Jump to content

The pros/cons of FUE. Myths dispelled.


Mickey85

Recommended Posts

 

What we are now discussing as a disadvantage of FUE is the long-term survival and characteristics of FUE grafts taken from the scalp for large transplants relative to the long-term survival and characteristics of FUT grafts taken from the scalp for large transplants -- the disadvantage of FUE in this context stemming from the necessity to take many of such grafts from above and below the "sweetest" zone within the safe zone where the best quality, most DHT-resistant follicular units within the safe zone are found.

if u take grafts from an area that is not resistent to DHT it will make no difference if they are from FUT or FUE so what exactly is ur point?

 

are you implying that those who have had FUE have grafts that are likely to fall out sooner then if they were taken via FUT?

Link to comment
Share on other sites

  • Senior Member
if u take grafts from an area that is not resistent to DHT it will make no difference if they are from FUT or FUE so what exactly is ur point?

 

are you implying that those who have had FUE have grafts that are likely to fall out sooner then if they were taken via FUT?

 

Please first read my four (4) posts on page 2 of this thread, then please re-read my posts on this page (p. 3) of the thread (I apologize for the inadvertent double post on this page).

 

The short answer is that much of the scalp hair transplanted in large numbers via FUE is at greater risk of thinning, miniaturizing, or dying in the ensuing years than scalp hair transplanted via FUT, and/or is at greater risk of doing so more quickly, because many of those grafts will have been taken from less optimal regions of the safe zone than grafts taken via strip. Why? Because for the same number of grafts, FUE will involve a much larger area of the donor than strip. The thousands of punch excisions must be spread out over a large area in order to avoid over-harvesting of any given area of the donor.

 

That is how it was explained to me. I doubt whether the risk of more or faster DHT-related effects on FUE grafts v. FUT grafts under these circumstances can be quantified, but the risk is there. ALL head hair on males with MPB is susceptible to some effects of DHT over time, including hair in the safe zone. It is just that hair in the safe zone is more resistant to DHT and its worst effects and for a longer period of time than non-safe zone hair. And the best of the best, most robust and DHT-resistant hair in the safe zone is located in a relatively small channel of it, where FUT grafts are taken from. FUE in large numbers doesn't have the luxury of confining itself to that very best section of the donor.

 

Whew! :)

Link to comment
Share on other sites

]

The short answer is that much of the scalp hair transplanted in large numbers via FUE is at greater risk of thinning, miniaturizing, or dying in the ensuing years than scalp hair transplanted via FUT, and/or is at greater risk of doing so more quickly, because many of those grafts will have been taken from less optimal regions of the safe zone than grafts taken via strip. Why? Because for the same number of grafts, FUE will involve a much larger area of the donor than strip. The thousands of punch excisions must be spread out over a large area in order to avoid over-harvesting of any given area of the donor.

thats quite an ASSUMPTION ur makn there. and considering beard and body hairs are no where near any area that is subject to DHT id say ur wrong.

 

FUE doctors can take all the grafts they will need from the safe area (either head or body) and have been for the last 10 years or so now so again ur assumption that grafts will be extracted from an area they should not be extracting from is like saying "If FUT doctors took a strip from an area thats outside the safe zone the grafts would eventually be subject to the effects of DHT". thats quite obvious isnt it?

 

and not to mention the "Safe zone" for FUE is wherever the doctor wants to remove the grafts from vs. strip where they have to be taken from one particular area so if that particular area is subject to DHT (like you stated) then based on ur theory or the theory that was explained to you then all the hairs in that area would eventually fall out. thats just not happening.

 

it sounds more like an FUT doctor tryn to cast doubt on a technique that he is either not comfortable, has little experience with or doesnt want to perform because FUT is more profitable to him.

 

lets face it there are quite a few doctors that have been performing FUE for nearly a decade now and if what you are saying was so their patients would be posting their complaints. I have yet to see any FUE patients complain that their newly transplanted grafts are now falling out.

 

I doctor can theorize anything he wants but unless there are numerous cases to back up his opinion id say he's just blowing smoke....:rolleyes:

Link to comment
Share on other sites

  • Senior Member

GNX1,

 

You obviously are sold on FUE, GNX1, and that's fine. Nevertheless, when actual ht docs tell me

(1) there are better parts of the safe zone than others, (2) that the safest of the safe grafts are located in the heart of the safe zone where the strip is taken from for an FUT transplant, and (3) grafts taken from above and below the heart of the safe zone, as must be done with large FUE scalp hair transplants, aren't as safe as the patient ages as grafts taken from the heart of the safe zone, that is information that I do not dismiss out of hand. If other Coalition or recommended docs dispute that information, then, of course, we will revisit the issue and try to sort it out. As of today, though, I personally would include this information in Mickey85's FUE "disadvantages" list.

