Is FUE permanent?

[N-6]

Aaron, thanks for the article.

 

Running through this thread there is an underlying assumption that the donor area for FUT is necessarily the same as the donor area for FUE. It is not. The donor area for FUT as a safe zone has been well-established for a number of years based on research and practice. FUE is a relatively new procedure which many times extends beyond the traditional FUT safe zone. Look at the FUE donor areas immediately post-op on this site, many of them extend beyond the traditional FUT safe zone. Given that it sometimes extends past that zone and that docs cannot reliably predict hair loss, FUE, in my opinion, can be very risky for a younger patient because the transplanted grafts may eventually fall out with the progression of hair loss.

 

This topic is touched upon at the following link, which has images of the actual safe zone for FUT versus the area where FUE may harvest grafts.

 

Medscape: Medscape Access

 

Below is also a quote from the website of Dr. Walter Unger, a well-published physician in hair transplantation.

 

One of the often unmentioned, but major, potential drawbacks of FUE versus SSSH, is that if very large numbers of grafts are likely to be required in a single or multiple sessions over the patient's lifetime, a larger percentage of the transplanted hair is more likely to be lost in the future than would be the case with SSSH. This is because all of the FU in a strip are utilized, whereas only every third to fifth FU can be extracted from a FUE donor area; taking more than that with FUE would result in that area being left with hair that would be too sparse and/or the small round scars being noticeable (Figure 17). Thus, to get the same number of FU as you would from a strip requires a donor area that is 3 to 5 times as large. A consequence of that is a FUE session of 1000 to 1500 FU spaced every 3rd to 5th FU apart, generally can be accomplished within "The Safe Donor Area", a 3000 FU session would require harvesting from twice that scalp area and a 4500 FU session would necessitate FU extraction from over three times that scalp area, etc. The latter two sessions would nearly always exceed the established "Safe Donor Area" boundaries. This would result in non-permanent FU transplantation and potential small round scars becoming visible as that area loses the original hair. As implied from the preceding, the younger the individual is, and therefore the less certain one can be about the ultimate width of the fringe, the more likely that this will occur. The older the patient, the less likely this will happen. A less important, but not unimportant, additional potential drawback of FUE is that the grafts produced via FUE have less protective tissue surrounding the hair bulbs within them and may or may not result in a lower hair survival than that seen with grafts that are microscopically produced from a strip (Figure 3).

 

Welcome to Dr. Walter Unger | The Procedure

[Thehairupthere]

N-6 I don't understand the reason for your original post. You had a question and you obviously already had an opinion on the subject and unfortunately it's wrong. The FUT and FUE donor areas are the same, period. Stop saying otherwise because you're clearly misinformed and you continue to say that it's elsewhere even though dozens of cases show that the areas are the same. I believe you are confused because you see such a large area being used because for FUE as opposed to FUT due to selectivity of the procedure. The quote you put up makes a good point about telling people that you cannot harvest as many grafts with the FUE which is absolutely true. But one quote "the latter two session would nearly always exceed the established "safe donor area" boundaries" I do not agree with because a reputable doctor would always know to not exceed these boundaries no matter the circumstance. If the patient requires to go outside that zone, than he or she should not have another procedure. Very large procedures over 3000 grafts as the quote suggests are not a very efficient way of having a procedure, and I for one believe that if the procedure is that large that the patient should seriously consider FUT, but these limitation with FUE are always clearly discussed beforehand. None of this however has anything to do with the FUE grafts being non permanent, because they are permanent just like FUT, please stop saying otherwise because it's horribly false, unless it's taken outside the permanent zone, which is should never ever be taken from.

[DISpHAIR]

I think N-6 raises some interesting issues. First we must understand that "safe zone" is just a made up term. I think that if you asked 10 top doctors to indentify the safe zone as accurately as possible, you would get 10 different answers. This is because this issue is subjective to opinion and can not really be proven with any scientific certainty, at least from my knowledge. I would assume that the safe zones would be close to the same from good doctors, but not exact. I personally am of the opinion that eventually everyone would be bald if we could live long enough. From our current understanding of hairloss, DHT amounts determines the speed in which hairloss progresses, but everyone has DHT to some extent. So if we all lived 200 years we would all probably be completely bald. If you agree with this premesis then you should accept that the safe zone is nothing more than a prediction of the speed of hairloss relative to the life span of the patient. The zone in all actuallality is not safe from miniturization, it is just predictied that in your lifetime the miniturazation will not occur in a certain area we coined "safe zone". From what I have seen, it does appaer that hair is taken from a higher area in FUE vs FUT. It is possible that this illusionary considering the way the grafts are extracted is completely different. There are other reasons why it may appear this way. Interesting topic none the less and an important one I think.

