1) The author, a hair transplant surgeon, underwent two FUE hair transplant sessions himself and re-evaluated the technique based on his experiences. 2) While FUE offered advantages like no visible scar and no stitches, the author found longer healing time, more numbness, cysts and ingrown hairs compared to the strip method. 3) Based on his experiences, the author now believes FUE is best for limited needs under 1500 grafts and that strip harvesting offers better graft survival and shorter downtime for larger procedures.

1. Konstantinos Anastassakis MD, PhD
Head & Neck Surgeon
Hair Transplant Surgeon
Trading Places!
An FUE surgeon
becomes
an FUE Patient
(and re-evaluates)

2. How I looked
back in 2008,
before my 1st
FUE session

3. Not THAT bad after
all…

4. HOW my HT transformed my practice!
2004-2012: 80% FUE / 20% strip 2012>: 20% FUE / 80% strip

5. 2 main HR techniques
The old (FUT, strip) and the young (FUE)

6. The only difference?
How we harvest the grafts
(BUT it makes ALL the difference!)

7. How I approached my decision:
(as a Hair Transplant Surgeon)
1. I do NOT want a visible scar (in case I want I
shaved look)
2. I do NOT want the “strip pain”
3. I do NOT want transected nerves-numbness,
cut vessels-bleeding or stitches
4. I do NOT want a lengthy down-time from the
gym

8. How I would have approached it
(if I were not a surgeon)
1. Newer technique
2. No pain (!)
3. No stitches
4. Less time till the next
session (!)
(THIS IS HOW OUR PATIENTS
MAKE A CHOICE!!!!)

9. Winner…FUE! (in both situations)

10. FUE drawbacks
(at least the ones I knew as a surgeon…)
1. Donor area shaving
2. Larger scar surface (Not scarless but scar
spreading)
3. Blind technique
4. Lower survival rate
5. Scared donor area left behind

11. 1. Donor area shaving
Before my 2nd session

12. …we had to shave the recipient area
for faster placement
$^!!!#!>??
@*#

13. This was my
look for
many
months…

14. 2 FUE sessions (2009, 2013) = 4,700 FUs
Equivalent to ± 25-26cm X 1.6cm strip
Wound lengthstrip=520mm= 50-52cm
Wound surfacestrip = 26 X 3-4mm = 70-100mm2
(if scar thickness=3-4mm)
2. Larger scar surface. But, how much larger?

15. 2. Larger scar surface. But, how much larger?
1. Wound lengthFUE
2πR=2 X 3.14 X 0.5=
3.14mm X 4,700FUs=
14,800mm = 14.8meters!
2. Wound surfaceFUE
πR2=3.14 X 0.52=0.785mm2
0.785 X 4,700= 3,690mm2
= 6cm Χ 6cm

16. 14.8m = 4 stories building
Not scar-less but scar spreading…
3,690mm2 = 6cm Χ 6cm =
5euros bill folded exactly in half!

17. 3. Blind technique
Strip FUT
All steps are under high
magnification vision
FUE

18. …but some grafts won’t
make it at the end…
FUE is promising in theory…
4. Lower survival rate

19. 4. Lower survival rate. Why?

20. After an FUT session
Future FUE or FUT sessions
are very hard after FUE
5. Scarred donor area is left behind
Donor area can be easily
re-harvested after FUT
After an FUE session

21. So, what have I learned…

22. 2009: 1st FUE session 1200 FUs,
0.8-1.0mm manual punch
I THOUGHT: ‘‘There will be no visible scar,
I can even have a shaved look if I want to…’’
Lesson 1

23. White spots from the 1st session were visible!

24. Hair had to be >5mm to cover my
older FUE scars
But then again, that length would
cover a good strip scar as well!

25. 10 days
5 days
Lesson 2
I THOUGHT: ‘‘Healing is faster…’’
30 days

26. Itching,
pain,
redness
for >60
days!

27. Numbness and very
“touchy” for >3 months!
(WHOLE occipital area vs
just on the strip scar
edges)
I THOUGHT: ‘‘No transected nerves-numbness…’’
Lesson 3

28. Lesson 4
I THOUGHT: ‘‘There are no complications…’’
Graft extraction is not always successful…
In grown hairs,
multiple cysts for
weeks!

29. Lesson 5
The RIGHT criteria MUST be STRICTLY MEDICAL!
Maximum graft survival
• All steps under direct vision
• Shorter session duration
• Easier for the surgeon (and patient)
• One session, even one pass!

30. Strip + Scalp Micropigmentation if scar was ugly!
What would I do today,
with what I know now?

31. Lesson 6
My (re-evaluated) FUE indications
1. Only for limited lifetime needs (<1500FUs)
2. ONLY if FUT is impossible or contraindicated or if patient insists!
• for exhausted “safe” donor area
• for “rock rigid” donor area
• for repair of scars or for graft redistribution
• for certain professionals (athletes, etc.)
• Ehler-Danlos syndrome (or similar)
3. For cherry picking of grafts (hairline refinement, eyelashes,
eyebrows, etc.)

32. A FACT for virgin scalps
• If >1500FUs are extracted from the whole donor area
(safe+…unsafe), white-spots will be VISIBLE, no
matter how well you spread the spots!
• A patient who needs <1500FUs will not shave his
head ANYWAY to cover thinning, he has plenty of
hair!
• So FUE scar-spreading advantage beats its own
purpose even on people who ARE candidates!

33. QUESTION
WHAT IS THE MEDICAL REASON for using
a technique with less graft- survival (all
other things equal), with 10X larger scar
surface and worse downtime on patients
with a virgin scalp and lifetime needs of
>1500FUs, if they will not be able to shave
their heads ANYWAY due to spots?

34. Take home messages
1. Working for years in a field does not make you
immune in taking non-optimal decisions in that
SAME field!
2. I believe FUE megasessions (>1500FUs) ALWAYS
compare unfavorably to FUT (all other things equal)
3. I advice you to avoid FUE if present (or lifetime
needs) >1500FUs or if at least one MEDICAL
indication is not met.

35. Konstantinos Anastassakis MD, PhD
Head & Neck Surgeon
Hair Restoration Surgeon