Repairing a Poor FUE Surgery With FUT
Hair loss affects millions worldwide, and consequently, many have sought surgical solutions through hair transplantation. Two dominant methods leading the pack are FUE and FUT, which stand for Follicular Unit Extraction and Follicular Unit Transplantation, respectively. While FUE remains popular because of its less invasive nature with minimal scarring, not all cases result in satisfying outcomes. Should an FUE hair transplant either fail or produce suboptimal outcomes, the FUT method has provided an effective solution for repair and restoration.
Before expounding on repair processes, it is important to understand what the difference between FUE and FUT is: FUE has to do with the individual extraction of the hair follicle from the donor area by using a punch tool, while in FUE, every follicular unit, containing one to four hairs, is taken out individually and placed into the balding areas. Advantages of FUE include minimal invasion of the skin, quick recovery and less post-operative discomfort, and is suitability for people who wear short hairstyles since scarring can barely be seen.
On the other hand, FUT is also known as the strip method, where thin strips of scalp are taken from the donor site, further dissected under a microscope to prepare the individual follicular units for implantation. Key advantages of FUT are that it has a high graft yield, allowing greater numbers of grafts in one session, it preserves the donor site for further procedures, and it minimizes the possibility of follicle damage during extraction.
Although FUE is popular, there are some factors contributing to the possibility of failure of such procedures. Candidate selection is considered very important; not everybody is a perfect candidate for FUE. The factors include the extent of baldness, hair type, and donor hair availability. Individuals with greater baldness or low-quality hair in the donor area might not get the desired density with a FUE procedure. This could be because of overharvesting the donor area and may result in visible thinning or scarring of that area, thus depleting the resource of the donor area for future transplants.
Technically, extraction or implantation of the grafts with mistakes in angulation and depth will lead to fewer graft survivals and the growth of hair that appears unnatural. Transection of grafts means unintentional damage of hair follicles during their extraction reduces their survival upon transplantation. Poor handling of grafts outside of the body, such as for extended time, dehydrating, and incorrect storage processes, affects graft survival.
This may be associated with dissatisfaction with the result despite the technical success of the procedure. The first step toward the correction of a failed or suboptimal FUE transplant is its identification. Common signs include poor hair density-the development of hair at the site of transplantation is sparse or patchy in nature; an unnatural hairline presenting an artificial look with inappropriate placement or direction of the grafts; visible scarring in either the donor or recipient site; donor area thinning because of overharvesting; and constant infection or inflammation indicating graft rejection.
When a FUE transplantat fails, the FUT method works very efficiently for a number of reasons. FUT thus enables a practitioner to extract more significant numbers of grafts in one session than FUE does, which is very important when previous procedures have depleted the original donor area. FUT minimizes further trauma to the donor area by taking out a strip of scalp and thus avoids damaging further hair follicles that may well be required in the future. It minimizes the risk of any injury that would lead to lesser survival and growth, due to minute dissection of follicular units under a microscope. Additionally, FUT may be used to improve cosmetic scarring from a previous FUE procedure by transplanting follicles directly into scar tissue. Greater density and a more natural look may be realized, especially in those whose expectation were not met with FUE, thus requiring higher yield and quality grafts. Repair of a failed FUE transplant with a FUT procedure generally consists of several stages, including a thorough evaluation by an accomplished surgeon: the history to review the presence of any medical conditions that can compromise surgery, scalp examination to assess the donor and recipient areas, hair characteristics, and the outcome of the previous transplant; discussion of goals to understand the patients’ expectations and the desired outcome from the proposed procedure. The preoperative preparation may be imposed to avoid medications like anticoagulants, smoking cessation to enhance the healing process and graft survival, and making arrangements for one’s recovery by planning time off from work and general help during the early stages of recovery.
The actual surgery, after injecting local anesthesia to kill the pain, is begun. A thin strip of scalp tissue is surgically taken from the back of the head, and the wound is carefully sutured with little more than a thin linear scar. The strip is further prepared under high-powered microscopes to harvest individual follicular units with minimal trauma. Small recipient sites in the bald areas are prepared in accordance with natural hair growth, in terms of angle, direction, and density that will provide the most natural appearance. The follicular units are then carefully placed into recipient sites in an attempt to gently restore density and correct an unnatural hairline or pattern.
