In the majority of cases, Dr. Lam performs either FUT (strip) or FUE in isolation. However, there are a few clinical indications for combining FUT and FUE during the same procedure. Depending on donor availability, sometimes a combination of two types of donor harvesting or two types of donor areas may be needed in order to obtain a maximum number of hairs to be transplanted. For example, a strip FUT could be combined with scalp or beard FUE. Each donor harvesting method and site is chosen for its advantages, such as a narrow strip because it could yield the highest number of the most robust grafts or beard harvesting because it provides “additional” hairs that are thick and could serve as a density builder.
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- Ideal candidate
- Men who have a stable hair-loss pattern and are diagnosed with genetic hair loss
- Men who desire hair transplant but have significantly diminished donor-hair availability due to previous hair transplants or sparse donor
- Men who have strong beard and/or chest hair
- What to do
- If body hair is to be considered part of the procedure, then create a long-term plan since body hair transplant usually requires more than one session to achieve adequate density.
- For beard hair harvests, avoid shaving for 48 hours prior to the procedure. It is important to keep your beard at a specific length (no longer than 1 to 2 mm or a 2-day growth). If your beard is white, you should color it the day before the procedure using Just for Men for Beard and Mustache.
- If scalp FUE hair is to be used at the same time as scalp FUT harvest, Dr. Lam and his team will shave the area for FUE harvesting the morning of the procedure in preparation for the procedure.
- If you are out of town, you will be required to arrive the day before the procedure and will be allowed to travel the day after, staying in town for a total of two nights. However, if you are not in town at two weeks after the procedure, you will need a professional to remove your sutures (stitches) if Dr. Lam performed an FUT procedure. Dr. Lam has many colleagues across the United States and the world who may be able to help remove your sutures so that you do not need to stay in Dallas for two weeks or return in two weeks to have your sutures removed.
- What to expect
- Beard harvesting sites heal very quickly and usually cause very minimal discomfort. You will be required to wet shave your beard (donor area) 48 hours after the end of the procedure.
- Occasionally harvest sites can look like small hypopigmented (reduced color) dots. The chest area has a tendency to create scars, so it may heal with more visible spots than the beard. Leaving some chest hair present may be the ideal method of camouflaging this area.
- Transplanted hairs should start growing 3 to 4 months post-procedure (but may take longer for substantial growth to be visible) and should improve in growth up to 12 months post-procedure (or slightly longer than this period of time).
- Beard hair could look and feel coarser than scalp hairs but should blend well. Body hairs could look and feel finer than scalp hairs and could go through shedding cycles more frequently than the scalp or beard hairs.
What is the most likely reason for Dr. Lam to combine FUE and FUT procedures?The most likely reason for a combined FUE and FUT procedure is simply for an individual who requires as many grafts as possible but has limited donor hair available using strictly FUT. For example, someone may have a loose temporal hair area (sides of the head) but a tight occipital area (central back side of the head), so Dr. Lam may choose to harvest FUE grafts from occiput and FUT grafts from the side. If the occiput has too few grafts available, then he will usually opt to harvest from the beard area, which is the second most preferred site for harvesting. He will harvest from the chest area if he needs further hairs to supplement his FUE harvest but only as needed.
Does Dr. Lam perform FUE and FUT harvest simultaneously in virgin cases simply to augment what is possible for a single harvest?In general, no with some exceptions. Usually, on a first pass there is plenty of hair that can be harvested via FUT alone. (Obviously, many individuals only want an FUE procedure to avoid a linear donor incision, so for someone willing to undergo an incision, the FUT should provide adequate hair in most cases for a megasession procedure (of 3,000 grafts or more). Some surgeons want to move 5,000 grafts or more using both FUE and FUT in a single session. Dr. Lam in general prefers not to perform these larger sessions for a few reasons. First, Dr. Lam believes that these very large sessions overly deplete the donor hair more rapidly and do not permit enough future reserve of donor hair for additional sessions. Second, Dr. Lam likes to see what grows after a single megasession to see what is necessary for an additional session if that is even needed. Third, overly dense packing of the entire scalp may cause a reduction in the percentage of growth, thereby wasting valuable donor hair. Fourth, if one is willing to undergo an FUT procedure, the surrounding FUE procedure may disrupt and depopulate the hairs and thereby limit the possibility for future FUT sessions. There are so many reasons that Dr. Lam prefers to use combined FUE and FUT cases for only those patients who truly need it.
FUE vs. FUT
|Procedure||Follicular Unit Extraction||Follicular Unit Transplant|
|Harvesting method||Small round punches||Linear Incision (Strip)|
|Ideal candidate||Men||Men and Women|
|Graft survival||Grafts fragile and easily injured; good survival||Grafts robust and resilient; great survival|
Please watch Dr. Lam’s SlideShare presentation on his philosophy, strategy, and design for crown hair transplantation.
Please watch Dr. Lam’s SlideShare presentation on the fundamentals of male hairline design.
Please watch Dr. Lam’s SlideShare presentation on recipient site design and distribution.
Please watch Dr. Lam’s SlideShare presentation on temporal point reconstruction.