Why are FUE Grafts so Limited for Exclusively FUE Patients?

[Cant decide]

The answer to this may be obvious but why is the amount of grafts that one can take using FUE (Assuming the patient never had strip) so limited? I keep reading of patients who did all FUE and maxed out at 4000-5000 over multiple procedures. We know that strip can yield more than 5000 total in most cases and then when stripped out, FUE can usually get some more. Therefore, why can someone get say 9000 lifetime grafts between strip and FUE while the same patient could only get 5000 if doing all FUE over multiple procedures?

[mattj]

With FUE, the extractions are spread out over the donor area and like spex said with his marble analogy, there will be come a point where no more grafts can be extracted without the donor area appearing thin. With strip you're getting every graft from within the strip that has been excised. It's all down to how the numbers add up before the limits have been reached with each of the two extraction methods. With strip, the numbers add up to a larger total.

 

Dr Rahal's limit on the number of grafts he'll extract in one procedure is based more on what he feels is acceptable use of the donor area in one session than the limits of what he and his team can actually achieve during a day of surgery.

[scar5]

FUE is no substitution for strip.......( it actually causes more scaring)

 

I think it's misleading. It's a scandal to say FUE causes more scarring IMHO. But the incentive for strip clinics or clinics who want to delineate FUE based on a plausible limitation is obvious.

 

How could Dr. Lorenzo be doing such beautiful work, with 5000+ FUEs if he didn't believe FUE is a substitute?

 

HT is an illusion, including the scarring.

[scar5]

With strip you're getting every graft from within the strip that has been excised. .

 

I believed the following to be true.

 

Within the strip, many of the telogen hairs (Telegon hair = 10% of your hair at any one time) get missed and binned. They are invisible, even under magnification. I was told by a doc that some?many? telogen hairs are still visible. Of course I wondered about scalp stretching and the impact it could have on easing the dead telogen hairs out. It seems to me that you don't get all hairs in the strip. You loose some due to telogen. Invisible to the cutters even under magnification.

 

Of course you don't get told this in the consultation.

 

Don't expect the truth all the time.

 

Especially from a disturbed and anxious poster like me!!

Edited June 21, 2012 by scar5

[Cant decide]

Thanks guys. I had a 5000+ strip surgury with Dr. Rahal so you know that I believe in strip over FUE when large numbers are needed

 

Would you say that in most cases, after a person is stripped out, they can at least get some more grafts via FUE. I would assume this is almost always the case, right?

[irishsailor]

Cant decide,

 

Yeah most people who strip out should have some reserves left for fue. I know that is my plan once im stripped out to tap into my fue

 

Lets hope neither of us need that though

[England]

An interesting question. Some observations of mine which I believe to be true (I've had a large FUE and strip):

 

1 - People who strip out normally have some reserves left for FUE.

 

2 - People who FUE out normally have some reserves left for strip.

 

3 - Whether you do FUE or strip first, the former reduces the yield from the latter. You can do either after the other, in any order.

 

4 - FUE scarring is far less evident than strip scarring (I know you didn't ask about scarring but replies to your post did)

 

5 - In the right hands (the best FUE surgeons in the world), the yield can be as good as 95% of a strip yield. In lesser hands this can be lower because FUE requires great skill.

 

6 - Some surgeons in the US are unable to do larger FUE sessions because they aren't legally allowed to have specialised techs doing the extractions, thus they simply do not have enough time to perform larger FUE surgeries, and they would suffer from fatigue etc if they attempted to given the work involved. While they may therefore state that FUE cannot work in large numbers, numerous world class surgeons in Europe / Canada etc perform large FUE operations on a weekly basis which shows it does work.

 

7 - Mathematically, whether you remove grafts via strip or via FUE, you still have the same sized head, so whether you take 2,000 grafts via FUE or 2,000 grafts via strip, you still have the same overall area to cover with the same number of grafts. In theory, this would mean that you have just as many grafts for FUE as for strip. In practise, however, strip certainly seems to have a higher maximum yield, and honestly I've not seen a good answer why. Here are some of my 'theories':

 

1 - Strip stretches the skin, rather than removing the hairs. Thus, you automatically achieve a spreading out of the hair grafts (and the gaps inbetween) which is perfectly distributed, whereas with FUE this depends on the skill of the surgical team and can never be perfect.

 

2 - It's possible that strip lifts the nape slightly to reduce the overall area that hair has to cover....

 

Essentially, the limiting factor with FUE seems to be when the hair starts to approach the 'moth eaten' appearance - in other words too many grafts were extracted from a specific region. This could be caused by any one of 1 or 2 above - generally I think surgeons are getting better at taking increasing number of grafts out in even distributions to increase the possible yield with FUE.

 

I do still believe that carried out perfectly, an FUE should mathematically have the same potential yield as strip. Of course it doesn't, and maybe it's not possible to carry out a perfect FUE - but I think surgeons continue to improve and will get closer to strip yields over time.

[England]

I was actually curious about extraction patterns of FUE vs Strip so I whipped this up in paint:

 

Top row (1-3) is FUE, bottom row (4-5) is strip.

 

Left boxes on both rows (1 and 4) are a normal head of hair - I think it has roughly 2,500 hairs on it.

 

Box 2 (FUE) is the result of extracting 1 out of every 2 hairs in each 'row' of hair, in an even way and trying not to leave gaps or patterns (believe it or not - try it if you don't believe me).

 

Box 5 (Strip) is the result of removing half of the 'rows' of hairs (as per a strip) - and evenly distributing the rest.

 

You can clearly see that strip appears more even and dense, despite the exact same number of grafts being removed. Thus, when FUE surgeons try to extract grafts evenly - it is almost impossible for them to achieve the density appearance of strip.

 

Box 3 is an interesting one. Instead of removing 1 in every 2 grafts, I removed every other ROW (leaving the same number of grafts as Box 2). You can see that it looks far more dense, and the same as the strip. Perhaps this very unscientific experiment suggests that the best way to reduce the 'moth eaten' look with FUE is to extract in 'rows' rather than trying to pick and choose dots like I did in box 2...

 

Food for thought anyway.

 

[SugarHighs]

Can someone who has had one FUE session, then later have strip? Or will the scarring from the FUE cause problems with the area that is to be taken out for strip?

[England]

I believe so - I was told that I could have a strip and another FUE in any order, by 2 separate surgeons.

 

Cheers

[mattj]

Can someone who has had one FUE session, then later have strip? Or will the scarring from the FUE cause problems with the area that is to be taken out for strip?

 

You can definitely have a strip procedure after FUE. Obviously the total number of follicles within the strip will be lower due to the FUE extractions, but high-graft procedures are still very possible.

[RCWest]

Certainly someone could have strip done after maxxing out FUE, but that is counterproductive and going completely against what was trying to be accomplished in the first place (trying to avoid a linear scar). IMO the donor would look more even in the end after doing strip first, then FUE to finish, than it would to max out FUE, then try to do strip.

[England]

Certainly someone could have strip done after maxxing out FUE, but that is counterproductive and going completely against what was trying to be accomplished in the first place (trying to avoid a linear scar). IMO the donor would look more even in the end after doing strip first, then FUE to finish, than it would to max out FUE, then try to do strip.

 

I disagree.

 

If you don't know what your future loss will hold, or are hoping that some kind of medical breakthrough happens before your loss gets too severe, trying FUE first may be a sensible approach - that way you leave yourself the option of not having a scar.

 

It makes little difference IMO whether you do strip or FUE first - if you strip first your hair is thinned already by the strip so FUE yield and risk of gaps is larger, exactly the same as if you do FUE first.