The pros/cons of FUE. Myths dispelled.

[s2thoudriver]

Hi Mickey85

 

Great thread here. I've been watching and reading in the background to get a good perspective all round on the various points.

 

It appears that there is certainly a shift more towards FUE and people are starting to listen to the points i (and yourself) have been discussing over the last year.

 

Even previous FUT strong believers are now moving away from 'promoting' FUT.

 

One major factor that people seem to overlook in these FUE/FUT discussions is the clinic/surgeons business motivations for promoting FUT/FUE.

 

As you are aware, i am a clear advocate of good FUE, due to extensive research, discussions and personal positive FUE experience and stongly believe that FUT has had it's day, but there are still those who promote such practices and risk scarring patients for life.

 

One thing to think about is that FUT is less times consuming for a surgeon, they cut the strip and hand it to technicians for discection. As such, more procedures can be completed, hence overall more profit.

 

For FUE, individual extractions are performed by the surgeon (provided the patient pays for their time), which is both more labour intensive for the surgeon and as a result, more costly for the patient.

 

Surgeons may also not want to invest in FUE tools and training so continue to promote FUT if they are more comfortable with it and get the results..

 

This is not a 'point the finger' post, simply an observation from a business perspective.

 

In terms of "you get more grafts with FUT than FUE" that gets discussed, you only get as many grafts as are extracted, regardless of method.

 

Keep up the good thread.

 

Rob

 

[Mickey85]

Great to have your input on here Rob. Your case certainly was a breakthrough and put to rest the notion that FUE is only good for slight recession. You got yours done for even cheaper than FUT costs in North America which is even more mindblowing.

 

I'm pro-FUE and do believe FUE can be a replacement to FUT, but if a patient does thorough research and decides FUT is best for them, more power to them. But I won't have surgeons going around saying FUE is only good for temple restoration or 1,000 grafts when it is abundantly clear that FUE can treat most Norwoods and has less drawbacks.

 

There has been a strong change in this forum, before it was FUT orientated but as of lately, it has swung toward FUE with some great FUE surgeons being added and members that have decided that FUE is the way to go for them. Where before it was in the minority.

[KO]

Do you think FUE's ability to focus on selecting triples and quadruple haired grafts is responsible for results like this:

 

 

http://www.youtube.com/watch?v=wwpD4xdo8xQ&list=PLE576692115C0EF0B&index=51&feature=plpp_video

 

If this is a regular thing...then I need to go visit Dr Lorenzo.

[Mickey85]

KO, definitely. Also Lorenzos extraction method is amazing. I compared his extraction method to another pretty well known fue surgeons method and the difference in the finese(spelling) and handling wqs staggering. And they were both using manual punches. Ill send you the videos. Lorenzo used the fewest turns possible from the manual punch and pulls the skin around the graft while extracting with forceps so that the pressure is not all on the graft. I do believe what you see with Lorenzo is quite possibly the best yield you can get with any method. The fact that the video you posted was done with only 6100 grafts shows this. Many other clinics would have needed 7000+ for the same patient.

[Levrais]

Nice work. Especially the crown whorl

[Nick153452]

The main reason I don't do FUE is due to price.. If I could get the same price for FUE as I can for FUT, I would be all over it.

[KO]

KO, definitely. Also Lorenzos extraction method is amazing. I compared his extraction method to another pretty well known fue surgeons method and the difference in the finese(spelling) and handling wqs staggering. And they were both using manual punches. Ill send you the videos. Lorenzo used the fewest turns possible from the manual punch and pulls the skin around the graft while extracting with forceps so that the pressure is not all on the graft. I do believe what you see with Lorenzo is quite possibly the best yield you can get with any method. The fact that the video you posted was done with only 6100 grafts shows this. Many other clinics would have needed 7000+ for the same patient.

 

Fascinating. Just looking at these videos, it's incredible the amount of coverage and density he's getting. Even strip rarely does this outside of H&W's results. What is also interesting is that he seems to target covering the entire scalp with one procedure, and using the second to recover the same area - rather than the conventional view of transplant the front to full density then transplant the crown.

[Mickey85]

Fascinating. Just looking at these videos, it's incredible the amount of coverage and density he's getting. Even strip rarely does this outside of H&W's results. What is also interesting is that he seems to target covering the entire scalp with one procedure, and using the second to recover the same area - rather than the conventional view of transplant the front to full density then transplant the crown.

 

Indeed hehe. I think he transplants over the whole area from the get go in order to avoid compromising the blood supply to the grafts. If you pack dense a small area then the yield might be low but if you do it in stages so the scalp can reestablish the blood flow, all the grafts have a better chance of growing.

[Mickey85]

The main reason I don't do FUE is due to price.. If I could get the same price for FUE as I can for FUT, I would be all over it.

 

There are docs that do quality fue for the same price or lower than the north american fut guys but you might have to travel.

[Nick153452]

There are docs that do quality fue for the same price or lower than the north american fut guys but you might have to travel.

