Dr Blake Bloxham

Huge improvement! Great work, Dr Gabel!

The pullback hairline shot says it all! Great work, as usual, Dr K!

Alright Delancy, let me try this again ... So the difference in the "plug and chug" -- reminds me of my high school math days! -- comes down to the definition of "visible thinning," the rule of averages, and what Dr Ron was describing in the first place. First, visible thinning: In order for the 76% yield value you plugged in to equate to a visibly thinner result, the average density would have to be about 60 FU/cm2 all over the entire scalp. It wouldn't be this high. In the hairline, maybe. But not all over the entire scalp. Let's say, for example, his average overall density was 55 FU/cm2. In order to get this down to 40 FU/cm2, you would need to have 72% at a maximum. At 76%, you would be at 42 FU/cm2 so you wouldn't technically hit the 40FU/cm2 cutoff. This means you'd need a lower growth yield in order to actually obtain a visibly thin result. So there was method to the values used in the equation. However, a lot of this is "nitpicky" math, and I'll give that to you. BUT, it's much less important than the next points: If we are sitting here being nitpicky with the math, remember that Dr Ron isn't. He is blatantly stating that he sees a visible difference in 20-50% (depending on which source you use) in the results. This doesn't mean we are dissecting out 76% versus 72% yield (which I will get into in a minute); this means we have one that grew like a strip and one that grew much less. And these are obviously in comparable patients. Otherwise the statement wouldn't make sense. And this brings me to the averages here ... remember that in a Gaussian distribution, you have an average at the top of the curve and a whole tail of lesser numbers trailing off to one side. In order to get the average growth of an FUE procedure to the 80% that's been thrown around (and not just by me), you need to have a lot of lower growth yields to balance out the high growth yield Dr Ron says occurs 50-80% of the time (and sit on the other side of the curve). You can have visible thinning at an average of 75-80% like I discussed above, but it's more likely at these lower yields. And if Dr Ron can see this without analysis, it leads me to believe that he is seeing the low, lows to balance out the strip level yields which, again, is going to give us an average in the 75-80% growth range (50 + 95 / 2 = 73%). Here, you can start to see visible thinning, but the numbers have to just work out (which is why we could go back and forth with only slight variations in the plug and chug equation above). However, in order to really have the right off the bat obvious lesser growth, you need to have these low numbers (20-50% of patients per Dr Ron) to balance out the high (50-80% of patients per Dr Ron), and this is going to put our average right on this debatable cusp of 75-80% (50 + 95 / 2 = 73%). As far as whether or not I've talked to other clinics: yes, I have. You'd be surprised. But just look at what Janna said if you need further confirmation. She's stating that she talked to the "top FUE" clinics and they said the same thing; 70-90%. Which averages out to 80%. And, again, having this discussion is all just for the sake of those coming here to research. Patients should go into surgery informed with realistic expectations. This makes for happy members, which is what we all want in the end. And thank you for participating. You are clearly a bright guy, and it's been a nice discussion!

Delancy, I just wrote a huge reply and HTN froze and it didn't post. Wow. I will try to recreate the points later if I have the time.

Delancy, Again, I'm not trying to be argumentative here; however, I don't think these quotes are being evaluated properly: Dr Ron says 80% of the time, he believes the yields are on par with strip. So let's say this is 92% growth because Hairshopeing is saying my FUT averages are too high -- haha. This means 20% of the time, they are "visibly less." Visibly less means yields that result in densities below 40-45 FU/cm2. This means a growth of around 50%. So, again, let's do some math: 80% of the time * 92% yield = .8(92) = 73% 20% of the time * 50% yield = .2(50) = 10% So let's add up the weighted averages: 73 + 10 = 83% overall average And remember from before that yields in the 70s - 80s can result in FUG densities below the 40-45 FU/cm2 cut off that leads to a visibly thinner result. So, again, we keep landing in the same range here. No matter how we try and play it, it keeps coming down to the same numbers when we really break it down. So overall, yes I think the yields are in this range. And I really don't think people are refuting it much when you get right down to it. And yes, research is key. But patients MUST have the facts. And hopefully this is helping. Good post! Thanks for sharing.

