Hair Transplant Comparison: FUE vs FUT vs DHI Hair Transplant

As an aesthetic doctor in Singapore who regularly consults with patients dealing with hair loss, one of the most frequent questions I get asked by patients considering a hair transplant procedure is whether a Follicular Unit Transplantation (FUT) or Follicular Unit Extraction (FUE) hair transplant procedure is the better option for them. While both FUT and FUE are widely regarded as permanent and effective solutions for addressing hair loss in Singapore, each technique comes with its own set of considerations, distinct benefits and limitations.

In this article, I aim to break down the key differences and provide a clear comparison between these two popular hair transplant procedures to guide those seeking to make an informed choice for their hair restoration journey in Singapore.

To understand the pros and cons of FUT vs FUE hair transplant, we first have to understand the mechanisms between the two hair transplantation techniques. The key distinction between FUT and FUE lies in the technique used to extract hair follicles from the donor area of the scalp.

FUT Hair Transplant Process

1. A thin strip of scalp tissue containing hair follicles is excised and removed from the donor site in a process known as strip harvesting. The length and width of the strip depends on the number of grafts required for transplantation. This strip is typically between 1 – 1.5cm wide. After the strip is removed, the incision in the donor area is then closed with sutures.

2. The excised strip is divided into individual strips, each containing multiple hair follicles.

3. The strip is further dissected under a microscope into individual follicular units (usually 1 – 4 hairs per unit).

4. Small incisions are made in the recipient area where the grafts are placed into.

FUE Hair Transplant Process

1. Micro-punches are made around hair follicles from the donor site one by one, using a punch tool (usually between 0.7mm to 1mm in diameter).

2. Individual follicles are extracted from the punched circle.

3. Extracted grafts are then sorted and preserved in a solution to the maximise survivability of the grafts.

4. Grafts are individually implanted with an implanter pen (choi pen) in the recipient area.

Several factors must be taken into account to evaluate whether an FUT or FUE hair transplant is a better option for your needs, namely the aesthetic outcomes, expected results, down to personal factors such as your budget.

Aesthetic Outcomes and Results

Hair Distribution
Whereas there is less flexibility in graft distribution due to the strip technique used in FUT, the precision in extracting individual hair follicles in FUE gives the surgeon control over how each hair graft is arranged and implanted in the scalp. Compared to FUT, the FUE technique allows for a more natural-looking implant distribution that mimics our natural hair growth and blends seamlessly with existing hair.

Survivability of Hair Grafts

Accidental transection (cutting) or damage to the hair grafts is a drawback of FUE compared to FUT. During FUE, there is some risk of transecting the follicular unit and accidentally stripping the protective layer during graft harvesting since only the upper part of the follicle can be directly visualised. In comparison, FUT grafts tend to have a higher graft survivability due to the integrity of follicular units being maintained during the extraction process – where the donor strip is first removed, before dissection is done, with their tissues intact. As the follicular units’ protective connective tissue is kept intact, the grafts are less likely to be damaged or transected during the process.

That said, while FUE tend to have a lower graft survivability, an experienced surgeon should be able to provide you with a high yield of 90% or more. The surgeon’s appropriate selection of punch size, force, angulation, direction of insertion all play in a part in enhancing the survivability of the hair grafts. Care should also be taken to prevent dehydration by utilising appropriate storage solutions during the graft dissection and implantation process.

Studies indicate a negative correlation between graft survivability and out of body (graft holding) time with a rough loss of 1% per hour. At Veritas, we minimise out-of-body time by using a first-out, first-in protocol so that hair grafts that are harvested earlier are implanted sooner.

Personal Factors (Suitability)

Scale of Hair Restoration
FUT is often recommended for patients who require a larger scale of hair restoration as strip harvesting allows for a large number of grafts to be transplanted in a single session. This makes it suitable for those with large areas of baldness. As individual hair follicles are extracted in FUE, the procedure is more time consuming and a smaller number of grafts are extracted in a session. While FUE can still work for those with extensive bald areas, multiple sessions might be required to achieve the desired density, making the process longer and costlier, along with marked difficulty in identifying locations where adjacent follicular units were not harvested in the previous session(s). FUE is therefore recommended for those requiring minimal to moderate scale of hair restoration, such as those looking to fix bald spots or a receding hairline.

