What is the Actual FUE Yield Rate....Please!!!

[Spanker]

What is the actual yield rate of a smallish FUE? I do not think that I have seen a good answer on this yet...that satisfies me as pretty solid anyway...

[Thehairupthere]

FUE should yield somewhere from 90%-95% of all grafts that are harvested. This number also depends on what instruments the surgeon uses, as well as the experience of the surgeon.

[hairlosscursed]

You are wondering for FUE yield like you are sure about strip...do you think you know the yield for strip???actually nobody knows...if there was someone knew the yield for sure for either procedures,hair transplant would something much much better than what is now and everybody would be happy without getting anxious and stressed if the procedure will be succesful...hairloss industry is in baby steps for the moment

[N-6]

"FUE should yield somewhere from 90%-95% of all grafts that are harvested. This number also depends on what instruments the surgeon uses, as well as the experience of the surgeon".

 

This is a percentage I've heard before. While this might be the short term yield, what is the long term yield for FUE? I think this could be an important distinction.

 

Grafts for an FUT is taken from a different area than FUE.

 

We know that the strip in FUT is taken from an area that is generally considered safe and subject to minimal thinning. Therefore, the grafts taken from this area are essentially safe for the long term.

 

However, FUE is not taken from this zone. Rather, its taken from areas above where strips are taken. Since it is not easy to predict the extent of hair loss of a particular patient, how are we, as patients (particularly younger ones), to be assured that FUE grafts wont simply fall or substantially thin after a number of years?

 

It would be really helpful if clinics or physicians respond on this topic as I'm not really clear on the long term yield of FUE. Thanks.

[uselessgomez]

It's not going to be the same for everybody. The exact same surgeon and team could work on 2 different patients but in very similar situations, and the yield could be different. The unknowns probably have a lot to do with how sensitive one's hair follicles are to the pulling, twisting, and pressing that occurs when they are extracted and implanting during FUE.

[Thehairupthere]

The long term yield is 90-95% if done correctly. If the grafts are put in properly and are growing properly they will continue to do so permanently, due to their inability to react to DHT, unless it's forcefully removed or damaged, or due to serious skin conditions like alopecia areata. The FUE grafts are taken from the same area as FUT are, they are both from the donor supply and both are DHT resistant, the doctor can be more selective in his choice because FUE offers that luxury, but it also depends on the overall size of treatment.

[N-6]

Thehairupthere, thanks for your reply. However, I do not understand when you say the following: "The FUE grafts are taken from the same area as FUT are, they are both from the donor supply and both are DHT resistant . . ." (I added the emphasis)

 

I really don't see how this has been established by anyone with any certainty. Descriptions of the procedure from various clinics and photos of the procedure from these same clinics clearly show that grafts from FUE are not taken from the traditional strip area of the scalp. In actuality, FUE grafts are taken from above this area of the scalp, which may not be DHT resistant in many cases.

 

So with FUE, we're not talking about FUT, which is a tried and trued method of taking grafts from an area that is generally safe from thinning (of course, with some exceptions). With FUE, we are talking about taking grafts from area which may eventually thin and fall anyway.

 

FUE may seem ideal for a patient with an established NW 2, 3 or 4 but for a patient whose balding pattern is not yet established and could progress to a NW5 or above, it would seem like FUE is almost a crapshoot. You may get immediate gains from the procedure but the hair will ultimately fall out in the future because of progressive hairloss.

 

If I'm missing something or not understanding this properly, please chime in, thanks.

[Thehairupthere]

The hairs in the donor area are resistant to DHT that is why they are the donor supply as opposed to any other hair. If a doctor is transplanting from an area that is not in the desginated donor supply area, than that is an error and should not done. The link below shows a patient that has had FUE procedure and you can see how it heals and how it looks like directly after surgery so you can spot where the grafts were removed from. The yield rate like I stated above is 90-95% which is not due to the hair being in the donor area or not, it simply due to the possible trauma caused to the graft itself, if it was taken out properly and transplanted properly it will certainly grow.

