FUE prevents a future FUT?

[andy79]

Hi guys, haven't posted in a while but am always reading. I'm 31 and have been on Propecia since I was 24. I halted the loss in my crown (even got some back) but am now thinning at the temples. I still have ok coverage, but the thinning in the crown and temples is getting harder to hide (especially when I sweat or my hair is wet). Side note: I used to take Propecia every other day, and it wasn't until this year that I started taking it daily...which sped up the thinning process.

 

I was thinking of getting an FUE - 1500 - 2000 grafts - to fill in a little crown and my temples. I won't waste any hairs rebuilding the hairline, just want to get some density with what I have.

 

I wish I could do a strip, but the nature of my job forces me to interact with clientele on a weekly basis...I can't afford to go through the "Ugly Duckling" phase as so many call it on this site. Also, I like shorter hair styles.

 

However, I know in the future I'd probably need another procedure. So I wanted to know (and cant seem to get a clear answer) would an FUE procedure now prevent me from getting a substantial strip or another substantial FUE down the road?

 

I appreciate any insight guys. It's been weighing on my mind a lot...

[splitting hairs]

Hi well FUE reduces your donor density as such. FUE can yield less than strip surgery as hair has to be left where grafts are taken from. The reduced density makes strip less effective in the future since u get less grafts for removing the same amount of skin. The best way to go is strip first until you have no more laxity then FUE after that. I would only recommend FUE if u are unlikely to experience further loss. Some clinics can transplant with minimal shaving and scars are generally good. Take a look at work by Ron Shapiro who does strip and FUE get a consult and discuss your issues also they don't always need to shave down for strip. Good luck.

[RCWest]

I would think FUE had more of the ugly duckling phase, since they shave the whole area where they extract from. A strip is covered by hair and even then it's not very noticeable. To get 2000 grafts via FUE they would just about shave your whole head.

[Sparky]

you could be out of the ugly ducking phase in about 7-10 days with good fue, then you would just have a shaved head look.

[Thehairupthere]

Agreed if you do the FUE you would have a more drastic change in your appearance as you will need to shave the entire donor area to get that much out. If your current hair length is a about 2-3 inches than you can easily hide the stitches and scar, and have longer hair on top to comb it in a way to hide the scabs, and in one week you will be pretty much back to normal.

[andy79]

Interesting. Thank you so much everyone.

 

Everything I saw made it seem within 2 weeks, with FUE, it would just look like a close croped/shave hair style. At least looking at the work I saw from Shapiro. I appreciate the comments guys. Anyone have photos, or a link to a post, where a strip was concealed after a two week treatment? I feel a lot of posts/photos don't show the immediete - to two week - to one-month donor area.

 

2-3 inches of length in the back is pretty long, but I guess I'd be willing to try it. What doctors are willing to perform without shaving? True and Dorin?

[Levrais]

Andy, take a look at my day 5 and day 8 pics after fue. By day 5 the donor was ok imo and by day 8 I think it was back to normal. I usually wear it short like that though. The hard part is hiding the recipient area regardless or whehter you get fue or fut. I have an office job with face to face contact and not able to wear hat. Went back to work on day 10 and as far as I know, I pulled it off. It would have been better to wait until day 15 though.

 

Levrais

[andy79]

Thank you for sharing your post with me Levrais. I've actually come across your pictures before. Really beautiful work, you must be very happy with the result. This is the sort of FUE pre-op to 2 weeks post op photos that makes me want an FUE.

 

However, if anyone has an example of a FUT/Strip where the donar scar can be well hidden within 2-3 weeks I'd love to see it. Even with True & Dorin, the only donor area shots I can find are 5 - 6 months later. The work looks phenomenal, but again, I can't go 5-6 months with a noticeable scar given the nature of my job.

 

Anyone have any examples? I've been searching and can't seem to find any. Also, at 31 y/o with the reality of losing more hair - am I shooting myself in the foot by not going FUT/Strip first?

 

Again, thanks gents.

