Complete coverage with FUE possible?

[wb280]

dude, i already emailed to u hope to get some news soon!! thanks!!!

[scar5]

As much as I respect Feller and Spex's posts (great post on shedding for example) I cannot object enough to comments like, "Strip is a MUCH better way to utilise YOUR donor area LONG TERM" .

 

I had ten happy years with a strip scar covered by a crop of hair augmented well by robust strip procedures. That's long term for many young guys. Fast forward ten years later. Ouch... Dodgy tattoos in my strip scars. Hopeless attempt after attempt at shaving and 'be proud' Nowadays, I am doing OK, but just. I grow it longer. It took me 15 years to accept he compromise. Maybe, 'that is all you need..."

 

Think carefully about the strip scar and 'long term'.

 

I also think these comments are dodgy,

"FUE is only suitable for small sessions up to around 1000+ grafts"

 

" Strip on the other hand enables you to use your donor supply safely"

 

And of course, "Once you have used up the strip donor sufficiently THEN its a better idea to go in via FUE to tap in to further donor supply if the demand for greater numbers is there initially."

 

Many people say I am bitter at being an 80s strip recipient. I look fine just now, it is not an issue most of the time, unless in harsh light.

 

If you have already accepted yourself it is one thing. If you have already accepted the 'mask' and 'the spin' and are happy with it, go for the strip, cause it's cheap and the yield is good. But if your sitting on the fence, I say think 'long term' about the strip scar.

[Sparky]

I agree scar5, I hate strip, and think that in the right hands fue can achieve very good results. FUE only yeilds less if the doc doesnt know what hes doing. I'd give almost anything to make my strip scar vanish.

[wb280]

sparky, scar 5, i just had an online consultation with a top dr, and he reckoned i should lose even more down the road so he does not recommend FUE as i prob have to prioritise my donor count higher up the list

 

In this case, what gives? I mean, if i insist on doing FUE now, only to realize u lack donors to sustain long term hair loss plans.

 

I know its a tough question and sparky, prob u still cannot concur with strip as it was hell of a nightmare for u, but just think objectively, what would be your choice?

[Sparky]

I wouldnt do either

[Sparky]

For everyone who doesnt know Spex, hes a top guy and wouldnt steer anyone wrong.

[EpilepticSceptic]

I think it really all comes down to the "characteristics" of each individual patient. I just had a major strip (4496 grafts). It was 2.5 cm wide in some places. On some patients there is no way the doc (even the best) could properly close that wound without a big, stretched scar. I just happened to have absurdly good laxity (top 2%, no scalp excersizes needed), and hence I was a candidate. I'm only 2.5 weeks out of the surgery and the scar has no indentations and appears that it will (hopefully) be pencil thin when fully healed. I see others who have indentations around the scar at this stage, creating the "hat-head" look -- and from top docs! That would not bode well with me. So far my scar is already easy to hide with short hair, even with substantial shockloss around it.

 

I have seen other similar patients to me with very short buzz cuts around the strip scar (tricho), and you could not find it unless you really put alot of effort into it scanning through with a comb. They also had GREAT laxity, so the wound had 0 tension from day one! I've also seen some FUE cases where the donor area look "pockmarked" (even with longer hair), but they had 4000+ grafts over time. And YES, from reputable docs!

 

IMO forums account for less than 50% of your research. Until you go to several clinics for evaluation and meet (in person) with at least 10 patients whose characteristics/goals are similar to yours, then you have no business moving forward with ANY type of HT! Had my laxity not been so exceptional there is NO WAY in hell I would have allowed any doc on this earth to remove a large strip. If you have a tight scalp, forget it! Either go FUE [if you have minimal loss and family history (BOTH sides!) of none higher than NW4], or just shave down and forget HTs alltogether. Any fool getting large #s of FUE today and thinking he can just shave down later if he heads to NW7 is a FOOL indeed ! Just shave down NOW and forget about the hair completely -- makes no difference whether you do it now or later, and you'll save alot of $ and stop waisting your life on these forums!

[TC17]

I think a lot of people on this forum will eventually turn into scar5.

