RecedingTide

The original hairline done with the other clinic was too low but nice job adding density to improve things.

No respect for the safe zone. This is only ok if those grafts outside the safe zone go into the crown or bridge.

Nah. You can see the extraction box with some coalescing of the scarring. Could be the punches or could be his physiology or a bit of both.

Exceptional result. No hair worries ever again.

Let me play devil’s advocate…

While the recipient looks great the donor does not. It shouldn’t look like this after only 1800 grafts.

In fairness, I think you probably did have a bit of shock loss up to 6 months. It look much better in the 2nd set of photos. You may actually have 2000-2500 left. That would help a lot. Good luck.

I happen to believe that under certain circumstances you can get almost as many from FUE as FUT lifetime. These caveats are that the candidate must not have any retrograde alopecia and must have good physiology in terms of wound healing.

No one seems to mention that 10-15% of your hairs are in the resting or telogen phase at any given time. What happens to these with FUT?

@Legend007 you absolutely should expect to make 70. If we get deep into our 80s and 90s we can expect senile alopecia to eat our hair.

There will definitely be pretty good solutions against senile alopecia when you get that old, if you get that old.

If you expect to make it to 70, you will also be expecting to make it to 100 when you're 70, given the advances that are anticipated in the medical world in the next few decades.

I'm not sure if you had permanent shock loss in the donor around the occipital ridge but if I'm honest I think it looks thinner than I would expect after 3915 FUE extractions.

Becareful with further transplants. I think 500 singles in the hairline and then 1000 multis in the midscalp to the vertex transition point. You could consider SMP to the crown and donor. I don't think you should push it further than that as you could have the moth eaten alopecia areata look. Just my 2 cents.

Thanks for starting this topic. However I think your assumptions and calculations are a little off. It is very much case by case but the donor area of a norwood 6 is usually roughly similar to the area of bald scalp.

A norwood 6 donor could be 8cm x 32cm or 256cm2. Untouched average density of approx. 85FU/cm2 in donor. This gives a 21760FU. 50% would equal 10880 grafts. I think that's probably a little much but taking 40% would be 8704.

I have a large head and I have a norwood 6 pattern. I have had 6572 FU transplanted by FUE. I have at least 2500 more that can be transplanted and I can cut my hair to a bare blade and I can hardly make out the extractions. I have been very fortunate however. Numbers wise, I have probably only depleted my donor by a third. Skill of the team and good healing physiology are important of course.

In short I think you're under selling FUE slightly. I understand that some people will make the argument that the best hair from 5-7cm from the napeline and FUT can get it all. This of course is a consideration for weaker donors.

You will lose all hair in a norwood 6 pattern and you will need 8000 FUE lifetime. Fortunately Feriduni can get you there. You only had about 5300 so you'll need the same size procedure again, with 1600 in the crown as it opens and another 1000 in the midscalp. It's just the maths of it unfortunately as you won't keep much native hair. It will work out I think.

Completely irresponsible. Only way you can justify this is if the guy is 50 or he doesn't have mpb.

I don't really believe he would have an FUE only policy for U30s. Surely this is the age group where future hair loss is likely to occur and a tidy donor area would need to be preserved.

As far as I am aware it's not a policy set in stone but it is his preference for a number of reasons. He mentioned this in a video a year or two ago I believe. It was on one of the European forums but might be up on youtube. It's not in English btw.

Ok, think of it this way from the doctor's perspective; you have a 25 year old man who is adamant on getting a HT. He is norwood 3 but his family history indicates he may have extensive loss if the future. Now of course you could just turn the case down but you're pretty sure if you don't offer it he will go elsewhere where he may end up getting FUT.

How about 2500 FUE or 2500 FUT (and the scar that comes with it)? Which do you believe is better for the patient? Which would you rather have in this situation if it's one or the other? Which provides more options for the future? Not that we should always practice defensive medicine but which route is less likely to come back and bite us 10 years down the road (as the doctor I mean). These are all questions you have to answer for yourself as YMMV but I personally can see the doctor's perspective on this issue.