[Levrais]

Andy, thanks for the compliment. I cant think of where right now but Ive seen fut pics where you cant see the strip scar immediately post op unless you move the hair and really look for it. If your donor area is dense and you wear hair a little long, you could easily hide it. This is assuming you get a good doc of course. I will see if I can find a link or 2 to show you.

 

As you know there is a big fue vs fut debate going on and I dont want to stir that up but for me, I wear my hair way too short to hide a strip scar and I dont care to wear it longer. Also, even though Im 45, Im not sure I wont get further loss. I would go in for maybe one more procedure if necessary but I doubt I would have enough donor supply for more that that. So, if I end up having to shave down later on, I would rather not have a large scar. Not trying to offend fut guys, just giving you my personal preference.

Either way, its exciting that we have these options and I hope you find what works besg for you.

 

Levrais

[wb280]

Everyone wants FUE, minimal scarring, getting to work asap etc. Mates, have we all forgotten our purposes in undergoin the op? Its about regaining back your hair! I am not biased against any procedure but do not just look the advantages of FUE and disregard the disad like potentially less yield among others.

 

Listen to the docs advice. If 10/10 suggest strip, will u still go for FUE? Good luck

[multiplier]

I don't have any pics, but my scar has never been noticeable unless I wear my hair really short. Even then, you really have to be looking for it, in bright light. And even then, you have to know what the hell an HT is. When pics of Jeremy Piven's strip scar surfaced, you wouldn't believe how many people on blogs were asking what it was. A lot of people fundamentally don't even know how how transplants work and are not looking that closely at the back of your head.

[Thehairupthere]

Here is an example of how the stitches look like from the same day as treatment with the strip FUT procedure. They are attached to this entry.

[England]

Some studies have shown that the yield of FUE is just as good as FUT - according to some doctors on forums such as this.

 

With FUE you can also extract from a wider area and so can actually achieve a greater number of grafts. You are also left with arguably less of a scar. Of course, it's more expensive.

 

With strip, you remove a strip of skin and hair, but this naturally means that the rest of your skin with hair on it has to stretch to cover the same area. As a result, in theory, you achieve exactly the same overall thinning in the donor area with strip as you do with FUE.

 

With strip there is no going back, FUE is a more conservative approach, IMHO.

 

http://www.baldtruthtalk.com/showpost.php?p=51097&postcount=17

Edited February 20, 2012 by England
Added source

[chrisdav]

England

 

If you listen to the very best and I mean best surgeons, they all generally come to the same verdict.

 

The consistent results that they display confirms this.

 

This might help.

 

http://www.shapiromedical.com/procedure/follicular_unit_extraction_fue/

Edited February 20, 2012 by chrisdav

[bonkerstonker]

Here is an example of how the stitches look like from the same day as treatment with the strip FUT procedure. They are attached to this entry.

 

 

Yes true enough but strip shockloss is fairly common and the scar area can look a lot worse within a few weeks than these pictures imo.

 

I've had fue and strip and in my experience 3 weeks after fue surgery nobody would have a clue what i'd done as i shaved my full head preop and 3 weeks of growth was enough to cover the donor easily also the work on top had healed fine.

 

With my strip surgery it took well over 4 months before i could hide my scar i did have a bit of standard shockloss around the scar but nothing really bad like i've seen on some people. For me fue is a lot easier to hide by a long way!!

[N-6]

Agree with bonker about pics posted. Scar pics were nice outcome but its unrealistic to think that every patients donor will look like that on day of procedure. Strip poses risk of scar stretching and donor shock loss. FUE no scar. That said I prefer strip because of superior yield and superior efficiency of harvesting grafts plus, of course, cost. Personally I have gone back to work by day 15 to day 17 and don't think anyone noticed anything. For my last procedure I had staples in for abt 2 weeks at my office, no hat,, and feel it was well concealed.

[Jotronic]

Fact: Take the top five strip clinics and show the best results possible from the past two years and then take the top five FUE clinics and show the best possible results from the past two years. Hands down strip will win as having higher overall consistency with excellent growth. FUE has produced some great results but not as often as seen with strip.

