England
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Posts posted by England
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Certainly someone could have strip done after maxxing out FUE, but that is counterproductive and going completely against what was trying to be accomplished in the first place (trying to avoid a linear scar). IMO the donor would look more even in the end after doing strip first, then FUE to finish, than it would to max out FUE, then try to do strip.
I disagree.
If you don't know what your future loss will hold, or are hoping that some kind of medical breakthrough happens before your loss gets too severe, trying FUE first may be a sensible approach - that way you leave yourself the option of not having a scar.
It makes little difference IMO whether you do strip or FUE first - if you strip first your hair is thinned already by the strip so FUE yield and risk of gaps is larger, exactly the same as if you do FUE first.
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I believe so - I was told that I could have a strip and another FUE in any order, by 2 separate surgeons.
Cheers
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I was actually curious about extraction patterns of FUE vs Strip so I whipped this up in paint:
Top row (1-3) is FUE, bottom row (4-5) is strip.
Left boxes on both rows (1 and 4) are a normal head of hair - I think it has roughly 2,500 hairs on it.
Box 2 (FUE) is the result of extracting 1 out of every 2 hairs in each 'row' of hair, in an even way and trying not to leave gaps or patterns (believe it or not - try it if you don't believe me).
Box 5 (Strip) is the result of removing half of the 'rows' of hairs (as per a strip) - and evenly distributing the rest.
You can clearly see that strip appears more even and dense, despite the exact same number of grafts being removed. Thus, when FUE surgeons try to extract grafts evenly - it is almost impossible for them to achieve the density appearance of strip.
Box 3 is an interesting one. Instead of removing 1 in every 2 grafts, I removed every other ROW (leaving the same number of grafts as Box 2). You can see that it looks far more dense, and the same as the strip. Perhaps this very unscientific experiment suggests that the best way to reduce the 'moth eaten' look with FUE is to extract in 'rows' rather than trying to pick and choose dots like I did in box 2...
Food for thought anyway.
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An interesting question. Some observations of mine which I believe to be true (I've had a large FUE and strip):
1 - People who strip out normally have some reserves left for FUE.
2 - People who FUE out normally have some reserves left for strip.
3 - Whether you do FUE or strip first, the former reduces the yield from the latter. You can do either after the other, in any order.
4 - FUE scarring is far less evident than strip scarring (I know you didn't ask about scarring but replies to your post did)
5 - In the right hands (the best FUE surgeons in the world), the yield can be as good as 95% of a strip yield. In lesser hands this can be lower because FUE requires great skill.
6 - Some surgeons in the US are unable to do larger FUE sessions because they aren't legally allowed to have specialised techs doing the extractions, thus they simply do not have enough time to perform larger FUE surgeries, and they would suffer from fatigue etc if they attempted to given the work involved. While they may therefore state that FUE cannot work in large numbers, numerous world class surgeons in Europe / Canada etc perform large FUE operations on a weekly basis which shows it does work.
7 - Mathematically, whether you remove grafts via strip or via FUE, you still have the same sized head, so whether you take 2,000 grafts via FUE or 2,000 grafts via strip, you still have the same overall area to cover with the same number of grafts. In theory, this would mean that you have just as many grafts for FUE as for strip. In practise, however, strip certainly seems to have a higher maximum yield, and honestly I've not seen a good answer why. Here are some of my 'theories':
1 - Strip stretches the skin, rather than removing the hairs. Thus, you automatically achieve a spreading out of the hair grafts (and the gaps inbetween) which is perfectly distributed, whereas with FUE this depends on the skill of the surgical team and can never be perfect.
2 - It's possible that strip lifts the nape slightly to reduce the overall area that hair has to cover....
Essentially, the limiting factor with FUE seems to be when the hair starts to approach the 'moth eaten' appearance - in other words too many grafts were extracted from a specific region. This could be caused by any one of 1 or 2 above - generally I think surgeons are getting better at taking increasing number of grafts out in even distributions to increase the possible yield with FUE.
I do still believe that carried out perfectly, an FUE should mathematically have the same potential yield as strip. Of course it doesn't, and maybe it's not possible to carry out a perfect FUE - but I think surgeons continue to improve and will get closer to strip yields over time.
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Gotta admit I would have absolutely loved this prior to my surgery.
I of course have concerns that it can never be 100% accurate, as surgery itself (and the results thereof) can vary by a whole host of unknown factors, but it still would have been great to see the potential gain from a transplant.