Link to comment
Share on other sites

GNX1,

 

You obviously are sold on FUE, GNX1, and that's fine. Nevertheless, when actual ht docs tell me

(1) there are better parts of the safe zone than others, (2) that the safest of the safe grafts are located in the heart of the safe zone where the strip is taken from for an FUT transplant, and (3) grafts taken from above and below the heart of the safe zone, as must be done with large FUE scalp hair transplants, aren't as safe as the patient ages as grafts taken from the heart of the safe zone, that is information that I do not dismiss out of hand. If other Coalition or recommended docs dispute that information, then, of course, we will revisit the issue and try to sort it out. As of today, though, I personally would include this information in Mickey85's FUE "disadvantages" list.

show me the patients that are complaining about their grafts falling out or thinning due to FUE. otherwise you know wat they say about opinions....:rolleyes:

 

actual hair doctors tell me. thats like saying "I hear this is true". lets see the evidence.

Link to comment
Share on other sites

  • Senior Member
No, no, no, Mickey. I'm not talking about FUE docs taking grafts outside the safe zone. I'm talking about FUE docs, when doing large transplants, necessarily taking many of the grafts from outside the BEST PART of the safe zone. The grafts still come from what is technically within the safe zone, but many don't come from that "sweet spot" of the safe zone -- the very best part of the safe zone, which is where the strip is taken from for FUT. That "sweet spot" within the safe zone is where the best, most robust, most DHT-resistant follicular units reside and comprises a rectangular "strip" about 1.5 inches or so high that runs smack across the part of the safe zone having the greatest density and thickest caliber hairs, which are the also the last hairs to be compromised by the effects of DHT over a lifetime.

 

Above and below that sweet spot are areas still technically within the safe zone, but as it was explained to me, follicular units residing in those areas are less safe from being at least partially compromised by DHT over the long haul than those that come from the optimum part/best part/sweet spot of the safe zone. In other words, "safe" is a relative term when discussing the safe zone, and not all follicular units within the safe zone are equally safe. Think of the cartoon image of the bald guy with only a solid strip of hair remaining, running across the back of his head. That "strip" (I'm using that term differently than how we think of strip) is the sweet spot of the safe zone. That is where all follicular units are taken from for FUT, but you can't do that all the grafts from that "strip" for large FUE transplants because that would result in an obviously depleted "strip" of donor area that looked moth-eaten if not nearly devoid of hair with lots of very close together punctate scarring. In other words, over-harvesting of a confined area. That is why with every large session FUE transplant we see post-op excisions all over the back and sides, stopping north just shy of the crown and stopping south just shy of the nape. Even thought all those grafts came from within the "safe zone," many came from above and below the sweetest part of the safe zone.

 

Anyway, as it was explained to me by a Coalition doc, that is one of the "cons" of FUE. The grafts taken from above and below the sweetest part of the safe zone may never thin or die, but there is a greater chance they will than those taken from that sweetest spot -- which is where all FUT grafts are taken from. I hope all that made sense. :)

 

ahhh i understand now. i have never heard of that before. not saying the doc is lying, but i will ask some other docs to validate this claim. i know the nape area is prone is loss over time but never heard of the mid section having degrees of safety. interesting. curious as to which doc told you this. i have heard many tall tales about fue by various docs, either pushing Fue or downplaying it. not saying this is the case here but id like some more opinions.

Link to comment
Share on other sites

  • Senior Member
ahhh i understand now. i have never heard of that before. not saying the doc is lying, but i will ask some other docs to validate this claim. i know the nape area is prone is loss over time but never heard of the mid section having degrees of safety. interesting. curious as to which doc told you this. i have heard many tall tales about fue by various docs, either pushing Fue or downplaying it. not saying this is the case here but id like some more opinions.

 

I'm with you, Mickey85. I'd be very interested to know what other docs have to say about this and whether there is a consensus as to its validity or not and a cause for concern many years down the road.

Link to comment
Share on other sites

If FUE was brand new I could see someone making that claim as a possibility but its been around for quite some time now with thousands of patients from around the world and none of them are complaining that because they received FUE their hairs are now falling out and minaturizing.

 

if that was so we would have surely heard about it by now.

 

there is simply no evidence to support that claim. in theory anyone can say anything but until there are patients complaining of such then its just speculation.