The detailed treatment for postoperative care may include antibiotics to avoid infection, analgesics to deal with discomfort, recommendations on cleaning and protection of the surgical sites, and not engaging in strenuous activities to avoid the displacement of grafts. Follow-up is also considered to check on the healing process and any other concerns.
The healing period involves slight swelling, tightness, or discomfort during the first few days, controlled by medications. Suturing to the donor area may require care until the sutures are removed within the first week. Most traces of the surgery disappear within two weeks, and patients are normally able to return to their regular activities.
The shedding of the transplanted hairs within one to three months is just a passing phase in thee process. Actually, new hair growth starts from three to six months fine at first but slowly thickens. Marked improvement in the density and coverage is noted from six to twelve months, although generally, the final result will be seen from twelve to eighteen months. Expected results are increased density with improved fullness in previously sparse areas, a natural-appearing hairline and camouflaged scarring that can usually be covered by surrounding hair. Generally safe, the risks associated with FUT are scarring, with a permanent linear scar remaining at the site where the donor strip had been taken from.
Infection can be prevented if the postoperative care is well addressed. On the other hand, infection is manifested by redness, warmth, or discharge of the surgical site. Numbness near the incision site is due to injury to the nerves and, in most instances, resolve in time. Unsatisfactory results occur in instances when expectation management is poor. Perfection may not always be achieved and in some instances, subsequent procedures may be required for optimal results.
Success usually requires an experienced physician. Qualifications and experience are key: board certification in dermatology or plastic surgery, fellowship-trained in hair restoration, extensive experience with FUT. It will be necessary to go through the before-and-after galleries of cases already performed to get a rough idea of the naturalness and density achieved. The patient testimonials and referrals will also give an overview of the quality of care.
FUE transplant failures could be minimized by precautions such as careful consultation and assessment of candidacy and the setting of expectations. A well-experienced surgeon, complemented by good supportive staff, minimizes risks through technocratic proficiency in the handling of grafts. As a rule, post-operative compliance consists of good post-care and timely notice in case something has gone wrong, which becomes very critical in graft survival and complication management.
Though a failed FUE hair transplant is very discouraging, a solid solution that does promise great hope of repair and restoration is the FUT technique. The patients can avail the benefits offered by FUT, such as higher graft yield and better preservation of the donor site for added density, natural hairline, and restored confidence. Success depends upon the proper selection of the surgeon, getting adequate information about the surgery, and keeping realistic expectations.
Frequently Asked Questions:
Can I have another FUE to correct a transplant that has failed? Yes, a secondary FUE can be done if the donor area is not particularly depleted. When the donor area is compromised FUT has generally been recommended because this approach will be able to harvest more grafts without further thinning.
Will the scar from FUT be visible? FUT leaves a linear scar; however, with advanced closure techniques and appropriate hair styling, the scar is generally not an issue for most patients. The scar is also easily camouflaged in those patients with longer hair.
How soon after an unsuccessful FUE can I have FUT repair? Generally, it is recommended at least a year after the original FUE as this will enable one to identify the full result of the first surgery and for the complete healing to take place.
Does FUT recuperation take longer when compared to FUE? In FUT, there is added soreness at the donor site because of the incision, which will add to the time needed to recover.
What if I don’t have very much donor hair left? It is the surgeon who will be able to evaluate your donor area and may recommend the addition of treatments such as SMP or PRP therapy along with FUT. Understanding such options and collaboration with a qualified professional can allow someone who has had a poor outcome from an FUE transplant to make an affirmative step toward their desires on hair restoration. The FUT method is, indeed, far more reliable, offering hope and tangible results to many looking to correct their past disappointments.
References:
International Society of Hair Restoration Surgery (ISHRS): www.ishrs.org
American Academy of Dermatology (AAD): www.aad.org
Journal of Cutaneous and Aesthetic Surgery: Various articles on hair transplantation techniques.
Hair Transplant Forum International: Publications on the latest advancements in hair restoration.
