EXPERT GUIDE

Hair Transplant Methods (FUE, FUT etc.)

Medically reviewed by Dr. Sternberg Written by David Stelzer on 1 Feb 2021

Hair transplantation originated in Japan and the USA. When it began, the methods for hair transplantation were not well-developed creating unnatural results that were very obvious. Since then, a lot has changed: the grafts (transplanted hair follicles) have become smaller, the operations easier and the methods more accurate overall.

With modern technology, a natural-looking result can be achieved and the scarring from the procedure very subtle. But what does modern technology mean? What exactly are the different methods of hair transplantation?

The most common methods

Currently, the FUT and FUE procedures are the most common techniques used. Regardless of the method, a hair transplantation consists of three phases: removal, storage and insertion of the hair follicles.

The insertion of the hair follicles into the bald area is virtually identical for each method.  Small recipient channels are prepared on the bald areas, into which the transplants are inserted with special angled tweezers.

However, the two methods differ fundamentally in the extraction and removal technique of the hair follicles.

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Follicular Unit Transplantation (FUT)

At the beginning of the 20th century the Japanese doctor Tamura invented the FUT method, also known as the Strip Method, this is because a hairy strip of skin is taken from the donor area, usually the back of the head.  The strip of skin is then dissected and prepared into individual follicular units, which are inserted into the recipient holes in the balding area. About 30% of all hair transplants worldwide are performed using this method.

Depending on the requirements, the elongated skin strip can be up to 20 cm long and 1 cm wide. In most cases, the skin strip is taken in the occipitoparietal area (between the auricles). The wound is then sutured or stapled.

Underneath microscope, the skin strip is divided into small strips called donor strips, which are then divided again into the individual follicular units. The follicular units are kept in a refrigerated sterile solution in a Petri dish until they are inserted.

According to our hair transplant study, the FUE method is currently the most used hair transplant method:

Pros FUT Cons FUT
Large graft volume: Compared to the FUE method, a larger graft volume can be obtained in a short amount of time. This makes the procedure particularly suitable for patients with severe hair loss, especially in the tonsure area. Scarring in the donor area: The visibility of the scar depends on the wound edges, wound closure and the size of the skin strip. Therefore, the treated doctor should work carefully and conscientiously. In most cases, however, the surrounding hair covers the scar.
No shaving required: Unlike the FUE method, the patient's head does not have to be shaved bald. Shock Loss in the donor area: Refers to the risk of tissue trauma and resulting hair loss around the donor area. This risk is higher for the FUT method as a strip of skin is removed rather than small individual hairs.
Higher growth rate: The growth rate of the transplanted hair follicles is generally higher than in the FUE procedure.
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Before and After of different methods

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Follicular Unit Extraction (FUE)

With the minimally invasive FUE method (Follicular Unit Extraction), natural hair groups consisting of one to four individual hair roots are extracted from the donor area using a very thin hollow needle and then inserted at the desired locations.

First the extraction needle is placed over the natural hair group according to the direction of the hair growth and using circular movements the needle exposes the hair group. Then, the hair group is removed with fine tweezers and stored in a sterile and cooled solution until insertion.

The small wounds resulting from the removal heal with little to no scarring, a few days after the operation. The FUE method is especially suitable for small interventions, e.g. filling up a receding hairline and also beard transplants.

Pros FUE Cons FUE
Tissue-friendly: In contrast to the FUT method, the risk of shock loss is much lower, since the removal of the natural hair groups is more tissue-friendly. Longer removal phase: Since the hair groups are removed individually, the removal phase with the FUE method takes longer than with the FUT method. The re-moval can be accelerated with the FUE method by using a hair transplantation robot (e.g., ARTAS). The FUE method is particularly suitable for filling the receding hairline.
No visible scars: The micro wounds in the removal area heal scar-free. Lower growth rate: The growth rate with the FUE method is often lower than with the FUT method.
Exact graft harvesting: Compared to the FUT method, the FUE method allows the exact number of grafts needed to be harvested. Shaving is required: The donor site, usually the back of the head, must be shaved bald for the hair removal.
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ARTAS Robot - Robotic hair transplantation

In recent years, machine hair transplantation, including robotic hair transplantation using the ARTAS robot, has gained momentum. This is a development of the FUE method, in which the removal phase is mechanically supported. Unfortunately, even when using the ARTAS robot, the donor area must be shaved to ensure that hair follicles can be removed with high precision.

The size of the donor area depends on the number of hair follicles to be transplanted and the quality of the hair. The ARTAS robot determines both in a scan of the donor area. For the ARTAS robot to start the process of removal, a tension grid is created for the patient, which marks a square removal area. Once this initial step is completed, the robot punches out selected hair follicles. As a rule, no more than 15-20% of the hair volume in a square centimeter is removed.