Link to comment
Share on other sites

  • Senior Member

i do believe fue was a progression from fut in that it eliminated alot of the complications that stoll plague fut today. fue is not perfect however and the closest thing to perfection will be hair cloning as the donor area will remain 99.99 percent untouched. however i favor fue for all norwood patterns upto 3 or 4 if the donor allows.

Link to comment
Share on other sites

  • Senior Member
If FUE was brand new I could see someone making that claim as a possibility but its been around for quite some time now with thousands of patients from around the world and none of them are complaining that because they received FUE their hairs are now falling out and minaturizing.

 

if that was so we would have surely heard about it by now.

 

there is simply no evidence to support that claim. in theory anyone can say anything but until there are patients complaining of such then its just speculation.

 

If you don't mind me saying so, you are sounding a bit proprietary and defensive about fue. There is no need to. A reasoned, dispassionate discussion of advantages and disadvantages of fue is, I believe, what Mickey85 was after when he started this thread. He specifically asked members here to add to the "disadvantages" list he had compiled if we were aware of any. In that spirit, I shared a disadvantage in the view of a Coalition doc, which was conveyed to me during a consultation. I was careful to point out that this "disadvantage," if valid, amounted only to an increased risk of earlier graft miniaturization and that this greater risk (if it exists) is unquantified and probably unquantifiable. Both Mickey85 and I would like to determine whether other docs share the view that was conveyed to me.

 

Factually, I would disagree with the anecdotal "test" you advocate to prove or disprove the validity of the theory or concern. FUE has been actively performed by substantial numbers of ht docs for barely a decade, maybe less. Many, if not the majority of the patients who have received FUE during this time period are younger -- in their twenties or thirties -- because today's younger generations favor the option of close cropped hairstyles and because, until relatively recently, FUE was mostly done in small sessions and therefore was appropriate mostly for younger patients who had not experienced higher Norwood hair loss. Age-related miniaturization of transplanted grafts likely would not yet have manifested in many, if not most of these patients. Don't forget: some miniaturization/thinning of transplanted grafts will likely occur as the patient ages, whether the grafts were harvested via FUT or via FUE. Why? Because virtually every man's hair begins to thin once he passes middle age, even the hair in his "safe zone." Ordinarily, the hair in the safe zone thins later and less than hair elsewhere on the scalp, but it does usually, eventually, thin out (which is why the linear scar of FUT can sometimes become an issue as men reach a more advanced age).

 

The question on the table, then, is whether there is such as thing as a "sweet spot" of the safe zone as I've described it and whether men's hair outside this sweet spot (but still within the safe zone) generally thins sooner and/or more than hair within that sweet spot. If the answer to that question is "yes" -- a question that only ht docs and dermatologists could answer, so far as I know -- then it follows that hair taken from outside that so-called sweet spot (if it exists) would be at an increased risk of thinning/miniaturizing sooner and/or more than hair taken from within that so-called sweet spot. If that is true, then it would follow that large-number FUE transplants carry a risk that many of the transplanted hairs will thin/miniaturize sooner and/or more than if the same number of hairs had been transplanted via FUT. How much sooner and how much more could turn out to be insignificant in the context of a patient's lifetime, or not, but I am certainly interested to know the answer.

 

So why don't we see what the docs have to say?

Link to comment
Share on other sites

  • Senior Member
Still waiting for dr's to comment on this thread. Hopefully a lot of questions will be answered.

 

Sadly most doctors who practice FUE on a very regular basis(I'm talking 50% of their practice of more like Umar, Feriduni, Bisanga, Lorenzo) do not post on the forums other than to post results.

Link to comment
Share on other sites

If you don't mind me saying so, you are sounding a bit proprietary and defensive about fue. There is no need to. A reasoned, dispassionate discussion of advantages and disadvantages of fue is, I believe, what Mickey85 was after when he started this thread. He specifically asked members here to add to the "disadvantages" list he had compiled if we were aware of any. In that spirit, I shared a disadvantage in the view of a Coalition doc, which was conveyed to me during a consultation. I was careful to point out that this "disadvantage," if valid, amounted only to an increased risk of earlier graft miniaturization and that this greater risk (if it exists) is unquantified and probably unquantifiable. Both Mickey85 and I would like to determine whether other docs share the view that was conveyed to me.