Hairshopeing, I actually don't think there is much controversy over FUT yield. This has been studied many times and the consensus (pulled from the textbook) shows average yields in the 95%+ range. And I do think FUE yields are lower than 90% on average. Like I've said before, I think the overall averages are in the high 70s to low 80s. You can always pull specific examples that fall on the outskirts of the standard bell curve, but I contest that the OVERALL averages above are accurate. And yes, there will always be opinions on certain aspects of the procedure. But there are also more objective, scientific observations that lend themselves less to opinion. And this is why patients needs the facts and opinions in order to weigh all the "pros and cons" and make an informed decision.

Wwizz, Nicely stated! Going to a top clinic with a LOT of doctor involvement is crucial in FUE. However, yields can still be variable even in the best of hands. This is simply a reality of FUE. It's just the nature of extracting FUGs in this manner. You can absolutely maximize your chances by going to one of these top clinics, but don't assume you'll naturally fall into the 95% growth category. Just go into it knowing the reality and you'll come out happier. I promise!

Delancy, I must disagree slightly. She didn't clearly state that the FUE yield at SMG is between 90-95%. She said the FUE yield is "getting closer" to 90-95% and they are "trying" to achieve better yields. And remember that Dr Ron himself told one patient he sees FUT-like results 5/10 (50%) of the time, and in another video states that he sees equivalent yield 80% of the time. This means that somewhere between 20-50% of the time, their yields are NOT at 90-95%. What's more, he also said that he notes results that are visibly thinner 1/3rd of the time. This leads to the same conclusions I, 'top FUE clinics' who have spoken to Janna, and Dr Ron have come to regarding average yield. It's not clearly 90-95%. I really don't want the average patient going into surgery thinking this because it's simply not accurate.

I dug around and couldn't find it. But the count and presentation was clearly done by the clinic -- I think I can tell which one too -- and makes me believe that those presentations floating around the web are their best growth percentages. Just like clinics don't release unimpressive grown out results into the internet ether, a clinic isn't going to do differently with their counting results. Again, I'm not trying to be negative or dissuade you or anyone else from any surgical procedure. But I do think this information needs to be out there for the sake of transparency and informed consent. Unless you have a specific set of characteristics (which are both known and unknown to the surgeon until the procedure is running full speed), you aren't likely to fall into the 98% growth rate category with FUE. The overall averages simply aren't near this. Even the most popular FUE clinics don't make these claims. Look at what Janna said earlier: "top" FUE doctors told her growth was 70-90% on average. Just know this going into it so you have realistic expectations and won't come out disappointed. That's all I'm trying to get across!

Yeah. I can't tell if it's an immediate post-op and they are estimating or using software (this does exist) or if they put dots over all the grafts that grew. Also, were these posted on a clinic website?

Very interesting! Thanks for sharing, Dr L.

Wwizz, How are they estimating yield here? That last shot looks like an immediate post-op, but there is a growth rate percentage on the image? Or are those dots they put over where the grafts grew?

Hi Bklynborn, Thanks for the kind words! You were an excellent patient, and I really look forward to seeing the results grow and mature! We'll add a few images to the thread as well. Grow well!

Again, the 80% number comes from Janna at SMG's (Shapiro medical group) direct quote: "as I [Janna] stated before, 70-90% range is what few of the top fue clinics were telling me was their typical yield rate." 70 + 90 / 2 = 80%. These aren't my numbers. What's more, I didn't share the information from Janna. It was shared by someone else on the thread. I'd be very much interested to review any objective, empirical data showing anything different. I'd love to speak with these doctors to see what they are doing differently too.

Mosd, You'll see good and bad examples of FUE and FUT scarring shared on this site. Statistically speaking, you'll likely fall somewhere in the middle. A general rule, however is this: don't expect to really ever "shave down" after hair transplant surgery. This holds true for both FUE and FUT. It's a fallacy that you can truly "buzz and move on with your life" if you have any type of surgery in the back of your scalp. The arguments about which is obvious, which isn't, who will be able to pick up what, et cetera can go on forever, but just keep the general rule in mind as you move forward. This will help you go into things with realistic expectations. And if you do have any intent to ever truly buzz down, do a trial of it now before you have any surgery. If you like the look, you're good and saved yourself tens of thousands of dollars!

