FUSS vs FUE - opinions please

[Perfect Fit]

Dear All

 

Before I begin, my congratulations to Pat for creating a fantastic on-line community. You have probably saved many more people than you realise from making errors or mistakes in relation to a HT - what better reward could there be?

 

My respect also to Bill for his prolific, thoughtful, and balanced posts.

 

Anyway - to the point:

 

1) I am a 30 year old male livng in London. I have balding in the crown area and recession at the front. I am probably a NW4. I have used Regaine for 5 years and herbal DHT inhibitor. Propecia has never appealed to me.

 

2) FUSS ve FUE? I am open to either but want to see whether FUE is proven before I waste a lot of money and grafts on something that may not have proven efficacy.

 

To this end I met with Armani in London for a consult and posed the following questions to him. His representative answered the questions as below.

 

Bill/ Pat - what do you think? I have read with much interest the debates around FUE and Armani in particular on this forum. Bill - your views have always been scientific - ie show me some empirical evidence for mega-session FUEs and until then I will continue to advocate FUSS as the procedure of choice.

I am grateful for your views and input.

 

PS - I also met with Dr Feller for a consult and cannot speak highly enough of him. Very professional and a straight speaker.

 

 

My Questions to Armani:

1) The results of the patients I saw at your consult were amazing. However a lot of these were strip cases as well as FUE. Do you have an example of a fully grown out mega session FUE case from Dr Armani? If so please send me pics

 

Answer: Here are some FUE patients, these are their own pictures and their own words: 4000 FUE & 3000 FUE. Our new website launches in November and will be dedicated to FUE results.

 

http://stonerosefue.blogspot.com/

 

http://www.hairlosshelp.com/websites/galleryview.cfm?id=gac201|gallery1.cfm

 

2) What was the actual procedure like for you? Did Armani use punches (if so what size?)

 

Answer: I found the procedure much more relaxing than I anticipated, I was look after throughout the day given lunch and snacks. My condition was monitored by a nurse and I sat back and watched a few films whilst Dr. Armani and his team worked away. I felt quite drowsy from the anaesthetic, some patients even fall asleep.

 

 

3) What are the rates for Armani per graft please?

 

Answer: Dr. Armani's normal rate per graft is $15 but is subsidised for patients who travel to Dubai down to $10/graft.

 

 

4) What are the recovery times for FUE?

 

Answer: The recovery for FUE varies from patient to patient but generally goes as follows, 2-5 days swelling progresses and passes. Crusts form in the recipient area and can last 2-3 weeks. Redness can be present from 2 to 5 weeks. The grafted hairs often shed after 3-5 weeks and can lay dormant up to 10 ??“ 14 weeks. Generally most patients can appear as they did before the procedure in around 3-5 weeks. After 10 to 14 weeks growth will start and at first appear thin, pimples can form but we give medications to help subside and itchiness and numbness can are sometimes present for up to 16 weeks. The growth continues and density improves, textural differences in the grafted hair can be noticeable for up to 5 to 7 months and 100 growth can often take up to 12months. My pictures give a good indication of what to expect but from what I have seen I seem to heal a little slower than the average patient: 2500 FUE

 

http://fue2500.blogspot.com/

 

 

 

5) Do you have any examples of "mature" transplants ie men intheir 40's with significant recession in front and crown?

 

Answer: There are mature patients with more advance hair loss on our website but these are FUSS cases our new website will show more but the patient in this link as above was fairly advanced: 3000 FUE

 

http://www.hairlosshelp.com/websites/galleryview.cfm?id=gac201|gallery1.cfm

 

6) Why has FUSS been completely stopped by Armani despite the excellent results he achieved historically?

 

The results with FUSS were fantastic but the advances and advantages of FUE do by far out weight the old procedure and the amount of bookings we were getting for FUE started to grow as we have started to produce the results. Like any Insustry old models are discountinued and replaced by the lastest prodcuts available.

[Bill - Seemiller]

Perfect Fit,

 

Welcome to our community. Your name is familar to me, probably from Hair Loss Help or Hair Loss Talk - of course, I also know I've heard from you privately.

 

In either case, I'm glad you have seen and found the great benefit that our community provides and that it's helped you in your hair restoration research.

 

Before I get into the specifics of FUE, I want to make a general statement that like FUSS/FUT, it is extremely important to look for positive and consistent results posted by real patients. Clinical websites are a good starting point - but if we were going to believe everything we saw in pictures, we might as well believe everything we see on TV too.

 

This is another reason why communities such as this one is vital to the physician selection process.

 

Whereas FUE certainly has some advantages, I have found that when it comes to FUE, there is certainly more "talk" than "walk", generally speaking.

 

I have seen a number of before and immediately post-op pictures of FUE - but as Pat has so rightfully pointed out, the majority of cases display before and immediately post op pictures but rarely come back to show the finished product. One has to ask the question why?