 

Factually, I would disagree with the anecdotal "test" you advocate to prove or disprove the validity of the theory or concern. FUE has been actively performed by substantial numbers of ht docs for barely a decade, maybe less. Many, if not the majority of the patients who have received FUE during this time period are younger -- in their twenties or thirties -- because today's younger generations favor the option of close cropped hairstyles and because, until relatively recently, FUE was mostly done in small sessions and therefore was appropriate mostly for younger patients who had not experienced higher Norwood hair loss. Age-related miniaturization of transplanted grafts likely would not yet have manifested in many, if not most of these patients. Don't forget: some miniaturization/thinning of transplanted grafts will likely occur as the patient ages, whether the grafts were harvested via FUT or via FUE. Why? Because virtually every man's hair begins to thin once he passes middle age, even the hair in his "safe zone." Ordinarily, the hair in the safe zone thins later and less than hair elsewhere on the scalp, but it does usually, eventually, thin out (which is why the linear scar of FUT can sometimes become an issue as men reach a more advanced age).

 

The question on the table, then, is whether there is such as thing as a "sweet spot" of the safe zone as I've described it and whether men's hair outside this sweet spot (but still within the safe zone) generally thins sooner and/or more than hair within that sweet spot. If the answer to that question is "yes" -- a question that only ht docs and dermatologists could answer, so far as I know -- then it follows that hair taken from outside that so-called sweet spot (if it exists) would be at an increased risk of thinning/miniaturizing sooner and/or more than hair taken from within that so-called sweet spot. If that is true, then it would follow that large-number FUE transplants carry a risk that many of the transplanted hairs will thin/miniaturize sooner and/or more than if the same number of hairs had been transplanted via FUT. How much sooner and how much more could turn out to be insignificant in the context of a patient's lifetime, or not, but I am certainly interested to know the answer.

 

So why don't we see what the docs have to say?

a discussion yes I agree. u were not making it a discussion. u were saying it as tho it is fact as being a disadvantage. a fact that is not supported by any evidence so ur comments are misleading to those who dont know better.

 

most everything Mickey stated is true and possible and I agree with. what you stated has not been substantiated by anyone and since its been around for a decade now we would have surely heard of this complaint or issue by now since there has been thousands of FUE patients from all over the world.

 

its not happening nor is anyone complaining that its happening so again ur comments are not supported by evidence other then some HT doctor trying to speculate and turn ppl away from FUE cause he or she doesnt perform FUE on a regular basis which means its simply conjecture and nothing else.

 

no one is being defensive when u make claims that have ZERO evidence to support them. there just calling them BS thats all.

 

just like claims were made at one time by FUT doctors that BHT would not take in the head and would not grow any longer then they would where they were taken from. that has been proven to be BS cause the body hairs grow much longer in the scalp then they do from the chest or legs or wherever they were takn from.

 

which coalition doctor was it and do they have a great deal of experience with FUE?

Link to comment
Share on other sites

  • Senior Member

i would like to know which coalition doctor it was also. i have heard many tall tales abput fue mostly negative which were not true. one doctor told that it is more 'brutal' and traumatic on the donor than fut and that he has not spoken to one fue doctor that disagrees which was an absolute lie. several fue/fut docs have told me it is less invasive and less traumaric. the deep cutting of the scalp and tissue with a scalpel is a thousand times more invasive(figure of speech but still much more traumatic). this doctor also happened to practise both procedures although strongly favors fut and rarely performs fue. nor saying the coalition doc is lying but more research needs to be done.

Link to comment
Share on other sites

  • Regular Member

Mickey85, thanks for putting together very useful information on FUE. If you can also put together the list of best doctors for FUE in the US and outside the US that should be useful for a lot of patients too. There are several senior members like yourself on this forum, and you probably may have an idea of the best doctors for FUE. Thanks a lot for your help to this community.

Link to comment
Share on other sites

  • Senior Member
Mickey85, thanks for putting together very useful information on FUE. If you can also put together the list of best doctors for FUE in the US and outside the US that should be useful for a lot of patients too. There are several senior members like yourself on this forum, and you probably may have an idea of the best doctors for FUE. Thanks a lot for your help to this community.

 

best fue doctors are Lorenzo in Spain, Bisanga in Belgium, Feriduni in Belgium, Erdogan in Turkey and that is basically it. there is a big gap between those that are excellent at fue and those that are merely ok at it. many might disagree but i challenge them to show me. a North American doctor who produces constant fue results that even come close to rivaling the aforementioned European doctors. This is just my assertion and opinion. Many will disagree with me for many reasons and that is totally fine. Some may take it as an attack on US and Canadian surgeons which it isn't, it is just my sentiment that the North American doctors have remained within their comfort zone in regards to FUE. Some use it merely to fill in slight hairline recession and some don't get great yields with it at all or both. The European doctors have embraced FUE as more than a supplementary method to FUT. Alot of European Doctors believe FUE can be an exclusive procedure for anyone up to a Norwood 3 or 4. The aforementioned Doctors also practice FUE at at least 50% of the time(Lorenzo is FUE exclusive) where someone like Rahal practices it 20-25% of the time which he mentioned in an interview recently. There is one US Doctor who I am uncertain about with FUE who practices is exclusively also and developed the manual tools that Bisanga, Feriduni and Lorenzo use and also trained Bisanga and Mwamba at FUE but I have to do more research on how good he actually is at FUE itself.

