Complete coverage with FUE possible?

[CHB81]

I forgot my original account details for user CHB8 so I had to create another one.

 

I've had one FUE in the hairline of 1000 grafts and it doesn't seem to be enough for full coverage as I've started thinning a fair bit in the last month. The results from the first procedure don't seem to be very apparent at the start of month 8 so at this point I'm looking for another procedure this year.

 

Personally I'm looking for a dense hairline and I'm okay with a less dense look in the back. I only have visual problems in the hairline at the moment and it is just in the middle of thinning so I still have a lot of natural hair. The crown and top is more stable with the finasteride so I can hold off on that for a while.

 

Since I started with FUE this got me to wondering if it would be reasonable to have full head coverage using FUE alone. I wear my hair shaved down on the sides and back so this is the best option for me at the moment. I might be able to go for strip down the road if I choose a more conservative hairstyle. I'm not sure how a doctor would compensate for this.

[CHB81]

Everything you've outlined is certainly true and makes sense. However I'm at a point in my life where I want to maximize the look and feel of my hair while I have the opportunity. So essentially I would like to do things in reverse since I'm already somewhat locked into more transplants having done the first already.

 

Having said that, I feel fairly comfortable with FUE scarring since I don't seem to have much in the donor or recipient. I haven't shaved down the recipient again to verify but I have worn a zero buzz on the donor several times and I don't feel that it shows up much at all. Obviously it would be more apparent with more extractions but I rarely go down to zero anyways.

 

My previous procedure evenly covered about 1" of the hairline with 1000 grafts. Although it seemed like it was enough, looking back I can see that the grafts were placed to help with density rather than designing a hairline. The additional thinning is thus becoming a problem and the recipient area is showing very uneven results with many grafts stuck as stubble even after 8 months.

 

I would like to stick with a younger hairstyle for a little while longer. I know it will cost much more up front than performing strip now and would probably last a short time. Still I'm curious more than anything and am trying to determine how many FUE grafts I would need to cover the hairline with good density while maintaining enough untouched space for a strip later on if necessary.

[TheEmperor]

If you feel you got good growth with FUE, then keep going with it. If you got poor growth, then what is to stop that from happening again? You will run out of hair before the front is completed to your satisfaction. And when it thins out behind, you will look like a freak.

[TC17]

I'm going to disagree with spex just a little bit here. Right now, strip is the better way to utilize your donor long term, but FUE keeps getting better and better. Right now, in the right hands, and with the right tools, FUE rivals strip in terms of growth rate. I understand that right now you can maximize grafts and minimize risk by going strip first and then FUE, but why have a permanent strip scar if it's not necessary? Maybe propecia will hold onto enough native hair that all you'll ever need is 3,000 grafts to get the result you want. Is that worth the strip scar? What if a better drug comes out and halts your hair loss even more? What if hair cloning comes out, or even a cure? If those things come to fruition, and I'm not saying they will, but if they do, wouldn't you be happy knowing that you don't have a strip scar? What if you're one of those men who age and thins considerably in his donor area? If that happens to you, either way you're losing transplanted grafts, but if you go FUE, you will not have a strip scar.

 

Research on this forum long enough and you'll see a lot of regret over the strip scar. There are tons of posts about tattooing into the scar, FUE into the scar, and many people who would love nothing more than to shave down, but don't feel comfortable in doing so because of their strip scar.

 

Just look at the improvements made to strip in the past 5 years. You don't think the same thing will be occur with FUE in the very near future? As spex said, everyone wants FUE, so there is the requisite demand to ensure further improvements to that technology. Right now, I'd rather have the 5,000 grafts available using FUE, than the 7,000 or 8,000 grafts from strip placed on top of my head.

 

Personally, I think my views on FUE are closely aligned with that of The B Spot. I'm not anti strip per se, I just feel that if you're young and with a virgin scalp, doing anything but FUE first is terribly foolish. You are limiting your future options when you cannot predict what the future will bring for you. FUE offers you a bit more freedom than strip does, and because we're facing such uncertainty, that freedom cannot be measured.

