There are a two primary methods of surgical hair restoration currently available today. They are strip hair transplant surgery (FUT or FUSS) and follicular unit hair transplant surgery (FUE). Each has their own distinct advantages and disadvantages.
Strip Surgery – This is the most prevalent form of surgical hair restoration, sometimes referred to as “FUT” surgery. If you refer to the section Hair Transplant Terms & Definitions you will understand why I say the term “FUT” is a double entendre and that the term FUSS should be the standard reference to strip surgery.
Strip surgery is getting more and more of a bad reputation and there are two reasons for this. The first reason is because there is an unpredictable element that goes above and beyond the question of “will the transplant grow” and it involves the chances of the donor scar widening as it heals.This is a very real possibility and something that patients should be completely clear about when they are considering strip surgery. With the number of resources available online it is getting more obvious to patients that the donor scar is a potential issue if they opt for this procedure. The second reason why strip surgery is getting a bad reputation is because the procedure is getting absolutely hammered by every single FUE only clinic in existence. It is in the marketing material and it is dripping from the mouths of the consultants and/or doctors. It is the easy sell and it is exactly what I would do if I were working for an FUE only clinic. Show a picture of a bad strip scar and you just cemented the deal. Done.
Strip surgery is exactly what it sounds like. It is when a doctor takes a strip of skin from your head to harvest hair for transplant purposes. It sounds and looks worse than it really is and it is not only a very reliable procedure it is also the best way to get to the sweet spot of your donor zone. Strip surgery is also the procedure to choose if you need or want to get the maximum number of follicular units in one day. When I say the “sweet spot” of your donor zone I’m talking about the area of the safe donor zone that has the highest density and the best quality and caliber hair. You can see it on most bald guys out there. If they have a horseshoe of hair around the back and sides of their scalp there is an area of higher density that usually runs through this horseshoe where the hair looks a bit thicker and a bit healthier than the surrounding hair.
The issues that a hair transplant surgeon must pay attention to when removing a donor strip in strip surgery include (but are not limited to):
So what is it that doctors look at when they are assessing the candidacy of a strip surgery patient? Obviously they are first looking at the supply and demand of the situation that the patient presents. What is the area of hair loss and the patient’s expectations for a result and does the patient have the donor reserves to meet these expectations with one or multiple surgeries? The physician should also be assessing if the expectations of the patient are realistic and if they are considering the potential downsides of the procedure. Once this is considered the doctor will assess the potential for the procedure by gauging the laxity of the donor scalp. The doctor should be assessing the posterior donor zone as well as the lateral donor zones (above the ears). There have been attempts to create a standardized laxity test but in my opinion simple experience will tell the doctor (or consultant) what size surgery will be possible. In addition to laxity the doctor should also be assessing donor density as well as, to a lesser degree, the type of hair being transplanted. It is coarse? Is it fine? Wavy? Curly? Straight. All of these factors work together to determine the potential for success or failure.
Assuming you wind up having surgery there are two possible ways that the surgery will move forward. Once you are in the clinic and you are prepped you will either be laying face down on table that is similar to a massage table with an opening for your face or you will be sitting up in a chair similar to a dentist chair. When one is laying prone or face down the doctor will have the patient tuck their chin in or “down” as this helps to expose the target donor zone. Furthermore, at this angle the doctor can easily position the scalpel so that as he is pushing the scalpel though the donor zone he can maintain the angle of the scalpel at the same angle of hair growth as it exits the scalp. This helps to greatly reduce transection and allows for a cleaner cut. it is also easier to prevent excess bleeding as any bleeding that does occur will “pool” in the donor wound giving the assisting technician time to absorb the blood with a dabbing gauze. Many doctors prefer when patient’s sit up in the chair as they feel it is more comfortable for the patient, which is true, but in my opinion the benefits cease there.
Strip surgery donor wound closure occurs in various ways. Some doctors will close the wound in sections as individual segments of the strip are removed. The wound will be closed before the next section is removed until the entire strip is removed and the wound is closed shortly thereafter. This is thought to be helpful as the longer the wound stays open the more difficult it is to close. Others will close the entire wound at once and others will close half of the wound before they move on the the second half. The two closure techniques are sutures and staples with a combination of the two also often used. When they are combined sutures are used for the deeper layers of the wound as it is thought that this helps to reduce the tension placed on the superficially placed staples.
Once the donor wound is closed the donor strip is already being addressed by the technicians assigned to the case. Depending on the size of the surgery and the number of technicians working, one or more technicians will be tasked with “slivering” the donor strip. This is the process of sectioning off narrow pieces of tissue that are so thin they are nearly transparent but they contain numerous follicular units. All slivering is performed under stereoscopic microscopes. These slivers are then handed off to the remaining technicians where they further refine the tissue down to the basic follicular units. They are then categorized and labeled as singles, doubles, triples, quads, etc. During this time the doctor is coordinating with the technicians to get an idea of how many grafts of each size are being dissected and this is where the recipient site incision making will begin. The doctor will make the incisions in the recipient zone then take a break to allow the technicians to begin placing the grafts. This “staggered” approach is fairly common but is only necessary for larger procedures. This part of the process is not the same for all clinics especially those that use the stick and place method but for the most part this is what one can expect during strip surgery. Once the placement is complete the patient is usually given a take home package with prescription painkillers and antibiotics.
Strip Surgery Advantages –
Strip Surgery Disadvantages –
There can be arguments made for additional disadvantages with strip surgery but the issues listed above are the primary concerns patients should be aware of.