Edited by Mickey85
Link to comment
Share on other sites

  • Senior Member
Thanks for your response, Mickey. I saw somewhere that 0.75mm punch is the latest that successful FUE doctors are using. That probably makes the results looks more natural.

 

Hmmm punch that size would make transection(especially of 3-4 hair grafts) higher. .75mm-.8mm would accommodate for single hair grafts and possibly 2 hair grafts depending on the patients hair caliber. But one size does not fit all. The honest clinics will tell you they use a range of punches usually ranging from .75mm to 1.00mm with a few inbetween. Just my opinion. Question everything, that's all I will say. If it sounds too good to be true, it usually is too goo to be true. I have heard of 'pencil thin' FUT scars and 1mm scars... But have very rarely seen them. I have heard of ludicrous claims(from a rep) that one particular surgeon's FUE yield was basically 5% off his FUT yield which is a total fabrication. I have heard one surgeon say FUE is more 'brutal' on the donor than FUT and he hasn't met a FUE surgeon yet that disagrees...I guess he hasn't spoken to any FUE docs out there who specifically state it is less invasive.

 

Ever notice that when a scar closure is excellent or graft yield is high it's because "We use a state of the art triple layer closure" or "The techs meticulously dissect the grafts and handle them with the utmost care" but when things go wrong it's "That's just how some patients heal" or "It's his physiology". I have been accused by one member on here for having a 'skewed perspective"(a way of discrediting my statements) because I have depression but I challenge and welcome him and anyone else to debunk what I say. If I am wrong, point out where I am wrong. If my perspective is 'skewed" or distorted, point out WHERE and WHY. Simply because I have strong and opposing views than those who believe all is dandy does not make my opinions any less valid.

Edited by Mickey85
Link to comment
Share on other sites

  • Senior Member
Mickey, any reason you left of Dr. Keser from your recommended list of FUE doctors in Turkey?

 

From the little results that I have seen, his yield with FUE is great, better than most of the North American doctors, however he does have the 'ethics's of some of the notorious North American doctor's when it comes to dense packing nw1s and 2s with 2,000+ grafts into the frontal third(or less) and takes hair well out of the safe zone. I think his hairlines are amazing though. Again I think his yield is excellent and but I would need to see more varied cases of higher Norwood patterns before I could recommend him. Very little is known about him in general. It's the same reason I don't recommend Dr. Hakan(although his results are also amazing) and Dr. Eser(the one result I have seen is stellar). More cases from both patients and clinic would need to be shown for me to recommend with solid conviction.

Link to comment
Share on other sites

  • Senior Member
Thanks for your response, Mickey. I saw somewhere that 0.75mm punch is the latest that successful FUE doctors are using. That probably makes the results looks more natural.

 

Like Mickey stated, most clinics use several different sized punches during an FUE procedure. I'd say most are probably between 0.75 mm to 0.9 mm. Of course, there are exceptions - like Dr. Gho using 0.5-0.6 mm punches during his "donor doubling" procedures and devices like the ARTAS currently utilizing a 1.0 mm punch.

"Doc" Blake Bloxham - formerly "Future_HT_Doc"

 

Forum Co-Moderator and Editorial Assistant for the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum

 

All opinions are my own and my advice does not constitute as medical advice. All medical questions and concerns should be addressed by a personal physician.

Link to comment
Share on other sites

  • Senior Member
Like Mickey stated, most clinics use several different sized punches during an FUE procedure. I'd say most are probably between 0.75 mm to 0.9 mm. Of course, there are exceptions - like Dr. Gho using 0.5-0.6 mm punches during his "donor doubling" procedures and devices like the ARTAS currently utilizing a 1.0 mm punch.

 

I personally don't see how Dr. Gho is getting away with .5 to .6mm punches whilst not transecting the follicle. To exacerbate the situation, he claims he only disects a section of the follicle, with no optical assistance whatsoever(blind extraction, cannot see under the scalp ala FUE). I'm very skeptical about his procedure.

Link to comment
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
×
×
  • Create New...