[TC17]

One final point that may or may not be relevant. When discussing hair transplantation with people who do not know much about it, they overwhelmingly support FUE. I've had my girlfriend, mom, dad, brother, and friends all read the pros and cons of strip v. FUE, and each and everyone has said FUE sounds better. They've read Dr. Feller's posts, Dr. Shapiro's, Dr. Devroye's, and watched an interview with Dr. Cole (which was in my opinion, a bit too optimistic about where we are with FUE right now). They have no interest in promoting one method over the other, they are just reviewing the information available and coming to a conclusion.

 

Because they're intelligent, completely neutral, and a fresh view on the issue, I do put some stock into their opinions. Not one of them thinks strip is the better option. My mom, my dad, and my girlfriend all said the same thing, "what if you lose more hair?" The answer to that question is that I have to have another surgery, and then another, and then another, and if my donor is exhausted, well I'm SOL. On the other hand, I can have 2,000-3,000 from FUE to the frontal 1/3rd of my head and call it a day. I would never have to have another surgery and would look very good with a short hair cut and a frame to my face.

[Sparky]

I know someone who went from NW6 to NW1 with just fue, he shaves his head to 2-3mm and you cant see any scarring. He has very good donor though 110 pr sq cm. He has had almost 8k grafts done, 800 of those being beard and chest hair. I've seen him up close, you can not see any white dot scarring. This case is probably the exception not the rule.

[Sparky]

yep i'll get on it

[Sparky]

I'll have to ask him first, i'm not bsing though, and he wasnt a cueball NW6.

[Sparky]

He takes Saw Palmetto, think he used to take proscar though.

[Bill - Seemiller]

TC17,

 

You said, "Right now, in the right hands, and with the right tools, FUE rivals strip in terms of growth rate".

 

While I agree that FUE has improved significantly in skilled and experienced hands, I feel compelled to make a few points so those reading better understand.

 

While some FUE procedures will match strip yield, when you consider the larger number of candidates for strip verses the smaller number for FUE and those surgeons who brute force FUE procedures, strip is still superior when it comes to consistent growth rates.

 

It's true that experienced surgeons who responsibly use FUE as a tool when appropriate for optimal candidates are indeed getting high growth rates. But responsible surgeons know that FUE is only suited for a select group and won't compromise a patient's limited donor for patients who aren't suited for the procedure.

 

So specifically, if you consider 20 hair loss sufferers, 15 may be suitable for hair transplant surgery via strip and only 8 may be a candidate for FUE. So while FUE is appealing for those who want to avoid a linear scar, not everyone who wants FUE should have it. Similarly, not everyone who wants strip hair transplant surgery should have it either.

 

I just thought I'd add my two cents.

 

Bill Seemiller

[TheEmperor]

I agree with TC17 and with Bill (to an extent).

 

Another factor that is not discussed (and I know Joe at H&W disagrees with), is what _exactly_ is happening to the rest of your scalp when a few cm of strip is removed?

 

In my personal experience as a (once) NW5a, the skin is pulled down and back. If you pull down the skin above your neck, you will see the skin on your forehead move up. The flesh slides along the surface of the skull.

 

Strip removal has the effect of making the bald spot larger. For someone who is a NW1-3, this probably doesnt matter. But for someone in the NW4-5 range, baldness that is not visible from behind or the sides, will become more visible.

 

Someone who is a NW6-7 , this probably doesnt matter as much as baldness on the sides and back is already visible from normal viewing angles.

 

I'm still unsure if FUE yield is the same as strip. If indeed only half of patients are good candidates for FUE, due to yield issues, then performing FUE without diagnostics would be tantamount to malpractice. Yet I know at least one FUE clinic that has switched to doing it exclusively. I think the current situation with FUE is that it is a gamble.

 

That said, if growth with FUE is good, a "less is more" look could be accomplished in the front with 3K grafts. The patient can buzz the sides and everything will look in proportion. The reality of strip surgery is that the sides must be kept longer which means that the top must also be longer to look correct, and it comes out looking like some variation of a comb-over.

 

FUE might also allow a doctor to hand pick healthy follicles in an individual whose hair quality is not uniformly good.

[TC17]

I disagree with you on some of your points, Bill.

