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2 hours ago, Rockstar30393 said:

Yeah it is combination of FUT, FUE and they used beard hair too..

Great choice doing the FUT FUE combo, that'll maximize your donor over your lifetime.

Really impressed with the coverage and her ability to transplant that many grafts in a day

Amazing what Dr. Munib can do with just over 2000 grafts. Do you have any crown loss and if so are you planning to do a second procedure for it?

I'm not sure it would be necessary to limit yourself to 5000 grafts if cost is not an issue since Dr. Pittella can do over 10k grafts in 2 days. 5000 grafts could cover the front and midscalp pretty well but you probably won't get much crown coverage. If you could reach the state that you showed in the pictures with the thinning crown, hair fibers would easily cover that area if you were willing to use them.

Absolutely, I would say 3000-3500 grafts for the front and maybe 1000-1500 for the midscalp would get the job done. The midscalp isn't even that thin so just doing the front will make a dramatic improvement.

Agreed, this is an amazing recovery. I would grow it out more. You may not even need a transplant, since you're scheduled for one I would still go for it but the number of grafts you'll need will be pretty low.

The extractions look flawless especially considering that almost 3k grafts were taken.

Saw this case where a patient who was fully NW6 got 9k grafts over 3 procedures using FUT and FUE. I think we can all agree that his donor was likely below average. In his third procedure he had some beard but I don't think it was a lot.

If this guy can get 9k from his donor, pretty much anyone can (unless they're a severe NW7).

https://www.hairrestorationnetwork.com/topic/71970-two-sessions-on-norwood-class-vi

Donor before:

This is the donor after 6.5k grafts taken (not sure the exact number that were taken via FUT or FUE but he had 3k FUT in the first procedure and 3k FUT + FUE in the second, so likely around 4k FUT and 2k FUE). So this crown result is not complete, he had more grafts placed in the final procedure.

It's a simple mathematical fact that combining both methods will increase the number of lifetime grafts significantly. Usually around 3000, and pretty much always over 2000.

Think of the donor as a rectangle 30 x 6 cm = 180 cm^2. An average patient may have about 75 FU/cm. The entire donor area has 13.5k grafts.

If you were to do only FUE, you might be able to take 40% of the donor. 50% if you have good characteristics. That means you have about 5400-6750 grafts to extract via FUE alone.

If you were do only FUT, you might have enough laxity for 6000 or so grafts in your lifetime. Around the same as what you'd get with only FUE.

Back to the rectangle. A strip is typically somewhere around 40 cm^2, maybe around 30 cm long x 1.3 cm wide. A 40 cm strip with a density of 75 FU/cm gives you about 3000 grafts per strip x 2 = 6000 grafts from earlier.

So if you take about two of those strips that are 1.3 cm wide and 30 cm long from the rectangle, you've now reduced the rectangle from 30 x 6 to 30 x 3.4.

However, the FUT strips have not affected the density of the remaining 30 x 3.4 cm at all.

You can still take 40-50% of the 30 x 3.4 = 102 cm rectangle, which should have about 102 * 75 = 7650 grafts in total. So conservatively, 40 percent of that gives you another 7650 * 0.4 = 3060 grafts. If you take 50% of that area, you can take about 3800 more.

By combining the FUT and FUE you have approximately 6000 + 3060 = 9060 or about 9000 grafts in total conservatively, or 6000 + 3800 = 9800 if you take 50% via FUE.

So we're looking at 9-10k scalp grafts in a lifetime by maxing out both methods. Very few patients actually max out their donor so we rarely see this.

This is the main advantage of FUT.

1 hour ago, asterix0 said:

FUT had its place before the progression of FUE made it obsolete.

If you look at the top tier clinics in the world and what they have achieved with FUE, with the number of grafts harvestable even in poor donor cases, Norwood 7 cases, it is apparent that FUT no longer has any advantages. 

Smaller punch sizes and strategic cherry picking of grafts has led to FUE becoming the best method, in 2024 and likely beyond until hair cloning becomes possible.

FUT is more invasive, the scar has a propensity to stretch, there is more of a risk for nerve pain. Also where a 2 or 3 guard on the donor would be possible with FUE without being too noticeable, the scar will probably be much more noticeable with FUT. 