I have heard of some surgeons already offering these kind of 3D 'projections' - may have been Devroye in Brussels, think you could have yourself a nice little niche business here.
While these kind of previews would need to come with heavy and clear disclaimers, I do think they would appeal to prospective clients.
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Good luck! I still think of you as a grey haired guy with a beard. No amount of real photos of you will change that.
This.
You can't go and shatter the illusion after all this time Spanker.
Seriously though, you're probably the most liked guy on here, you're polite, courteous, and you're THOROUGH.... so you'll get yourself a great result.
If only everyone researched as much as you
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Copying this from another thread, a structured idea of what you need to gain from the consultation:
1 - What is your long term strategy for my hair transplant journey?
This is a broad question which will necessitate the doctor analysing your donor density, the loss you have seen already as well as looking at any miniaturisation elsewhere on the head, planning the best utilisation of the available donor and ensuring that if your hair loss progresses you will have sufficient donor to cover those areas too. They may mark the areas which need to be treated, in most cases this involves the drawing of a hairline. The doctor should tell you his vision for numbers of grafts required in areas (present and future) as well as the cosmetic improvement you should expect to see given said plan.
2 - Can I meet some of your patients and see some of your results?
VERY very important that you actually meet with multiple people who were treated by this surgeon, as well as see results they present similar to yours, online or on their computer. Not only does this help you review the surgeon, it also gives you realistic expectations. If you can find someone independently (ie, not someone the surgery recommend you see) that is even better.
3 - What process will I have to follow before, during and after the surgery?
The surgeon should tell you key information like whether you have to shave your head, costs, how long the surgery will take and who will perform which parts (it's very important that you understand what will happen before hand so you arent unnerved during the operation). This may include understanding the process of injections, the extraction, incisions, placement, and who on their team performs what. The surgeon should also inform you of the necessary after-care process, what you have to do and how long it'll be before you can go out in public, what to expect after surgery eg swelling, and growth timescales. Finally, the surgeon may recommend taking preventative hair loss medication such as Propecia to stabilise your hair loss. This will give you a much more precise feel for what you are committing to - how long it will take, how much it costs, what will happen, and what you will have to do for the rest of your life.
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For any of the above question to be relevant at all, you have to be absolutely sure that the surgeon you're meeting with is an ethical one (and that you're meeting with THE surgeon who will perform your procedure). You can't tell this from the surgeon, and that's where sites like this one come in - a poor surgeon could answer the questions above dishonestly and you would have no way of knowing - this is how many guys get sucked in. It's also important for the same reasons to consult with multiple top top surgeons and compare their recommendations. By 'top surgeons' I mean IAHRS registered surgeons who are recommended on this site and for whom you have found numerous patient posted stories online which you like the results of. I really want to emphasise the point to you that the difference between a transplant from a poor surgeon and a world class surgeon is LIFE changing.
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First of all, fantastic result in the recipient area - congratulations.
I can understand why you're a little disappointed with the scar being visible - your hair looks very dense and thick and a decent length too, yet the scar still shows.
I can relate to this because I feel very insecure with my hair short due to my visible scar - even if it's only an indent, I feel like people will know what it is and that is the last thing I want. For me this is a major problem with your surgery - it would be good if we could get an explanation as to why it happened from the clinic / surgeon.
I guess this is the main disadvantage of strip - even with a top surgeon you may be left with a visible scar. If you plan any future surgery you could potentially have the scar re-closed or you could have some FUE in the scar to try and hide it a bit better?
As per the other request, do you have any pictures of the scar itself so we can get a better idea why it's visible?
Cheers
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It was Norton Clinic - very bad reputation (as I'm sure you know).
However, it looks like I got lucky - during my recent consultations they said I didn't need any repair work, the yield and strip scar looked fine. The main problem with the surgery was the direction of some of the grafts in one small area of the hairline, but it's not noticeable when grown out. It lasted me well for 7 years so I think it's one of the better examples of their work.
:-)
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As far as I'm aware, there's no difference.
Regaine is the name in the UK and Australian markets. Rogaine is the name in the US market.
Cheers
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Dr Charles,
I've noticed on a few threads that I've looked through that you've added knowledgeable comments, it helped me a lot when preparing for my surgery and in dealing with any unexpected things post op.
