One important decision you will make when planning a hair transplant procedure is whether to get a strip excision (AKA follicular unit transplantation/FUT) or follicular unit excision (FUE). While some hair transplant surgeons only have the technical capacity to offer an FUE, Dr. Ratushny feels that it is important to offer both procedures to his patients. There are many variables you should consider when making this decision. One variable is whether you plan to crop your hair very short or shave your hair in the future. If so, Dr. Ratushny typically recommends an FUE. If you do plan to keep your hair length longer, Dr. Ratushny usually recommends FUT/strip excision. Also, FUT/strip excisions are preferable to use for female patients. One important variable you should consider is your total donor capacity, or the average number of hairs that you can transplant over your lifetime from the back of your head (donor zone) to the front/top of your head (recipient zone).
The total donor capacity depends on the type of hair transplant procedure you choose, with strip excisions allowing a greater amount of harvestable follicles than FUE. Typically, the total lifetime donor capacity ranges from 3000 to 6000 follicular units if one proceeds with only FUE procedures. In contrast, strip excisions allow for a total donor capacity of 5000 to 8000 follicular units. The reason for the greater capacity for strip excisions is that Dr. Ratushny can remove all the follicles within the strip during one procedure in the most optimal donor area in the mid back of your head. Subsequently, a repeat procedure can be done in a way that we remove the original strip scar so that we don’t create multiple strip scars in the back of the head. In an FUE procedure, Dr. Ratushny uses the WAW-FUE device to remove every 3rd or 4th follicle throughout the donor zone in the back of your head. During repeat FUE procedures, Dr. Ratushny is very careful to retain enough hair follicles in the back of the head to camouflage the donor area. Overharvesting of the donor zone in an FUE procedure may result in a spotty appearance in the back of the head, which Dr. Ratushny tries to avoid in his patients. If one gets both strip excisions and FUE in successive hair transplantation procedures, one can further increase potential total donor capacity.
Dr. Ratushny recommends a conservative approach with hair transplantation to avoid overharvesting your donor zone with 1 or 2 massive procedures. The reason for this is that if you remove all the useable donor hairs in the back of your scalp, your options are limited if you have further hair loss after your initial procedure/s. Also, the density of hair placement in an individual procedure is limited by the fact that placing at too high of a density can create hair “popping” and may result in decreased growth of transplanted follicles that are placed too close together. However, if you place hairs at a given density for an initial procedure, you always have the option of increasing that density in a subsequent procedure by placing grafts among the already transplanted hairs.
It is for all these reasons that Dr. Ratushny prefers to do hair transplantation using a conservative number of grafts per procedure, in a way to preserve donor density and appropriately manage the donor area of his patients. This gives his patients more options in the future for dealing with further hair loss or increasing hair density at various areas on their recipient site.