Confused about which Technique is best

[GMAN]

Dear Members,

 

I been researching HT's for the past-year and it comes down to FUE vs FIT method.

Dr.Bernstein look pretty good and Dr.Cole method seemed intresting.All I need is 1,200

grafts to fill the crown area, the rest is normal. Anyone out there can share there experience

with what method and the type of blade they use. Single vs Triple,

 

 

Thank You

GMAN

[GMAN]

Dear Members,

 

I been researching HT's for the past-year and it comes down to FUE vs FIT method.

Dr.Bernstein look pretty good and Dr.Cole method seemed intresting.All I need is 1,200

grafts to fill the crown area, the rest is normal. Anyone out there can share there experience

with what method and the type of blade they use. Single vs Triple,

 

 

Thank You

GMAN

[NervousNelly]

Gman,

 

I will readily admit that I am not an expert on FUE, but what I can tell you is that you should also get other consults with other doctors. Those mentioned are good, but it might be wise to consult with Dr. Feller and Dr. Rose.

 

Are you certain that all you need is 1500 fu? How old are you? If you are younger and there is a chance that you might have more future hairloss I would definitely consider strip. If you are older and quite certain that your hairloss is stabalized, then possibly FUE is a good choice.

 

It is critical with HT's that you choose the right doc, but it is even more critical when getting a HT via FUE. Why do I state this? There are more variables with this technique and viability or yield is a concern if not performed by a very skilled doctor. Make sure that you do lots of homework.

 

Good luck.

 

NN

[Bill - Seemiller]

Gman,

 

Welcome to our community.

 

Just so you know, FUE is the same procedure as FIT, though there is a slight variation in instrumentation depending on the clinic. FUE stands for Follicular Unit Extraction. FIT stands for Follicular Isolation Technique. Both hair restoration procedures work by using a refined extraction tool (as small as .9mm) to extract follicular unit grafts from your donor area. They are then transplanted into recipient sites made with custom cut blades or needles.

 

Therefore, the single, double, triple blade equestion only comes in when referring to FUT (Follicular Unit Transplantation) via Strip surgery.

 

To learn more about Strip Vs FUE, I recommend reading the following Hair Loss Q&A Blog

 

Like NN stated, I have some reservations as to whether or not 1200 grafts in the crown is all you need. Typically the crown requires more grafts to achieve a cosmetically pleasing look.

 

Keep in mind that younger people with minimal crown loss should not consider getting their crown done due to the unpredictability of hair loss.

 

I hope this helps.

 

Bill

[bverotti]

Bill,

I just read some of the text on the link presented by you. It is quite shocking to read for me since I basically disagree with about everything that is mentioned about FUE.

Maybe we should ask the writer to check out a true FUE specialist.

Then of course who is a true FUE specialist?

I would strongly suggest talking to the people who do perform FUE day in day out. To my knowledge these are : dr. Woods, Dr. Ilter, Dr. De Reys (maybe some others, please add to the list if you have other names)

Drs who offer FUE as strip alternative, or perform it once every week, even twice, are NOT in the same leage.

So maybe we should really get some guys together and talk things over.

My suggestion is that you talk to dr. Ilter during the upcomming ISHRS. Maybe you or Pat are present.

That would be extremely interesting for all the readers here to read what a true FUE expert has to say.

[Bill - Seemiller]

bverotti,

 

I wrote the article. A lot of the information I have gathered from research and discussion with world class hair loss physicians who perform FUE (Dr. Feller is one such example).

 

I caution you to be careful in your presentation, however, because it appears biased. After all, you do work for the clinic you are stating is "of a different league"

 

Your statement can also be interpreted as insulting to other leading hair restoration physicians who perform FUE surgery (whether as a strip alternative or not).

 

What specifically do you disagree with?

 

I believe you are the one who has strongly advocated that FUE will one day replace strip.

 

Please understand that not many (at this point) share your views.

 

My mind remains open, however, so feel free to present your case. But keep in mind that in order to present a case that goes against the flow successfully - it is best to provide proof.

 

Bill

[MrJobi]

I'll give you one big difference.

 

Price!

[Bill - Seemiller]

Mrjb,

 

That's mentioned in my blog

 

Bill

[bverotti]

Originally posted by Bill:

bverotti,

 

I wrote the article. A lot of the information I have gathered from research and discussion with world class hair loss physicians who perform FUE (Dr. Feller is one such example).

 

I caution you to be careful in your presentation, however, because it appears biased. After all, you do work for the clinic you are stating is "of a different league"

 

Your statement can also be interpreted as insulting to other leading hair restoration physicians who perform FUE surgery (whether as a strip alternative or not).