 

First, the question is not which approach is better, as that answer depends upon each individual. My overall theme throughout this point is to highlight the fact that factors other than a need for graft numbers must be considered when deciding whether an individual would be better suited to FUE, or to strip. My biggest gripe is that extensively bald men, or men who will become extensively bald are consistently steered away from FUE and towards strip by being told that they're not good candidates. I'm sorry, but that's ridiculous. If you can harvest the grafts safely, which as we all know is becoming much easier and more reliable, then you're a candidate for FUE. The debate then centers around which one is more suitable for the individual.

 

Perhaps I should have been a bit more clear regarding my views. There is no question that strip is superior to FUE in terms of yield and growth rate. It is likely that FUE alone will never surpass strip regarding those factors. It makes perfect sense that maximizing grafts requires strip and FUE together. There is no denying that with regards to FUE v. strip, strip wins easily in terms of growth rate, survival rate, and graft numbers. Maybe in time that will change, but right now, strip wins. I am not going to argue FUE v. strip regarding those points, because as I just said, strip wins.

 

But, determining a patient's candidacy for hair transplantation based upon those factors ignores the tangible and intangible benefits associated with FUE. Less visible scarring, less recovery time, less pain, more flexibility and freedom for the future, and the option to eventually have a strip surgery if the patient desires all exist if a virgin scalp has FUE first. On the other hand, having strip first permanently removes many of those benefits. There is no going back if you go strip first, and that is scary. If candidacy is determined by need for shear number of grafts and nothing else, then ABSOLUTELY strip wins. But, candidacy is not so simple. When you weigh the pros and cons there is no clear cut winner.

 

Again, I do not believe that FUE is for everyone, but I also don't believe that strip is either. Strip WAS the default because for years that's all we had, but, that's no longer the case.

 

I'm going to be bold here and say that if a doctor can safely remove grafts using FUE, then that person is a candidate for FUE, regardless of how bald he is. This is not a debate about the limitations of FUE, it's about which plan is best for the INDIVIDUAL, and that requires an personal approach that goes far beyond which type of surgery allows for more grafts.

 

Virtually 100% of patients are candidates."

(right from Dr. Harris's website on FUE)

[TheEmperor]

TC17,

I believe you are suggesting that FUE is an option for an advanced Norwood, as long as he is willing to accept less grafts overall.

 

I'm not sure how many less grafts. If transection rate is minimal, then sure, everyone should get FUE. If a graft is killed for every graft harvested, then it may be another story.

 

I think Bill assumes that the advanced NW patient wants to get as many grafts as possible.

 

I think if the patient only wants a "less is more" or frontal forelock, he will be better served by FUE. If the doc goes crazy and attempts to rebuild a full hairline with FUE, that is where the problems begin.

[TC17]

Yes, to some extent, Emperor.

 

At the risk of over simplifying, my point was that candidacy for FUE should not be reserved for the minimally balding, and that strip should not be promoted as the best option for the extensively bald.

 

As I see it, the goal of hair restoration is to look good now, and to look good in the future. How one accomplishes those goals is the crux of this debate. As I'm fond of saying, there is more than one way to skin a cat. It takes a case by case, and person by person analysis to decide whether strip alone, FUE alone, or a combination of both is best for the individual patient.

 

While some people believe that the extensively bald man is not a candidate for FUE because he would need the high number of grafts available only through strip, I do not subscribe to that viewpoint. To do so would weigh graft numbers more heavily than all other factors. Maybe graft numbers alone are more important to 99.9% of all bald men than any other individual factor, but is having those additional grafts more important than the benefits of FUE combined? Specifically, is having more grafts and a cheaper surgery worth the additional pain, the linear scar, the lack of freedom in the future, and the worry about potential future loss that also comes with strip? A worry that for the extensively bald man, especially if he is younger, is quite real. For some people, the answer is yes, for others, the answer will be no.

 

And that is the ultimate point here. Because each individual will have different goals, or will answer that question differently, it is important that each individual be fully apprised of the benefits and drawbacks of each type of surgery. Only then can he truly make an informed decision. I believe that a group think mentality has taken hold on this forum and that many of us are too quick to say that really bald men are limited to strip. My hope is that that sentiment goes away from this forum, and that people considering surgery really sit down and question which approach is best for them now, and in the future.

