FUE working system?

[MAGNUMpi]

I was wondering why if the downsides of FUE seem to come from the fact that the grafts are out in the air too long and possible transections why don't the doctors work like this:

1. Do 100-200 grafts (lets say)

2. take a break while assistants place those grafts

3. do 100-200 more etc.

 

This would reduce the time the grafts are out in the open and also because the doctor would be better rested it would cut down on mistakes and transections.

 

Seems simple. What do you guys think?

[Mickey85]

most great fue doctors do actually do this Feriduni told me they extract about 500 grafts, insert them, extract 500 more, insert etc. some have unfortunately not caught on to this method and their results may suffer especially with large quantities.

 

the downsides of fue have been greatly exagerated by clinics who either dont perform the method, cant perform or dont want to perform it. even doctors like feriduni and bisanga who still are 50/50 fut/fue have no problem doing cases of 2000+ even 3000 donor permitting. everyone keeps saying 'fut and fue have their pros and cons' but they rarely elaborate and when they do they always bring up the yield aspect but never acknowledge the multiple disadvantages that fut exhibits which are yield related (transection during strip incision, dormant grafts in the strip discarded, transection via human error).

Edited February 21, 2013 by Mickey85

[MAGNUMpi]

Yea it seems smart. I read so many of these write ups and it's always " the doctor took all the grafts out, then we took a break, then the assistants placed them, end day".

 

even doctors like feriduni and bisanga who still are 50/50 fut/fue have no problem doing cases of 2000+ even 3000 donor permitting.

 

I for instance need about 2000+ grafts now for hairline (NW3 A) but I've had 2 Doctors tell me I will probably progress to NW5 in time. They said I have good donor density and should have enough grafts to cover everything I might need. Should I go for FUE knowing I will need more in the future?

[Mickey85]

Yea it seems smart. I read so many of these write ups and it's always " the doctor took all the grafts out, then we took a break, then the assistants placed them, end day".

 

 

 

I for instance need about 2000+ grafts now for hairline (NW3 A) but I've had 2 Doctors tell me I will probably progress to NW5 in time. They said I have good donor density and should have enough grafts to cover everything I might need. Should I go for FUE knowing I will need more in the future?

 

Are you on proprecia without any side effects? Has your hair held up for quite some time?

 

From our conversations I remember you telling me you were in your late 30s-early 40s(I could be wrong), your hairloss is not bad at all for your age, this is coming from a guy in his late 20's with minimal recession. You certainly have many options before you that people of younger age/higher Norwood patterns simply do not.Let's say you went for 2,000 for the hairline, you could very easily obtain another 1,000 at the very least(being ultra conservative) via FUE. It wouldn't be impossible to obtain 4,000 grafts for a good donor. The options you do have revolve around what kind of hairline you are after. If you want to be cautious about future loss, a conservative hairline would be wise. Planning for potential future loss is important. I have seen patients blow out 5,000 on the frontal third alone(They go to an aggressive doctor like Armani and have a failed procedure so they go to another aggressive doctor for repair).. Those guys are truly digging themselves a hole.

 

When you say "should I go in for FUE knowing I will need more in the future", the same thing would apply for FUT. They both diminish your eligible donor supply. Would you get more grafts total by combining FUE and FUT? Undoubtedly. Regardless of what certain clinics may tell you, an FUT procedure is viable even after your have undergone FUE, just as FUE is viable once undergoing FUT. You have options, you have contingency plans.

 

You are also correct in hearing many patients say "The Doctor extracted X,000 grafts and made the incisions and then the techs implanted them". I'm no expert, but this could be a strong factor as to why some FUE results do not work out. The top FUE Docs I have spoken to all extract a small amount first then implant. There are alot of clinics(even world class, have won awards etc) who do not take all the proper precautions. Some strip doctor's pay no attention to the scalp tension and do not accommodate the strip width accordingly, as a result, it can stretch. Or they pay no attention to their suturing technique and end up killing hair around the scar due to too much tension and/or strangulation of surrounding grafts. Some clinics blame the FUE method and not their own tools and abilities, not taking into account punch gauge being too small for 3-4 hair grafts or the heating of the motorized tool affecting their ability to feel when the punch is made blunt and needs replacing. This attributes(or lack of) are what separates excellent Doctors like Hasson, Bisanga, Lorenzo, Feriduni from merely good doctors.

[MAGNUMpi]

the same thing would apply for FUT. They both diminish your eligible donor supply.

But isn't it true that you can get more grafts with FUT in general than FUE or is that just factoring in the possible lower FUE yield? Thanks man.

[Mickey85]

that part may be true, especially if fut is used exclusively such as jotronic. Joe would most likely not be able to obtain 10000 grafts via fue alone. however scalp laxity is in Joe's favor as even dr. wong said Joe has super-natural scalp laxity(not exact words) so it would not mean everyone could get the same amount. Joe has had 4 strip surgeries at the very least, alot of people would not be able to have 4 strip surgeries. but in general yes you would get more out of strip if you compared each method independantly if scalp laxity provides for it.

[michaeljames]

I was wondering why if the downsides of FUE seem to come from the fact that the grafts are out in the air too long and possible transections why don't the doctors work like this:

1. Do 100-200 grafts (lets say)

2. take a break while assistants place those grafts

3. do 100-200 more etc.

 

This would reduce the time the grafts are out in the open and also because the doctor would be better rested it would cut down on mistakes and transections.

 

Seems simple. What do you guys think?