 

FUE can offer more grafts than strip but only if you compare an FUE patient with high density vs. a strip patient with low density. Strip patients, assuming average density and average laxity, can get up to 8500 or 9000 grafts in "x" number of procedures. FUE cannot touch this, again, assuming average characteristics. Rare cases do not count. Technically, FUE can take every graft in the donor region but I think it's safe to assume we are talking about what is cosmetically possible as taking more than a few thousand grafts from the average patient will result is a noticeable decrease in donor density.

 

FUE can also cause donor shock. I've seen it.

[England]

I think that the vast majority of surgeries are FUT. Partly because some clinics don't offer FUE yet, partly because almost every clinic who offers FUE also offers FUT, and partly because it's cheaper. I also think that FUE can yield lower in the wrong hands.

 

Because so many more people get FUT - it would logically follow that there were more top results from FUT, but that of itself doesn't mean that FUE is less effective. Time and cost factors apply most to the cases who require the most grafts, which can distort the evidence because there are not many people who can afford 6,000 - 10,000 FUE grafts.

 

I have consulted with numerous top surgeons, many of whom have confirmed to me that given any one patient - it is possible to extract a higher number of grafts via FUE (without cosmetic problems). This is because FUE can be taken from 'safe zones' which ordinary strip cannot reach (such as further wide). I also believe that the best FUE surgeons can achieve yields which are as good as FUT.

 

People seem to have a mistaken perception that when you have a strip, the hair at the back isn't thinned. It is thinned exactly the same as an FUE result is - when your scar is closed, all of your existing hair is stretched over a larger area. This results in a % reduction in density which would be the same as if you had the same number of grafts removed by FUE (assuming no capping).

 

The advantage of strip, in my opinion, is that it reduces the risk of capping, can be handled by less expert doctors without reducing yield, and that all of the hair can be taken from one place (which is advantageous if other areas are thinning). I believe the majority of this advantage is removed when you go with a top FUE doctor. And of course, with FUE you leave yourself the option to shave down in the future or when you get very old and all of your hair thins, with scars which are barely visible.

[chrisdav]

England, I can understand your arguements and I think they are valid.

 

But these surgeons meet regularly in meetings.

 

Here is one example:

 

The International Society of Hair Restoration Surgery is an international, non-profit medical association comprised of over 900 physicians specializing in hair loss representing over 60 countries – dedicated to promulgating the highest standards of medical practice and medical ethics. The ISHRS provides continuing education to physicians specializing in hair transplant surgery and gives the public the latest information on medical and surgical treatments for hair loss.

 

MISSION: To achieve excellence in patient outcomes by promoting member education, international collegiality, research, ethics, and public awareness.

 

The good doctors speak to each other,share information,techniques, display new tools and perform on patients together in workshops.

 

The message seems to be a coherent one and it is very hard to disagree with them unless you believe they are all not telling the truth.

 

I think I know which surgeons you are referring to but I am interested to know who they are.

Edited February 27, 2012 by chrisdav

[Jotronic]

Because so many more people get FUT - it would logically follow that there were more top results from FUT, but that of itself doesn't mean that FUE is less effective. Time and cost factors apply most to the cases who require the most grafts, which can distort the evidence because there are not many people who can afford 6,000 - 10,000 FUE grafts..

 

Logically, if that is what I requested, but it is not. I said to take the top five clinics from each discipline over the past two years. This was to keep the comparison as close to equal as possible. This is graft for graft, case for case so logically, if we assume each practice is booking five days a week then the playing field is even.

 

I don't buy the argument that we don't see 6000 to 10,000 graft cases of FUE due to financial limitations. If there is one thing I've learned in my ten years on this very forum and twenty years as a hair transplant patient, come Hell or high water, many men will find a way to finance their hair.

