FUT vs FUE

[daw721]

Can somebody please give me a short explanation as to the difference between the two and which one should be used for what?

 

Thanks

[thanatopsis_awry]

http://www.hairrestorationnetwork.com/eve/showthread.php?t=155835

 

But basically FUE is where the ever-delicate follicles are individually extracted; in FUT a "strip" of your scalp from your donor area is excised, and then repaired using tricophytic closure. In the right hands, FUE leaves less visible scarring (which isn't to say FUT leaves very noticeable scarring), and a quicker recovery time. However, there is generally a higher yield in FUT, and you can safely extract a much larger number of grafts in a given session. It's also much less expensive, as FUE is more labor intensive.

[bverotti]

Originally posted by thanatopsis_awry:

http://www.hairrestorationnetwork.com/eve/showthread.php?t=155835

 

However, there is generally a higher yield in FUT,.

 

This is a blunt statement. In the right hands both procedures produce equal yield, period.

[thanatopsis_awry]

"there is generally a higher yield in FUT"

 

I don't really see how you could adamantly disagree with that statement, which also included "and you can safely extract a much larger number of grafts in a given session".

 

You say: "In the right hands both procedures produce equal yield, period."

 

Even if that is true in a vacuum, and applies to each and every patient -- and saying ", period" isn't a debateable statement -- are you not agreeing that session size, a huge factor for any prospective patient, plays a role in a FUE yield? If I remember aright, even within your clinic's claims, your sessions top out at around ~3k...?

 

Henceforth, FUT yields are "generally higher" than FUE in a session, which encapsulates sessions ranging from ~200 to ~8k. I suppose you could debate the semantics of "generally", but when the most important, and clearly wavering factor with FUE yield is the size of the session, I think it is a pretty fitting description.

 

I do agree that what I said was a blunt statement; but I would also say that it is accurate.

[bverotti]

Yes, we average a maximum session size of about 3000 grafts, unsplit.

Guess what, most strip surgery average .... about 2500-3500 grafts, split.

Yes, I know you have the exeptions, but that is not the rule.

 

I was more thinking about yield in terms of % of regrowth however, I guess in this case you would agree with me.

[thanatopsis_awry]

Interesting. Can you elaborate on the FUT splitting (of other clinics) and the unsplitting at yours? What is the "exchange rate", approximately -- 3k (unsplit) at yours would be equal to _____...

 

I do agree with you that FUE yield in the right hands can be excellent, and just as high as strip; and your clinic(s) are on the vanguard. Your clinic also makes claims -- and I'm not saying that they are incorrect -- that are phenominal, when compared to most other FUE docs. So I believe that until a clinic -- perhaps yours, I hope -- provides comprehensive and compelling evidence regarding ~2500-3k sessions, that to say FUE yields are "generally weaker" is an accurate statement, all things considered.

 

But, I'm not saying that FUE yield is absolutely weaker than FUT in and of itself -- rather, that it generally becomes more difficult to consistently maintain the greater AND greater you go for in a single session, no? And that at a certain point, especially for certain people, you simply can't safely reach a certain level of extraction because of the nature of the procedure. I remember you mentioning in a recent thread that sometimes you have to split sessions up because certain individuals are more receptive to the procedure.

[Bill - Seemiller]

Bart,

 

This is a blunt statement. In the right hands both procedures produce equal yield, period.

 

Though I appreciate your enthusiasm about FUE and the possibility of FUE megasessions for all, you have to understand that the MAJORITY of reputable hair transplant surgeons, YES, even FUE surgeons believe that hair growth yield is less and sometimes substantially less with FUE than with FUT.

 

I enjoy your enthusiasm for FUE tremendously but you have yet to admit the potential problems with FUE let alone how your clinic has overcome them. In my opinion, those who only discuss the benefits without every discussing the risks are not benefiting the patient.

 

Perhaps one of your physicians can discuss the technical details of FUE surgery and how they've overcome the risks in order to produce high growth yield for ALL FUE patients.

 

I admit however, that your clinic does appear to be producing some high quality results.