 

Hello Magnumpi;

 

This is a great question regarding the use of FUE. Of course you are most aware that the shear human demand on physician and medical technicians makes reducing the number of grafts a feasibility issue for some doctors. ISHRS now has a committee specifically researching issues regarding FUE. Also the chairman of that committee Dr. Parsa Mohebi (I work for him) has done studies on the viability of grafts outside the body in an effort to find an optimum time between extraction and implantation. I think you may request that he join this thread and provide his insights on this. He is recommended on this forum here:

[Jotronic]

that part may be true, especially if fut is used exclusively such as jotronic. Joe would most likely not be able to obtain 10000 grafts via fue alone. however scalp laxity is in Joe's favor as even dr. wong said Joe has super-natural scalp laxity(not exact words) so it would not mean everyone could get the same amount. Joe has had 4 strip surgeries at the very least, alot of people would not be able to have 4 strip surgeries. but in general yes you would get more out of strip if you compared each method independantly if scalp laxity provides for it.

 

I've actually had six FUT surgeries when you factor in the two surgeries I had that Dr. Wong repaired. I had two donor scars stacked one above the other. Not pretty.

 

No, I would not be able to get 10K plus grafts via FUE and quite frankly neither would most anyone else with zero evidence of surgery. There are a few out there but they are would have mutant density like I have "mutant laxity" (the exact quote by Dr. Wong;)).

 

Most people would not need four surgeries like me. My first with Dr. Wong was in March 2002 and the two donor scars and the era itself limited what could be taken. A virgin scalp patient today can get 4000 to 5000 grafts in one session assuming average laxity and average density of the donor zone. A second session would probably pull 2500 to 3000 grafts. The average patient will have 8000 to 9000 grafts available over "x" number of procedures.

[GreatPelo]

MAGMUNpi,

 

Take your time researching which option is best for you. If you visit ishrs.org (click on articles and then find the one on FUE) you will get a great deal of independent information. Then, try finding a clinic that offers both options, considering a clinic that only performs one will promote that specific option.

 

The main benefit of the FUE is if you're going to wear a tight hairstyle (whether you're a military lifer or just don't want to lose the option of a tight hair style). When it comes to transection, the higher yield will be the FUT "strip" method considering you are separating grafts under microscopes compared to the FUE method which is a blind harvest (meaning you have to guide yourself by the direction of the hair when harvesting, not allowing you to obviously see under the scalp to find the follicle). BOTH methods leave scarring....a linear scar compared to small, round scars (round, small scar all less noticeable with tight hairstyles). However, if a patient is going to need more than one surgery, FUE might create a difused look in the donor area, compared to the Strip, being performed by a skilled surgeon, leaves one line but the rest of the area is as full as when you were born.

 

Just a few thoughts....good luck in your research.

[Mickey85]

MAGMUNpi,

 

Take your time researching which option is best for you. If you visit ishrs.org (click on articles and then find the one on FUE) you will get a great deal of independent information. Then, try finding a clinic that offers both options, considering a clinic that only performs one will promote that specific option.

 

The main benefit of the FUE is if you're going to wear a tight hairstyle (whether you're a military lifer or just don't want to lose the option of a tight hair style). When it comes to transection, the higher yield will be the FUT "strip" method considering you are separating grafts under microscopes compared to the FUE method which is a blind harvest (meaning you have to guide yourself by the direction of the hair when harvesting, not allowing you to obviously see under the scalp to find the follicle). BOTH methods leave scarring....a linear scar compared to small, round scars (round, small scar all less noticeable with tight hairstyles). However, if a patient is going to need more than one surgery, FUE might create a difused look in the donor area, compared to the Strip, being performed by a skilled surgeon, leaves one line but the rest of the area is as full as when you were born.

 

Just a few thoughts....good luck in your research.

 

That is true but strip also obliterates the natural direction and angle of the donor area, sometimes quite abruptly. It also eradicates the smooth transition of courser, mutli-hair grafts in the middle of the donor to the finer, single hair grafts toward the bottom of the donor. These two important facts are always evaded when FUT clinics say "the only difference is the kind of scar" when comparing the two methods..

[michaeljames]

MAGMUNpi,

 

Take your time researching which option is best for you. If you visit ishrs.org (click on articles and then find the one on FUE) you will get a great deal of independent information. Then, try finding a clinic that offers both options, considering a clinic that only performs one will promote that specific option.

 

The main benefit of the FUE is if you're going to wear a tight hairstyle (whether you're a military lifer or just don't want to lose the option of a tight hair style). When it comes to transection, the higher yield will be the FUT "strip" method considering you are separating grafts under microscopes compared to the FUE method which is a blind harvest (meaning you have to guide yourself by the direction of the hair when harvesting, not allowing you to obviously see under the scalp to find the follicle). BOTH methods leave scarring....a linear scar compared to small, round scars (round, small scar all less noticeable with tight hairstyles). However, if a patient is going to need more than one surgery, FUE might create a difused look in the donor area, compared to the Strip, being performed by a skilled surgeon, leaves one line but the rest of the area is as full as when you were born.

 

Just a few thoughts....good luck in your research.

 

Hello GreatPelo,

 

You are getting some good advice here on doing your research. I would like to contribute that many patients are experiencing reduce scarring with 'Strip Method' FUT. Special methods of closing wound along with utilizing FUE and SMP post the initial surgery may make this type of surgery a good option even if one is concerned about the scarring. The top surgeons can do a lot surgically and post surgically to render the scar almost undetectable. All the Best, Michael