In truth, younger than 30 is never an ideal age for anyone to have a transplant (don't let anyone tell you otherwise) but just think about the ramifications of doing so since nowadays this demographic makes up a large proportion of prospective patients.

Clearly FUT provides great results in the right hands but FUE gives a young man an option he would not otherwise have. Both have roles. Both can be awesome, one is right for one person, the other for another.

If the market is demanding FUE, well then clinics will evolve and attempt to master it. However, if we have a spate of unhappy FUE patients (like we did 10 years ago) public opinion will swing back towards FUT. Both will be around for some time to come.

Dr. Feriduni is doing 95% FUE these days. He doesn't like to offer FUT to anyone under 30 unless they already have a strip scar. He has transitioned his practice to almost entirely FUE the last 3 years.

That being said, clearly FUT still has a role for a 50 year old norwood 5 or 6 who wants to get as much hair as possible now and move on with life.

Receeding,

I want to correct you with respect to cherry picking grafts during FUE. You wrote it was of course true. In fact it isn't true. FUE is a blind procedure. We have no idea how many follicles are under the skin in a follicular unit until it is actually extracted. It is only during FUT that grafts of any kind can actually be cherry picked.

 

Dr. Feller

Great Neck, NY

So you are saying you can't target multi-haired grafts with FUE than FUT? I happen to believe both procedures have a place and I think both have their own distinct advantages. Please give your anti-FUE tirade a rest. It's becoming tiresome.

What about when you cut the strip? I suppose you'll have us believe you don't transect or damage a single hair and that no follicles in the telogen phase end up in the bin either with strip?

I actually mentioned that one of the advantages of strip is that you get that sweet spot of donor hair where the hair calibre is most coarse. However you decide to continue your anti-FUE propaganda war by disagreeing with me when I say you can cherry pick multi-hair units with FUE...So according to you Dr. Feller, you cannot target multi-hair units with FUE?

It is so transparent what your sole purpose is on the forums these days. I think it is a short sighted approach but hey if that business model works for you then enjoy it.

I would say that judging by the 1 year result it doesn't appear that one tech was inferior to the other as the low yield looks uniform across the recipient.

Hey RecedingTide,

 

Thanks for the advice. Much appreciated. I'll talk to my doctor about getting this test done. As regards dermatitis, is it seborrhaic dermatitis you are referring to? Also, what exactly do you mean by "you can see its effects [...] under magnification"? What signs should I look for? I have no dandruff type flaking whatsoever, just some small redish spots on the recipient area...

Yes. Seborrheic dermatitis is a big one. Androgen mediated so sometimes teens with bad acne go on to develop it even later in life. In theory fin should help but in reality to what degree I have no idea. Under magnification you can see peri follicular erythema and definitive loss of hair calibre when compared to non affected areas. It can be quite shocking to see as you often won't notice with the naked eye.

What calibre/shaft diameter are your hairs? Ensure you have acell if you are going for a second pass.

Ezel,

 

I also had close to no growth from my first 3000 graft hair transplant with a top coalition doctor recommended here. I've just done another HT and am waiting anxiously for the result, but am really scared my grafts might not take again for some odd reason. RecedingTide recommended some kind of antibody test. He also mentioned that having dermatitis is a risk factor. Does anyone else think these are relevant, especially the latter? I believe I suffer from (very mild) dermatitis on my scalp and forehead.

If you have dermatitis you can see it's affects on the donor area under magnification. The same applies for the recipient area. The problem is you simply won't know what effect it has until after the fact. As for rheumatological antibodies, we still just don't know enough about all the factors at play from a physiological standpoint with hair loss and hair transplantation. There are a lot of cutaneous manifestations for many a rheumatological condition. Some people are completely asymtomatic and have no rheumatological condition per se but if you did an antibody screen there could be something there. The significance of which is often unclear. That being said if I had either and a less than stellar previous HT result, I'd proceed with caution.