 

If I was 100% confident that I would die an old man with little to no donor thinning, I would absolutely go with a strip procedure. Sure, there would be additional pain, more downtime, and limitations on future hair styles, but for me, the difference in cost would justify those inconveniences. Unfortunately, I've seen far too many older men who have lost considerable hair in the donor area, and at 27, I have a lot of years of future loss ahead of me.

 

I very rarely see anyone under the age of 50 with donor thinning, but I see a lot of men who are 60+ with donor thinning. And I've said this before, but it bears repeating. Every morning I work out at a gym that has a lot of older men, and there are a lot more NW 6's, NW 6.5's, and NW 7's than any of us would like to admit. They're coming from somewhere, and that somewhere is the position where we are now. The extensively bald older man was at one time a moderately balding younger man. What happens if the young strip patient becomes the old strip patient with a thin donor?

 

I realize that many people share spex's view that a hair transplant is a waste if you're just going to shave down eventually, and I agree and disagree. If the goal is to eventually shave down no matter what, then it is a waste. However, if I personally underwent an FUE procedure I would only shave down if I could no longer keep up with future loss because of a depleted donor and far too much surface area to cover, or if I became financially unable to continue with hair transplants. All it takes is a major illness/injury and the associated medical bills, a lawsuit, the loss of a job, children, a mortgage, or any other financial drain to put any of us in a tough spot financially. Up until a few years ago law school grads at the largest law firms were starting off at $160k per year, now many of those people are unemployed, or working for a significantly reduced salary. Would anyone here have cautioned a 30 year old associate making $160k about the financial commitment of hair transplants a few years ago?

 

While I agree that strip does yield more than FUE, does it yield enough for the average extensively bald man? I say no. How many extensively bald men have any semblance of a full head of hair? I can think of maybe a dozen off the top of my head. Bill has a very nice head of hair, but he's had four surgeries and has put over 9,000 grafts into it, and even still he admits that his crown is still thinner than he would like! Most of us don't have anywhere close to 9,000 available grafts. I'd rather have 4,000 from FUE, which is about average, than the 6,000 or 7,000 average from strip. But of course, that's just me.

 

But just imagine how someone like Jason Statham or Vin Diesel would look if either one of them had a strip procedure, but ended up with not enough hair to cover the crown like Bill. Would they look OK if that were the case, or would they look better if they had FUE to frame the face, a bald crown, and shaved down? Which would require less maintenance? Which would require less future worry? Can you get a better result with fewer grafts doing FUE because of cherry picking multi follicular units? Which would cost more? We all know that FUE is more expensive graft per graft, but 4,000 grafts with SMG using FUE is going to run you around $24,000, while 7,000 strip would be just about the same, and if you can get more hairs using FUE, those 4,000 grafts might look more like 5,000 or so. Would you rather have more grafts and a strip scar, or less grafts and no strip scar? These are the questions that the individual needs to ask himself, and ultimately decide for himself. The informed hair transplant doctor can certainly apprise the patient of the pros and cons of each surgery, but the doctor cannot decide for the individual which approach the patient should chose.

 

For too long the debate between FUE and strip has centered around which surgery is better. That is the wrong question to ask. It's not a question about which surgery is better, it's a question about which approach is better for the individual standing before the doctor at that moment in time.

[EpilepticSceptic]

Some good point TC17!

 

Personally, I wouldn't recommend any type of HT to anyone under 40. I purposefully waited until age 41 to see where my donor and level of loss would be. If you are going to have bad donor thinning, then you will probably start seeing the signs by this age, along with all those grey hairs in the beard and chest.

 

Over the years I have seen many of my friends go from NW0/1 to NW6/7, and it's almost ALWAYS in their late 20s to late 30s when this loss occurs. For many finasteride did absolutely nothing. Whether you have strip or FUE, if really bad donor thinning ensues then you are screwed. Unless you had so few grafts via FUE that it made no cosmetic difference to anybody else but you anyway. If you have 4000+ FUE and your donor thins out badly you might end up looking like a buckshot blast went off in the back of your head for the rest of your life. I might actually prefer a pencil thin smiley-faced strip scar to that.

[wb280]

hi sceptic, tc 17, mind boggling questions indeed! got me thinking right there... did not ever consider the fact that donor area might be so depleted at 60+ that whichever way u choose u are screwed...