 

If the only thing preventing this claim from being validated is a lack of financial means by most patients then I propose this counter point. If I were an FUE surgeon making the claim that 6000 to 10,000 grafts were routinely and commonly possible with little to no evidence of surgery or thinning etc, as you stated, then I would perform ten of these procedures at little to no cost in exchange for full marketing rights of the results. The onus would be on me to validate something this extraordinary and this would be the best way to do it. This would put the argument to rest once and for all and would open my practice up to bookings years in advance. "Studies" that cannot be validated hardly prove a thing. FUE has been in North America for ten years now so there has been ample time to show that this is what the average patient can achieve.

 

People seem to have a mistaken perception that when you have a strip, the hair at the back isn't thinned. It is thinned exactly the same as an FUE result is - when your scar is closed, all of your existing hair is stretched over a larger area. This results in a % reduction in density which would be the same as if you had the same number of grafts removed by FUE (assuming no capping).

 

You are correct, when a strip is taken the donor zone is thinned. However, it is magnitudes less donor thinning with strip than compared to FUE. With FUE there is a direct proportional reduction of density with each follicular unit extracted. Extract 3000 grafts then your donor zone is reduced in density by 3000 grafts. Remove 3000 grafts via strip then the area thinned is spread out over the entire donor zone by temporary tension that eventually returns. If the thinning was equal in strip compared to FUE then my donor zone would be a waste land after having over 10,000 grafts extracted. My donor zone is anything but.

 

I have no idea what you refer to when you talk about "capping" so I cannot comment on this. One thing is clear to me however. These FUE experts you have been speaking to have been trying to validate FUE above and beyond the one advantage it does have. With a safe amount of grafts extracted you can cut your hair shorter than with strip. That is it, period. It is accepted and discussed among doctors, publicly and privately, that FUE does NOT offer the same survival rates across the board as strip (assuming top talent performing each procedure). The cost is greater, the sessions are smaller and this is not because of the cost overall. It is because of the inherent limitations imposed by a finite donor zone and the law of diminishing returns. Once you cross a certain threshold that is unique to each patient the visual benefits for the recipient zone are outweighed by the degradation of the donor zone.

[Jotronic]

Because so many more people get FUT - it would logically follow that there were more top results from FUT, but that of itself doesn't mean that FUE is less effective. Time and cost factors apply most to the cases who require the most grafts, which can distort the evidence because there are not many people who can afford 6,000 - 10,000 FUE grafts..

 

Logically, if that is what I requested, but it is not. I said to take the top five clinics from each discipline over the past two years. This was to keep the comparison as close to equal as possible. This is graft for graft, case for case so logically, if we assume each practice is booking five days a week then the playing field is even.

 

I don't buy the argument that we don't see 6000 to 10,000 graft cases of FUE due to financial limitations. If there is one thing I've learned in my ten years on this very forum and twenty years as a hair transplant patient, come Hell or high water, many men will find a way to finance their hair.

 

If the only thing preventing this claim from being validated is a lack of financial means by most patients then I propose this counter point. If I were an FUE surgeon making the claim that 6000 to 10,000 grafts were routinely and commonly possible with little to no evidence of surgery or thinning etc, as you stated, then I would perform ten of these procedures at little to no cost in exchange for full marketing rights of the results. The onus would be on me to validate something this extraordinary and this would be the best way to do it. This would put the argument to rest once and for all and would open my practice up to bookings years in advance. "Studies" that cannot be validated hardly prove a thing. FUE has been in North America for ten years now so there has been ample time to show that this is what the average patient can achieve.

 

People seem to have a mistaken perception that when you have a strip, the hair at the back isn't thinned. It is thinned exactly the same as an FUE result is - when your scar is closed, all of your existing hair is stretched over a larger area. This results in a % reduction in density which would be the same as if you had the same number of grafts removed by FUE (assuming no capping).

 

You are correct, when a strip is taken the donor zone is thinned. However, it is magnitudes less donor thinning with strip than compared to FUE. With FUE there is a direct proportional reduction of density with each follicular unit extracted. Extract 3000 grafts then your donor zone is reduced in density by 3000 grafts. Remove 3000 grafts via strip then the area thinned is spread out over the entire donor zone by temporary tension that eventually returns. If the thinning was equal in strip compared to FUE then my donor zone would be a waste land after having over 10,000 grafts extracted. My donor zone is anything but.