[Thehairupthere]

http://www.hairrestorationnetwork.com/eve/158019-dr-dorin-1441-frontal-fue-14-days.html

[mattj]

A strip is taken from roughly the middle of the 'safe zone', whereas FUE grafts are extracted from a wider area of this zone, but are nonetheless still within it. In general. Obviously I can't say that some surgeons don't stray outside the limits of the safe zone.

[Spanker]

A strip is taken from roughly the middle of the 'safe zone', whereas FUE grafts are extracted from a wider area of this zone, but are nonetheless still within it. In general. Obviously I can't say that some surgeons don't stray outside the limits of the safe zone.

 

 

That said, I have seen a strip or too cut that I thought was out of the safe zone.

[N-6]

Thehairupthere - "The hairs in the donor area are resistant to DHT that is why they are the donor supply as opposed to any other hair. If a doctor is transplanting from an area that is not in the desginated donor supply area, than that is an error and should not done"

 

This sounds a little circular to me. To arrive at proper donor supply, a doc has to predict with reasonable certainty that the grafts taken from this donor supply will not thin or fall completely with time. Unless you're dealing with a patient who has an established balding pattern (probably an older patient), how can a doc determine what is proper donor supply outside the area where strips are usually taken? Doesnt the risk exist that FUE grafts taken from outside the strip area will simply thin substantially or fall?

 

Just calling the area from where FUE grafts are taken a safe and permanent zone doesnt make it so. We can say that about strips in FUT because the procedure has been around a long time and even in NW 7 patients, the hair in the area where strips are taken tends to remain in tact.

 

It seems that with FUE (which I don't think has been around as long as FUT), people are now extending the safe, permanent zone upwards to areas which may very well thin or fall. If that area above the usual strip area were indeed safe and permanent, then why aren't strips taken even higher than they are now?

 

Maybe this discussion should be limited to potential NW 5's and above as the sides of those patients may drop and horseshoe pattern develop. Is FUE a riskier procedure for these patients in terms of long term yield?

 

Doctor input is always welcome, thanks for your responses guys.

[Blake Bloxham]

Spanker,

 

I think there are two things to consider with regard to follicular unit extraction (FUE) and yield: 1. any damage to the graft during the extraction phase (which would damage the follicle and result in a graft that didn't grow) and 2. a graft extracted from outside the universal extraction zone, which would be susceptible to future hair loss (as the graft wouldn't be as resistant to dihydrotestosterone - DHT).

 

The first variable is dependent on the skill of the practitioner and, to a much lesser extent in my opinion, the tool that they use. If you visit an experienced FUE surgeon, my guess is that the '90 - 95%' number quoted earlier would be accurate. If someone has less experience with extracting follicular units, than issues with transection become apparent and the 'yield rate' will suffer as a result.

 

The second variable is really up to the surgeon, how many grafts he/she is trying to extract, and whether or not they feel like the follicles in these extraction areas (outside of the universal safe zone) are susceptible to future loss or not.

 

Some hair transplant surgeons seem to think that analyzing familial balding patterns and the patient's current situation can give a good indication of whether or not these grafts should be utilized or not. Think about it this way - if the hair transplant surgeon is certain the patient won't progress past a Norwood V, for example, than he/she would probably feel comfortable removing grafts from zones that would normally be affected by loss in a Norwood VI - VII patient.

 

Personally, I think this is a bit of a gamble, and something that can affect the actual yield rate for FUE procedures. If the surgeon is wrong and these grafts aren't as resistant to DHT as assumed, then they could shed (eventually) and affect the yield/result as a whole.

 

If you select a talented, ethical hair transplant surgeon for your FUE procedure, my guess is that a modestly sized session could yield around 95% growth. Now, whether or not you're an appropriate candidate for FUE is a different discussion entirely!

[Dr. Alan Feller]

90%-95% is not an accurate number for "consistent" yield in my opinion. It is lower, unfortunately.

 

Even the most meticulously performed FUE will result in consistenly lower yields compared to strip. Why?

 

Because there are three traumatic factors that play a roll in any and all FUE procedures:

1. Torsion

2. Traction

3. Compression

 

If a particular patient has "tough" physiology and the surgical team are skilled and experienced- then you can have a 90-95% growth yield. Unfortunately, there is no way to know what the physiology of a particular patient is until you've actually done an FUE and seen how it grows.