And actually, with just FUE you can get more lifetime grafts and with intelligent, homogenous extraction, the donor can look very good even with a high number of grafts extracted.

 

I think until most of the top clinics have achieved this level of skill, we can't say FUT is obsolete because there are not enough top tiers surgeons to meet the demand. Right now the two that come to mind are Pittella and Zarev that are able to extract extremely high numbers of scalp grafts, and even Pittella relies on beard grafts a lot.

Personally, as someone who is progressing into a high norwood, I don't mind my donor being somewhat "depleted". I couldn't care less if doctors extracted 60 percent of my donor and it looked a bit thin. But how many doctors are willing to do that? Let's say I have 14k grafts total in my donor area, most doctors would only take 6k total. Which doctors aside from Zarev and Pitella will actually do 8k+ and can pull it off?

1 hour ago, Melvin- Admin said:

I agree the demand is dying, there’s no question. But if FUE was inferior and got poor growth FUT would still be popular. 

I agree newer surgeons may not be in a position to comment on FUT if they never did it. But  I have spoken to numerous surgeons who started off FUT and abandoned it because they think FUE is a less invasive and refined technique. 

I think this idea you can only get 6,000 grafts max is been proven wrong on multiple occasions. I have had 8,000 through FUE and still have grafts left. I’m no outlier either my donor was average at best. Multiple people on this forum have had 9-12k from FUE alone. 

Check out this podcast I did with Behnam who used to be FUT primarily 10 years ago. He was one who switched to FUE because he thought it was less invasive for the patient. 

 

I agree with the fact that it seems like the donor can handle much more than 6k in most cases. But most doctors seem to still operate and plan based off of that number.

You and @general-etwan for example have each had 8-9k scalp FUE with little to no visible donor depletion. I’m sure there are plenty of others.

I did an in person consultation with a doctor recommended here and was told that I have 8-10k lifetime FUE grafts which I found very hard to believe. But maybe nowadays Drs are starting to take a more aggressive approach across the board.

42 minutes ago, mr_peanutbutter said:

people like zarev extract 10k via fue though; so yes, with people like zarev fut is outdated. compared to rando. fue butcher in bangladesh probably not

also i heard once you go with fut you cant be too aggessive with fue anymore because you need a certain density to properly cover that scar (not sure about that argument though)

I would concede that once many surgeons are able to perform FUE as well as Zarev there will be negligible benefit to do FUT. 

It's a simple mathematical fact that combining both methods will increase the number of lifetime grafts significantly. Usually around 3000, and pretty much always over 2000.

Think of the donor as a rectangle 30x6 cm = 180 cm^2. An average patient may have about 75 FU/cm. The entire donor area has 13.5k grafts.

If you were to do only FUE, you might be able to take 40% of the donor. 50% if you have good characteristics. That means you have about 5400-6750 grafts to extract via FUE alone.

If you were do only FUT, you might have enough laxity for 6000 or so grafts in your lifetime. Around the same as what you'd get with only FUE.

Back to the rectangle. A strip is typically somewhere around 40 cm^2, maybe around 30 cm long x 1.3 cm wide. A 40 cm strip with a density of 75 FU/cm gives you about 3000 grafts per strip x 2 = 6000 grafts from earlier.

So if you take about two of those strips that are 1.3 cm wide and 30 cm long from the rectangle, you've now reduced the rectangle from 30x6 to 30x3.4.

However, the FUT strips have not affected the density of the remaining 30x3.4 cm at all.

You can still take 40-50% of the 30x3.4 = 102 cm rectangle, which should have about 102 x 75 = 7650 grafts in total. So conservatively, 40 percent of that gives you another 7650 * 0.4 = 3060 grafts. If you take 50% of that area, you can take about 3800 more.

By combining the FUT and FUE you have approximately 6000 + 3060 = 9060 or about 9000 grafts in total conservatively, or 6000 + 3800 = 9800 if you take 50% via FUE.

So we're looking at 9-10k scalp grafts in a lifetime by maxing out both methods. Very few patients actually max out their donor so we rarely see this.

This is the main advantage of FUT.

