What are the pros and cons for FUSS and FUE

There are two methods of harvesting hair grafts during hair transplant surgery, which are Follicular Unit Excision formerly known as Follicular Unit Extraction (FUE) and Follicular Unit Strip Surgery (FUSS). FUE harvests one hair graft at a time with a tiny punch that ranges from .7mm to 1mm in size. These punches leave circular scars in the donor area. On the other hand FUSS harvests the hair grafts by cutting a strip of donor tissue which is dissected in to 1,2,3 and 4 hair “follicular unit groupings”. This method results in a linear scar in the donor site. Which technique is best for you? How do you decide which method to pick? It is difficult choice for many prospective patients. However, after going over the pros and cons of both methods in depth, you will be in a better position to make a well informed decision for yourself. There are many pros and cons for both FUE and FUSS harvesting methods.

The Pros for FUE: 1. The scars exhibited through FUE are tiny and scattered throughout the back and sides of the scalp (donor area), which allows an individual to wear his or her hair short because these types of scars are difficult to see 2. FUE is less invasive than FUSS, because the scalp is intact during the harvesting part without cutting open any scalp. 3.  Overall there are fewer risks associated with FUE.  4. With FUE there is a lower chance of infection and other post-operative complications. 5.  FUE is less painful than FUSS for the majority of patients during the recovery process. 6.  FUE generally heals faster than FUSS, which allows the patient to continue their normal routine sooner.  7. There is a lower chance of damaging nerves with FUE.

The Cons for FUE: 1.  FUE is generally more expensive than FUSS because it is more labor intensive during the harvesting part. 2.  You can have good hair growth and results with both FUE and FUSS, but with FUE the growth rate is around 5%-20% less than FUSS. Results vary from one hair transplant surgeon to another. 3.  FUE harvests the hair grafts less efficient than FUSS. With FUE a surgeon can harvest around 1,000-4,000 hair grafts per session. Thus, FUE is recommended for mild to moderate hair loss. Although, FUE can be used for advanced hair loss, but there will be a need to have multiple hair restoration surgeries ranging from 2-5 sessions depending how many grafts can be harvested per session. 4.  The FUE donor area will be shaved down more aggressively than the FUSS method. The FUE donor area can look presentable from 1-8 weeks depending on how dark the individual’s skin tone is and how long the pinkness lasts post surgery.  

The Pros for FUSS: 1.  It is typically less expensive than FUE because it is less labor intensive to harvest the hair grafts. 2.  It is more efficient to harvest hair grafts. FUSS can harvest a large number of grafts ranging from 4,500-5,000 hair grafts per day. Thus, FUSS is recommended for patient’s with extensive hair loss because a large number of grafts can be harvested and transplanted in one surgical session. 3.  A patient is not required to shave the donor area, this allows an individual to walk out with long hair to hide the donor incision. 

The Cons for FUSS: 1.  FUSS is more invasive than  FUE because FUSS harvesting involves cutting a strip of skin with hair follicles in the back and sides of the scalp. 2.  FUSS will leave a linear scar in the donor area which will be more visible with short hair than the FUE scars.  3.  FUSS can be more painful than FUE during recovery for some patients. However, both FUSS and FUE are minimally invasive procedures and thus are being performed in outpatient surgical settings. 4.  In rare cases, the numbness along the linear scar may be permanent. 5.  FUSS takes a longer time to heal than FUE however, the difference is minimal and around 2-4 days. 6. FUSS has a slightly higher risk of infection, however the infection rate is very rare for both FUSS and FUE surgeries.

After going over the pros and cons of both FUE and FUSS harvesting methods, there are a few more questions you can ask yourself in order to make an educated decision of which harvesting method is best for you. 1.  Can you live with a  linear scar for the rest of your life? Scars are permanent. 2.  Will you ever wear your hair very short? 3.  How advanced is your hair loss and how advanced will it be in the future? By going over these questions you may have a better understanding of which technique is best suited for specific goals and needs.

Written by,

Dr. John Diep– Recommended on the Hair Transplant Network

Published by,

Melvin, Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.
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