 

...Guess what, most strip surgery average .... about 2500-3500 grafts, split.

 

 

What are you considering splitting grafts? Though it is true that almost all physicians will occasionally split grafts to create more singles for the hairline, I disagree emphatically with your above statement or at least its implication. Where are you getting your statistics on this? Please explain.

 

Regards,

 

Bill

[bverotti]

Bill,

Here is a list of surgeons that I know disagree with most points made in the article 'potential problems with FUE'

Dr. Ilter

Dr. De Reys

 

here is a list of surgeons that I believe/suspect will most likely will disagree with the article :

dr. Cole

Dr. Woods

dr. Hussain

dr. Armani

 

Please notice that all of the docs mentioned are FUE experts, not offering strip, or not offering strip anymore.

 

Furthermore notice that all of the above use different techniques, or at least claim to use different tools - technique - routines ...

[bverotti]

From my visits to several advanced surgical courses during the ISHRS I know that strip grafts average 2,0 hair per grafts.

 

When we extract grafts using FUE, for example 2000 grafts we average 2,3 hairs per graft.

 

2000*2,3 = 4600 hairs for FUE grafts

2000*2,0 = 4000 hairs for strip grafts

 

That is more than 10% difference.

[Bill - Seemiller]

Bart,

 

I'd like to hear some of these physicians dispute to the points made in the discussion.

 

Perhaps you can ask your physicians to offer their input from a technical perspective.

 

But until I can hear a valid technical argument as to why there exist NO "potential problems with FUE", I will remain skeptical of anyone who discusses only its benefits.

 

Bill

[Franklin]

Bill. Of course there is potential problems with Fue. Same as I use to here aout strip megasessions until they were proved(and by viewing patient results)that they work. When I first came to this site we saw a lot of the same docs that are on here saying the yield will be lower when doing megasessions. But we know different. We don't really need a lot of jargon we just need to see results. Any procedure performed incorrectly and without doing it day in and day out. Is big time potetial for failures.

[Bill - Seemiller]

Of course there is potential problems with Fue.

 

Franklin,

 

The problem that I have is that some clinics deny this, when clearly there are POTENTIAL problems with ALL surgery.

 

The question then becomes not whether or not there are problems, but HOW leading clinics have OVERCOME the potential problems.

 

I agree that results are ultimately what matter, but don't you find it fishy that most advocates of FUE megasessions only focus on the benefits without ever discussing the risks or potential problems?

 

I think those who understand how FUE surgery works clearly understand the increased risk of follicular transection and POTENTIALLY lower growth yield with FUE over strip. Those who deny the increased risks are only adding to ignorance.

 

I personally would have more respect for any physician or clinic who discuss the potential problems of FUE and how they've overcome them then those why deny that they exist.

 

Note that just because FUT / strip surgery has a high success rate and has been highly consistent in the best hands does NOT nullify the fact that risks and potential problems exist. But these surgeons who have mastered FUT have also thoroughly discussed the potential risks and how they've minimized and/or overcome them.

 

Bill

[Franklin]

 

I personally would have more respect for any physician or clinic who discuss the potential problems of FUE and how they've overcome them then those why deny that they exist.

I hear ya on this. I had long discussions about Fue before I had it done. And what would happend if not craefully done. From Woods and Bernstein at the time. They had different opinions on who a good candiate was but I was happy for the incite. Also I would have had a lot more respect if more clinics even acknowledged that Fue was a option even if they were not doing it themselves back in 2000.

[bverotti]

You know, when you attend the ISHRS advanced courses, a large portion of the time is spend on how to deal with strip problems : how to avoid too much tension, suturing techniques, widening scars, tissue damage/waist, nerve damage, pain control during and after the procedure, excessive bleeding ...

 

 

It is generally accepted that FUT has inherent and build in potential risks for the patients. With the vast majority of surgeons performing strip surgery for many decades you would think a 100% solution for all those potential problems would have been found by now, unfortunately nothing is further from the truth.

 

Read the potential strip problem list again and then think about FUE, get it ?