 

I have no idea what you refer to when you talk about "capping" so I cannot comment on this. One thing is clear to me however. These FUE experts you have been speaking to have been trying to validate FUE above and beyond the one advantage it does have. With a safe amount of grafts extracted you can cut your hair shorter than with strip. That is it, period. It is accepted and discussed among doctors, publicly and privately, that FUE does NOT offer the same survival rates across the board as strip (assuming top talent performing each procedure). The cost is greater, the sessions are smaller and this is not because of the cost overall. It is because of the inherent limitations imposed by a finite donor zone and the law of diminishing returns. Once you cross a certain threshold that is unique to each patient the visual benefits for the recipient zone are outweighed by the degradation of the donor zone.

[chrisdav]

Great Post Joe.

[NEWHAIRPLEASE]

Andy

FWIW I had strip with Dr Rabal in January. I stayed at the foxbar with a guy who had 1200 FUE the day before my surgery. At day 5 post op, I really could not tell he had anything done!

[England]

Logically, if that is what I requested, but it is not. I said to take the top five clinics from each discipline over the past two years. This was to keep the comparison as close to equal as possible. This is graft for graft, case for case so logically, if we assume each practice is booking five days a week then the playing field is even.

 

The point is, you have to apply logic when making a logical point. You can only compare by looking at 'top 5' if the same number of surgeries are FUT and FUE. I already explained to you that most clinics who offer FUE also offer FUT, so each practice booking '5 days a week' isn't relevant at all. I think I read somewhere that only 10% of surgeries are FUE, mainly due to cost.

 

I don't buy the argument that we don't see 6000 to 10,000 graft cases of FUE due to financial limitations. If there is one thing I've learned in my ten years on this very forum and twenty years as a hair transplant patient, come Hell or high water, many men will find a way to finance their hair.

 

I completely disagree with this. If there's one thing I've learned simply by living and knowing people - the majority of people can't afford to spend 30-40k on their hair. To disregard this is a factor is... unsympathetic to the situation many patients find themselves in, in my view

 

If the only thing preventing this claim from being validated is a lack of financial means by most patients then I propose this counter point. If I were an FUE surgeon making the claim that 6000 to 10,000 grafts were routinely and commonly possible with little to no evidence of surgery or thinning etc, as you stated, then I would perform ten of these procedures at little to no cost in exchange for full marketing rights of the results. The onus would be on me to validate something this extraordinary and this would be the best way to do it. This would put the argument to rest once and for all and would open my practice up to bookings years in advance. "Studies" that cannot be validated hardly prove a thing. FUE has been in North America for ten years now so there has been ample time to show that this is what the average patient can achieve.

 

Firstly, I didn't say that 6,000 to 10,000 grafts are 'routinely and commonly possible' by FUE- so I don't know where that came from. That isn't even the case for strip. What I said, to be clear, is that some top doctors have told me that more grafts can be extracted in FUE in some patients, due to a larger available 'safe zone'.

 

Secondly - The top FUE doctors in question, as you said, are fully booked for months in advance, so why would they feel the need to prove anything at their own expense, which they haven't even claimed (as I said above)?

 

Thirdly - Since you're claiming FUE is so much worse, feel free to prove this or evidence it in any way in a double-blind study with a world class FUE doc. They have portfolios of results showing the success they have achieved, and first hand experience performing both FUE and FUT. Do H&W perform FUE?

 

You are correct, when a strip is taken the donor zone is thinned. However, it is magnitudes less donor thinning with strip than compared to FUE. With FUE there is a direct proportional reduction of density with each follicular unit extracted. Extract 3000 grafts then your donor zone is reduced in density by 3000 grafts. Remove 3000 grafts via strip then the area thinned is spread out over the entire donor zone by temporary tension that eventually returns. If the thinning was equal in strip compared to FUE then my donor zone would be a waste land after having over 10,000 grafts extracted. My donor zone is anything but.

