Senior Member notgoing2gobald Posted December 27, 2007 Senior Member Share Posted December 27, 2007 I was considering today if I want to go forward with a ht soon. Then I thought that if I ended up becoming one of the unlucky ones years down the road with a huge bald crown that cannot be filled densely if I had the procedure done FUE I could simply buzz down my head. So I was wondering (apart from the cost) what are the other risks/downsides with FUE compared to strip? (i) is it true the yield is lower than strip? if so, then how much lower? (ii) in the first picture in the link below, is it normal to get donor this high on the sides of the head via FUE: http://www.hairlosshelp.com/websites/galleryview.cfm?id=shuffle|gallery1.cfm I thought this was outside of the safe zone? I ask because this is where my hair is the thickest and it REALLY accentuates the thinning areas. I even have the barber run the thinning -sheers through this area so as to make my thinning top less obvious. So, I thought it would kill two birds with one stone by thinning that area out by extracting additional donors from it and re-distributing them atop my head. Any thoughts? (iii) can you shave down the entire donor area (as in bic it) and have absolutely no visible scar with FUE? (iv) if one did do strip and wanted to fill in the scar with FUE for the same reasons given above, roughly how many grafts would it take and is it possible? Link to comment Share on other sites More sharing options...
Bill - Seemiller Posted December 28, 2007 Share Posted December 28, 2007 NG2GB, I recommend reading the following dialogue between myself and Dr. Feller: What are the benefits, risks, and potential problems with FUE/FIT? Bill Link to comment Share on other sites More sharing options...
Senior Member notgoing2gobald Posted December 28, 2007 Author Senior Member Share Posted December 28, 2007 I read it. Would still like additional input as my questions are not answered. Link to comment Share on other sites More sharing options...
Senior Member wylie Posted December 28, 2007 Senior Member Share Posted December 28, 2007 Thats an interesting and informative link, I didnt know it existed, answers alot of questions I had about FUE. Unfortunately (for me, anyway) it sounds as if this procedure does not work well unless two things are working in the patients favor, one of them being a virgin scalp, the other being doctor skill. Link to comment Share on other sites More sharing options...
Bill - Seemiller Posted December 28, 2007 Share Posted December 28, 2007 NG2GB, To answer your questions specifically. (i) The risk for lower yield is much greater with FUE than strip. But it's not necessarily fair to make that a surefire statement. (ii) In my opinion, hair was taken outside of the universal safe zone. I know often times physicians make decisions based on a patient's characteristics, age, and family history of hair loss. So even though hair may have been extracted outside of the universal safe zone, if the liklihood that a patient won't lose hair in that area is high, a physician with patient's consent may take hair from that area in order to increase graft/hair count. I recognize that this is highly debatable and there are varying views on this. Form your own. (iii). Don't count on it. FUE is NOT a scarless procedure (iv). Can't answer this with numbers unless a specific case is given. It depends on the length and width of the scar for starters. On an average strip scar however, I'd suggest a good 500-800 grafts will probably make a good difference assuming high hair growth yield. But as you have seen, there is greater risk of transection and damaging the hair follicle with FUE. Combine that with trying to grow it inside of scar tissue, there are additional risks. I'm not saying it's not potentially an effective means to camoflauge the scar. I'm only stating that there are many hurdles to be overcome. Wylie, I'm glad the above article has helped you. Bill Link to comment Share on other sites More sharing options...
Senior Member Janna Posted December 28, 2007 Senior Member Share Posted December 28, 2007 Can I call you "not"?, I think Bill did a good job addressing your specific questions. We are pretty much in agreement with our opinion on FUE. I've seen many fue cases being done in person and have seen results from fue. First off, when viewing fue technique in action, I've seen a lot of transections. It takes way more time to extract then what doctors claim. Then going outside the safe zone -- what's that about? It's considered outside the safe zone for a reason-there's likelihood that you may someday lose those hairs. Secondly, "scar less" is very subjective. I think I saw one patient where it was really unnoticeable, but then they only received 500 grafts. He needed very minimal work in the hairline. Patient Care Services & UK Patient Advisor for Shapiro Medical Dr. Ron Shapiro, Dr. Paul Shapiro and Dr. David Josephitis are members of the Coalition of Independent Hair Restoration Physicians. http://shapiromedical.com/info@shapiromedical.com http://shapiromedical.com/contact/request-a-consultation/janna@shapiromedical.com Link to comment Share on other sites More sharing options...
