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FUE Questions!!


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Could someone explain to me why FUE would NOT be a good choice? I have heard that it really does not leave any scarring, is this true? I guess I'm just curious about the details of it because I don't really know, and if I had I choice I would rather do FUE and go without a scar.

 

Thanks!

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You'll get varying opinions on this but I'll give you mine.

 

<UL TYPE=SQUARE><LI>FUE does not have the proven graft survival percentages that STRIP does. I believe FUE is around 80% (if you are a candidate) and STRIP is above 95%<LI>FUE usually costs more than twice as much as STRIP<LI>FUE does leave scars for most.......little tiny white dots that you will see if you want to shave down

 

 

Do some searching here using the "find" feature for more information. With the trichophytic donor closure method used for STRIP surgery, the hair grows through the scar so it's really no big deal.

 

If you don't want any scarring and want the ability to shave your head, I wouldn't get a HT.

Hairbank

 

1st HT 1-18-05 - 1200 FUT's

2nd HT 2-15-06 - 3886 FUT's Dr. Wong

3rd HT 4-24-08 - 2415 FUT's Dr. Wong

 

GRAND TOTAL: 7501 GRAFTS

 

current regimen: 1.25mg finasteride every other day

 

My Hair Loss Weblog

 

Disclaimer: I'm not a Doctor (and have never played one on TV ;) ) and have no medical training. Any information I share here is in an effort to help those who don't like hair loss.

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Another disadvantage of FUE is session size; you will generally get a lot more grafts from a strip than you would with FUE. So if you prefer 1-2 large sessions and being done with it rather than more smaller ones, you'd want to go with strip.

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I don't think a forum can tell you if fue is good or bad for you in particular. It has much more to do with the ability to extract the fu's with minimum transection, and that is based on your physiology/hair characteristics more then a doctors skill(assuming you go to a top fue doc). If I wanted to know if fue was good for me I would personally have a consult with Dr. Feller.

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5 years and still hearing these different opinions. Ok I will give you mine since being a recipient of both. Does it leave sarring?that is allways visable? It can and does depending who you go to and how it is extracted. I can tell you I had my head shaved and my strip scar exposed for 7 months after my Fue and no one even looked at myhead and asked about my it. Just my strip scar. I can say you can easily get a wy with a #1 clip if it is performed properly. As far as yields my Fue Yield was better than my strip. But I hold that to the doctor. My first doctor was crap who did my strip . So these questions are to wide based for a cut and dry answer. If you need large amounts of grafts in one shot go to a quality strip doc that has proven they get results. I myself would feel very comfortable going in for 3-4000 more grafts via Fue if I ever needed more. Thank God at 44 my hair is holding steady.

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Originally posted by trueinnuendo:

Is this evidence-based (research)? Thanks.

 

 

<UL TYPE=SQUARE><LI>FUE does not have the proven graft survival percentages that STRIP does. I believe FUE is around 80% (if you are a candidate) and STRIP is above 95%

 

 

My opinion was based on evidence gained researching this site as well as other hair loss related articles and given from memory. After doing further research, I really can't post a concrete reference for survival percentages but results seem to indicate only a 8% better survival rate for STRIP versus FUE rather than 15% as I indicated earlier in my post.

Hairbank

 

1st HT 1-18-05 - 1200 FUT's

2nd HT 2-15-06 - 3886 FUT's Dr. Wong

3rd HT 4-24-08 - 2415 FUT's Dr. Wong

 

GRAND TOTAL: 7501 GRAFTS

 

current regimen: 1.25mg finasteride every other day

 

My Hair Loss Weblog

 

Disclaimer: I'm not a Doctor (and have never played one on TV ;) ) and have no medical training. Any information I share here is in an effort to help those who don't like hair loss.

