FUSS+FUE Combined Hair Transplant Procedure
Dr. Ali Emre Karadeniz, MD, PhD
Ali Emre Karadeniz, MD (Dr. K) is the only American Board of Hair Restoration Surgery Certified Turkish plastic surgeon. He has performed over 3000 hair operations. He is an active member of the International Society of Hair Restoration Surgery (ISHRS). More info about Dr. Ali Emre Karadeniz and AEK Hair Clinic.
I'd like to talk a little about FUE + FUSS, strip surgery combined procedures and where it could be used. There's a lot of debate about whether to choose FUE or strip surgery and that's another topic; in fact I think that discussions are more or less irrelevant and both techniques have their value.
But there are some instances where using both of these methods in one visit has value and these I could summarize as patients who have limited donor area due to advanced hair loss or limited donor availability due to multiple previous surgeries where a single technique does not offer enough improvement or good donor but very advanced hair loss so there's a lot of donor availability but there's also a huge area to cover and the limitations of a single technique in one visit do not allow for a significant coverage.
In these cases, we could actually do a strip plus FUE combined or combo procedure. Let's give a few examples to this.
Let's say a patient had one or two strip surgeries prior, so he has a strip scar, if you do only strip again you're gonna get a limited number of grafts, 1.500 or maybe 2.000 grafts. If you do FUE, the previous strip has limited donor area, it's narrow and also you have to leave some areas around the scar untouched so it's camouflaged, so again you're somewhat limited to let's say 2.000 to 2.500 grafts. But let's say you do a combined procedure so you do the strip and you get 2.000 grafts and then you do the FUE and you get another 2.000 grafts, so suddenly you're able to do a huge procedure after multiple ones in one visit. I don't mean that all this has to be done in one session. It's frequently a good idea to do in two separate days so that the grafts are not under too much risk and the operation time is not too long.
Or let's say there's a patient who had FUE, so his donor area is diffusely scared and we know that if we try to do FUE again on an operated patient, donor availability is significantly reduced due to the fibrosis that's all over the area, the scarring may look good to the eye but when it comes to a second surgery becomes very difficult to get good grafts. So then again, a combined procedure can come in and you get the nice 2.000 – 2.500 or 3.000 grafts and then you can do some FUE and then suddenly you're talking about 4.000 – 5.000 good grafts, so again it works.
And also with previous strip scars, you can remove the scar, you could get few grafts from it but then you add FUE so again you do a decent sized hair transplant while improving the previous scar. So, using two technniques at the same time has some advantages in these difficult situations.