 

What specifically do you disagree with?

 

I believe you are the one who has strongly advocated that FUE will one day replace strip.

 

Please understand that not many (at this point) share your views.

 

My mind remains open, however, so feel free to present your case. But keep in mind that in order to present a case that goes against the flow successfully - it is best to provide proof.

 

Bill

 

Well, this is what makes weboards a valuable place : difference in meaning and interesting discussions.

 

Let me start out by pointing out that no surgeon would be insulted if some of his collegues find solutions to problems. Most surgeons would welcome these ideas and incorporate them for the welbeing of patients.

 

Maybe you can share with us the people you are basing your research upon. That would make a good start.

 

In case you have not included dedicated FUE docs (like the ones I mentioned) then I respectfully suggest rewriting your text after finding out what the experts are saying about FUE.

 

BTW, I am well aware that we are going against the flow ... but you know tides do change !

[TheHairLossCure]

GMAN,

 

I am not sure if you are deciding between STRIP and FUE, or FIT and FUE.

 

But you mentioned single vs. triple blade, which leads me to believe you are at least considering strip. If you go for strip, SINGLE BLADE excision is the only proper may to do the harvest. A triple bladed knife will destroy many precious follicles unnecessarily (among other complications). As far as I am concerned multi-blade strip harvesting should not be a consideration.

 

BTW, I use "FIT" and "FUE" interchangeably. Dr. Rose termed his follicular extraction work "FIT" (Follicular Isolation Technique) and, while I think it is a better descriptive term, FUE is more generic. Ultimately every physician does follicular extraction differently. FIT vs. FUE is a matter of preferential terminology. In other words, look at the quality of the doc, not the "brand".

[bverotti]

Oh yes, FUE is going to replace strip as a preffered method of choice, no hair on my head that doubts it.

Look around the boards worldwide and you will notice that the word FUE is become more and more popular.

However the problem today is that there are just TOO FEW good FUE docs around. Furthermore FUE wannabees are going to jump in for the money and leaving a trail of unhappy patients.

But wait ... that has been going on with strip since I dont even remember when it started.

[Bill - Seemiller]

Well, this is what makes weboards a valuable place : difference in meaning and interesting discussions.

 

I agree...

 

Let me start out by pointing out that no surgeon would be insulted if some of his collegues find solutions to problems. Most surgeons would welcome these ideas and incorporate them for the welbeing of patients.

 

 

You are correct. The interpretation of insult i was referring to is that you are suggesting that well known elite physicians such as Dr. Feller (for example) are not in the same league as your doctors. Perhaps that's not what you meant...it just appeared that way. Here's a chance to withdraw your statement...or you can add to it.

 

Maybe you can share with us the people you are basing your research upon. That would make a good start.

 

 

Discussions with Dr. Feller, a few technicians from other leading hair transplant clinics, and through patient observation - experiences, photos, etc.

 

In case you have not included dedicated FUE docs (like the ones I mentioned) then I respectfully suggest rewriting your text after finding out what the experts are saying about FUE.

 

 

Obviously one cannot consult with every HT doctor before writing such an article. But since your information goes against the flow, it is up to you to convince the world that what you are selling is true. Until that time, my article goes with the mainstream belief because it has not been otherwise disproven. Therefore, there is no need to rewrite my blog. I'll be happy to adjust it/make revisions as I see more EVIDENCE that FUE has advanced further.

 

BTW, I am well aware that we are going against the flow ... but you know tides do change !

 

 

Times do change...I agree....hallelujah!

 

Now that you are done with the generalities...why don't you address my questions:

 

1. What do you disagree with in my article? I can't debate with you if you aren't going ot refute something specific.

2. Since your views are against the mainstream flow...what can you do to convince hair loss sufferers and world class hair restoration physicians alike that FUE is superior to strip and is READY to replace it?

 

Bill

[gazzasgoin2]

I believe FUE/FIT will overtake strip in the future as the favoured method of surgery.

 

However, firstly there has to be more evidence of successfull FUE mega-sessions and secondly the price will need to come down to c$4/5 per graft.

 

There does already seems to be an increasing awareness of FUE and subsequent demand. Further as FUE only clinics become established there should be more evidence of results over the next few years.

 

Presently there are only a few clinics worldwide who claim to offer large FUE session successfully and the $ is still too high.

 

However, im sure results will begin to filter through and prices will decrease. Then you will see a definite switch to FUE/FIT IMO, likely within 3 - 5 yrs. It is a more patient friendly technique with shorter recovery time less evident scarring.