If your theory is right Blake, we should perhaps consider trialing VEGF, kind of like how PRP was used a couple of year ago. Might be worth a shot.

I'm sorry but FUT is more popular for one singular reason: It works better than FUE.

 

It would be nice if there were a scar free and consequence free surgery out there that would allow people to have their cake and eat it too, but unfortunately that doesn't exist. And FUE, such as it is, does not fill the bill.

 

FUE has it's place, but not in large sessions and certainly not in young men who most likely will need every graft they can get in the future.

What do you consider a large FUE session these days?

Of course each method has it's advantages and disadvantages. With a top notch FUE clinic the amount of grafts that fail to grow due to the slightly reduced yield is in my opinion offset by the telogen grafts that end up in the bin with FUT. I still think you can get about 15% more grafts with FUT alone vs FUE alone lifetime, but in chasing those extra grafts you risk a wide scar.

If someone is Norwood 4 or more at the time of going for their first transplant it makes sense to go FUT just to get a satisfying result within a year. Norwood 3 or less have both options. That being said Lorenzo and Erdogan are two guys that seem to be able to make a big difference to Norwood 4s in just a single pass.

Dr. Feller, with the greatest of respect, you should still seriously consider taking on more FUE cases going forward. I say this as many people are informed of the slightly lower yield (especially with singles in the feather zone of the hairline) but they simply do not care as for many the scar really is a deal breaker.

Let's not forget the life changing result your provided for Spencer Stevenson with FUE.

I know you have no hard feelings against the clinic and they are known for being transparent and forthcoming but I think you can paraphrase things rather than post the whole email. If it was another clinic not offering to help you out as much I'd say go ahead and post it but it sounds like they are trying to work things out as cordially and fairly as they can so I don't see a need to put the full email out there.

I think the way you have conducted yourself so far is admirable and very professional. The clinic will always do their best to make things right, but I'm sure they will be pulling for you even more given your exemplary approach to what I am sure has been a disappointing experience thus far.

Stay positive and things will work out in the end. Good luck mate.

It might be an option to bulk up the weak patch in the donor area with a 300-400 beard hairs. I certainly wouldn't look to transplant any scalp hairs into this area. There are definitely still options Ezel.

I am sure you are a healthy guy from everything I have read but consider getting a rheumatological antibody screen just to rule out things on your side as the reason for the yield. I am also pretty convinced that any history of dermatitis on or near the scalp is a risk factor too.

Stick and place with acell might be the way to go. The clinic sometimes use it for difficult cases.

Dr. Karadeniz you are quickly establishing yourself as a member of the top tier of docs. I appreciate how you explained about looking to transfer more hair, not necessarily more grafts. This is refreshing.

He will have exceptional yield when they resurface. Great work. My temple points grew the most post op. About half of the temple point hairs didn't shed and just grew like weeds. Maybe because they were only out of the body for such a short time.

Irish,

 

That's what I generally tell patients: you should be able to buzz to a 3 guard before the scar is noticeable. However, the most popular option right now seems to be the fade cut. Guys tell us they want to buzz it to a 1-2 on the lower part of the sides and fade up to a 3-4 higher up. I've seen a few that look really, really good. We're even able to pull the sides of the incision line up a bit if guys want to sport this cut.

The best strip of hair in most patients is actually almost high enough in the donor region to allow such a fade haircut. Look at Dr. Hasson's strips which are a little higher than some other strip docs. Hair calibre is often slightly thicker here plus density is usually very good. It's the golden area of donor region and the fact you can get all of it with strip is in my opinion the biggest advantage of FUT vs FUE. People will say you can cherry pick grafts and multi hair units with FUE which is of course true but you can't get all of that area with FUE.