Just wanted to say thanks, it's very much appreciated to have surgeons such as yourself helping out the rest of us.
Cheers
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Yeah Sean,
I met with Stephen too, saw and touched his hair first hand. He's very lucky to be able to pull off that buzz style - he's a good guy too.
As you say there are no marks at all or any indication that he's had surgery. Fantastic show piece.
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Keep in mind though that if you hammer your donor area with a large FUE session then it makes for smaller strip surgery harvests.
It's also true that if you hammer your donor area with large strips it makes for smaller FUE harvests.
There are advantages and disadvantages to both.
@Chris - I clearly said excellent progress so far, the fact he has many more months of improvement only strengthens my point. I also referred to hundreds of other case studies.
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It's important to note that my top 3 FUE surgeons, worldwide, regularly perform large (~3,000) FUE sessions and have the portfolio of excellent results to back it up. They would certainly not agree that they don't recommend FUE surgeries of this size, at all. They are also, arguably, far more experienced when it comes to FUE surgery than other doctors who perform mostly (or more) FUT, and certainly they are more knowledgeable than any of the posters on this site.
Sean has already posted his results from his 3,000 FUE which have been compared to strip favourably, and Ben had a similarly large session which is showing excellent progress too. After having had consultations with multiple top FUE surgeons I saw hundreds of cases showing the same or similar results.
It is worth noting that ALL surgeons, strip or otherwise, will state that their technicians perform a critical role in the operations and are just as important as the surgeon - it's a team effort wherever you go and whichever surgery you opt for. I believe that for legal reasons in some countries, technicians are limited in what they can actually do so some clinics are simply incapable of performing surgeries over 1,000 grafts - it doesn't mean they don't work.
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Hi Sanjay876
1 - Obviously I'm not a surgeon but as a layman's estimate it looks like you need around 2,000 grafts. This largely depends on the density the surgeon recommends. I would recommend you get at least 3 consultations done online and compare the recommendations.
2 - Many clinics can do this in one sitting. I recently had 2,550 FUE in one sitting.
3 - Punch size should ideally be 1mm or less to minimise scarring. The surgeon should be responsible for the overall operation but often it is far better for your graft survival and result if the technicians perform a lot of the work. For example, typically the technicians perform the extractions of the grafts (in teams), then the surgeon performs the incisions, and finally the technicians place the grafts into the incisions. This is beneficial for many reasons: a) The grafts are out of the head for less time, increasing survival rate. b) The technicians are very specialized in extractions and so can do it at least as well as many surgeons c) If the surgeon had to do every extraction himself he could suffer from fatigue and that could affect the result and d) the direction of the incisions by the surgeon, if done properly, can allow placement of the grafts in only one way so the technicians can't change the direction of the hairs.
In terms of the technique used by the surgeon, rather than saying that one technique is better than another (manual vs motorized) etc, I would say just look at lots and lots of their final results and meet some of their patients, decide which results you prefer. What is very important is that you understand the process before you go into the operating room, as much to reduce your stress levels as anything..
Best of luck.
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Hey Sean,
Yeah - you're bang on. I'm at 2 months right now and pretty much in the doldrums as expected, I'm finding the whole experience strangely pleasant though! I've uploaded a series of pictures to an album in my profile and I'm 90% through writing my story - when finished I'll definitely post here.
I've seen the results on your thread - simply awesome result - I'm really happy for you.
Cheers
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For me this case wasn't posted in order to try and demonstrate that FUE is bad, per se - it's about what happens when FUE is performed with a larger punch and the problems that this causes. It's a demonstration that if you do opt for FUE it should be with a top surgeon.
As I mentioned previously (and as the doc concurred), had the surgeon who did the work on the sides done the work at the back, using appropriately sized extraction tools (~1mm or less) there would likely be no problem. Typical transection rates in FUE with the top surgeons are very low - the hair is normally shaved so that the direction of the hairs is quite clear (at least for Caucasians) - and the extractions are performed under magnification. In my recent FUE, transection rate was just 4.5% - the extraction tool was 0.9mm for both 1's, 2's and 3's (I have fine hair). There are some disadvantages of strip too with grafts lost and nerves cut during the slicing process, I've had a strip surgery too so hopefully I can directly compare the results from both in 10 months time. What I think this case does show is that if you're going to get an FUE transplant, you need to think very carefully about who you select to be your surgeon.