[bverotti]

Bill,

Dont take our discussions personal, I just want to express not only myselve, but my opinion is exactly what our docs stand for.

In other words, my statements here do not differ from that of our docs. Obviously I can not speak for other FUE only docs.

We feel that strip surgery is no longer a first option for HT candidates. In any other medical field, less invasive treatments are always preffered if they give same results, why not in hair restauration ?

 

 

To sumerize : I disagree :

Growth yield : if both are executed correctly there is no difference between strip and FUE grafts

 

Session size :

Let's talk averages, not extremes

FUE will ALWAYS produce faster or equally fast final results then strip surgery on the average person.

To max out a person donor area a FUE-strip combo is at present the best solution.

Candidates :

There is no such thing as a good or bad FUE candidate. Seriously, this non issue just a lack of experience of the doc. Black, white, straight, curly ... FUE docs will not shy away or throw the towel. From own experience I can officially state that we have never send a patient home because of certain hair characteristics.

 

Price :

Prices are certainly not double anymore, I suggest doing some updates.

 

What is needed?

More well trained and experienced FUE dedicated docs. There are just far TOO FEW.

 

With all respect, but I again want to inform that you should talk to FUE experts.

By no means I want to suggest our docs are better, but I am convinced they have more FUE experience than any hybrid FUE-strip surgeon, hands down.

[NervousNelly]

Very interesting topic again. I also believe that in near future FUE will likely surpass strip as the method of choice, but I'm not so certain that it should.

 

I think that it is very appealing to many because of the limited scarring and the quick recovery but I personally don't think it is as simple as that. Yes there are the factors of the price and the megasession demands but that too will gradually lower. Even when that happens should it still be the primary choice for all?

 

Remember also that there is a certain percentage of the population that don't want to shave their heads for the procedure. Even if it is just a short term thing many men do not want to shave their heads. Yes to many it is not a big deal, but to some it is. With strip a person can keep hair longer in front and back.

 

 

My main arguement however, is that of the donor area thinning. With strip at least the donor area is decreased, whereas with Fue the donor area is not diminished and as people age it might have that "motheaten" look to it. Remember, we are in the infancy with this procedure and give it time and more of the negatives will start to become more apparent.

 

I would think that in that 10-15 yr. time frame there will be some other method such as cloning that will become the ultimate choice. Only time will tell.

 

 

NN

[the B spot]

There is a place for both strip and fue.

 

Each has postive and negative variables that should be measured carefully.

 

fue will never completely wipe out strip

 

However, fue will reduce the amount of potential strip patients, especially in the 20-30 year old patient (IMO)

 

Bverotti is right however, that fue pricing is becoming more attractive.

In addition, doctors like Rose, Harris, Feller, Bisanga, Prohair clinic, etc... are moving toward the .75mm extraction punch as the norm, with the .9-1.0mm punch the exception.

 

I still remain unconvinced that fue megasessions are a real option at this point in time, but I think we are moving toward actually finding a place for fue in the HT world.

 

Yield, consistancy, percentage of donor harvest, and donor scarring still remain topics under review.

 

Time will tell.

 

Take Care,

J

[Bill - Seemiller]

bverotti,

 

Don't worry...I'm not taking the conversation personally...I enjoy a good debate.

 

But I do get a bit hyped up when blanket statements are made without evidence.

 

Instead of posting on this thread about why you personally feel FUE is better, I think your time would be better spent posting patient photos as proof.

 

We can all sit here and speculate why FUE megasessions may or may not replace Strip as the dominant FUT method - however, it's the proof that will actually get us there.

 

Besides...

 

When all is said and done, people care less about what is said and care more about what they see. "A picture is worth a thousand words" I believe the saying goes.

 

I want to be clear...

 

I agree that BOTH FUE and Strip have their place.

 

But I am still unconvinced that FUE megasessions for everyone is possible at this point. Convince me and the general public.

 

Believe me...I wouldn't fight against progress...in fact, I'd cheer it! I'm not trying to be difficult. If it's there, let's see it. And I'll applaud your clinic for taking FUE to the next level!

 

Session Size: If you take a look at the overall averages of session sizes of HT doctors for both techniques, then Strip is STILL in the lead by far. You are claiming your clinic does more...awesome! I'm just saying I want to SEE it. It's not publicly documented anywhere...right now we have your word of mouth. Prove it

 

Candidates:

 

I encourage you to read the following post by Dr. Feller. Him and I had a good debate some half a year about these things. It was a learning experience and I enjoyed it.

 

Price: Many physicians still charge almost double for FUE. If I am wrong, I'll be happy to change it. How much in American $ does your clinic charge for FUE?