 

Yeah, I've been looking into that, and it's something that I may do next year if I go back to Europe on my vacation. I know people say that you shouldn't hair-transplant on a vacation, but I don't see why not, if you're already over there and it was well planned out in advance. I really like Doganay in Turkey; are there any other lower-cost, great results doctors out there?

[Mickey85]

Yeah, I've been looking into that, and it's something that I may do next year if I go back to Europe on my vacation. I know people say that you shouldn't hair-transplant on a vacation, but I don't see why not, if you're already over there and it was well planned out in advance. I really like Doganay in Turkey; are there any other lower-cost, great results doctors out there?

 

Erdogan and keser in turkey. Bhatti in India. De Reys in belgium.

[KO]

This is probably a loaded question for Mickey. But for a large procedure (4k+), how would you rank FUE docs? Apart from Lorenzo, I do not see many FUE docs regularly do these procedures, even Bisanga and Feriduni seem to restrict it to smaller jobs, but that's just from what I've read.

[Mickey85]

This is probably a loaded question for Mickey. But for a large procedure (4k+), how would you rank FUE docs? Apart from Lorenzo, I do not see many FUE docs regularly do these procedures, even Bisanga and Feriduni seem to restrict it to smaller jobs, but that's just from what I've read.

 

4,000 graft procedures in one single session seem to be the domain of mainly Turkish FUE surgeons. Lorenzo himself caps him daily sessions at circa 3,000. In terms of accumulated 4,000 sessions or over, Drs Hakan, Erdogan, Umar, De Reys and Lorenzo do not have a problem with utilizing FUE for high quantities and higher Norwoods. The pool of surgeons who do this is smaller however, I do consider Bisanga, Feriduni, Mwamba etc to be more of the 'in the middle' in terms of their utilization of FUE but their skills with FUE is very impressive. There was a time where performing FUE at all was looked down upon many years ago. Then is was ok to perform temple restoration with it. Then it was viable to restore Norwood 3s. Now Doctors like Erdogan, Lorenzo, Hakan etc are showing the whole world that you can restore a norwood 5 with FUE with even fewer grafts than you would need via FUT. This result from Lorenzo is INSANE(and available to view in video format)

 

5,035 grafts

Work of Dr Lorenzo

 

All with just over 5,000 grafts, via FUE. Absolutely mind-f@#*ing-blowing. FUE allows the surgeon to target exactly how many 1, 2, 3 and 4 hair follicles he wants so that he can create the most density from the donor area. That is invaluable when trying to create the illusion of density.

 

FUE also benefits the hairline where finer caliber single hair grafts are vital to replicate a natural and non-artificial hairline. With FUT, that is left to chance. With FUE, the surgeon can target finer hairs in the whole donor area such as behind the ears, toward the bottom of the donor etc to use. Look at this, same patient, same surgeon. Had FUT first, then FUE to refine the hairline. You tell me which looks more natural:

 

 

The benefits of cherry-picking that FUE allows cannot be exaggerated enough, it really if a huge breakthrough for hair transplantation.

[Mickey85]

There is a video of the Lorenzo 5035 case. Will pm you it when i get on my laptop hehe. The Feriduni case looked pluggy due to the inability to target finer hairs for the hairline from strip. The photo below it shows the refinement that came from fue.

[KO]

I think the Lorenzo video you're referring to looks thin because he has his hair long, and slicked back. Hate that style, if you have thinning hair, you should comb it forward and try to layer it like a caesar cut.

[Mickey85]

I need to check the Lorenzo video in question.

[Mickey85]

12,000 views and counting. Much love!!!

[Dr. Timothy Carman]

I just read the initial post of this thread- and the section on "graft selection" is nonsense, and misleading. Saying that as a surgeon my selection of grafts is "left to chance" when utilizing strip harvesting is ridiculous. Moreover, as can be seen in your photo, titled "Surgeon can target specific grafts" transection rates are higher in FUE procedures (regardless of the hype), again as CAN PLAINLY BE SEEN in your photo. I would not expect ANY of those grafts to grow, as they are ALL transected. Amazed this post has withstood scrutiny, really. Granted, I have not gone through the ensuing 25 pages!!!!

[Mickey85]

I just read the initial post of this thread- and the section on "graft selection" is nonsense, and misleading. Saying that as a surgeon my selection of grafts is "left to chance" when utilizing strip harvesting is ridiculous. Moreover, as can be seen in your photo, titled "Surgeon can target specific grafts" transection rates are higher in FUE procedures (regardless of the hype), again as CAN PLAINLY BE SEEN in your photo. I would not expect ANY of those grafts to grow, as they are ALL transected. Amazed this post has withstood scrutiny, really. Granted, I have not gone through the ensuing 25 pages!!!!