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FUE does not have the proven graft survival percentages that STRIP does. I believe FUE is around 80% (if you are a candidate) and STRIP is above 95%

 

I might actually dispute this...in the hands of an excellent doctor, I believe yields can be up to 10% higher, around 90%. From all the research I've done, it does appear, however, that Strip does still have a slightly higher yield (95% as opposed to 90%). Also note that strip candidates are much easier to come by than FUE candidates which seem to be more rare. Only the TOP FUE candidates with the right doctor can seem to yield up to 90% growth successfully. An ethical doctor won't perform the surgery if you are not an excellent candidate for FUE. Though Dr. Feller (a very well respected ethical doctor who yields excellent results with both strip and FUE - with the right candidates refering to FUE) that he will ATTEMPT to do the surgery on people he THINKS are candidates, but even then they MAY turn out not to be good candidates and stop the surgery after 45 minutes. I remember this from another thread where I had a detailed debate with Dr. Feller on this. IMO, FUE doesn't seem worth it...HOWEVER, the ones who have had great success with it will disagree with me, and rightfully so in their case. FUE just isn't a surefire thing for everyone where Strip is for most.

 

Bill

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Hi

 

I think it basically comes down to price and quantity of grafts needed.. These criteria will determine which you will choose more often than not

JOBI

 

1417 FUT - Dr. True

1476 FUT - Dr. True

2124 FUT - Dr. True

604 FUE - Dr. True

 

 

 

 

 

 

 

My views are based on my personal experiences, research and objective observations. I am not a doctor.

 

Total - 5621 FU's uncut!

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for some reason I was under the impression that those who do get good results from FUE are able to keep their heads shaved fairly short. I understand that it is fairly rare for people to get good results from FUE, but I thought those that did were able to buzz their hair to at least a 1.

 

You mention, "little tiny white dots" as scars that are visible. I was wondering if you could expand on this a little more? I have just not really heard much about the scarring from a successful FUE.

 

thanks

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The instrument used in FUE for graft removal is called a punch. I tried finding some pics to post for you but couldn't............if you want to search using the find feature on this site, or do a Google search, you can see what I mean. To harvest for FUE, the head is shaved down in the donor area, the punch harvests the grafts, then then are placed. Sometimes, depending on how a person heals, there can be little white "dot" scars where the punch took the grafts. Others seem to heel pretty well.....it just depends. Here's a quick link for you to review the procedure.

Hairbank

 

1st HT 1-18-05 - 1200 FUT's

2nd HT 2-15-06 - 3886 FUT's Dr. Wong

3rd HT 4-24-08 - 2415 FUT's Dr. Wong

 

GRAND TOTAL: 7501 GRAFTS

 

current regimen: 1.25mg finasteride every other day

 

My Hair Loss Weblog

 

Disclaimer: I'm not a Doctor (and have never played one on TV ;) ) and have no medical training. Any information I share here is in an effort to help those who don't like hair loss.

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Originally posted by Bill:
FUE does not have the proven graft survival percentages that STRIP does. I believe FUE is around 80% (if you are a candidate) and STRIP is above 95%

 

I might actually dispute this...in the hands of an excellent doctor, I believe yields can be up to 10% higher, around 90%.

Bill

 

Yes..........I believe I was a little on the harsh side in my earlier comparison, Bill. However, I did try to search for averages but didn't find the concrete information I was looking for. I, too, found information supporting a 90% survival rate for grafts taken FUE versus 95%-98% for STRIP as I mentioned posting an 8% variance in survival rates between the two, but I still wish there were more out there to further define a standard survival rate for each.

 

One thing I will mention.......I think you "hit the nail on the head" with your mention "TOP FUE candidates with the right doctor". In my mind, this often can be far from the case and, in situations where an average to subpar Doc is performing FUE, I believe the variance in graft survival rate could be very substantial when compared to the average STRIP survival rate.

Hairbank

 

1st HT 1-18-05 - 1200 FUT's

2nd HT 2-15-06 - 3886 FUT's Dr. Wong

3rd HT 4-24-08 - 2415 FUT's Dr. Wong

 

GRAND TOTAL: 7501 GRAFTS

 

current regimen: 1.25mg finasteride every other day

 

My Hair Loss Weblog

 

Disclaimer: I'm not a Doctor (and have never played one on TV ;) ) and have no medical training. Any information I share here is in an effort to help those who don't like hair loss.