 

Cheers,

 

Bill

[bverotti]

Bill,

We have invited sereral well known docs already to come in and watch a procedure. To date not one has showed up.

Price :

Ok, the dollar is extremely weak against the Euro and makes it all a bit unfair to compare at this moment. This makes our prices artificially more expensive.

 

Our docs, who work independantly of each other are charging:

dr. Ilter : 6 Euro per graft

dr. De Reys : 4,5 Euro up to 1000 grafts, 2,5 thereafter.

[Jotronic]

Bverotti,

 

You have mentioned session size and the averages. Let's talk about this. With strip, the average clinic gets probably 2500 to 3000 grafts on any given patient. You have advertised that your clinic can hit these numbers. Session for session,you say that your clinic matches the average strip clinic.

 

The problem lies in the number of sessions. What happens to the FUE patient when they have hair loss beyond a NW4? I think everyone here has learned that a lot of the time, people with a classification of NW4 or greater and only get 2500 to 3000 grafts will come back for round two for more density. Given that FUE will thin the donor on the average patient what will this patient do for that added density? More FUE or go for strip? The idea of maxing out via FUE first then going for strip is counter productive. If the donor area is thinned then that causes problems for donor area camouflage. Additionally, when the donor area has had a pass of FUE there is subdermal scarring that can come into play. This scarring distorts the hair angles and the tissue itself is more difficult to deal with . This leads to unnecessary transection and overall lower yield. I've seen this myself on many occasions.

 

Then there is the issue of NW5, 6 and 7. There is no way one will get the same results with FUE on these patients as with strip. Donor thinning aside, this does not touch on the issue of results, graft for graft. FUE has been around in North America for five years now. The argument was once posed that there are not as many "great" FUE results because it is new and has not had time to produce these results. Well, five years has gone by and I still do not see them. Pick any one good strip clinic and compare to any one good FUE clinic. It cannot be done, still, to this day. FUE will always have it's place for those that are head shavers and are victim to the fear mongering about strip that is spread around of late. There were many advantages posed in the beginning as to why FUE was better. Better growth and no scarring. Both, in my opinion, have proven to be false. Strip is and will be the preferred method of transplantation because as I always say, the truth is in the results, and the results of strip are undeniable.

[bverotti]

Joe,

Making claims that the average strip clinic gets 2500-3000 grafts is just plain wrong. The docs represented on this board are mostly the top strip clinics worldwide. However we both know that thousands of other dr and institutes are not represented here. Heck, just down the road we have a doc doing 800 FUT sessions maximum.

So lets agree that top clinic average out about 2500-3000 grafts per session. I say average, I know there are giga cases, but there are some guys with poor laxity and poor donor area that can not even get 2000 in a session.

 

Now, from our experience we can say that the Average person can have 3000 grafts harvested by FUE in 1 session (be it in 1 or 2 days) provided he had no previous surgeries. We are talking about intact full FU"s, not counting splitted grafts.

We are seeing patient comming back to us for additional work that we initially thought would not be possible to get more grafts. Sometimes we are just amazed ourselves to see that another big session is possible ... as if some hairs regrew in the donor area (which obviously is not the case).

To date we estimate that about 4000-5000 grafts are harvestable on the AVERAGE person using FUE only. If a person wants even more it is technically possible, however thinning may start to be visible. Some people have told us however that a thinning donor area is mixing in better with hair transplants which are hardly ever high density on progressed NW patients anyway.

Since we can start a second procedure in just about 2 months after the first treatment, patients with average donor supply choosing FUE will have full results faster. It is just math, and it all adds up.

 

The main issue I feel is that it has not yet been accepted that FUE growth yield is equal to strip yield. This is an ongoing debate and we will work on this. Your clinic was in a similar situation proving first mega sessions and afterwards giga sessions. You came through and your claims are now widely accepted and copied. We offer surgeons to witness our procedures, heck I even invited dr. Wong last time we met in Paris.

As you have backup up your claims, so will we.

 

BTW we have never stated FUE would produce better results and no scarring. You know this is false, I know this is false. Every time skin is cut it forms scarring. Question is how to minimize the unnatural appearance of scarring. By default linear scarring is unnatural. Patients with previous strip sessions always have this tremendous problem hiding their linear scar after FUE, that is fact.

 

You are comming from a top strip clinic and have good results with the system that you are using. I might have a diffent view on things if I where in your shoes.

My experiences with hair surgery has led me to believe that results also include donor area problems. These problems are IMHO lowballed.