 

Your observation of the quality hair transplant results found in photosgraphs of patients who underwent a FUSS/FUE combo is an interesting one. Where are all the FUE megasession standalone before/after pictures?

 

Now I don't want to insinuate that FUE megasessions aren't possible - I'm simply stating that many clnics often oversell the benefits of FUE without addressing the potential downfalls. Welcome to the world of marketing!

 

Though FUE certainly has advantages, from everything I've seen, the risk of damage to the follicular unit graft is greater with FUE than FUT/FUSS for a few reasons - which ultimately means, the potential for lower growth yield.

 

1. The cutting and pulling of the hair graft with the surgical extraction tool has been known to transect or damage the grafts, especially since supportive tissues are often torn away.

 

2. Extracted grafts lack the protective dermis and fat surrounding the base of the graft and are more vulnerable to damage leading to poor growth.

 

3. The splaying of the hair follicle adds to the difficulty of cutting it with a punch

 

4. Placement of the graft into recipient sites becomes more of a challenge because during FUT/FUSS sessions, the techs typically insert the graft by grasping onto the protective dermis.

 

But many ethical hair restoration physicians have done and continue to do a lot to advance FUE without overselling its benefit.

 

From what I have seen online (generally speaking), FUSS is still superior to FUE when it comes to larger sessions and high growth yield.

 

An article I wrote on Strip Verses FUE can be found here.

 

You can also see information on FUE from Pat's attendance of the annual ISHRS meeting here.

 

I hope this helps.

 

Bill

[blowdry]

I would stick to Strip. Why would you thin out an area with FUE. Years down the road most people will start to thin in the donor area, so why give it a head start.

If they ever perfect BHT, FUE would be perfect for that.

[Bill - Seemiller]

Many people prefer FUE because they don't want a linear scar going from ear to ear. Of course, FUE still scars, but because it is patterned, the potential for less evidence of scarring with shorter hair cuts is present.

 

Of course, many first-rate FUT/FUSS surgeons have improved the strip closure technique and have been producing very fine scars that are hardly noticeable even with shorter hair cuts.

 

I think both FUT and FUE have a place and in the hands of an ethical and skilled physician - both will be employed properly leaving the hair transplant patient with excellent results. One just needs to be aware of the benefits, risks, and limitations associated with both types of surgeries - which is what this thread is all about.

 

Bill

[TheHairLossCure]

Perfect Fit,

 

What do the 2 docs you mentioned proposed in terms of how many grafts are needed to treat your hair loss? You threw out some numbers but I think you were referring to other patients. I tend to think that Strip is a better choice for patients needing over 2,000 grafts.

[chris_wellser]

hi perfect fit,

 

you said, "Propecia has never appealed to me."

 

does that mean you never tried it or does that mean you tried it and it didnt work?

 

if you never tried it, how come?

[Perfect Fit]

Guys - thanks for your helpful responses.

 

THLC - Feller proposed 1500 frontal third and 1500 crown via STRIP. Armani proposed 3500 frontal third and 3500 crown via FUE. Two very different opinions I'm sure you'll agree. I have to say Feller spent much more time with me and was more thorough.

 

Chris - i've never taken propecia. Concerned about side-effects and long term impact.

[TheHairLossCure]

The session Dr. Feller suggested - 3,000 grafts total - is a healthy strip sugery. That sounds about right for a NW4. If you have at least average density you will be able to do more work should your hair loss accelerates later on, or should you just want more density etc. 7,000 FUE grafts seems extreme to me. I have never seen 7,000 FUE done in a single session. Also, 7,000 grafts is a lot for a 30 year old (young guy) considering your potential for additional loss. I hope long term planning is a consideration.

[bverotti]

As you know I prefer FUE over strip. However I doubt we are ever going to see a 7000 grafts FUE case, one pass. Looking at donor areas (safe zoned) immediately after extracting 3000 in 1 go I can't think of how to aim for double that amount or more in one pass.

 

I believe it makes more sense to talk about averages. IMHO FUE averages are 4000-5000 grafts on most patients, regardless of laxity, 2 sessions.

 

Furthermore I would like to point out that the FUE vs strip article by Bill is his view and the view of the docs that contributed. I believe none of the contributing docs are FUE dedicated however (meaning they only perform FUE, no strip).

However Bills article does NOT reflect the experiences and opinions of other docs who have been doing FUE exclusively for many years. In fact some of the contents is incorrect in our opinion.

 

Thanks for letting me post opinions that differ from the mods view.

[Bill - Seemiller]

Bart,

 

Though I can appreciate that you have a different opinion about FUE (and you are allowed to express it), you continue to fail to provide proof of your claims.

 

Therefore until you can, your view can easily be rejected by any intelligent viewer that comes along.

 

Let the members reading this be suspicious of any claims made by mouth without visual proof.