Senior Member bverotti Posted December 28, 2007 Senior Member Share Posted December 28, 2007 Originally posted by notgoing2gobald:I was considering today if I want to go forward with a ht soon. Then I thought that if I ended up becoming one of the unlucky ones years down the road with a huge bald crown that cannot be filled densely if I had the procedure done FUE I could simply buzz down my head. So I was wondering (apart from the cost) what are the other risks/downsides with FUE compared to strip? (i) is it true the yield is lower than strip? if so, then how much lower? (ii) in the first picture in the link below, is it normal to get donor this high on the sides of the head via FUE: http://www.hairlosshelp.com/websites/galleryview.cfm?id=shuffle|gallery1.cfm I thought this was outside of the safe zone? I ask because this is where my hair is the thickest and it REALLY accentuates the thinning areas. I even have the barber run the thinning -sheers through this area so as to make my thinning top less obvious. So, I thought it would kill two birds with one stone by thinning that area out by extracting additional donors from it and re-distributing them atop my head. Any thoughts? (iii) can you shave down the entire donor area (as in bic it) and have absolutely no visible scar with FUE? (iv) if one did do strip and wanted to fill in the scar with FUE for the same reasons given above, roughly how many grafts would it take and is it possible? I would like to take the opportunity to answer your questions taking into account OUR experience, obviously we can not account for other peoples experience. 1. If you are asking about maximum amount of grafts harvestable : strip is limited by laxity, FUE is limited only by the patient accepting thinning donor area. Technically it is possible to harvest many more grafts using FUE, I doubt anyone could question this. At this point we believe that FUE produces about the same amount of grafts when compared with strip surgery, on average 4000-5000 grafts. 2. Looks maybe a little high on the crown, the sides seem ok. 3. No, FUE may not leave visible scars, but at a certain point missing hairs will become visible as white dot like areas. But even this will be MUCH less visible at bic lenght then even the best scar or tricho scar 4. You wont know how the scar will turn out until 6 or more months after the session. I have no crystal ball, but personally I would not count on FUE scar filling to make the scar invisible at bic level. I have seen FUE scars filled with no result, most results are good in 'softening the scar', rarely the scar is invisible after FUE'ing them. Again these are our opinions that are based on our experience doing FUE on a DAILY basis. Consultant-co owner Prohairclinic (FUE only) in Belgium, Dr. De Reys. Link to comment Share on other sites More sharing options...
Bill - Seemiller Posted December 28, 2007 Share Posted December 28, 2007 Bart, I appreciate your posting your experience on this thread from an all FUE clinic's point of view. I have a couple points based on what you said and want to see if you agree with me. Technically it is possible to harvest many more grafts using FUE, I doubt anyone could question this Technically you are correct however, what you are leaving out is that harvesting more grafts via FUE will most likely leave the average patient looking like swiss cheese. Therefore I would suggest that one could extract on average just about as many grafts with Strip as with FUE. I believe we agree on this point as per your last statement. No, FUE may not leave visible scars...But even this will be MUCH less visible at bic lenght then even the best scar or tricho scar FUE may NOT leave obvious scars, but I'm not sure I would go as far as to say that it doesn't leave visible scars. That would be like calling a procedure "scarless" which isn't true. I think it is safe to say that at best, FUE scarring may be less obvious at skin level than than a typica strip scar. However, I have seen some bad strip and FUE scarring cases. In the hands of a proven quality hair restoration physician, these risks are minimized. Bill Link to comment Share on other sites More sharing options...
Senior Member notgoing2gobald Posted December 28, 2007 Author Senior Member Share Posted December 28, 2007 Bill, Janna, Bvretti, thanks for the responses. I was just thinking that if I ended up with a big ass crown that could not be filled later during my Alzheimer filled golden twilight years in which I will be hobbling involuntarily having gasteroal passes then if I had done FUE I could at least shave it down to a #1 or #2 clipper with no really visible scar when compared to having a smiley face "have a nice day" sign on the back of my head... I guess at least the people walking behind me will be happy and having a nice day even if they are holding their noses. When you guys say that it takes docs a much longer time to perform the surgery, then that means that it might just take 4-5 days of going in rather than one with strip, right? I think the biggest detterent with FUE is the lower yield. Who wants to take that risk? I only have so many donors which will enable me to live up to my name... Janna, no! You have to spell out my name with each letter... Link to comment Share on other sites More sharing options...
