JohnBob

So then it's shit cheap clinics fault, not a problem with the method itself, no? I assume shitty clinics botch FUT procedures too so that's not a fair comparison.

If those scars don't affect the adjacent follicles and the extractions are done in spread out pattern, then why it is a problem?

So if the FUE extractions donesn't damage any of the surrounding follicles, why is that your clinic (according to your website) recommends FUT for large sessions instead of FUE? https://bhrclinic.com/fue-or-fut-first-thats-the-question-2/

Not only stitches, but the strip means you make two huge horizontal cuts that will for sure damage a lot surrounding FUs too. I wonder why that's never talked about? Your though process makes sense, but I would like to question the premise being used. Why is the consensus that you can't extract a high number of FUs via FUE (2000 in your example)? Too many tiny little scars all over the scalp can damage the skin and cause shock loss? This is an assumption that has been thrown without much scientific evidence IMO. Doctors like Zarev are pushing the limits of what can be done with FUE and are harvesting 10,000+ follicles while keeping the donor aesthetically good. So the dogma that FUT is better than FUE for high numbers of donor harvesting should be challenged.

Why? Why taking FUs in bulk is better for your donor than taking each FU individually?

For example, this is a single session 9000+ graft restoration by Dr. Hasson Look how wide the strip was. How many follicles were transected because they were in the way of two horizontal incisions, and also in the area of the stitches? Probably more than a thousand? Nobody talks about that. With FUE you don't have that problem (if the surgeon is good).

Thank you for attacking one of the biggest dogmas of the HT field, the FUT yields more/harvests better than FUE. It seems like it's much more dependable on the skills and tools of the doctor than to the procedures itself.

The donor are actually looks better AFTER the procedure. It's incredible how much difference lighting makes.

Another question that would be interesting if he answers -- if he does 10,000+ grafts restorations and what's the biggest restoration he has done so far.

Please ask him if the FUE technique has made any significant advancements during the last 5 years and if he believes nowadays FUE can achieve the same level of donor harvesting as FUT. Thanks!

Thank you for your explanation Raphael, very informative and didactic as always.

Very clean procedure, it looks like it's going to be a home run (fingers crossed). Out of curiosity, did they measure how much density you originally had in your donor area and/or estimated how many extractable grafts you had in the bank?

I'm afraid it's not that simple. These docs can be getting a 2-5% loss with FUE but with small sessions, say 1000 grafts. But FUE is a complex procedure and as the session gets bigger the challenges grows exponentially. So the same doctor could have 50% grafts to die if he tried to perform a 5,000 grafts session like Zarev. Most doctors avoid doing mega sessions with FUE and prefer to keep them small actually - and that may be one of the main reasons.

Not yet, I'm thinking about flying to Bulgaria to do a in person consultation once this covid mess is over.

This dude had a similar shockloss effect in his donor area (albeit not that big) and it ended up recovering. Hopefully given enough time yours will recover too

True, eat least the cases his clinic shows are pretty well documented I still find it hard to believe how you can extract 12K grafts via FUE and the donor still look that good under intense lighting conditions. The result on the recipient area is top notch too, you can't even point where is the division between original and implanted hairs - very refined work. Those results are so ahead of the curve compared to other docs there must be an explanation.

Very interesting tactic. I would make sure to ask about that once I get my first consultation.

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Dr. Feller has a nice article explaining the difficulties of doing mega sessions via FUE that helped me understand better the technical challenges related to it. The full article is here: https://fellermedical.com/hair-transplant-mega-session/ Some of the most interesting parts related to FUE: And more about mega sessions What he says makes total sense. But if he is saying to totally true, then doing what Dr. Zarev is doing would be impossible - unless he really had a breakthrough in terms of technology.

Ditto, extracting 5000 grafts for example via FUE is MUCH more time and labor intensive compared to FUT but Dr. Zarev already showed us it's possible, or no? The guy does 9000 graft sessions in two days, working 10-11 hours each day.

According to their own website: https://bhrclinic.com/fue-or-fut-first-thats-the-question-2/ FUE, the donor surface area is opened to the maximum but that does not mean there are more follicular units (FU) to be taken in comparison to FUT. Every FU removed will reduce the density, the more removed can noticeably drop the density and impair the donor for future procedures, FUE or FUT. Assuming an average density around the safe zone of 80 FU cm2 if the extraction pattern is spread and no areas are over harvested around 4000 FU could be removed according to the protocol we use at BHR clinic, this will drop the overall density down by around 30%, leaving a density near 60 FUcm2 in the donor, and this would then be considered low density on a virgin scalp. ... [...] grown out results of 3500 FUE plus grafts are not the norm and require very good donor characteristics.

Yes I'm considering that 🙂

According to the research I'm doing, this FUE limitation may be the true based on the tools and skill of the current doctors, not on the procedure itself. For example, while you have Dr. Bisanga stating in his website that the max they can extract with FUE without over harvesting is around 4000 grafts, you also have Dr. Zarev extracting 12000 grafts via FUE and the donor still looking good. You may say Dr. Zarev is maybe extracting beyond the safe zone, but if you subtract 4000 from the 12000, you still get 8000 grafts, double what Dr. Bisanga believes is possible with FUE.

Exactly. You have doctors stating that with a donor with 80 FUs/cm2 the most they can extract is 4000 grafts. Then you have Dr. Zarev extracting 3x that (with a donor with smililar density) and the donor still looking good. I'm starting to believe he really made a significant improvement on the standard FUE technique and is one step ahead the whole industry in that regard.

Thanks, good article.