[CHB81]

I was hoping to avoid the strip vs FUE battle that will never have a winner. I had a good feeling that the general consensus for full coverage would be a 'no'. Still I was hoping to be proven wrong as Sparky may end up doing, even if that is a unique case. I fully understand that strip has higher yield and is much cheaper but that is not always the most important thing.

Most obviously is that I do not want to be burdened with a strip scar and change my whole appearance at this stage in my life understanding that I may need to in the future. I wonder if other guys with different (longer) hairstyles might not be able to see this side of the FUE fence since they don't have the same issues.

 

Personally I do not *appear* to have much hair loss at all. At this point I would be happy with the hair I already have if no more was lost. However I don't believe this will be the case, at least not in the hairline. I do believe the meds are working to some degree and I would like to see how far I can take it combined with FUE before resorting to strip which forcibly changes my hairstyle and to some extent my perceived lifestyle, as I want to maintain what is in my mind a youthful look.

 

I was recently on vacation in a busy metropolis and had the chance to analyze the hairlines and balding patterns of similar men. I was surprised at spotting more than a few persistent hairlines and thinning (sometimes extensive) of the top/crown. Although perhaps they too had some work done, many of these men appeared to have a decent enough coverage/comb-over where FUE could possibly bridge the gap allowing for a thin to moderately covered appearance with a strong frame. I think that could be acceptable at an older age.

 

Planning conservatively is always advisable which is why I would like to have the option of strip if the need arises. I may be in a different boat than most of the posters on this board as I am in the earlier stages of MPB and my first doc told me that I have 'great density'. While I don't feel that I was nearly as informed about the world of HTs back then as I am now, I am currently seeking a second opinion including a mapping and analysis done from a board recommended doctor before doing any further work.

 

To answer a previous question about my results, I did not go with a recommended doctor previously which is why I would like to reinforce the work that was done.

If the outlook was positive enough I would go for another 1000-1200 FUE into the hairline to define and strengthen it and possibly another 1000 or so into the remaining frontal third as I do not need that much density to have a full look. If absolutely necessary I would consider strip for top coverage later on in a few years hopefully.

 

Of course I don't want to blow all my donor too soon with FUE, but similarly I don't want to commit to strip and find out later that I didn't have to. I think this is a reasonable strategy to present to a doctor, at least for me personally but likely a few others too. I was surprised that I wasn't able to find greater interest for this type of planning from doctors and patients alike.

[Julius]

I have never seen an extensively bald man (NW 6 or 7) with ‘average’ characteristics achieve full coverage with fue as they would run into significant scaring or have a depleted donor requiring strip before it was accomplished. The ‘less is more’ thing sounds great but I haven’t seen much documentation, what makes it most dubious is that the doctors on this forum who are known for their transparency don’t seem to be taking this approach to fue much. I think if the ‘less is more’ look worked we would see more results of it from Feller and SMG etc, they would even probably recommend it to extensively bald men who want to shave down. A real problem with ‘less is more’ is the mismatch in density between the permanent zone and that where it has been transplanted or is thinning (believe me it is discernable to the naked eye)! It may however be a better contrast than that of strip with the same number of grafts (scar aside) because this permanent zone would have been thinned out more so it would match the density of the transplanted hair better. Of course buzzing down to a one will also help reduce the contrast.

[Sparky]

The person I know would rather me not show his pics, however I found this:-

 

http://dermhairclinic.com/video-gallery-head-and-non-hair-videos-My-Severe-Baldness-Cured.html

[wb280]

hi all, this thread is particularly mind boggling as we weigh all the pros and cons of strip vs FUE. One trend i realized was that i seemed to come across much more HT goers who are extremely displeased with their strip scar... so far, correct me if i m wrong, i have only read of displeased results from some FUE patients. So maybe Spex u r right, when it boils down to growth and yield, strip might be superior BUT the potential damage it can do when a strip surgery is not done properly is a hell of a nightmare

 

I am scheduled with Dr Pat From Thailand in end june.. but honestly i m still v concerned over the strip scar and the down time... thats the reason why even until now i am still so hesitant. So guys, help me out on this. Dr Pat does not provide FUE anymore... and i am staying in the vicinity of Bangkok, so do u guys think i should really venture as far as into the states to look for Dr Feller etc? Travelling is not really an issue... but its like, i cannot possibly travel to states, have a consultation and fly 16hrs back home. So it will be like, once i travel, i will have to get it done..