 

An honerable clinic will stop an FUE procedure if the number of failed extraction attempts becomes a high percentage of total attempts.

[N-6]

FutureHTDoc echoes my point - it seems that FUE can be a gamble in certain patients because thinning/balding pattern cannot be predicted with reasonable certainty. So you might have hair for several years after an FUE but this could ultimately thin out and fall completely because the grafts which were extracted during FUE were not DHT resistant in the first place.

 

Dr. Feller, docs, what do you think about this?

[Spanker]

Dr. Feller,

 

What would you consider a "consistent" yield? Since you are consistently considered (on this and other forums) one of the top FUE docs in the world....your opinion is greatly appreciated and I believe will greatly add to this discussion.

 

 

As far as the safe zone...when I do pull the trigger....my session will be fairly small and I also plan on asking the doctor to consider me a NW VI as he extracts....even tho I am almost 32 and NW2.5

[Thehairupthere]

The donor area is different for every patient. That area needs to be assessed for every patient and then it can be determined where the "safe zone" or donor supply area is. Once that is established the grafts would be taken from that area, some doctors may take a risk and take from other areas, but that is up to the surgeon and the patient to accept that risk. Some surgeons may see the yield rate as lower, it is certainly possible for it to be less, it depends on many things, such as experience of surgeon as well as the quality of the hair that is being transplanted, and the physiology, but from my experience in our practice the number is 90-95% yield success rate.

[N-6]

thehairupthere, with what degree of accuracy can Dr. True generally predict the extent of thinning/baldness in a patient whose pattern has yet to mature?

 

I guess this is a question for all physicians on this forum who do FUE.

 

If a doctor cannot predict this reliably in such a patient, then how do we trust that they are properly identifying a safe donor supply?

 

Of course, these questions dont apply to a 50 or 60 something year old patient whose thinning may have already run its course. I'm talking about patients in their 20's, 30's and 40's who show some thinning but the extent of which is not yet clear.

 

90-95% yield sounds nice but those seem to be short term results. We're talking about long term yield (15 years onward), does anyone have percentages as to that? Maybe not because it doesnt sound like FUE has been around that long in general practice.

 

Thanks for all your responses. This is helpful.

[Thehairupthere]

The doctors can predict quite accurately what Norwood class a patient will regress to if he or she were to avoid using medical therapy or transplantation. This would have to be done during a consultation where we can inspect the donor supply as well as the current hair loss. There is no percentage of accuracy that I can give you, but if you are using Finasteride or Rogaine the chances of you progressing to a Norwood 6 or 7 are greatly diminished.

[TC17]

I'm sorry, but I do not believe that a doctor can accurately predict with any degree of accuracy the final balding pattern of a man if that man is in his 20's and 30's. When Robert McNamara died there was a post on this forum about the amount of hair he lost from the age of 45 on. I find it EXTREMELY unlikely that a doctor would have been able to look at 35 year old McNamara who was a NW 1.5 at the time, and predict that he would be a 75 year old NW 6.5.

 

http://www.nndb.com/people/387/000022321/robert-mcnamara.jpg

young McNamara

 

http://www.sanfranciscosentinel.com/wp-content/uploads/2009/07/mcnamara.jpg

McNamara in 1979, when he was 63! you can see he's thinning, but again, would anyone think he would have become as bald as he did when he died?

 

http://media.mcclatchydc.com/smedia/2009/07/06/11/768-070609-mcnamara-alone.standalone.prod_affiliate.91.jpg

McNamara shortly before his death, so he was in his upper 80's here

[N-6]

Thanks for your responses. Thehairupthere, I'm not convinced that a doctor can predict the final balding pattern "quite accurately" of many patients. Your doctor's own site states that the balding pattern is "somewhat predictable". I take this to mean that they may have some idea but this isnt the same to me as "quite accurately". As a patient, predictability percentages (if they exist) would be informative.

 

Also, don't meds lose their effectiveness over time? I don't see how we can say for sure that taking rogaine, propecia will greatly diminsh a patient's chances of progressing to a NW 6 or 7.

