation, 6th ed. New York: Thieme; 2023: 280-284
• 19 Bernstein R, Rassman W, Anderson K. FUE megasessions—evolution of a technique. Hair Transplant Forum Int. 2014; 14 (03) 97-99