 

The only problem with FUE is that it takes time to acquire the right skills, lotsa time. Most are unwilling to spend it due to costs and longer working hours.

 

IMHO one can not oversee the potential benefits of FUE over any other kind of hair restauration technique offered today.

The proof is in our pics that we present and from others that are dedicated FUE experts.

 

Obviously we will continue to post FUE results as a backup to our words.

[djdennis]

I was thinking very deeply before my 1st procedure on Fut Vs Fue.. The undisputed champion of the world is Fut for the yield I wanted. Im thinking of fut for my 2nd procedure for the touchup work if it is even needed. I dont think Fue would of pleased me at this stage of the game in technology. Hopefully soon there will be a better risk with fue

[Bill - Seemiller]

Bart,

 

I see you are quite good at pointing out the potential problems with strip. And I absolutely agree with you...these are clearly risks and should be discussed.

 

I am not picking on you personally. If anyone denied the potential risks that went along with strip, I'd be all over them too.

 

But to say that the ONLY potential problem with FUE is that it takes time to acquire the right skills is quite vague and shows either 1) that you are purposely being covert or 2) you don't have the technical knowledge to address these questions.

 

Again, I ask, what do you see as the potential risks with FUE and how have your doctors overcome them?

 

I do not deny that much of the work you presented is quite good, but I'm asking for your technical opinion. After all, this IS an FUT vs FUE thread, so let's discuss technical details since you brought it up.

 

If you are not equipped to answer the technical questions, I'd encourage you to report back to your physicians and ask them to address this.

 

I know that you have expressed interest in your physicians being recommended in our community. Though picture evidence of results is clearly the most important, we interview our prospective physicians heavily to gain a full understanding of their clinical ability and philosophies, including opinions on risks and how the physician has overcome them.

 

Bill

[bverotti]

Originally posted by djdennis:

I was thinking very deeply before my 1st procedure on Fut Vs Fue.. The undisputed champion of the world is Fut for the yield I wanted. Im thinking of fut for my 2nd procedure for the touchup work if it is even needed. I dont think Fue would of pleased me at this stage of the game in technology. Hopefully soon there will be a better risk with fue

 

I do not deny that in terms of shear numbers, FUT still has the uperhand IF you opt for a handfull of surgeons worldwide (most docs still perform strip sessions of 2000-3000)

 

On the other hand it is technically possible to achieve 4000-6000 graft sessions using FUE over a couple of consecutive days.

The reason why we are holding back is because we take a step by step aproach. We are unsure about the effects of such sessions on the donor area. The major questions being : if you harvest that many grafts in a short time, will we no risk donor area shockloss ?

 

So instead of rushing in and perform giga sessions we would like to slowly move forward with this, I dont think anyone will object to a conservative aproach.

 

For the sake of arguments let suppose for now that such giga sessions do not produce any side effects. This would mean that almost ANY patient, regardless of laxity could achieve 4000-6000 grafts in 1 session, that would be a fantastic breakthrough, not ?

[bverotti]

To answer some points in the list of supposed problem with FUE

 

Traction force :

In the hands of our surgeons we do no see this problem at all, very simple. The surgeon will know through experience how shallow or deep to perforate in order to have the graft slide out easily. For beginners this could indeed be a temporary problem that can only solved by : achieving expert hands and using proper instruments.

IF the twisting and tortion force would cause such great follicular damage we would have noticed it also in our results ... nature has a way of showing us when we are doing things wrong. We do not see any such evidence in our results, sorry.

 

Tearing of shearing grafts:

Indeed, some hair characteristics like tiny grafts are more difficult to extract. An expert FUE doc will recognise this situation immediately and adjest his speed/angle/depth/speed. The answer to this pitfall is .... experience.

 

Instruments:

Many will try to impress with patented tools, voodoo tools ... what not. No, we just use of the shelve instruments that anyone can buy, period.

 

We do agree that surgery should not least over 12 hours. In our office it is extremely rare that we go over this limit. I read on another board however that a 4100 graft strip session took 12 hours to complete, what happens to patients who are lucky to get 5000-6000 grafts ?

