I’m 52 and have a pretty big bald patch and would like to know what is the best method for harvesting a large number of grafts, FUE, FUT or something else?
Dr. Friedman’s Answer:
When you have a large bald area to cover, the best method for harvesting grafts is Follicular Unit Transplantation (FUT) utilizing the strip method as compared to Follicular Unit Extraction (FUE). In the strip method, a long elliptical strip of tissue is removed from the donor region and is closed with sutures. In FUE, individual follicular units are removed with a very small cylindrical punch.
With the strip technique, we can harvest the maximum grafts from the donor region. What limits the number of grafts being harvested is strictly dependent on the patient’s hair density, scalp elasticity, and the length of the donor region. Obviously, the more grafts per square centimeter, the more grafts will be harvested from the donor strip. If one person has 60 follicular unit grafts per square centimeter, and another has 90 grafts per square centimeter, the patient with the larger number will get one-third more grafts from the same length and width.
Another variable in the number of grafts harvested is scalp elasticity. The more elastic or loose the scalp, the wider the donor strip. In a tight scalp we typically remove a strip measuring 1.0 centimeter in width, whereas in a loose scalp we can remove a strip 1.5 to 2.0 centimeters in width. The patient who has a tight scalp will only be able to remove a strip one-half as wide as the patient with a loose scalp.
The third variable is the length of the donor region. The average male patient measures approximately 30 centimeters from ear to ear, yet in a patient with a large head the length can be 33-34 centimeters.
In a perfect world, we would prefer a dense donor region in a very loose, big head. Yet, this is extremely rare. The typical patient either has a lot of elasticity or marked donor density.
Our average FUT is approximately 3,000 follicular unit grafts, but we have had numerous patients in the 4,000 graft range and others we could only harvest 2,000 grafts from one strip.
Remember, these figures vary from patient to patient. The good news is even in a patient with a tight scalp and average donor density; we can harvest several strips over several surgeries to obtain the number of grafts needed to cover the bald areas.
— Dr. Shelly Friedman, DO
Board Certified Hair Restoration Surgeon
Arizona’s Most Trusted Hair Loss Doctor
Named Phoenix Magazine’s Top Doc – Hair Transplant Surgeon