Senior Member thanatopsis_awry Posted December 29, 2007 Senior Member Share Posted December 29, 2007 A poor yield is what scares me the most as well; however, it seems like various docs (Dr. Feller in the U.S., Bart's clinic to a greater extent) can do ~1000+ feeling very comfortable in a single session -- especially if you take the FOX test (I think it's called) and are a good to great candidate. If say you desired/needed a 2k procedure, and your doctor feels very comfortable performing 1k in a single session....is there anything bad about going in for a 1k procedure, then a week or two later going in for another 1k procedure? Or 3 days of this if you need 3k, etc. ----------- *A Follicles Dying Wish To Clinics* 1 top-down, 1 portrait, 1 side-shot, 1 hairline....4 photos. No flash. Follicles have asked for centuries, in ten languages, as many times so as to confuse a mathematician. Enough is enough! Give me documentation or give me death! Link to comment Share on other sites More sharing options...
Senior Member notgoing2gobald Posted December 29, 2007 Author Senior Member Share Posted December 29, 2007 thant, did you discuss the possibilities of doing FUE with Feller? what exactly is the FOX test? I have never really researched FUE as I always thought strip was better just to get more grafts. I wish Dr.Feller or someone of real expertise would jump in on these types of questions. I have always only read unfavorable things regarding FUE on this forum, for the most part anyway. The Feller article on this post was interesting but did not directly answer any of my questions. I would like to hear a doc discuss the difference in yield--if any-- with FUE versus strip. This is the only real downside in my lights as well. As far as having your sessions spread out over three to four weeks: that is a very small price to pay for having a virtually non-visible scar AND less healing time since there is no strip scar to scab up and worry about stretching. FUE actually sounds fantastic if I could get a solid answer on yield... Link to comment Share on other sites More sharing options...
Senior Member thanatopsis_awry Posted December 29, 2007 Senior Member Share Posted December 29, 2007 I was very hot for FUE for a good while; the FOX test is a sort of biopsy (spelling?). Anyways, it gauges how good a candidate you are: "The FOX?„? Test can identify those individuals with the optimal hair and scalp characteristics to get maximum benefit from the FOX?„? Procedure. In the FOX?„? Test, follicular unit extraction is performed in a sample area in the back of the scalp. The FOX?„? Test is performed under local anesthesia and takes about 15 minutes. Patients who are FOX positive will be good candidates for Follicular Unit Extraction. If the test is negative, conventional strip removal with microscopic dissection is the best option. Presently, we are limiting the procedures to only those who are FOX positive." That is from newhair.com/NHI. FUE has gotten a lot of backlash on boards, imo, because some may very well be bamboozling people into buying into unfounded hype; marketing and taking advantage of this "revolutionary" procedure. Most of the concern and questioning is well founded to me. However, I in the most capable of hands (e.g. Dr. Feller), for some people, it can be a wise alternative. With the right doctor, with the right patient, with the right graft count, the yield can be very much acceptable AFAIK. I have a suspicion something isn't kosher, though, in our master plan of spreading out FUE sessions to total the single session FUT procedures. Don't know for sure, though. Personally, I'm quite keen on FUE if it gone about properly; and, in the future, I definitely will keep a close eye on finding any way I could incorporate it into my battleplan if it makes sense. ----------- *A Follicles Dying Wish To Clinics* 1 top-down, 1 portrait, 1 side-shot, 1 hairline....4 photos. No flash. Follicles have asked for centuries, in ten languages, as many times so as to confuse a mathematician. Enough is enough! Give me documentation or give me death! Link to comment Share on other sites More sharing options...
Senior Member notgoing2gobald Posted December 29, 2007 Author Senior Member Share Posted December 29, 2007 so what, did Feller say you were not a good candidate or did you just decide on strip altogether? Link to comment Share on other sites More sharing options...
