The pros/cons of FUE. Myths dispelled.

[s2thoudriver]

You will not find any white dots in my donor area whatsoever. I can only presume the 'very respected surgeon' you refer to is still pushing strip procedures.

 

It is purely an 'opinion' based on what I have read/seen over the recent years.

 

FUT is an old technique, with less and less surgeons performing it at all these days.

 

When I asked about FUT in Turkey, I was informed that they'd stopped doing the strip method 4yrs ago...that was 2yrs ago, so 6yrs in total.

 

I think that suggesting anyone risk having a very large section if their scalp removed via strip method and with that, a high risk of scar stretching and discomfort, is far more irresponsible than recommending FUE with additional BHT if required.

[GreatPelo]

s2thoudriver,

 

In the last 15 years, I too have learned and read a great deal of information as a patient...and also have been a consultant for 10 years in the industry. I have done consultations for thousands of patients, which gives you the opportunity to really learn who's a candidate for a certain method...and who's not.

 

On a young patient with an aggressive hair loss pattern, it may not be in the best interest of the patient to perform an FUE surgery considering it starts to scar, whether you see them or not, his donor area. IF that patient, along the years, keeps coming back for more surgeries, which he will need, he starts to put more scars between the dot scar, thus resulting in a difused look in his donor area. So while trying to help him get density in his front/mid/crown areas, he now has to deal with a difused look in his donor. If he chooses FUT, he will have a linear scar..and one that may need FUE on it to hide later on, but the rest of his donor area will not be jeopardized. It will be as thick and dense as the day he was born.

 

So although I think FUE is a great option, the above is just an example of a patient that is NOT A GOOD CANDIDATE FOR FUE. As far as the doctor who stated FUE is not for everyone, he was actually one of the doctors on the initial board for the ARTAS...go figure!!! Even though he feels the FUE is great, it becomes a dangerous thing when recommended TO ALL PATIENTS!

[s2thoudriver]

Ah, you are an industry consultant who has done thousands of consultations....that explains your answers entirely. Thanks for clarifying your position in the field.

 

If you have patients that you are happy to advise to risk FUT, then so be it. I just believe that patients are swayed towards it far too often and regret it later.

 

For the record, any surgeon worth his or her salt, would assess the donor area PRIOR to depleting it to ensure the diffused look is avoided. Also, decent surgeons plan for future loss, based on age, photos, how rapid the loss is and the pattern of loss. Reserve donor should then be calculated and left for future ops if required.

[Jotronic]

There are many cases where strip will always be a better option. My own case illustrates this perfectly because no FUE practitioner will claim that a result like mine is possible with FUE with head hair only. I've had 9500 grafts with Dr. Wong via strip AFTER I had two previous procedures where 800 mini grafts were supposed to have been taken (only 300 grew). I'm not anti-FUE but I am against the idea that FUE is the only option. This is a statement made by the uneducated or those that work for FUE only clinics. It's one thing to say FUE is the only option, it's another thing entirely to back it up with a result for every scenario.

[GreatPelo]

s2thoudriver,

 

What experience do you have in the industry? If you're a patient and had a successful FUE surgery, congratulations! OR maybe you represent a doctor that only does FUE??? Being part of the FUE cheerleading squad with pom poms and all can misguide other patients that might not be as good FUE candidates. So to say FUE is for everyone and FUT is a thing of the past, this statement alone shows your inexperience and/or overzealous nature. Since you're not listening to me, maybe you'll listen to jotronic...

 

There is evidence already of patients having had a few FUE surgeries whose donor area are diminished and difused. This is evidence that the ISHRS and professionals in the industry are starting to be concerned with. I'm not sharing my opinion just because it's something I think...there's actual based evidence of this occurring already.

[1978matt]

I had to check and no it isn't April 1st.

 

For someone who has been a member for over 2 years, s2thoudriver is probably the least educated and informed person I ever came across!

 

To make all these claims - which fly in the face of industry experts - is completely baffling, especially considering his position as an advocate for HTI.

[Questionmark]

There are many cases where strip will always be a better option.

 

Which cases? I definitely see the raison d`?tre for FUT, in order to gather the highest amount of grafts possible for high NW cases, in combination with FUE. But in which cases is FUT a better option than FUE, if they are evaluated alternatively? Could only be due to higher yield, but I guess this claim had been refuted quite some time ago now. Plus with FUE the surgeon is able to cherrypick certain grafts and not relying on the area he extracts.