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In Hariri's defence, almost nobody posting their opinions on any thread comparing top surgeons has had surgery with both/all of them, so a true experienced opinion is a rare commodity indeed, and one statistical data point is pretty irrelevant anyway.
Just like the rest of us, opinions are based on experiences of dealing with a collection of patients from said surgeon and forming an opinion as a result, almost every comment which was relevant to the original question draws on similar experiences. To recommend any doctor - which many have done on this very thread - you necessarily must imply that you don't believe the other options are as good. Suggesting that the patient care or ethics of one surgeon are better is not the same thing as accusing the other doctors of being unethical or having poor patient care. It's all relative, and people should be allowed to voice their opinions without fear of being belittled. It is the combination of different opinions which makes the forum such an accurate and representative source of information.
From my own perspective I can vouch for the patient care of Dr Feriduni being second to none - I can't think of a single thing they could have improved. For example, I was invited back every day for 2 weeks to have a checkup/wash, taxis paid for every time.
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1 - What is your long term strategy for my hair transplant journey?
This is a broad question which will necessitate the doctor analysing your donor density, the loss in crown as well as looking at any miniaturisation elsewhere on the head, planning the best utilisation of the available donor and ensuring that if your hair loss progresses you will have sufficient donor to cover those areas too. They may mark the areas which need to be treated, in most cases this involves the drawing of a hairline but for you probably an area drawn on the crown. The doctor should tell you his vision for numbers of grafts required in areas (present and future) as well as the cosmetic improvement you should expect to see given said plan. Bear in mind Stem Cell research is by no means guaranteed and some links have been found to cancer, so as per the Bourne Ultimatum, 'hope for the best, plan for the worst' - you need to plan for a Stem Cell technology free world. Since you mentioned you are thinning in your front, this would become far more of an issue for you in the future than a bald spot which you can't see when you're looking in the mirror, so you need to keep your options open.
2 - Can I meet some of your patients and see some of your results?
VERY very important that you actually meet with multiple people who were treated by this surgeon, as well as see results they present similar to yours, online or on their computer. Not only does this help you review the surgeon, it also gives you realistic expectations. If you can find someone independently (ie, not someone the surgery recommend you see) that is even better.
3 - What process will I have to follow before, during and after the surgery?
The surgeon should tell you key information like whether you have to shave your head, costs, how long the surgery will take and who will perform which parts (it's very important that you understand what will happen before hand so you arent unnerved during the operation). This may include understanding the process of injections, the extraction, incisions, placement, and who on their team performs what. The surgeon should also inform you of the necessary after-care process, what you have to do and how long it'll be before you can go out in public, what to expect after surgery eg swelling, and growth timescales. Finally, the surgeon may recommend taking preventative hair loss medication such as Propecia to stabilise your hair loss. This will give you a much more precise feel for what you are committing to - how long it will take, how much it costs, what will happen, and what you will have to do for the rest of your life.
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For any of the above question to be relevant at all, you have to be absolutely sure that the surgeon you're meeting with is an ethical one. You can't tell this from the surgeon, and that's where sites like this one come in - a poor surgeon could answer the questions above dishonestly and you would have no way of knowing - this is how many guys get sucked in. It's also important for the same reasons to consult with multiple top top surgeons and compare their recommendations. By 'top surgeons' I mean IAHRS registered surgeons who are recommended on this site and for whom you have found numerous patient posted stories online which you like the results of. I really want to emphasise the point to you that the difference between a transplant from a poor surgeon and a world class surgeon is LIFE changing. Please don't take that decision lightly. They are NOT all created equal. Also, I have only watched your most recent video - have you decided between Strip and FUE yet?
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The reality, in my opinion, is that the doctor who is claiming doctors can't achieve 40 grafts per sq cm is proven wrong by thousands of cases which are posted on here, all at a density of 40 / sq cm or above. It is not true that 20 grafts per sq cm by this doctor will result in the same or better appearance as the 40 grafts / sq cm by a top doctor due to yield issues.
In fact, 20 grafts per sq cm is typically not sufficient to achieve an illusion of density at all. I would be very surprised to see any recommended doctor on this site claim what you stated.
There are some possible reasons why a doctor could recommend going less density, such as there being a large area to cover, limited donor supply, big risk of future loss. The other important factor is how much native hair you already have in the area, if you have a lot (say 40-50 grafts per sq cm) then it's possible 20 could be enough whereas 40 could put you more at risk of shock loss.