 

It is not misleading at all. Fue can give a surgeon exactly the amount of grafts he or she desires. They need 1000 singles? The target 1000 singles. They need 1500 3 hair grafts for added density, they target 1500 3 hair singles. Fut does leave that to chance, unless you have a new method that can give you exact graft via strip? And the photo was for illustration purposes only so show various hair grafts. Nothing more. Transection depends on the surgeon skill. I have seen fue yield as good as the best fut surgeons from Lorenzo, Hakan, Erdogan, Bisanga, Demirsoy, Reddy and more. They dont seem to have an issue.

[greatjob]

I will say that Dr. Carman has some valid points. Addressing the parts of the thread that he raised questions about, many of the points highlight in the post are the worst case scenario with strip and the best case scenario with fue.

For example This post:

 

No increased scalp tension: With FUT, with each procedure a patient endures, laxity is taken away from the scalp. Most are lucky in that they do not notice but the unlucky few can experience a tighter scalp. Some have reported a 'facelift' effect on their scalp where the hair above the ears and the nape is raised after a FUT procedure. One patients with an already tight scalp, these effects can occur in just one procedure.

 

While this is theoretically possible in the 10 years I have been investigating hair transplants I have only seen one example of this, so unless you are listing the probability of this happening as something like 0.001% chance, it is a bit misleading.

 

Another post is this one:

 

 

You suggest that the added density is due to the advantages of fue, when in reality the added density is due to a subsequent procedure and would likely be the same had the patient opted for strip or his donor would have allowed for another strip procedure.

 

Additionally your argument that a strip procedure changes the natural direction of the donor hair was well disproved in this thread by Jotronic:

 

http://www.hairrestorationnetwork.com/eve/170130-question-joetronic-pics-inside-2.html

 

But you still used the same examples.

 

 

I honestly like and respect you Mickey and have no problem with you. To be honest I had never looked at this thread, but this post is clearly biased to display the best examples of fue and the worst examples of strip. I really could care less about anyones personal preference for either procedure, because the reality is both procedures have a place in the hair restoration field until new technology comes to market. However, as someone who works in the scientific field I can't sit back and let personal bias lead you to a biased conclusion.

[greatjob]

I will also say that the ability to cherry pick multi hair grafts with FUE over strip is a definite advantage.

[Mickey85]

Greatjob, the fut and fue patieny i posted was not to show added density of fue but the selection of finer hairs from the donor. Thats what i mean by cherry picking. His hairline looks much more refined due to the usr of finer hairs targeted via fue from various points that fut cannot go to. I will talk more later about the other points brought up.

[Mickey85]

And i will just say that i have noticed increased scalp tension after a procedure. As i said in the first post, all these are 'potential' advantages and drawbacks. If one patient in 20 sustains one drawback, i feel everyone has the need to know. I went out of my way to include such minor drawbacks to fue too like having to shave the head. Even the disadvantage of the fue punch killing surrounding follicles was listed however rare it is. No doctor can claim in writing that FUT might not increase scalp tension and i have seen patients publicly say they have had permanent tingling, itchiness and a dull pain in the donor.

[Mickey85]

In regards to FUT changing the direction of hair growth, that can happen if the patient has a natural wave in the donor area because a large section is cut and two foreign sections are joint together. On a patient with very little wave in hair direction the effect wont be apparent but look at the second example on there(the one that has the staples intact, you can clearly see a drastic change compared to the untouched natural area. But anyone is free to believe what they want and i will stand by my words regardless of who im debating(doctor, rep, or forum member) unless they show me im wrong as i have shown many examples backing up my claims. Doesnt mean im the end all be all, because im still human, but so os everyone else.

[Mickey85]

I just read the initial post of this thread- and the section on "graft selection" is nonsense, and misleading. Saying that as a surgeon my selection of grafts is "left to chance" when utilizing strip harvesting is ridiculous. Moreover, as can be seen in your photo, titled "Surgeon can target specific grafts" transection rates are higher in FUE procedures (regardless of the hype), again as CAN PLAINLY BE SEEN in your photo. I would not expect ANY of those grafts to grow, as they are ALL transected. Amazed this post has withstood scrutiny, really. Granted, I have not gone through the ensuing 25 pages!!!!

 

OK now I have time to properly reply.

 

Dr Carman, with all due respect, FUE does offer the surgeon control of the exact quantity of grafts he or she desires. The patient needs 2,000 grafts and only 2,000 grafts? Done. With FUT it is very possible to get under or over that figure and it is left to a mix of luck and skill, unless you have a method that allows you to get exactly the specific amount of grafts you desire all the time that you have not told us about. FUE also allows the surgeon to target the exact quantity of single, double, triple-hair grafts desired. Not to mention it allows for extraction of finer caliber hair outside the typical strip zone like toward the lower donor or behind the ears.

 

In regards to the picture I used that showed grafts that happened to be transected, I just used that photo because it was a close up of grafts and various hairs in them. Also if you read the post further below, you see that I do mention FUE does typically have a higher transection rate. I even mention drawbacks to FUE that few others do like the need to shave the donor and cost(as it in not an inherent flaw in the method itself). I hardly see how using a photo of transected grafts debunks anything written.