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Also note that strip candidates are much easier to come by than FUE candidates which seem to be more rare. Only the TOP FUE candidates with the right doctor can seem to yield up to 90% growth successfully. An ethical doctor won't perform the surgery if you are not an excellent candidate for FUE. Though Dr. Feller (a very well respected ethical doctor who yields excellent results with both strip and FUE - with the right candidates refering to FUE) that he will ATTEMPT to do the surgery on people he THINKS are candidates, but even then they MAY turn out not to be good candidates and stop the surgery after 45 minutes. I remember this from another thread where I had a detailed debate with Dr. Feller on this. IMO, FUE doesn't seem worth it...HOWEVER, the ones who have had great success with it will disagree with me, and rightfully so in their case. FUE just isn't a surefire thing for everyone where Strip is for most.

 

Bill

 

Is this true, most people aren't good FUE candidates? What makes someone not a good candidate?

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Hairbank,

 

I'd say between the two of us, we gave a good summation icon_wink.gif

 

Aesarca,

 

I can't really argue whether most people are or are not good candidates, but I can say for sure that the number of FUE candidates are much fewer than strip candidates. Since I haven't done extensive research on what makes a good FUE candidate, maybe someone else (especially a doctor) can answer that question. What I do know, however, from what I said above...classifying a good FUE candidate is not surefire until after the surgery is attempted. See my more detailed response above.

 

Bill

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Hi everyone,

I just answered this question to one of the readers of hair transplant network and I thought its worth sharing it with you:

 

Patient's question: I was just wondering about a price range. How is the Fue compared to strip?

 

My answer: You need to know the pros and cons of the FUE technique, before you decide to choose it vs. a strip technique in your hair transplant procedure.

 

 

FUE pros

"?? There will not be a detectable scar in donor area. Of course the scar will be present after every skin incision, but since scars are very small and scattered in a larger area, they are not detectable even on a head with a close crew cut.

"?? There are no sutures or staples to be removed. The small pointy wounds on the back will be left to be closed on their own with no sutures or bandages.

"?? There is minimal or no pain in donor area after the removing the grafts.

 

FUE cons

"?? Not everyone is a good candidate for this procedure. We always test our patients before doing the actual procedure with several biopsies with different methods and see the grafts under microscope to see whether we can harvest the grafts without damaging the hair follicles. If we see a lot of transected (damaged) follicles, we can not proceed with this procedure.

"?? It is more expensive (almost double). The procedure is very tedious and every graft should be individually extracted by surgeon as oppose to strip method that skin is removed first and grafts are harvested under microscope.

"?? It takes more time, sometimes up to twice of the time when compared to a strip procedure for the same number of grafts. A procedure to harvest one thousand grafts may take six to eight hours.

"?? A large area of the scalp needs to be shaved or clipped very short. This is not acceptable for many patients.

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Dr. Rassman,

 

Thanks for your response,

 

I think it's important to add to the con list that:

 

1. FUE yield is typically not as high as that of strip

2. Maximum session size for FUE is much smaller than that of Strip, therefore people who have a lot of hairloss probably should not consider FUE.

 

I want to add that for strip surgery when done well, most likely, there will also not be a detectable scar after it fully matures, and at worst case scenerio, FUE can leave scarring. My point is, when Strip and FUE is done well, scarring is minimal in both cases, though admittedly the potential for an undetectable scar with FUE seems to be higher.

 

Bill

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  • Senior Member

Ok,

Here is my personal opinion.

 

I had 1 strip and 2 large FUE sessions.

To be honest my strip was not done by a surgeon who is recognised as being a top strip doc. The user Hairobservator however believes my strip dr is one of the leading strip drs worldwide. You can ask him for more information.

 

The 2 FUE sessions, 2100 and 1800, where done by dr. Jones and dr. Ilter.

 

My first FUE dates from 2003 and was probably one of the first FUE megasessions.

 

Both FUE sessions gave me much higher yield than my strip procedure.

 

I see no reason why a good strip graft should have higher or lower yield than a properly extracted FUE graft.

 

Even in 2007 there are very few FUE experts. What I mean is drs who actually perform this type of surgery on a daily basis. It is not enough to perform FUE once in a while. It takes months and months and even years to collect a bag of experience and routines.

I compare it with a soccer player like Zidane or Beckham. Both players have an build in talent and belong to the worlds leading players. However if they do not train on an almost daily basis they will never be able to play at this high level.