Looks like you're on track. I'd let the hair grow out for a while from this point on

It's a legit option IMO. 

Looking through his videos, I've seen several patients with ridiculously high hair per graft rates approaching 3. I've seen multiple with 2.7 and one (might have been Dr. Pinto) with 2.9.

These guys get 14-15k hairs from just 5k grafts that also have high caliber. Which would be the equivalent of 20k hair in terms of coverage/density for someone with an average hair caliber.

I still think Cuoto/Pinto etc. are exceptional surgeons, just wondering how much of a factor this is. Seems like that part of the world has the best hair characteristics for transplants by far.

Looks great, how many grafts and what was the distribution between the front and crown?

24 minutes ago, romeo_gent said:

Hi guys, thanks for the kind interest and follow up. I’m now exactly 4.5 months post surgery. Although it is not looking bad, I still feel the growth is not as much as I expect. Upon consulting doctor, I increase the minoxidil dosage from 1.25mg to 2.5mg about 1 week ago. Doctor did tell me that my growth is already above average and remind me of the patience I am lacking. 
here are some quick pictures taken few minutes ago. You can be the judge and share your feedback if you think my hair growth is good or otherwise. Thank you in anticipation!! 🙏🫡
 

 

 

I think you're on track. You should see a lot of improvement in the next couple months.

8 minutes ago, Cory said:

Okay. What’s your experience with it?

No side effects, some regrowth but nothing crazy. Hair loss stopped. I take 1.5 mg dutasteride and 5 mg oral minoxidil daily. But you don't need more than 0.5 mg dutasteride.

13 hours ago, mr_peanutbutter said:

yes ive seen crownloss with intact midscalp and front but here its not even the real crown region but the region behind the crown "the dip“ where people tend to lose their hair the last but here it seems to be the beginning

 

very interesting info and potential interesting for ht patients who fear of looking unnatural because they dont have donor to cover everything at thr back of the head

Also concealers work very well in the crown because it's completely surrounded by hair (if you have hair in the midscalp). So if someone focuses on the front 2/3 and adds a small amount in the crown, they can use concealers and have the appearance of a full head of hair.

I don't see much of a downside to adding in dutasteride once or twice a week. Most studies show no significant difference between dut and fin side effect incidence but dut works better.

I never took fin, went straight to dut.

Final result is very dense. How do you avoid shock loss when the patient has this much native hair?

I lost my hair similarly, the crown lost 80 percent of the density in a NW6-7 crown pattern and my hairline and midscalp were still pretty intact.

7 minutes ago, 4chanhrn said:

Yes, I completely agree. I also feel people's opinions are skewed because people look at select cases where great surgeons have managed to overharvest(not sure if this is the right word) from unsafe donor and still managed to make it look great. But it is risky for many reasons. And very expensive because you need to pay for the best.

One underrated thing about FUT is that it reduces overall area of the scalp, while the actual overall density remains the same. If you do FUT, you can always goto a Zarev or Pitella later. That option is completely open to you. You could also just get more FUEs.

Scar is a complete non-factor for me, but I understand why people would be concerned about it. Before I knew what transplants were and if I had looked at Joe Rogan's scar, I wouldn't have known or cared at all.

I am open to using beard/body hair. FUT+beard/body hair+FUE w/ Verteporfin can potentially give huge no. of grafts vs just doing FUE today and probably much cheaper?

Yeah 100%, I never noticed Joe Rogan's FUT scar and I'd been watching MMA for years before I got into HT research and learned he'd had one. Not the end of the world.

And exactly no matter how good the technique, you simply cannot extract 100 percent of the donor from any subsection of the donor with FUE like you can with FUT. Unless of course you're just gonna leave a massive bald scarred area visible.

Yeah I think either way it'll cost a lot though. I will say, PIttella is 4-5 dollars per graft which is not much higher or the same as several of the surgeons you mentioned. Only thing is he has a massive waitlist of 1.5 years now and it's expanding fast. But with Pittella FUE + beard you probably will get full coverage in one session. He also uses a TON of grafts. You'd probably get 9k minimum from him.

Also check out Melvin's podcast with Ted Miln that just came out. Another FUT guy who seems solid. His IG has some great results.