Edited December 22, 2011 by DISpHAIR

[N-6]

Thehairupthere, I posted a question to gather info on a topic I was actively researching and share my preliminary opinions on the matter. Surely, you're not saying that I'm not allowed to do that in a public forum?

 

You also misunderstand my point-I'm not saying that the FUT and FUE donor area are always different, just that sometimes they are. I've cited several blogs which contain photos clearly depicting this very point. Are you really disputing what is clearly visible to the naked eye?

 

If you are, what do you think about this case-a 24 year old with self-described "strong family history" of baldness who undergoes nearly 3K grafts via FUE during a 2-day period. Is his donor area in the safe zone? Or are you going to explain that this is the safe zone because the doc says its the safe zone?

 

http://www.hairrestorationnetwork.com/eve/163495-2-968-fue-dr-feriduni.html

 

You also say: "But one quote "the latter two session would nearly always exceed the established "safe donor area" boundaries" I do not agree with because a reputable doctor would always know to not exceed these boundaries no matter the circumstance".

 

This quote shows the fallacy of your argument. No doc, no matter how reputable, can reliably predict hair loss progression in a younger patient so how can he ever know what the safe boundaries are in the first place for FUE?

 

You're basically saying a doc knows what the safe zone is because that zone has hair that will be fairly resistant to DHT and the doc knows it is fairly resistant to DHT because it is the safe zone. Classic circular reasoning.

 

The article I cited does not say that only large FUE sessions are inefficient. In fact, it says that FUE of any sort when compared to FUT is inefficient "because all of the FU in a strip are utilized, whereas only every third to fifth FU can be extracted from a FUE donor area; * * * to get the same number of FU as you would from a strip requires a donor area that is 3 to 5 times as large".

 

You further state: "None of this however has anything to do with the FUE grafts being non permanent, because they are permanent just like FUT". Really? Guess you missed this from medscape:

 

"Furthermore, as each individual follicle extracted must be separated by three or more intact neighboring follicles so as not to create a uniformly alopecic donor area, the risk of needing to harvest follicles from a larger surface area that extends beyond the limits of the safe donor area is heightened (see the image below). Over time, as the fringe hair beyond the safe donor area is lost, the punctate scars may be exposed and transplanted follicles harvested from this fringe area may disappear".

 

And you did allude to this and large FUE sessions are certainly being done:

 

The latter two sessions would nearly always exceed the established "Safe Donor Area" boundaries. This would result in non-permanent FU transplantation and potential small round scars becoming visible as that area loses the original hair. As implied from the preceding, the younger the individual is, and therefore the less certain one can be about the ultimate width of the fringe, the more likely that this will occur. The older the patient, the less likely this will happen.

 

Disphair, you get what I'm saying. This isnt a black and white issue by any means. In FUT, the safe zone is well-established as a zone that is fairly resistant over a certain period of time to DHT. By definition, this excludes the area where some FUE donor hair is being extracted, particularly for those younger patients who want and receive mega-session FUEs. Now a patient's donor area can vary from patient to patient but when I see a case of a young patient like the one above undergoing FUE donor harvesting that far above the well-established FUT safe zone area, it concerns me.

[Thehairupthere]

Please don't put words in my mouth, never did I say you should not post anything nor would I. You posted a question asking is FUE permanent and I gave you an answer and you disagreed with me and argued with me right off the bat. I gave you an answer based on my years of knowledge, first hand experience and work in this field and you come to a conclusion which I still believe is false. I will not post further on this topic because there is nothing else to be said.

[N-6]

You questioned why I posted this topic, I gave you a response and asked you a question. I appreciate your input on the topic but I completely disagree with your position as I think its based on conjecture rather than actual medicine. My position is based on research, observations, and significantly, the strength of literature published by medical doctors, including a pioneer in the field of hair transplantation.