Donor Area Density
The donor area, located at the back and sides of the scalp, provides hair follicles for transplantation to the recipient area. For those with limited donor hair density, extracting hair from the donor site may result in an “over-harvested” patchy appearance. For such individuals, FUE could be a more ideal procedure as it allows for hair follicles to be selectively harvested from various parts of the scalp to prevent visible patchiness. With FUE, it is even possible to transplant beard, chest or other body hair onto the scalp in patients who do not have sufficient donor hair on their scalp!

Budget
FUT hair transplant is a more budget friendly option, with costs ranging from $5,000 to $12,000 on average in Singapore, depending on the number of grafts required. FUE Hair transplant on the other hand, is typically costlier, ranging between $6,000 – $15,000, due to the process being more labour-intensive and time consuming.

Recovery And Downtime
As FUT is a more invasive surgical method requiring stitches, it has a longer downtime of 2 weeks or more, with moderate swelling following surgery. As there is no large, linear incision required and minimal trauma to the scalp during FUE transplants, postoperative recovery time is relatively short (usually about a week), making it an ideal option for those who are unable to deal with long downtimes.

Both FUT and FUE are stellar hair transplant options, with each procedure carrying its own advantages. While FUT was first popularised in the late 1980s, FUE, which was introduced in 2003, has quickly surpassed FUT in popularity and for good reason. Today, FUE has become the dominant option for hair transplantation, accounting for 75% of all male hair transplantation procedures compared to just 21% for FUT hair transplant cases.

Hybrid FUE Transplantation at Veritas

At Veritas, FUE transplants are combined with the Direct Hair Implantation (DHI) technique, a modified version of the FUE, to improve transplant outcomes.

DHI is a hair transplantation technique that is almost similar to FUE except for how donor hairs are implanted into the recipient area. In FUE, channels have to first be opened via micro incisions (holes) on the scalp before hair grafts are implanted with forceps. For DHI, harvested hairs are not stored before implantation, and an implanter pen is used to punch and implant hair directly.

While DHI offers advantages such as faster recovery time, ability to obtain higher hair density, and more control over the angle, depth and hair graft placement for a more seamless and natural appearance, DHI poses limitations when used on areas with complete baldness, larger bald recipient areas, or in cases where the patient’s skin tissue on the scalp is too hard. DHI uses a specialised pen shaped tool for direct implantation onto the scalp. This creates pressure when the needle enters the skin and the pressure can cause other implanted hair grafts nearby to pop out, in a hair transplant phenomenon known as ‘Rebound’. Rebound is especially prone to occur when follicles are transplanted tightly on completely bald areas of the scalp. Due to the aforementioned reason of DHI affecting nearby implanted hair, DHI is ideal for implantation on recipient areas where there is mild balding or severely thinning hair, but still some native hair present, whereas FUE is more well suited for treating areas with complete baldness.

To perform FUE hair transplant on bald areas while reaping the benefits of DHI, we use a hybrid technique of first making small incisions on the scalp manually to open the channels, as is done in traditional FUE transplants, before using the DHI approach of placing the hair grafts with an implanter pen. This step helps to greatly reduce rebound pressure. Such combination approach enables us to take advantage of each technique for optimal transplant outcomes and is suitable for patients who have a complete pattern of baldness in one area of the scalp and still have some hair in another area. While there is only a minor tweak between FUE and DHI method, the difference between the methods is small but meaningful.

From both a doctor and patient perspective, having personally undergone a hair transplant procedure myself, I’m in favour of FUE/DHI over FUT due to the natural results it offers, without the drawbacks of visible scarring and lengthy recovery times. I find the aesthetic outcomes of FUE generally superior to those of FUT due to its ability for individual follicle selection to ensure that the implanted hair complements the patient’s existing hairline and facial structure. For those who are keen to learn more, here’s a documentation of my FUE hair transplant experience.

FUE does have a steeper learning curve and is a more tedious technique as compared to FUT, but it can yield exceptional results in skilled hands.

If you have any questions about your suitability for a hair transplant procedure in Singapore, feel free to drop a message or email to ask@veritas.com.sg. I’ll be happy to answer them.