Senior Member thanatopsis_awry Posted December 29, 2007 Senior Member Share Posted December 29, 2007 Woops, missed that question. I initially went to Dr. Feller w/ regard to receiving FUE; at the time, I was under the assumption that FUE could be performed with strip-equivolent megasessions (re: Armani, who I *almost* went to). You may very well agree w/ me that recovery, and to a lesser extent scarring, are prime things regarding the HT process that stress one out. I wasn't a good candidate for FUE because my hair loss and desires for my 1st procedure exceeded what I could safely receive from FUE and dictated strip. FUE is far more expensive, and more importantly Dr. Feller is truly on the vanguard of the procedure and has been one of its biggest (realistic) proponents -- so, if there was a way for FUE to suit my needs better than strip I really can't see a reason why Dr. Feller wouldn't have discussed a way. ----------- *A Follicles Dying Wish To Clinics* 1 top-down, 1 portrait, 1 side-shot, 1 hairline....4 photos. No flash. Follicles have asked for centuries, in ten languages, as many times so as to confuse a mathematician. Enough is enough! Give me documentation or give me death! Link to comment Share on other sites More sharing options...
Senior Member notgoing2gobald Posted December 29, 2007 Author Senior Member Share Posted December 29, 2007 DYOHLITFT? ---just kidding! I was going to compose this entire post out of acronyms... don't you only have loss in the front third? did you discuss the possibilities of getting 3K grafts spread out over 3 sessions if your finances permitted?----just wondering if he thought it was possible and why or why not... Link to comment Share on other sites More sharing options...
Senior Member thanatopsis_awry Posted December 29, 2007 Senior Member Share Posted December 29, 2007 Ya, frontal 1/3rd pretty much -- but it is quiteeeee ravaged, despite having no "bald spots", per say. I actually didn't discuss this possibility; it didn't occur to me until fairly recently. I asked about this in another thread a few days ago (no answer), so I am fairly curious. But, I have various suspicions that it has drawbacks; and, the bottom line is that strip will still have a more robust yield on average. In the long-term, I personally think a combo of strip and fue is the way to go.m I am looking at 3kish grafts right now from strip, which I know is *the* most reliable, and should make a big difference and lay a great foundation as well. In the coming years I can re-evaluate my hair situation with increased clarity and FUE may be more suitable...PLUS, it wouldn't surprise me if in the coming years someone like Feller or whomever solves the current problems associated w/ fue. ----------- *A Follicles Dying Wish To Clinics* 1 top-down, 1 portrait, 1 side-shot, 1 hairline....4 photos. No flash. Follicles have asked for centuries, in ten languages, as many times so as to confuse a mathematician. Enough is enough! Give me documentation or give me death! Link to comment Share on other sites More sharing options...
Senior Member notgoing2gobald Posted December 29, 2007 Author Senior Member Share Posted December 29, 2007 the only draw back is that you will already have the strip scar... strip probably is the best way to go from my research as well. Fantastic FUE article which indicates transection rates are 2-5% for strip and 10% for FUE: http://www.baldingblog.com/2006/11/17/what-doctors-dont...u-to-know-about-fue/ FUE scar shaved down WOW!!!!: http://www.baldingblog.com/2007/05/09/1-year-post-op-photo-of-fue-donor-area/ FUE into scar by Feller: http://www.hairlosshelp.com/forums/messageview.cfm?catid=48&threadid=56190 FUE--8th question directly compres FUE to strip: http://www.baldingblog.com/category/fue/page/4/ FUE and the first question discusses how some skin characteristics lend themselves to scar stretching: http://www.baldingblog.com/category/scarring/page/3/ But, I would still like some answers from top docs like Feller regarding both yield and drawbacks, if any, to having 3-4 FUE sessions over a few weeks to match grafts yielded from one strip mega session... Regarding getting strip then later FUE-ing in the scar: Even if one ended up with a big ass crown years down the road and didn't have the 5K donor grafts to densely fill it in, I still think the 5-800 or whatever the # may be to have FUE'd into the scar might still be a good idea if you just say---"to hell with it! I can't fill in my crown and just want to shave my whole head down to a #2-#3 without really seeing the scar... no one ever discusses this option--they always say once you do a ht you can't go back. while I believe that to be totally 100% correct, still if you could fill in the scar with FUE to *somewhat* make it less obvious then I think this is another option years down the road if you just say to hell with it... Link to comment Share on other sites More sharing options...