As soon as the ARTAS robot has removed the follicles, the hair transplantation continues as usual. The hair roots are stored separately in a concentrated nutrient solution, the hair channels in the bald areas are opened and the grafts are inserted in the natural growth direction.

 

Pros Robot Cons Robot
Time saving: In contrast to the manual removal of grafts, the ARTAS robot can remove hair faster while maintaining the same quality. Higher costs: It is not uncommon for machine-assisted hair transplantation using the ARTAS robot to be more expensive than the fully manual hair transplantation.
No visible scars: The resulting micro wounds in the donor area heal without scarring. Lower growth rate: The growth rate of the FUE method with ARTAS robot is still lower than the FUT method.
Exact transplantation: Only the exact number of grafts required is harvested, taking into account the quality of the hair. Shaving is required: The donor site, usually the back of the head, must be shaved bold for the removal of the hair groups.
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NeoGraft

The NeoGraft transplantation method is a semi-automated form of the original FUE method. It is marketed as a more effective form of FUE as it is intended to remove some of the human error associated with the process.

It does this by using a “wand” of sorts to specially remove the hair grafts with suction rather than a surgeon manually removing them. This method will help reduce trauma to the hair follicles, which should in turn improve the survival rate. Furthermore, the NeoGraft method decreases the removal time for the transplantation, which also increases the survival rate as the grafts are removed from the blood supply for a shorter time.

Direct Hair Implantation (DHI)

The Direct Hair Implantation, or the DHI method (also called CHOI method in rare cases) is the latest advancement of the FUE method. As previously mentioned, every hair transplantation goes through three interdependent stages: the removal of the grafts, the storage of these and finally the insertion of the removed hair follicles. The first two stages have been the focus of optimization projects in the past (see ARTAS robot). In 2010, however, Prof. Dr. Konstantinos Giotis took a completely new path and refined the insertion process to create the DHI method as it is used today.

Choi Implanter Pen

The Choi Pen Implanter was first invented at Kyungpook National University in South Korea in 1992. It has been used extensively in Asia and recently it has found its way into the Western hemisphere. It is used in the DHI method to speed up the transplantation process, up to 6 pens are used in a procedure.

To obtain the grafts in the donor area, the donor area must be shaved. For smaller operations, however, partial shaving or transplantation without shaving is also possible. A high-precision hollow needle is used to remove the hair follicles, it is driven by a micromotor to guarantee clean and accurate extraction of the hair. This is followed by storing the grafts separately in a nutrient solution. This is followed by the final step of hair transplantation, the implantation of the extracted grafts.

This is also where the difference between the DHI method and traditional methods becomes apparent. Instead of first opening the recipient channels at the desired locations and then transplanting the hair, these two steps are combined. With the help of special “CHOI Implanter Pens” the hair is transplanted directly without opening the hair channels beforehand. The advantages of this method are that the transplanted hairs lie closer together and the implanted grafts have a higher growth rate. This results in a fuller and more natural looking result.

Pros DHI Cons DHI
Partial shaving possible: With the DHI method, partial shaving or no shaving is possible with this method of hair transplantation. Higher costs: Usually, hair transplantation with the DHI method is slightly more expensive than FUE or FUT.
No visible scars: The resulting micro wounds in the donor area heal without scarring. Limited availability: The DHI method is still relatively new. Accordingly, there are few providers that use this method. Most of them are located abroad.
Higher hair density: Due to the possibility of transplanting more hair per square centimeter on average, the DHI method allows a higher hair density. Lower graft count: The DHI method is very time-consuming. Therefore, usually fewer grafts can be transplanted. A good threshold value is around 3000 grafts per session.
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Sapphire, diamond and gold hair transplant

Recently, clinics located abroad have supplemented their services with “newer and better” methods of hair transplantation. The hair transplant procedures have memorable names, such as the Sapphire, Diamond or Gold Method (the list of “methods” is not exhaustive). However, it is in essence a regular FUE hair transplantation.

The difference between the known and established methods, however, is the use of a “tool” made of different materials. For, as the name already suggests, the corresponding variants of hair transplantation use utensils with, for example, a gold, diamond or sapphire blade. Regular methods, on the other hand, rely on steel or titanium.

The purity, hardness and sharpness of the aforementioned tools should lead to a more precise and well tolerated hair transplantation. Sapphire, diamond and gold have historically held the reputation of stimulating the body’s wound healing. The question that arises here, however, is whether this really leads to an improvement in the results of hair transplantation or whether the new tools are more influential as marketing props. Since there are no extensive clinical studies on this topic, a positive effect cannot be proven.