 

 

Dr. Rassman, are you going to be in Paris during the ESHRS in May?

Consultant-co owner Prohairclinic (FUE only) in Belgium, Dr. De Reys.

 

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I am not planning on going to Paris this year. I read your comments on FUE. I thought it might be useful to reflect on my history with this procedure. I started doing it in the mid-1990 and although I published the first article in 2002 on the subject, the experience went way back. You are correct in that it takes years of experience in doing these procedures to be good at it. I have had the opportunity in developing this technique to learn my skills on hundreds of patients every year starting in the 1990s. The learning curve is a gradual curve and the skills take a long time to acquire. But like riding a bike, once you learn them, it is easy to go back on the bike anytime.

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The question posed to me was: "

Thanks for your response,

 

I think it's important to add to the con list that:

 

1. FUE yield is typically not as high as that of strip

2. Maximum session size for FUE is much smaller than that of Strip, therefore people who have a lot of hairloss probably should not consider FUE.

 

I want to add that for strip surgery when done well, most likely, there will also not be a detectable scar after it fully matures, and at worst case scenerio, FUE can leave scarring. My point is, when Strip and FUE is done well, scarring is minimal in both cases, though admittedly the potential for an undetectable scar with FUE seems to be higher.

 

Bill"

 

We need to recognize normal physiology in healing when we talk about scars. Everyone who is cut upon will scar and FUE causes scars, just different ??punctate' scars not linear ones. Although I originated the FUE procedure, I am not necessarily its biggest fan. Linear scars are sometimes a problem, but that is in less than 5% of the general population who get such transplants. The issues are of hair growth (how close to 100% does the surgical team routinely obtain) and the art (does it look like a transplant?). We spend too much time talking about the occasional scars from traditional strip harvesting in forums like this, although they do happen. For most people who get transplants, the last thing that they will plan to do is to shave their head, so even if there is a linear scar that falls in the 5% of patients who have detectable scars, it is not seen by most transplant patients and few of my patients ever complain about it. What I tell my patients is that "if there is a scar and the scar bothers them, I will try to fix it at my cost". The issues are really issues on the quality of the transplant as is seen by patient and his networked people. No one wants to have a transplant and then have his best friend tell him: "Nice transplant, Dude".

 

With regard to your estimate of yield, I believe that yield is consistently high with a strip procedure (95%+) while it is all over the place on FUE. By yield I mean hair yield, not graft yield. IF a four hair graft gets two survivable hairs, then the graft yield is 100% but the hair yield is 50% so the metric for yield must always be put in terms of hair yield, not graft count. I don't believe that this is the standard of care today, but it should absolutely be the only acceptable standard. Any attempt to substitute graft counts with good hair counts reflect badly on the ethics of the doctor.

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I enjoyed reading this thread since I plan to do an FUE procedure later this year to fill in the cracks in my hairline and fill in the temples a bit from my previous two HT's, both with a doctor not in the coalition. Unfortuantely, this was before I even knew about the coalition. I'm still happy with the results in comparison to what I looked like before the HT's, but I would have gone with a coalition doctor and had it done correctly the first time had I known about them.

 

I'm guessing about 400 grafts will do it. Of course, I will be doing some consultations first.

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Dr. Rassman-

 

Thank you - you've contributed to a great thread. The key statement you made that resonated with me was "I believe that yield is consistently high with a strip procedure (95%+) while it is all over the place with FUE". Also, your comment on how much of the concern the scar should be for ANYONE getting a HT is something mentioned many times by myself and others. Why get a HT if you plan on shaving down so close you can see the scalp? Kind of quenches the spirit of the reason for getting a HT in the first place.

 

I supposed I can understand a person opting for FUE in small cases, as Kamin has mentioned below, involving 400 grafts or so. However, I personally would probably still choose STRIP as the scar has NEVER been an issue for me and the PROVEN growth percentages are better. Us follicularly challenged types need all the help we can get icon_cool.gif!