Sunseeker, Actually, I'm glad someone brought up the mathematics of a visibly thinner result. Let's look at that a bit deeper: Per Janna's comments above, the "top" FUE doctors she has spoken to say their yield is between 70-90%. So, let's average that out and say the overall average these FUE doctors are getting is 80%. Now, we know that thinning is visible when the density of your hair drops below 50% of your natural density. Natural hair density is 80-120 follicular units (FU)/square centimeter (cm2). So let's, again, take the average of that and say most people have around 95-100 FU/cm2. This means you have visible thinning at around 40 - 45 FU/cm2 Most hair transplant doctors will vary in the density they transplant based upon where they are working in the scalp, the area they are trying to cover, the perceived blood supply/density of the existing hair of the patient, and the overall goals. However, most seem to fall between 45 FU/cm2 on the low end and 60 FU/cm2 on the high end. So, let's say a doctor is working on two identical patients: one done via FUE and one done via FUT. Again, per Janna's statement above the yield for FUE average is around 80% and FUT is 98%. So say the doctor transplants at 55 FU/cm2 in the micro and macrohairline and 50 FU/cm2 in the less visible frontal and midscalp regions behind it. The FUT patient's yield is as follows: 55 FU/cm2 * 98% growth = 54 FU/cm2 in the hairline and 49 FU/cm2 in the rest of the frontal and midscalp. These numbers are all greater than the lower limit of visible thinning (40 - 45 FU/cm2) and the result is substantial. The FUE patient's yield is as follows: 55 FU/cm2 * 80% growth = 44 FU/cm2 in the hairline and 40 FU/cm2 in the other areas of the scalp. Now, you have a problem. Now you DO in fact have visibly thinner results. And keep in mind that these aren't my averages I'm using here. These are averages coming from another FUE/FUT clinic AND the averages given by "top FUE" doctors. These small numbers seem trivial when discussing these things online, but they absolutely matter in the reality of hair transplant surgery. Again, I'm not saying all patients should run from FUE because of a lower growth average. They simply need to be aware of the REALITY of the growth averages and that they can result in a visibly thinner result (and this isn't even going into the quality of the growth from FUE; simply the quantity). If they understand this and would still prefer this method, that's just fine! But there is no point trying to downplay the reality of the potential differences in yield. Janna provided input from top FUE doctors above, and at least two other Coalition hair restoration physicians -- Dr Wesley and Dr Beehner -- have evaluated the situation and found statistically significant differences: (And a funny additional comment on the Beehner study: the skeletonized grafts were actually extracted via more gentler methods than traditional FUE grafts, and additional detrimental forces that would have reduced the yield further were actually negated because of this. This means, theoretically, the averages would have likely been lower if the grafts would have been removed by some of the less gentle/meticulous protocols used in some instances today. Some have misunderstood this.)

Thanks for the kind words, Tyler and HairJo!

Excellent work, as usual, Dr Nakatsui!

CaliHairGuy and Voxy, Great posts!

Again, I'm not trying to be argumentative or inflammatory here, but Janna isn't saying anything different either: "I do think that yield in general for FUE procedures are still slightly lower than that of strip, however. I read that one of the Turkish doctors told his patient to expect 85% yield. I've personally heard from quite a few FUE doctors say 70%-90% is the norm" (85 + 70 + 90)/3 = 81%, which falls right within the 75 - 80% average I've said the whole time -- and, according to Janna, this data comes from FUE doctors themselves (including the ones in Turkey). "We've always felt our strip yields approx. 98%+ and fue is now closer to 90-95%. We will keep trying to achieve 98% or better with our fue." Strip at 98% consistently ("always") and FUE getting "closer" and "trying" to achieve similar yields. And remember that Shapiro medical has been doing FUE for a long, long time. "as I stated before, 70-90% range is what few of the top fue clinics were telling me was their typical yield rate." "Top FUE clinics" stating the same things I've said before (and actually, 70% is lower than what I quoted). "Patients I have spoken to were fully aware the yield tends to be less than strip but felt it was worth it to have small white dots instead of the linear scar." Now that's informed consent! Thumbs up, Janna. Totally agree with this overall approach. Reference: Dr. Paul Shapiro-8 Months FUE RESULT ? 2226grafts/4497hairs - Dr. Paul Shapiro - Hairtransplant Doctors - Click on a Doctors name to view their results - Hairloss Experiences Hairloss Forum