 

Bart...I think you should spend more time focusing on producing evidence of your clinc's work than posting why you think FUE is superior, etc.

 

Words without evidence ultimately means nothing.

 

Bill

[bverotti]

Bill,

I can understand that you doubt my words, no problem with that.

At one point in time everyone believed the earth was flat. However there was a guy who disputed this fact, he bluntly claimed it was round. Although he was right, he was never ever in a position to proof himselve.

 

Now, I don't want to die before it has been proven beyond doubt that FUE megassesions work for anyone that wants to have FUE.

 

Let me however ask you in return why it is that you have never contacted dedicated FUE docs for their opinion ?

Understandably you turn to coalition docs with great strip experience if you want information about strip. Why is it that we have never seen any interviews with full time FUE docs ?

[Bill - Seemiller]

Bart,

 

We've been down this road before you and I.

 

You have been asked countless times to provide the evidence of your FUE megasession claims and have been registered here longer than I have.

 

Where is your visual proof?

 

You spend more time debating why FUE is the best alternative and you don't post pictures to prove it.

 

My opinions are not based solely on discussion with hair transplant doctors, but visual proof posted all over the internet.

 

Until you start providing impressive before, immediately post op, and after pictures from your clinic, nobody is going to take you seriously.

 

But I'll tell you what...you want an interview?

 

1. Start a new thread and address all the potential problems and hurdles that have to be overcome during FUE surgery from the extraction process to placement and how your clinic has overcome them.

 

2. Explain the instrumentation you use in great detail and how these instruments and extraction methods safetly remove the follicular unit grafts while minimizing the risk of follicular unit damage.

 

3. Explain your placement technique and how they are safely positioned into recipient sites without damaging the follicle.

 

4. Explain approximately how many follicular unit grafts can be extracted per minute and how speed of extraction and delicate treatment of follicular unit grafts are balanced in order to ensure safety of the graft and high growth yields as first priority.

 

5. And finally...display impressive before, immediately post op pictures of FUE megasessions 2500+ in a single session in similar lighting and angles.

 

Best wishes,

 

Bill

[bverotti]

Yeah ... that road ... been there with you.

I just wish Pat had been able to witness a procedure during his visit with us. Surely that road would have been much much shorter :-)

[Perfect Fit]

Guys - thanks for your responses and the healthy debate. Just for clarity Armani was proposing 3500 FUE in one session (frontal third) to be followed at least three months later by a second session of 3500 FUE in the crown. He was not proposing 7000 in one session. I continue to research FUE as an option but my mind is still not made up as I agree with Bill's point I just can't find the results on-line! Worth noting that all of the Armani "models" I saw at his consultation were a combination of strip and FUE. So still doing my homework!

[Bill - Seemiller]

Bart,

 

You realize that Pat's visitation to your clinic is only part of our assessment of a clinic and their work right?

 

I hope one of your doctors (or you if you are well versed enough) will take the time to answer my questions I posed above and post pictures as suggested. Dancing around them now that I've posed them only makes your clinic look bad.

 

Perfect Fit,

 

Dr. Armani's ethics have always been questionable in my opinion which is why we do not recommend him on the Hair Transplant Network. But recently I have seen a number of cases where Dr. Armani has suggested a much greater number of follicular unit grafts than needed. I don't recall him doing this in the past when he did FUT/FUSS work. In addition to your post, two examples of this can be found here and here. This is seriously alarming to me.

 

I guess I can't help but wonder if some hair restoration physicians (including Dr. Armani) have been suggesting more grafts with FUE due to the fact that growth yield is potentially lower than with Strip - especially if the risks associated with follicular damage are ignored. There is a greater risk of donor hair follicle transection when extracting or placing the graft via FUE. This is due to the traumatic tearing of the follicle away during the extraction process and the lack of protective dermis and fat around the base of the hair follicle leaving the hair graft more fragile and potentially more easily damaged. I would think speedy removal of the grafts would further increase the risks.

 

Many hair restoration physicians are selling the concept of FUE megessions in a single session. This means that follicular unit grafts are being extracted much more speedily than those FUE surgeons doing smaller sessions in a single day.

 

Therefore the obvious question is:

 

Did these surgeons radically advance and overcome the problems that the majority of ethical FUE hair restoration surgeons still face? Or are follicular unit grafts simply being removed more quickly using the same tools and techniques while the potential problems and hurdles of FUE are being ignored?

 

If the answer to question number one is "yes", then why aren't these hair restoration physicians presenting these new techniques and tools at the annual ISHRS meeting or other hair restoration conferences so that other hair restoration physicians can follow their example like many strip surgeons have done? And where are all the impressive photos?

 

To put it simply - one should proceed with extreme caution when proceeding into any type of surgery. Don't buy into marketing hype alone. Question everything and look for visual proof of radical claims.

 

Best wishes,

 

Bill