# Hair Transplants > Hair Transplant Videos, Patient Interviews and Surgeon Q & A >  FUE Vs. Strip Hair Transplant | Dr. Glenn Charles Responds

## tbtadmin

Question submitted through thebaldtruth.com

*IAHRS Member, Dr. Glenn Charles of Boca Raton, Fl. Responds:
*
I have been doing as much research as possible about hair transplants and my head is spinning. Just when I think I made a decision I read about another type of surgery or something new from one doctor or another. From a price point I was going to go with a strip hair transplant but some people write not to and that FUE is the only way to go. Im confused and just want a straight answer. If I need bout 300O hair grafts and have thick donor hair do I really need to spend the money for FUE? Is it really better?
Thank you for your time, this is a wonderful service you provide!

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## bigmac

Cool
I like this idea. :Big Grin:

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## John P. Cole, MD

I've been advocating the FUE procedure over a strip procedure since 2003.  The rationale for this is based on experience.  Prior to advocating the FUE procedure, I had performed over 8000 strip procedures and i had seen the negative sequelae of multiple strip procedures over time.  

The first thing to consider is that a properly performed FUE procedure will yield 2.9 hairs per graft in my hands.  This is far more than the 2.0 hairs per graft that a strip procedure will produce in expert hands in an average case.  

The next obfuscation you will encounter with strip surgeons is that a larger procedure is better off with a strip procedure.  An average donor area has over 16,000 follicular units and there is no reason you cannot remove 25% or more with FUE.  An average donor area that yields 4000 grafts averaging 2.9 hairs each is certainly going to yield more hair (and coverage) than the same 4000 grafts averaging 2.0 hairs per graft.  The next thing to recognize is that the average strip transplant achieves it's graft count by splitting 3 and 4 hair grafts into 1 and 2 hair grafts.  Certainly, you can produce more grafts by fractionating full size follicular units into smaller grafts.

When you chat with strip surgeons, they will champion their procedures, but recognize that they do not do the graft dissection.  Most likely they have never cut grafts in their entire surgical experience beyond a cursory exposure.   As such, they really don't know what their technicians are producing beyond what they were taught technicians do in their own cursory training experience.  If you are horrified at this point, you have a substantial reason to be concerned.  

There are negatives to any surgery.  The best solution is to avoid it altogether.  If hair is your prerogative, then the options condense.  

FUE removes individual follicular units or groups.  Strips remove large wedges of your scalp and leave you with often unsightly strip scars.

Removal of individual follicular units leaves gaps where follicular units once existed.  It is like removing cars from isolated individual parking spaces.  Removing a strip is like removing multiple rows from a parking lot and trying to condense them into one long line.  Wow!  How natural could that be?

The survival of strip and FUE grafts in capable hands is the same.  The number of hairs per graft is greater with FUE.  The potential for negative scarring is greater with strip surgery. The potential coverage from either procedure is better with FUE based on similar numbers of grafts.  

What you need to recognize is that the proponent of strip surgery is simply in the dark because they simply do not know any better. Time will change everything.

In 2002 FUE was essentially non-existent.  In 2006 it was 7.4% of all hair transplant surgeries.  In 2008 FUE was 10.4% of all hair transplant surgeries.  In due course, it will continue to grow.  

if you are confused and uncertain what to do, wait.  In time your choices will narrow.  Certainly, it is very likely that anyone under 30 will not have a strip as their initial surgery.  Of course this is what i have been advocating for over 6 years.

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## Dav7

> I've been advocating the FUE procedure over a strip procedure since 2003.  The rationale for this is based on experience.  Prior to advocating the FUE procedure, I had performed over 8000 strip procedures and i had seen the negative sequelae of multiple strip procedures over time.  
> 
> The first thing to consider is that a properly performed FUE procedure will yield 2.9 hairs per graft in my hands.  This is far more than the 2.0 hairs per graft that a strip procedure will produce in expert hands in an average case.  
> 
> The next obfuscation you will encounter with strip surgeons is that a larger procedure is better off with a strip procedure.  An average donor area has over 16,000 follicular units and there is no reason you cannot remove 25% or more with FUE.  An average donor area that yields 4000 grafts averaging 2.9 hairs each is certainly going to yield more hair (and coverage) than the same 4000 grafts averaging 2.0 hairs per graft.  The next thing to recognize is that the average strip transplant achieves it's graft count by splitting 3 and 4 hair grafts into 1 and 2 hair grafts.  Certainly, you can produce more grafts by fractionating full size follicular units into smaller grafts.
> 
> When you chat with strip surgeons, they will champion their procedures, but recognize that they do not do the graft dissection.  Most likely they have never cut grafts in their entire surgical experience beyond a cursory exposure.   As such, they really don't know what their technicians are producing beyond what they were taught technicians do in their own cursory training experience.  If you are horrified at this point, you have a substantial reason to be concerned.  
> 
> There are negatives to any surgery.  The best solution is to avoid it altogether.  If hair is your prerogative, then the options condense.  
> ...


 Hi Dr. Cole, and apologies to all for resurrecting a zombie thread, but I feel this is as relevant now 5 years later as back in 2009. Are you saying basically that with FUT that a clinic can basically band over more of the work to lesser qualified technicians/ staff etc. than having the surgeon perform most of the surgery, whereas with FUE you are guaranteed that the surgeon himself/ herself will be doing most of the procedure?

This is an important one to me as I would like to have a HT within a clinic whereby the surgeon themselves performs most of the procedure, as opposed to simply offshoring most of the work to technicians/ junior doctors and medical staff. 

And lastly, I'm wondering if you could actually confirm this again that FUE can yield as good results than FUT, as this has been one of the rationales for moving me toward the strip route given that I need 3,500 - 4,000 grafts given that I have been informed that FUT provides better coverage. Is this a fallacy, or is there still truth in this claim, e.g. any hair loss case that has progressed beyond the Norwood, Level 3 stage of MPB is better served by FUT/ Strip, or can one who needs extra grafts still benefit from FUE when it comes to coverage, yield survival etc.

Thank you.

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