 

Lying about the actual numbers :

We offer our patients to inspect the grafts and count them, no secrets here. Splitting only occurs if there arent enough single grafts for the hairline, otherwise the grafts contain 1,2,3,4 hair grafts and are reimplanted in the same way.

 

Dr. Ilter gave a presentation on his FUE last year during the ESHRS. I believe some coallition members where present as well. During his speach he informed how he had started with small FUE sessions and slowly changed routines and instruments in order to harvest up to 3000 unsplit grafts with virtually no transections.

I spoke to many docs that where attenting and they where truly amazed by what they heared. On the other hand they could not imagine how it is possible to keep up concentration for such a long period. If you ask me about FUE problems this one is key : fatigue. Most docs starting with FUE will be tired after only 1 hour. Just like a runner has to build up his strenght a doc should therefore train train train and eventually he will be able to concentrate very long hours. At a certain point they become so experienced that performing extractions is no more that walking .... you need not think about how to do it.

 

STrip distortion :

underneath the stripped skin the follicle direction is often very distorted. Normally the doc knows the angle and depth, but in patients with previous strips the direction and depth is sometimes extemely distorted by the pulling and traction forces caused by the attempt to close the wound. This is a problem and therefore it is again advisable for people to start HT using FUE. The more previous strips the more distortion is noticed ... what is very logical.

[P.J]

Guys,

 

Is there a coalition Dr that performs FUE exclusively?

 

I believe Bart is in the minority on this site.

 

It would be nice to hear from a Dr that only performs FUE day in and day out.

 

I take more value from someone that does it on a daily basis exclusively

 

 

PJ

[PLEASE GROW PLEASE]

They are too busy extracting grafts.

Dr Feller does both and as much or more expierence then any of them and he posts here all the time.

Search on here and youll find everything youll looking for.

Bart isnt a doctor so he doesnt count in your request

[Bill - Seemiller]

Bart,

 

This is the most educational and informational post I've seen from you yet. Well done!

 

I particular like that you were specific on how your physicians reduce the risk of the tearing/pulling force by controlling the speed, angle, and depth.

 

This is also the first I've heard about "strip distortion", but logically, it makes sense.

 

Specifics help patient members understand a clinic's philosophy and goals. Next time don't make me beat it out of you .

 

I will be attending the ISHRS conference this coming September so I hope that Dr. Ilter may yet again present on FUE.

 

Bill

[P.J]

Please Grow,

 

I do think this is very valuable site and very informative.

 

But you ask me to take all the FUE information based on one Drs opinion.

 

While I think Feller is one the best and most honest Dr.s I've read about - I cannot take his opinion as gospel. I believe there can be different approachs to the same end result.

 

I would like to hear other opinions from Dr.s that do this every day because skills are perfected with pratice.

 

PJ

[Bill - Seemiller]

P.J,

 

Great point. I agree that it is important to speak to many physicians woh ultilize a technique to get an overall perspective rather than just one. That's why I was pressuring Bart to give us his opinion from a technical perspective. I'm glad he finally shared a bit more detail. I'd love to see a technical debate on any aspect of hair transplant surgery between physicians who vary in their philosophy and techniques.

 

Bill

[MeBlindMelon]

PJ,

 

I think PGP gave you a sufficient response. Dr. Feller is the only (that I'm aware of) coalition Dr. that does fue's AND is active on this site. I don't think he was suggesting that you take Dr. Fellar's words or opinion as 'gospel'. But again, he is THE fue Doc on this particular site and as you mentioned, "one of the best and most honest read about".

 

You and Bill make a great point, I think we all would appreciate seeing the two techniques and philosophies discussed by the actual Doctors themselves.

[Franklin]

I could be wrong. But isn't Dr. Rose in the coalition? I know he does Fue. So does Bernstein and Rassman. How much they do at this time. I really have no idea.I do see them post from time to time. Best way is to contact the docs yourself and ask to meet some former patients. Also I do agree that information from a doc that does it day in and day out is valuable.