After the strip is dissected, it is generally passed on to a team of technicians who trim the strip into individual grafts. During the process of trimming there is an unknown entity that becomes into play. That is the skill and motivation of the technician. Hence it is a known fact that surgeons that have consistent teams achieve far better results than someone that relies on freelance technicians. Whilst exploring options of a strip surgery, it is advisable for a patient to meet the team and get to know the team that will be operating.
It is a well known fact that strip surgery can produce significant scarring in the donor area, when performed by untrained hands. A simple test a patient can perform is to pinch the back of the scalp to check for signs of laxity. If the client is known to have a tight scalp the chances of poor scarring with a strip surgery increase exponentially.
Historically strip surgery has been promoted as a surgery that has better outcomes because of the presence of galar fat at the bottom of the grafts. Whilst it might offer better leverage for the technicians whilst replacing the grafts, studies have shown that the growth of the grafts is not dependent on the presence of the galar fat. With improvements in extraction and placement of grafts by FUE, the outcomes are much better with a strip surgery.
During the process of extraction of follicles using strip surgery, the number of follicles per graft is significantly less compared to that extracted by FUE. This is because most of the grafts that are extracted with a strip surgery have follicles containing single and double hairs. Whereas with a FUE, the surgeon has complete control over the grafts and he can pick and choose the ones that give maximum benefit to the client. Besides, the technicians are encouraged to keep the grafts skinny by dissecting most of the tissue surrounding the grafts as this helps in quicker placement of grafts. I believe the preservation of the pilosebaceous unit is key maintain the natural appearance of follicles and this is where FUE trumps FUT.
There is a common misconception that FUE leads to pitting scarring. Though it is a fact that badly performed FUE can lead to visible ‘dot’ like marks on the back of the scalp; with improvements in FUE, the chances of visible scarring is negligible and by following certain protocols and extraction there is evidence to suggest that the scarring is almost invisible.
Whilst everyone acknowledges the fact that FUE takes a lot longer to perform and hence the grafts might stay outside the body for a longer duration than in FUT, my argument is that one can achieve good outcomes with FUE with fewer grafts than with FUT. This helps with improving the yield as it decreases the duration of the surgery and also the fatigue factor associated with technicians replacing a large number of grafts associated with FUT surgery.