 

Sorry, but again, I completely disagree with this. Mathematically, if you lose 3,000 grafts, whether that's with FUE or FUT - you still have 3,000 fewer grafts at the back of your head, with which to cover the same area. Unless your head has shrunk during the surgery - that means you will see the same loss in density in both. The only counter argument to this is if strip raises the bottom of the back of your hair, meaning that it has a lower area to cover, is this the case? The reduced density at the back of your head doesn't get resolved by 'temporary tension' subsiding - because the tension only subsides when the skin becomes accustomed to being stretched, not because the hairs become any more dense.

 

I have no idea what you refer to when you talk about "capping" so I cannot comment on this.

 

Capping for me, is the main disadvantage of FUE. It's when the doctor attempts to extract a graft unsuccessfully (typically by slicing the top off), which can leave the graft damaged, or with a reduced number of hairs. This decreases your donor without giving you increased hair in the recipient area.

 

One thing is clear to me however. These FUE experts you have been speaking to have been trying to validate FUE above and beyond the one advantage it does have.

 

The doctors in question are both FUE and FUT experts - so I respect their opinion on the comparison the most, given that they routinely perform both. That being said, they do suggest FUT is slightly more advisable in certain situations - due to the reasons I stated (less volatility - potentially higher yield, no capping, quicker, less expensive). To clarify - in my post I explained what advantages strip does and doesn't have, I didn't reach any conclusion that FUE is always better, or even better at all.

 

With a safe amount of grafts extracted you can cut your hair shorter than with strip. That is it, period. It is accepted and discussed among doctors, publicly and privately, that FUE does NOT offer the same survival rates across the board as strip (assuming top talent performing each procedure). The cost is greater, the sessions are smaller and this is not because of the cost overall. It is because of the inherent limitations imposed by a finite donor zone and the law of diminishing returns. Once you cross a certain threshold that is unique to each patient the visual benefits for the recipient zone are outweighed by the degradation of the donor zone.

 

I agree that the general consensus is that on average, FUE yields marginally lower. I also agree that not having a scar with FUE is a massive bonus - and it's enough of an advantage to make FUE desirable for many patients - particularly if yields are similar.

 

The cost is greater simply because FUE takes much longer, and arguably requires more skill. For example, for a 6,000 FUE, this would have to be spread over 2 surgeries of 3,000 each spread out ideally over 18 months, each of which taking 2 days (and would cost 30,000 EUR). Overall, to have and grow out both surgeries, it could take 4 years. Contrast to a strip surgery which could be done in a day and be grown out in 12-15 months, and the cost far less. It's obvious why such patients pick FUT for the larger procedures, but that of itself doesn't prove that FUE wouldn't work in such a case.

 

In summary, FUT clearly has advantages and disadvantages, and is often the preferred choice (even for experts of both FUE and FUT) - but claims of being able to extract hair without thinning the donor as much are not the reason for this.

Edited February 28, 2012 by England

[BaldWhisky]

I completely disagree with this. If there's one thing I've learned simply by living and knowing people - the majority of people can't afford to spend 30-40k on their hair. To disregard this is a factor is... unsympathetic to the situation many patients find themselves in, in my view

 

 

 

I'll leave for others to commment on the other parts but this part is focused on the wrong part.

 

Let's say there are 30 doctors we could rate as "top". Each parform say 150 HTs a year. As these are the top doctors people from all over the world will consider them. In total they would perform 4500 HTs a year.

 

There are about 3billion men in the world. Let's say 1% of them consider an HT. If anything I'd think that's on the moderate side.

Now lets say only the 1% richest poople in the world could affort the money you mention. That's 3,000,000,000x1%*1%=300,000 men.

So for it to be possible 1.5 percent of the 1% ricehst and the 1% that consider an HT (4.5'/300') would have to decide to go with one of the top 30 FUE doctors.

 

It speaks for itself that if it was possible to stand out doing 10,000 graft FUEs on a regularly basis at least one doctor would have taken taht opportunity.