Hairbank

 

1st HT 1-18-05 - 1200 FUT's

2nd HT 2-15-06 - 3886 FUT's Dr. Wong

3rd HT 4-24-08 - 2415 FUT's Dr. Wong

 

GRAND TOTAL: 7501 GRAFTS

 

current regimen: 1.25mg finasteride every other day

 

My Hair Loss Weblog

 

Disclaimer: I'm not a Doctor (and have never played one on TV ;) ) and have no medical training. Any information I share here is in an effort to help those who don't like hair loss.

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  • Senior Member

Hi

 

Very good thread.. For 400 I might do FUE as well. although not a huge fan of it, I cannot see going through the healing process of a strip for only 400..

 

Overall, I do prefer strip due to price & graft yield.

JOBI

 

1417 FUT - Dr. True

1476 FUT - Dr. True

2124 FUT - Dr. True

604 FUE - Dr. True

 

 

 

 

 

 

 

My views are based on my personal experiences, research and objective observations. I am not a doctor.

 

Total - 5621 FU's uncut!

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Dr. Rassman,

 

Thank you for your reply and again, thank you for contributing to this post.

 

One thing you said I didn't even consider...the survival of a graft but not all the hairs within that graft. I never really considered this possibility at all. My assumption (perhaps wrongly) was that the follicular unit as a whole (no matter how many hairs) would either survive or die. So I have to ask...what would cause a follicular unit to survive but then lose one or two of it's hairs in the unit?

 

Certainly the importance of hair counts have been discussed in multitude on other threads...I think this particular statement above throws the whole graft/hair count question all out of whack. Because how do we know how many hairs out of the graft survived?

 

Bill

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There are a few issues that are important to look at and understand. Hairs within a graft can be killed by improper harvesting (e.g. drying, cutting it at a critical point in its anatomy of a hair follicle within a follicular unit). This can happen if there is poor cutting techniques in strip harvesting, or in actual transection of hairs within a follicular unit during an FUE procedure. I personally do not believe most of the doctors who claim 95+% successful hair counts from FUE and I would love to pay a visit to some of these doctors and actually do the hair count from their FUE extracted grafts.

 

Thick grafts (those that are transplanted with fat around the follicular unit) can tolerate air exposure longer than a skinny graft (which can dry in seconds when exposed to the air). But tolerating air exposure for longer than 10-20 seconds suggests to me that hair follicle death may occur and the staff do not have strict quality control process implemented. What is important is not how many hairs are extracted successfully and anatomically intact, it is "Will they grow"

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As someone who uses the FIT/FUE procedure you need to know that FIT/FUE is NOT scarless. Anytime one cuts into the dermis of the skin (the skin has 2 basic layers uppermost layer termed epidermis and lower layer termed dermis. Under the dermis lies the fat)a scar will result. The scar may not be visible to the naked eye but it is there.

I have been fortunate in not having patients who have developed visible remnants of the FIT/FUE procedure but I have certainly seen the remnant white spots in patients who have had work done elsewhere, particularly in Europe. I also tell my patients that it will probably happen to me at some time but I can't predict when.

I do think there is a place for FIT/FUE and I offer it to patients who prefer this to a possible linear scar. I would assert that since I have utilized my ledge closure technique that the scars I obtain are significantly less apparent and in some cases I have difficulty finding the scar. As I have mentioned in other posts FIT can be used to fill in if there are apparent spaces in the resultant linear donor scar.

I would respectfully disagree with hairbank on survival. I have not seen a reduction in survival with FIT vs Strip. Survival of grafts probably has more to do with density and placement among othere variables.

FIT is certainly more expensive and time consuming and I tell patients that on a cost benefit ratio strip is more practical.

If someone is not going to plan on shaving his head then strip makes more sense. As I stated above even with FIT/FUE a patient may still be unable to shave his head because of the "dots" or moth eaten appearance of the procedure.

The formation of spotting is most evident in patients with more pigmented skin-Asians, Blacks etc.

Also if too many grafts are taken in an area the remaining donor area can look moth eaten.

 

Paul T. Rose MD

Immediate Past President ISHRS

thehairlosscure.com

813 924 4247

Paul T. Rose, MD, JD

President ISHRS

Board of Trustees ISCLS

 

Dr. Paul Rose is a member of the Coalition of Independent Hair Restoration Physicians

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