 

just a penny for ur thoughts, guys following this thread, i know the risk that comes along with a strip surgery but spex is right... not all are eligible for FUE, esp those at a younger age ( like mid 30s ) who are diffuse thinners... u will not be able to identify the loss patterns down the road... thats my case... somehow i feel i have no choice but to undertake the strip road as i need to save whatever donor i have ( to be more conservative )

 

so in that case, what gives? If i insist on FUE, i prob can find a gd doc to do for me but prob he will also warns of the risk of depleting my sources too early via FUE... any takes?

 

Lastly, for the donor thinning at old age, can i suggest we do a small FUE to cover the scar ? does it help a little?

[TC17]

While I agree that waiting until 40 to have a transplant has its benefits, who wants to go through his 30's bald? Now filling in the crown before that age is a different story.

 

Regarding the thinning donor and a "buckshot" appearance, there is no doubt that poor FUE leaves terrible scarring. But, when done properly, the scarring can be virtually undetectable to the naked eye.

 

My ex girlfriend's dad was a principal at a high school in Cincinnati, OH. A few years back he agreed to shave his head bald at an assembly if the students raised a certain amount of money for a charity or something. I was over their house eating dinner when my girlfriend of the time asked her dad if he was worried about his scars showing. I had no idea what she was referring to, but quickly found out that her dad had undergone an FUE procedure with Dr. Wolf a year or two prior to this. Long story short, the students raised the money and he kept his promise. I was there the day after his head was shaved, and there was no evidence of any scarring. I have no idea how many grafts he had, but he went from NW 5a to a NW 2.5. Once again, NO evidence of scarring. I have no idea whether that's the norm, but he was fully capable of shaving his head with a razor and have no visible signs of scarring.

 

wb280, I personally believe that younger patients are the ones who should be getting FUE. If you start with FUE, you can still turn to strip down the road without sacrificing the total number of grafts available. But if you start with strip first, you forever lose the flexibility that FUE provides.

 

Nobody wants to think that they're going to be the NW 6+, but some of us are. Just think about how many of us were in denial about losing our hair. I know that I for one convinced myself that it was a cowlick, or that I was always thinner back there, and I completely denied the fact that I was balding. I did this even though my dad was a NW 6 and that baldness ran in my family! It's just like death, nobody likes to talk about it because nobody likes to be reminded of their own mortality, but it eventually will come for us too. Let's face it guys, if you're balding in your 20's, the odds of you becoming that really bald old man are a lot greater than if you start in your 40's. Sure, you might stop at a NW 3, NW 4, or NW 5, but is that likely? Even if your family history is relatively good, you might very well be the unluckiest one in your family. My paternal grandpa is 90 yeas old and has Ronald Regan hair. My dad, his son, is almost 60 and is NW 6.5! Does it matter one bit that my dad's history didn't point to that level of baldness?

 

No doctor can predict anyone's final balding pattern with any degree of certainty. You can look for miniaturization and take a detailed family history, but those are just guides in helping to make a guess.

 

I've seen two very well respected coalition physicians regarding my own hair loss, and each has said that right now I'm classified as having a NW 2.5 hairline with crown thinning, but that upon magnification I'm showing a NW 5 pattern. When I asked each one whether that meant I would get to a NW 5 and stop, they both said that there is no way of knowing. I didn't like that answer, so I kept pushing. I desperately wanted to have my fears of becoming a NW 6+ assuaged, and thought that the doctors would be able to do that. They weren't though. I finally shut up about it when I asked one of the doctors to tell me what percentage he though it to be that I would advance past NW 5, and he said "flip a coin, there is no way of knowing."

 

Any hair transplant is a risk. FUE is a surgery and can have disastrous consequences if proper planning isn't done and proper techniques are not used, but for the young patient in particular, I cannot see any rational for going strip first.

[EpilepticSceptic]

Well, considering that Dr. Feller charges $10 per graft for his FUE and has also patented special tools related to the FUE field, I will definitely take his word on this issue seriously.

[Preserve the follicle]

Was wondering about success rates and what to expect when using FUE 200-300 grafts in an area that has already been transplanted. Obviously to thicken the area. So it's a second procedure into an area that is mostly consisting of transplanted hair. Any thoughts on shock hair loss? scar tissue and thickening of scalp caused by first transplant session? would this slow down or obstruct the fue hairs to grow through? many thanks for a well informed answer.