Warning

In our hair transplant cost study we found there are not only considerable price differences between individual providers, but also that the methods and quality vary greatly. This makes it even more important to inform yourself comprehensively. Our hair loss experts will be happy to help you and find the best and most affordable method for your hair loss: Request a hair loss analysis now

Long Hair Method

With the Long Hair Method, the name provides a clue to how it differs from other techniques. It is a FUE hair transplantation, in which the hair is not transplanted in full length into the recipient area, but the hair of the donor area can be left up to about 8 cm long. The hair transplantation is thus carried out either with partial shaving or no shaving.

This makes the Long Hair Method particularly attractive for women who are reluctant to have their hair shaved. It is also perfectly suited for people who wish to return to their everyday life almost immediately, without it being noticeable that they have undergone a hair transplant.

The first successes of a hair transplantation using the Long Hair method can be seen immediately after the hair transplantation. Nevertheless, there can be “shock loss”, in which the transplanted hair falls out gradually, but it will grow back again.

The long hair transplantation requires a lot of attention and care. It is significantly more time-consuming than other methods, which is why a smaller number of grafts must be transplanted. On average, up to 1,000 grafts are taken from the donor area in comparison to an average of 2,500 grafts with other methods. In addition to the increased time, the treatment costs also increase – by up to 25%.

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Body Hair Transplant (BHT)

The Body Hair Transplantation, or BHT, is one of the newer methods of hair transplantation. This is another form of an FUE transplant. Although body hair is structurally, and often also colored, differently from the hair on the head, the BHT has proven itself useful as a hair transplant method.

Many patients suffer from such severe hair loss that there is not enough hair available in the donor area to fill in bald spots on the top of the head. If the donor area is exhausted, body hair can be inserted in less visible areas. For instance, the area in the center of the top of the head. It is now also assumed that the structurally different body hairs behave like normal hair after implantation in the scalp.

Body hair transplantation is particularly time-consuming, which means that fewer grafts are transplanted at a higher price. In addition, body hair is increasingly taken from the chest area. Here, however, the hair density is usually not as high as in the back of the head, from which the donor hair is usually taken.

Also, the difference between chest hair and hair from the scalp is that on the top of the head grafts have between 1-4 hairs. In the chest there are mainly “single grafts”, from which only one hair originates. Finally, it can be assumed that the growth rate of the transplanted grafts is lower than in a regular hair transplant. In conclusion, it must be considered in each individual case whether the Body Hair Transplantation is suitable as a method to regain the lost hair.

Pros BHT Cons BHT
Higher number of possible grafts: In contrast to other methods, additional grafts can be obtained with the BHT method outside of the traditional donor area. So-called "giga sessions" can take place, in which several thousand grafts are transplanted. Longer extraction phase: Since the hair groups are extracted individually with high precision, the BHT takes a correspondingly long time.
Possible solution in cases of severe hair loss: Often patients with too little hair in the donor area are rejected. The BHT method as a supplementary measure can also help patients with these issues to achieve full hair. Lower growth rate: The growth rate of the BHT method is the lowest compared to all other methods listed.
Multiple donor areas: The BHT method uses several donor areas. For example, the chest, the belly, the beard, the back or even the legs are possible. High costs: The costs of the BHT are significantly higher than those of other hair transplants due to the time required and the complexity of the procedure.
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Punch method

The punch method (also known as Micro-Grafts or hair plugs) is the oldest hair transplant procedure and is no longer used today, as the 3.5 to 4 mm transplants lead to an unnatural and tuft-like result. In addition, the transplant yield is not as high and the removal area after the operation is disfigured by noticeable scars.

Conclusion

Each method has its advantages and disadvantages. The FUT method is particularly suitable for patients with severe hair loss (Norwood scale 4+), e.g. at the crown. The FUE method is more tissue-friendly and leaves no visible scars. Which method is the most suitable for your needs can be best determined by the specialist in the initial consultation. Nevertheless, in most cases the hair transplant needs to be complimented with medical proven hair loss medication such as finasteride or minoxidil.

 

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Where is hair transplantation possible?

Hair transplantation offers are a dime a dozen. Furthermore, the regional price differences are high. Therefore, get an overview of the offers and compare the hair surgeons in United Kingdom, US or Turkey based on experiences of real patients, costs and treatment methods:

Is your preferred city or country not included? No problem, you can easily request an overview of all suitable offers. Would you like to learn more about hair transplantation? Then inform yourself now in our guide!

Frequently Asked Questions

Is the FUE hair transplant procedure painful?

How dangerous is hair transplantation?

What are FUE Grafts?

What is the best hair transplant method?

Sources

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