 

Also, i dun seem to have come across any dr who does FUE without shaving... Correct me if i am wrong!

[Sparky]

If I were to do it again, I would NEVER let s strip of my scalp be cut out, its basically a steak! FUE for me, I've had over 2k grafts moved via fue and I cant find a single scar, but my strip scar that yeilded much less will always be there. Yes I had bad docs do my strips, but I still dont like the method.

[Bill - Seemiller]

Both FUT/strip and FUE are here to stay and the good news is, patients have options. FUT/strip will be more suitable for some patients and FUE will be more suitable for others. Those overly concerned about having a strip scar should definitely at least consider FUE. However, whichever procedure is chosen, a patient will have to accept the advantages and disadvantages of both procedures - many of which, have been laid out in this discussion.

 

Currently, there are more limitations on what can be accomplished with FUE in large part due to the fact that only a very small handful of physicians are performing this procedure well. While I expect this to change in time, I don't believe FUE will ever replace FUT/strip but just give patients more options.

 

Best wishes,

 

Bill Seemiller

[wb280]

Bill, hence my dilemma. maybe i will set up a new thread but anyway i will post some questions so those reading this thread can comment

 

Like i said, i dun stay near any recommended doc who provides FUE services, and Dr Pat in Bangkok does not... according to him ( which i believe should be the case), i prob need 2000-2200grafts to achieve a a dense hairline, and my donor area is thick so supply should not be a problem

 

Moreover, the Dr did not expect me to progress to a NW 5 or 6 and my loss should be contained within the forelock region and maybe some losses on the crown.

 

With all these in mind, plus my concern with a strip scar, do u think i should opt for FUE instead? Also, anyone can shed some light on whether any surgeon does perform FUE without shaving? As far as i notice, all FUE drs require the donor and recipient area to be shaved. Thats really tough as that would mean i cannot go back to work at least within a mth after the surgery. At least with strip, if i keep the hair long enuff, its very decently covered.

 

Any advice is very much appreciated!

[Julius]

I must admit Sparky that was impressive. However that was not fue solely from the head but included body and beard hair. Of concern is the use of nape hair as I have heard doctors on this forum says that it is not always permanent. Further I have heard other people on forums say that often the difference between head hair and body or beard hair is discernable. I think it’s a better strategy not to use body or beard hair to solely cover a specific area but rather disperse it amongst head hair to beef up density. I am not a fan of such an aggressive hairline and I could still discern where he had the grafts transplanted from the native hair at his Norwood level due to the disparity in density. Although I think it would be less obvious if that guy buzzed down to a #1.

 

Any chance of seeing some picture of your scar now and the fue work you had done?

 

I think a better option for those with significant loss is fut then bht into the scar or even a tattoo over it then buzzing down.

[wb280]

spex, i m not sure if ur reply was directed at me but in any case, maybe u misunderstood. why will i go thru the torment of a HT if i shave in the end? illogical, at least to me

 

wat i am trying to say is i realized FUE drs normally shave off the donor and recipient areas of the patient and i am trying to ask if there is any recommended dr here who does not shave off both the recipient and donor area. Its really very hard to go back to work in the half shaven half not situation.

 

Also, i suppose i should be suitable for FUE as i prob need abt 2k grafts to cover my frontal loss... my crown etc are all in tact

 

point is i am residing in Asia so it will be very inconvenient to travel half the globe but if u guys feel its worth it, then so be it! but firstly, very important factor to me is to find a dr who does shave off the donor and recipient sites. or is it mandatory? so that to achieve a gd result?

[Sparky]

Best I could do, as my m8 didnt want me to post pics.

 

Yes everyone obviously wants fue, and I feel more strongly about fue, because if it was around in 1998, that would of done me a treat, and I would no way of needed a strip, I didnt need anything tbh.

[wb280]

hi spex, i tried both ur AOL and hotmail account but failed. The emails just bounced back.

 

U have other email addresses?