This comes from prominent New York hair transplant surgeon, Dr. Michael Beehner:
With FUE, it is easy to fracture the neck of the base of the follicle when the bulb is “naked” and then grasped for placement, while in microscopic dissection with a strip harvest, there is good fat around the base of the follicle and fracture of the hair follicle almost never occurs during placement. When all of the people placing the grafts have to grasp the naked follicle, I think this causes a kink on the end of the exposed follicle and may be accompanied by poor growth.
Quite frankly, I wish that, instead of our always talking to the patient about the choice between FUE and “strip” harvesting, I would rather talk about FUE vs. “microscopic dissection of grafts”, because this is where the biggest difference is between the two procedures. Also, the FUE often strips the end of the graft as it is being pulled out, leaving less tissue and fat on the end. With strip harvest and microscopic dissection, the doctor’s staff have total control on how that graft will be produced and we never see stripped grafts. Also, the fact that in a strip surgery, we are always taking the strip from the absolute richest center of the scalp where the best hairs are, this makes the choice difference for me a “no-brainer”.
I have no trouble convincing 95% of my patients who walk in seeking FUE to go with strip when I present the FUE problems to them this way. I explain all of these things and reassure them that many patients have almost undetectable strip scars.
We wrote about Follicular Unit Extraction (FUE) vs Strip (FUT) nearly two years ago: FUE vs FUT — Which is Better?
When you look at a follicular unit, you will see all of the anatomical parts that are traditionally created from a strip harvesting technique. All of the critical anatomy is preserved as the grafts are dissected under a microscope from the strip harvest. Damage, providing that the grafts remain hydrated, is rare and growth is excellent.
When FUE’s are done, the follicular units are not-infrequently disrupted in some manner, and these grafts may not grow as well as a result of the disruption. This is shown in some grafts that we put aside for trimming when a patient had the type of collagen that resisted the extraction in the FUE process. This is viewed here. Once these second class grafts are trimmed, they must be grasped with a forceps at the bulb or just above the bulb, which can fracture the hair shaft (this is what Dr. Beehner was talking about above).
With good instrumentation and considerable experience, FUE can be done as successful as with a strip; however 100% of patients do not have a tissue anatomy that allows such a clean FUE. This was discussed in our pioneering article that introduced FUE to the medical profession.