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FUE or FUSS Large Surgery

FUE or FUSS Large Surgery – Which Technique is Better?

FUE or FUSS Large Surgery - which method is bestOne of the greatest debates within the hair transplantation industry is whether FUE (Follicular Unit Extraction) or FUSS (Follicular Unit Strip Surgery) is a better method for large surgery.

Both techniques definitely have their benefits…  and, depending on the scenario, some small disadvantages. Both techniques also have their share of doctors that hard-sell one or the other technique. Typically a Hair Transplant Surgeon will recommend the one that they regularly or exclusively perform and ridicule the other technique to make a sale.

When it comes to massive hair transplants of 3000, 4000 or 5000+ grafts which method out of the two is a better surgical technique overall?

The beauty of visiting Newin Institute is that the entire team is educated and highly skilled in both FUE and FUSS surgeries and in small and large surgeries. So you know you’re getting unbiased recommendations based on your individual circumstances and assessment. We have no vested interest in pushing you towards one or the other technique – we’ll let you know which type you are suited for – even if it’s both. Our interest is getting to the best results possible, quickly and with minimal complications or requirements for unnecessary surgery.

FUE or FUSS Large Surgery – Our opinion based on  years of experience in both methods

Six years ago if someone asked Dr Rhett Bosnich which hair transplant technique is the more popular he would have reported that 90% of his surgeries performed are via FUSS and that 10% are via FUE.

Now fast-forward to today and we find the numbers have changed significantly: where 70% of all his surgeries are via FUE and 30% are via FUSS.

But why is this so?

The Current Trend in FUE for Large Surgery

In our experience at Newin Institute, patients today seem to prefer FUE over FUSS surgery and we believe this comes down to two main factors.

The first factor is that the biggest selling point of FUE is that you don’t end up with linear scar within the donor region. If you want to shave all your hair off you will not be left with obvious scarring.

The second reason, we find, is that the FUE one-by-one fine punch extraction approach appears to be less invasive and less daunting from the patient’s perspective than having a strip of skin removed from the back of the scalp. It just seems less scary to patients to opt for FUE, but that shouldn’t necessarily be the case.

Is the FUSS Method In Fact A Better Approach For Large Surgery?

What about when it comes to requiring large sessions of 4000-6000 grafts? The below points are things to consider for any patient that requires such large numbers of grafts and needs to choose the right technique: FUE or FUSS Large Surgery.

Scarring Type

FUSS – Leaves a fine linear scar running from ear to ear that usually measures 1-3mm thick. Many time the scar is so fine that the individual can wear shorter hair style without an issue, but  usually people want to wear their hair a bit longer – so worst case scenario is that the scar is covered by hair and unnoticeable to others. If you se a surgeon who performs FUE well, that scar can have a few extra hairs implanted into he scar area at a later date to disguise it even further and this is usually sufficient, leaving a highly satisfied customer.

FUE – Leaves tiny 1mm scar spots scattered over the donor region. The size of the spots are in proportion to the FUE punch that the surgeon uses. If a 0.8mm FUE punch is being used, these scar spots will be smaller than those made with a 1.2mm punch (which is a punch size used by less experienced FUE surgeons)

Ability to hide the surgical scar

FUSS – It is common knowledge that a linear scar can be hidden under a number 3 or 4 clipper length which measures 10 to 13mm long. In rare cases some can be cut as short as a number 2 length which means 7mm.

FUE – In theory even a donor hair length as short a 3mm can be worn without the many small FUE punch holes being obvious. However this is not always the case.

FUE requires the donor region to be shaven and for the Doctor to extract a set number of grafts from a much larger surface area. For example 2000 follicular unit grafts may be extracted over an area that contains 10,000 follicular units representing a 20% reduction in donor density based on hairs per square inch. This will not be noticed even under very short hair.

However what if a patient opted for 5000 grafts to be taken out from the same area. Doing this means that one in two follicular units would be taken representing a donor density reduction of 50%. When this much hair is taken out via FUE, the now thin donor is visible and obvious under short or long donor hair. If the same person instead obtained 5000 grafts via FUSS, the donor region would have slightly shrunken in surface area but maintained its density. The linear scar would be easy to hide under slightly longer donor hair.

For this reason we always advise if requiring big graft numbers in the vicinity of 4000-6000 grafts, FUSS is a better alternative; or a combination of both FUE and FUSS combined.

Long Term Survival of Grafts

Surgery aside, it is quite common for a person that is suffering from Androgenetic Alopecia to notice their donor area reduce in size as a result of this medical condition. It is evidenced by the hairs at the bottom of the donor region becoming weaker, causing the back hairline to sit higher up on the neck/scalp.

This is most obvious in older hair loss sufferers in their 60s and over.

The same can be said for the hairs at the very top of the donor area which, over time, also miniaturise causing crown hair loss to recede further and further backward until it encroaches the upper part of the back of the scalp we call the “Donor Area”.

So we can basically conclude that the donor region is broken into three sections which are the upper, middle and lower thirds. The middle region would be the permanent zone (where the least number of hairs miniaturise over the long term) while the upper and lower thirds would be semi-permanent zones (as many of these hairs may disappear over time).

FUSS – All grafts are taken from the middle band of the donor which is the most permanent zone

FUE – Grafts are extracted from the whole donor meaning that as much as 50% of the grafts are taken from the less permanent upper and lower thirds. This factor does not apply as much for FUE surgeries of up to 3000 grafts. However it does for the more massive surgeries.

Growth Rates

These are comparable, however, FUSS does have a slight edge:

FUSS – Average growth rates of around 95-98% survival

FUE – Around 90% growth is the average

Duration of the Session

If a patient requires 4500 grafts they can be given the option to do it as per the following:

FUSS – All within one day if they can get it

FUE – Three 9 hour days where around 1500 grafts is obtained each day

FUE or FUSS Large Surgery – Our Experienced Conclusion

Overall, FUSS shouldn’t be scary or off-putting for the appropriately selected patient. Consult carefully with a doctor that is experienced in both techniques, such as Dr Rhett Bosnich. In the hands of a great surgeon and his team, pain is managed very well and the procedure itself is tolerated well by these appropriately selected patients.

In our experience at Newin Institute we classify:

  • FUSS as a better extraction method for large surgeries of 3000 to 6000 grafts; and
  • FUE for smaller surgeries of under 2000 grafts

What about for the 2000-3000 graft range you ask?

Then it comes down to personal preference…

If you’ve been considering hair transplant surgery and can’t decide between FUSS or FUE surgery, speak with us today for unbiased information and find out which method you may be suited for.