Senior Member bverotti Posted December 29, 2007 Senior Member Share Posted December 29, 2007 Originally posted by Bill - Moderator: Technically it is possible to harvest many more grafts using FUE, I doubt anyone could question this Technically you are correct however, what you are leaving out is that harvesting more grafts via FUE will most likely leave the average patient looking like swiss cheese. Therefore I would suggest that one could extract on average just about as many grafts with Strip as with FUE. I believe we agree on this point as per your last statement. No, FUE may not leave visible scars...But even this will be MUCH less visible at bic lenght then even the best scar or tricho scar FUE may NOT leave obvious scars, but I'm not sure I would go as far as to say that it doesn't leave visible scars. That would be like calling a procedure "scarless" which isn't true. I think it is safe to say that at best, FUE scarring may be less obvious at skin level than than a typica strip scar. However, I have seen some bad strip and FUE scarring cases. In the hands of a proven quality hair restoration physician, these risks are minimized. Bill Bill, I agree with you that FUE is not a scarless procedure, anyone who claims otherwise is stretching the truth. We all know that cutting the skin will leave some kind of scar. But there are scars and there are scars. Some remain (highly) visible, some are hardly visible (example > no visible scarring after an injection). To date one has to accept some form of scarring when considering a HT, period. Indeed, I agree with you that the numbers available for strip and FUE are about equal for the average patient. FOX test : This test was an initial attempt to find out who is a FUE candidate and who is not. This test was developed in the early FUE stages when there was little experience. Dr. Jones discarded this test during the ISHRS in Vancouver for the following reasons : you could to a few extraction in an area to find out if the grafts come out easily. This test however does not take into account that hair directions change. So someone could be FOX rejected, but if the test had been performed in another area of the scalp the FOX test would be positive. In our opinion there exist no such thing as a non FUE candidate. Consultant-co owner Prohairclinic (FUE only) in Belgium, Dr. De Reys. Link to comment Share on other sites More sharing options...
Senior Member latinlotus Posted December 29, 2007 Senior Member Share Posted December 29, 2007 (ii) in the first picture in the link below, is it normal to get donor this high on the sides of the head via FUE: http://www.hairlosshelp.com/websites/galleryview.cfm?id=shuffle|gallery1.cfm I thought this was outside of the safe zone? I ask because this is where my hair is the thickest and it REALLY accentuates the thinning areas. I even have the barber run the thinning -sheers through this area so as to make my thinning top less obvious. So, I thought it would kill two birds with one stone by thinning that area out by extracting additional donors from it and re-distributing them atop my head. Any thoughts? I have the same issue as you. I think FUE is the best way to thin out the sides of my head. I discussed this with a DR., who thinks that it is an interesting strategy. However, you must take into account that as you age, the sides will thin out on its own also. Personally i am thinking about going for the 1st HT with strip (mainly due to higher growth rates and lower transections rates) then, with FUE on subsequent procedures as the balding progresses (in order to reduce the chance of scar stretching due to a 2nd or 3rd strip procedures). The scar from strip (from a 1st HT) is really not an issue with me. Any thoughts on this? ******** I am not a doctor. The opinions and comments are of my own. HT with Dr. Cooley on Nov 20, 2008 2097 grafts, 3957 hairs Proscar, 1.25 mg daily, skip the 5th day, started Nov 2007 My Hair Loss Blog - Hair Transplant with Dr. Cooley Link to comment Share on other sites More sharing options...
Senior Member bverotti Posted December 29, 2007 Senior Member Share Posted December 29, 2007 Donor area of a patient that shaved down to the bone 1 year after his FUE session. As usualy dr. De Reys used 0,7 mm punch to extract the grafts. Please note the the red spots are psoriasis, nothing to do with the transplant. I brightened up the image a bit to make it more clear (the original was a bit too dark). Consultant-co owner Prohairclinic (FUE only) in Belgium, Dr. De Reys. Link to comment Share on other sites More sharing options...
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