 

In the end the HT industry will face a patients revolution rarely seen before. It will be patients who will push clinics and docs to change the way things are done. I note that already 1 other strip clinic has taken the step towards full FUE. Why would they do it? I am sure they had strip patients lined up from here to Tokyo and back.

 

Have a good weekend,

Bart

[NervousNelly]

I note that already 1 other strip clinic has taken the step towards full FUE. Why would they do it?

 

 

I think many of us have a good idea about that one$$$$$$$

 

 

NN

[Bill - Seemiller]

Bverotti,

 

I appreciate your input...but since you are making radical claims, people want radical proof. I am not going to sit here and sing "liar, liar, pants on fire" - but without evidence, I fear that you will convince very few educated people that what you claim is realistic.

 

However, I fear that newbies will be taken in with great hope. If the proof isn't available, I will not feel comfortable recommending your clinic.

 

I agree with Joe...that maxing out FUE before strip is counterproductive as well. IMO, one can obtain the greatest number of grafts doing the reverse.

 

I'll ask again...

 

I know you keep stating that you've invited Dr. X and Y to come witness these FUE megasessions. But you have a public resource available to you right here! Use it to display your clinic's work.

 

Clearly if this is average for you, your clinic MUST have a lot of pictures of results to choose from.

 

The proof is in the pudding!

 

Bill

[bverotti]

I beg to differ on this point.

We want to show our work, not hiding anything. We prefer to have other docs come in and check it out. These drs are in a much better position to check reality from fiction.

If we where just talking BS, we would NOT ask for verification, it would be suicide ... I am sure you can agree to this.

 

Pictures are good, on hand verification is far better.

 

Listen, if I where in your shoes Bill, I might be just as sceptical as you are now. To you our claims sound radical, to us it is daily stuff.

 

Our main problem is getting people to show there results. The 3000 graft case we presented on this website was cancelled today. Although the patient has his own website, he does not want his pictures to be used anymore and we have to respect this.

Please do not make any speculations about this, the patient is very happy with his results, there are no problems.

It just illustrates that we have little patients helping us presenting cases.

[nobuzz4me]

Originally posted by Bill:

Bverotti,

 

I agree with Joe...that maxing out FUE before strip is counterproductive as well. IMO, one can obtain the greatest number of grafts doing the reverse.

 

 

Bill

 

 

 

I completely agree with Joe and Bill. It seems you would get the best graft production this way thus the max number of grafts.

 

AND - If you had a scar problem you would be able to use fue to fill in the scar or touch up a hairline if needed. If you did strip last, you would be screwed if that scar turned out bad. IMO fue would be a good way to touch up at the end of your HT journey.

[Bill - Seemiller]

bverotti,

 

There is good reason for my skepticism. The internet (and the world) is crawling with organizations making radical and faulty claims. The primary reason for this community is to help patients make educated decisions and recommend those clinics who meet our high level of standards. In order for these clinics to meet these standards, proof must be provided. This is why clinical visitation is vital (thanks to Pat for being so dedicated to this) to this process. But active involvement while providing surgical details (photos, videos, etc) can be just as persuasive to the general public. If you are sincere, then you can/will provide these. The educated patients will be able to see through gimicks...so be warned.

 

But all I keep hearing from you are excuses (whether legitimate or not) of why you can't provide what you do on a daily basis. This throws up a red flag.

 

Based on what you just stated, one could assume you have ONE 3000 FUE case out there. I thought you did this on a daily basis? Besides...don't you take any pictures of pre-op and immediately pos op while you have the patient there? I'm sure at least one of the patients will volunteer to let you share their immediately post op pictures and maybe even come back 1 year later for "after" shots. I understand a lot of people are concerned about confidentiality - but perhaps they'll give permission if you blot out their face.

 

I agree that in-person verification is better...but you can't do that from a forum - so you have to use what means you have. And I must state...that witnessing the surgical experience can certainly tell someone a lot - but until the final product is seen, post op results don't mean anything - not as a stand-alone testimony anyway. Sure one can tell a lot from view post op photos - but until the hairs grow in - one can't determine the success of the result.

 

I want to add that I believe educated patients have just as much ability to determine reality from fiction.

 

But if you prefer to have doctors come check out your work, then what are you doing here? What are your motives?

 

Do you not want your clinic to be recommended on the Hair Transplant Network? Why? Because your clinic knows that a recommendation from this site means something! It's a solid stamp of approval, and it is. But how do you think the high level of standards are met? Only through proof. Part of that verification process comes from observation of surgery. But there is much more.

 

We are a network that is run by patients. If a patient is not convinced you an provide what you are selling, they will go elsewhere. Convincing the patient is equally as important as hair transplant physicians.

 

Cheers,

 

Bill