FUE vs. FUT for Crown Hair Transplant

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This podcast is talking about selecting an FUE versus FUT procedure for crown hair transplants. I thought about this topic because I’m actually going to be giving a couple of lectures for a global hair summit on this topic, as well as for an advance course and hair restoration for the ISHRS meeting that is virtual this year. I just wanted to address some of the thoughts I have on this. I know that FUE is very sexy nowadays, and it is something that people are using all the time for everything, because they believe that the strip procedure’s outdated, I’m actually today just finishing an FUE hair transplant on the crown. I just did one last week as well. So it’s sort of on my mind, but I wanted to talk about when such a procedure would be indicated when, in my opinion, it may not be, Now a lot of my podcasts for hair can be a little bit esoteric and difficult to understand.

So I hope it’s not, but I want to talk about when do I do FUE for a crown or when can I do it? And when I don’t think it’s reasonable now the whole topic of when to do a crown transplant to begin with is already been covered before. And that’s a very long discussion as well, but let’s first assume that a hair transplant is safe and reasonable for you in the crown area. Now, if we have that, how do we decide which method to use FUE versus FUT? The F U E has a lot of benefits in the sense that you could potentially wear your hair super short and not see a scar that’s visible, even though it is not scarless, you can have little tiny white dots. That’s important to know that, but when you look at a crown, we talk about something called PI R squared, which is the surface area of a crown that needs to be transplanted.

So when you look at that surface area, you need to be able to put enough grafts to make it look good. So once the radius doubles, so that radius becomes squared, your surface area, quadruple, so requires a lot of grafts. So when I do with a small to medium sized crown, if I’m doing it either in isolation or the limited front area, I can do FUE, but when it becomes a very large crown, you face two major problems. So the first I’m going to talk about is total donor capacity. So FUE takes a lot of hairs from the back of the head. If someone has poor to moderate density in the backside, you can get a lot more hairs with FUT or strip procedure than with an FUE procedure. But if someone has a very high density then, and the crown is not too large, oftentimes you can get enough to do the crown well, but you don’t want to burn out all the hair grafts in the back through the crown.

So I’m always thinking about not only how many grafts is going to take me to do the crown, but will I have enough grafts to come back and do the crown again, because the crown can expand over time, especially if you’re younger. So that’s another variable. So there are a ton of variables in my head when I do a crown transplant, not only will I be able to cover it in this current session, but also enough for future hair loss. So total donor capacity is a subject, which means how many donor hairs I have for current and future problems in your lifetime projecting forward. Now, of course you don’t have an accurate assessment because as let’s say, the crown gets larger, your total donor capacity reduces. So even if I look at that number of hairs in in your donor area, it does change over your lifetime.
So I have to predict that as well. So are a lot of variables here, FUE by its very nature has a more limited total donor capacity than FUT or strip. Now one good saying by my colleague is that almost all FUE procedures and eventually an FUT, when you run out of hairs for FUE and almost all FUT procedures are strip procedures and with FUE, when you run out of hairs. So the concept though, is that in short, if you have a very large crown FUE may not be your best option because I may not have enough grafts to do it now. And I may not have grafts for the future or one or the other categories, both of which are problematic. The other issue is something called SDA or safe donor area. So when you’re doing FUE and you need it, and you have a relatively large crown, you have to harvest from a wider area and you have to harvest right up to the edge of the crown

sometimes. When you do that, you’re getting to the edge or beyond what is called a safe donor area, which means those hairs that are toward the edge may not be programmed for survival. They may actually be programmed for genetic loss. So now you’re taking hairs that are susceptible for future hair loss. So again esoteric concept here, but when you deal with a very large crown FUE, FUE may not be the best option because of total donor capacity and risk of getting non-viable hairs that over time, you start to lose. As I said, I do a lot of FUE for crowns. I just did two this last week. So it’s not as if I believe that it’s something unsafe or inappropriate, but you have to be very careful. If a lot of places out there only practice FUE, they don’t do any FUT or strips.

So they have to sell you the only surgery that’s available. This is all based on if you’re even a candidate to do this, because some people are just, I don’t believe safe to do to crown transplants where they are better off doing medical therapy alone. So the summary to make it very simple is that if your crown is small to medium, and I am not doing a massive number in the front of the hair where I’m going to be eating up, a lot of grafts, FUE or FUT could be acceptable. If I have to do a lot of grafts in the front or your crown is too large, I would most likely tell you that an FUT procedure would be better or we have to scale back the procedure. Cause a lot of people out there are sales people that try to sell you a surgery today. They don’t care what your donor area looks like in 10 years. I’m constantly thinking about both options, both issues. So I know this is very complicated. I hope you sort of understood what I was trying to get at and during a consultation, I can more tailor it for you. When I look at all the variables that are there when I see you in person.