 

Given all this, it just seems that FUE can be fairly risky for many patients. Are there any contraindications for FUEs in patients who may progress to NW 5-7?

[Zup]

Hello All,

 

As far as predictability of future progression, if the pattern is at all unknown, one needs to plan the patient as if they may progress to a type 6-7 pattern and stay within the defined safe zone. If there is very little sign of progressing to a type 7 one may find it is worth the risk and use much of the side planes, but still understand the need to stay lower in the back. On type 6 patterned the sides are retained high while the posterior area on the crown can recede lower. Many times there are strong signs of demarcation where hair is miniaturizing. Generally any young patient thinning (in your 20’s) should always be address as if they are going to progress to a 6-7. The tendency is when one starts thinning in there 20’s it is a strong indicator that the hair loss may be more extensive and progress faster. So until one shows they won’t progress to extensive loss we need to address them as if they will. However, if ones on meds this may mask the problem as someone else mentioned. And, some patients may be inclined to take a calculated risk to work outside or on the border to increase their donor source or pick up a few fine hairs for the hairline.

 

Now, in regard to yield with FUE, and this is what caught my attention to this thread. I would say survival is on the average lower then 90-95%. I believe at the leading clinics with strip today waste with dissection is approx. about 5%, survival of the 95% that is transplanted approx. 90-100%. While, FUE with a skilled extractor the transection can be quite low again maybe only 5%, but the survival of what is transplant without transection is more like 75-100%. We believe even if the graft has been dissected cleanly as Dr Feller mentioned, the means of extraction even when there is no transection: torsion, traction and compression are still placed on the graft. Plus, the unit alone is a more delicate unit and not as hearty as strip graft. Focus, patiants and skill of the extraction minimizes these fore mentioned forces but they are still present.

 

FUT, did not have the most desirable survival in its infancy either until doctors recognized it was an all in all, a more delicate procedure and were required to change their protocol round it; in regard to greater detail, stronger instrumentation, proper number of techs and increase hand eye coordination with techs. Today the procedure is quite consistent in the hands of many physicians. We feel FUE can possibly be the same and the yield may become as reliable but today it is not quite there on a consistent level. This seems to be the overall census from many of the recognizes physicians Dr Shapiro knows and respects from around the world that possess the greatest experience with FUE. Much of this feedback was gather as resent as a month ago attending our industry’s largest International Conf. in Boston.

 

Happy Thanksgiving, Matt

Edited November 26, 2010 by Zup

[N-6]

Thanks for the response Matt. I'm considering undergoing an FUE procedure because I am likely done with strip after next one but the relative unpredictability of hair loss, the less than optimal yield rate and high cost, are making me have doubts about the procedure. It would really suck to pay all that money now only to lose FUE hair several years down the line.

[BaldingBogger]

This is a good topic. The real FUE (or FUT) yield is not clear for me. Although we see lots of online great yield FUE results these days. After conducting a lot of more in depth research my impression is a lot of FUE yields (Lorenzo excluded whose results seem amazing) are actually somewhere around 70-80%.

 

A lot of these results dont make it online fully as the patient inevitably does not want to rock the boat with the clinic and needs the repair. (Hopefully offered free by the clinic).

 

I think most people can expect to go for a second procedure or 'touch up' in order to get a satisfactory result. It seems there are a lot of cases where there is always a weak area after a first op that needs addressing.

 

Im of the opinion that a lot of these cases dont make it online. I'd be interested to hear if people had a 'home run' first time.

 

I actually feel the above also applies to FUT results.

 

Btw i still would only personally go for FUE even if it did mean less hair in the long run.

[Mickey85]

I think it depends on the surgeon. Poor FUE surgeons often blame the method itself rather than their own skills while people like Lorenzo, Bisanga and Erdogan are consistently getting strip-like yield and have been for years. Some tools are not as good as others either. I personally have not seen many great results come from the SAFE motorized punch. The ARTAS machine has also been very unimpressive up to this point. I think an inadequate tool can certainly inhibit a surgeon's ability to produce a good result.