Just watched the video ... Didn't realize it was one I'd actually seen before. He says several important things: 1) "3/10 times you'll get worse growth with FUE because the grafts are more fragile" (he notes that this occurs even when you go out of your way to preserve the grafts -- and this is very likely because the damage is actually done during the extraction process). 2) "A very good FUE transplater should be able to get CLOSE to a similar growth rate at least 80% of the time." 3) "There IS an increased risk [of lower growth] so sometimes it will be less" (note that this is said right after the 80% estimate -- which I take to mean that it does occur even WITH a good 'FUE transplanter' who is taking every precaution he described above). 4) "So if you really want to be 100% of the time ... and when I see the two ... I still think FUT has the edge." So what is he actually saying here: 1) Approximately 1/3rd of the time you're going to have a VISIBLY lesser yield 2) 20% of the time you're not going to get the same growth, even when all precautions are taken 3) FUT growth is still the most reliable I know I'm a little louder than Dr Ron, but this actually 100% in line with what I've been saying the whole time. And again, this isn't anything crazy. I'm not sitting here saying FUE = bad and everyone should 'go strip or go home!' But I'm just saying that there are physiological reasons why FUE grows less on average. Patients should be aware of these when making their decision. A good chunk of guys will still accept this risk as a trade off for not having the linear scar, and that's perfectly fine! Is that really so crazy?? Maybe I've lost it. Haha.

Wwizz, So now it's 70% and not 80%? I'll have to go watch the video. Here is where the 50% number comes from: http://www.hairrestorationnetwork.com/eve/180883-pics-stats-first-surgery-way-6.html#post2446704 And this was in a private conversation with a patient who was considering both FUE and FUT with Dr Ron, and booked for FUT.

Wwizz, I don't think we are actually disagreeing here. If you have the great characteristics and match up with a good surgeon, there is no reason to believe you can't get the 90% growth you're discussing above. But this begs the question: do you have the great characteristics? And the answer: you don't know. I don't know. And unless the surgeon does the type of testing I discussed above, there is really no way to know until the deed is done. And if you really look around at a lot of the cases being shared and discussed, you'll see the average yields I'm referring to (75-80%). They are passed off as other things, but really take some time to look and you'll see this pattern emerge. But I'm not here to dissuade you. It seems like you want to go the FUE route, and I only wish you the best! However, my big pet peeve is people going into any hair transplant procedure without true "informed consent." Based on the research and general consensus from practicing surgeons, FUE yield is lower than FUT. Estimated averages vary, but I believe it's 75-80% -- and believe me, it's not hard for a procedure with less consistent results to gain popularity in medicine/surgery as long as it's perceived as newer or less invasive; this is a timeless tale in the medical world. This isn't saying you can't obtain the 90%+ you described above if the stars align, but averages exist for a reason. There you go! That statement is really the only reason to even have this discussion. If you've read it and still feel like FUE is the best choice for you, then you are fully informed and have the capacity to make your own personal decision. I wish you the best of luck and I hope you'll keep us updated on your progress!

Delancy, I'm not sure where the 80% number came from, but here's what Dr Ron told a patient last week during a consultation: "Analogy Dr. Shapiro used was 10 patients come in for FUT and FUE, 5 of 10 will achieve equivalent results. " So here he's saying 50% will grow at the level of strip yield. This is equivalent to what Drs Rassman and Bernstein quoted in their original "FOX" paper 15 years ago. They said around 30% of patients are "FOX 1 or 2s" which meant they were "very good or good" candidates for FUE. This means growth rates would be acceptable. Another 25 or 35% or so were "FOX 3" which meant they were essentially decent candidates and growth should be comparable. Put that together and you get roughly the 50% Dr Shapiro quoted earlier.

Newbie, Haha! You're doing great, my friend!