However, the reason that you state the doctor gave is not one of these possible reasons so I personally would avoid, assuming that your question paints an accurate picture.
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Really happy for you, Sean. You must be made up with this result, and as you said you've still got more density to come.
3,000 FUE is a large procedure and what a success you've had!
Looking forward to more updates!
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Agree with what Chris said, Strip is marginally more consistent and on average yields very slightly higher.
Dr Feriduni is one of the few FUE surgeons in the world I would trust to go with FUE over strip, because in the wrong hands it can be significantly inferior to strip. In the hands of the very best surgeons, eg Feriduni, Rahal, Shapiro, it can yield almost as high as strip.
I personally can only talk about the customer service at this stage - I will reserve judgement on the final result (I am in the doldrums right now, 2 months after surgery). I would happily meet up at a later date when my hair grows in.
Hopefully in 6-10 months time I'll be raving about the end result ;-)
Edit: I'm sure you were informed that with any surgery (strip or FUE), there are no guarantees. 90-95% can be achieved, and may be the average, but you can never be absolutely certain with surgery.
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Mattj - thanks - my strip scar being relatively thin and easy to hide was one of the reasons I didn't want to risk it getting any worse (or longer) by having another strip. Considering I had my treatment done at a relatively poor clinic I got quite lucky with the scar I think.
Cdog - I had 2,500 ish extractions. I think you're right in that light hair helps. The dots were slightly red at first but are fading now and just look like pores if visible at all, I don't think they'll go white due to my skin tone. Fantastic that you can't see any dots on your hair with 2 weeks growth. Have you healed any more since your original post?
@Both - the main reason I posted was for people considering scars of strip vs scars of FUE - this gives a direct comparison on the same head of hair. At just 2 weeks post FUE op (a relatively large one), it was the strip scar that stopped me going outside without a hat. While everybody who has researched knows that FUE isn't technically scarless, when it's undetectable with short hair it's far 'more' scarless than strip. :-)
Best FUE Drs for advanced balding 5-6
in Hair Transplant Reviews
Posted · Edited by England
Few comments:
1 - There are very few cases of repeat FUE or strip-after-FUE with which to evidence your 'scar tissue' claim. Scar tissue can affect the yield in the recipient area (for both FUE and strip) but I haven't seen any evidence that FUE affects the growth or transplant suitability of hairs surrounding the extraction sites. That there is scarring around extractions doesn't mean it affects the extraction of future grafts.
2 - The FUE comparison you suggest is flawed for several reasons:
- Far more operations, globally, are strip, than FUE. Much more than 2x so.
- Part of the reason for this is that FUE is significantly more expensive so not an option for lots of people. The additional expense of FUE also means that the majority of FUE's which do happen are smaller.
- Another reason for this is that there are fewer surgeons practising FUE.
- Surgeons in the US are not legally allowed to enlist the help of technicians while performing extractions. Since FUE takes a long time, this means that they physically cannot do operations above 2,500 without suffering exhaustion and over several days. This is the real reason why several 'well regarded' US surgeons do 'not recommend' large scale FUE - they simply can't perform them for legal reasons. Of course, this can be marketed as an advantage 'the surgeon performs all the extractions' but the reality is a team of fresh, specialized technicians rotating will achieve a better result than 1 single surgeon who has a whole host of tasks to complete working for several hours straight (and better than automated tools).
- FUE is more difficult than FUT. It is much more significant with FUE that you go to one of the top top surgeons. This means that there are far fewer capable FUE surgeons (even of those which perform FUE) and this lessens the 'pool' for information.
- Finally, this forum is known (rightly or wrongly) as pro-strip, the majority of users on this forum end up with strip so that will skew the results even further.
FUE is, in the right, hands, about 95% as good as FUT in terms of yield, according to the numerous surgeons I spoke with, with the obvious advantage that you don't have a large strip scar. The problem is it's more expensive, highly specialised, requires a higher calibre of surgeon, takes longer, and is therefore practised much, much less. This is the reason for the lack of case studies, not that the methodology doesn't work.
Having had both a strip and a large (>2,500 FUE) I feel I am in a relatively unique position to assess the pro's and con's of both. So far I am delighted with the yield from my FUE, as I was with my strip. The difference is I can't feel the constant tugging from the strip which stayed with me for years after my strip. I also didn't extend my scar into an ear-to-ear line, which I am very happy about.