But I always welcome new knowledge, so thanks for explaining!

[GreatPelo]

I can accept the fact that a patient is happy he/she had an excellent result with FUE, HOWEVER, to come on a forum and make this kind of statement, where so many people searching for help in order to make a decision whether to move forward with HT and which method to use, is irresponsible.

 

It's great to be excited about one's experience and results...but it's important to relax and find balance by informing ourselves correctly about the industry as a whole.

[Rootz]

On a young patient with an aggressive hair loss pattern, it may not be in the best interest of the patient to perform an FUE surgery considering it starts to scar, whether you see them or not, his donor area. IF that patient, along the years, keeps coming back for more surgeries, which he will need, he starts to put more scars between the dot scar, thus resulting in a difused look in his donor area. So while trying to help him get density in his front/mid/crown areas, he now has to deal with a difused look in his donor. If he chooses FUT, he will have a linear scar..and one that may need FUE on it to hide later on, but the rest of his donor area will not be jeopardized. It will be as thick and dense as the day he was born.

 

When FUE is done by a reputable doctor the difference in density in the donor area is unnoticeable. Only around 20% of the grafts are harvested in any given donor area. We know if you can transplant hairs at 50% normal density, the result looks natural... FUE will leave the donor area at 80%+ normal density. The white dot scars are really only noticeable if you're completely shaved to guard 1, someone is staring at your head, and the extractions are clustered together (as opposed to spread out)... and if by some miracle someone notices them, they'll probably have absolutely no idea what it is and think nothing of it.

 

There is really no comparison with FUT scars. Yes, some FUT scars turn out well but a lot do not and it's very hard to predict... going to the best FUT doctor in the world is in no way a guarantee the scar will turn out well. It's a roll of the dice, and even when it turns out well it's still usually 100x more noticeable than FUE scars.

[GreatPelo]

....and for the record....the doctors I've represented do both method: FUE and FUT. So for s2thoudriver to say I only guide patients down the FUT path is bologne, otherwise known as rubish!!

 

As far as Rootz, you can harvest more donor with the FUT without difusing the donor area than using the FUE method. You'll be left with a linear scar that can later be improved upon if need be. The rest of the donor area is untouched. FUE will leave dots, or areas with no hair, which can create a difused look. From my experience, FUE is excellent for smaller cases of patient with non aggressive hair loss patterns. I'm sure there's a gray area within both FUE and FUT of those than are candidates of not, but to generalize FUT being a thing of the past and FUE being for everyone is not accurate.

 

And Yes, obviously, this all depends on the ethical nature and experience of the surgeon. That's a given!

[Questionmark]

I don`t think s2thoudriver`s posts deserved to provoke such harsh and personal opposition at first, maybe beside the "FUT is a thing of the past"-claim, but also then it`s a pity to see personal attacks like that... Why not adressing his claims one by one (quoted), and provide substantiated counter arguments (just like greatpelo did in his latest post). Btw I still wait for answers on my question from my last post.

[GreatPelo]

Questionmark,

 

Your question has been answered in previous posts. A very young patient with an aggressive hair loss pattern may not be the best patient for FUE. Considering the amount of loss, I'll take more FUE surgeries to cover that area and a wider area of the donor is now being encroached upon, which can create a difused look in the donor area for these patients. I've seen many young patients with aggressive hair loss ask for FUE and FUE only...and we've let them leave rather than take them down a path that will not help them achieve their goals and also create more problems for them.

 

Every case is different....therefore....generalizing is not a good thing when it comes to the HT industry.

[Jotronic]

Which cases? I definitely see the raison d`?tre for FUT, in order to gather the highest amount of grafts possible for high NW cases, in combination with FUE. But in which cases is FUT a better option than FUE, if they are evaluated alternatively? Could only be due to higher yield, but I guess this claim had been refuted quite some time ago now. Plus with FUE the surgeon is able to cherrypick certain grafts and not relying on the area he extracts.

But I always welcome new knowledge, so thanks for explaining!

 

My own case for one. I was between a NW6 and NW7 and have had multiple procedures with strip to repair my older 1990's work and then subsequently to add more for enhancement. I've had nearly 10,000 grafts via strip only AFTER having two failed previous procedures and TWO donor scars combined into one. With FUE I would look like a plucked chicken before I would get to half that number.

 

FUE is great. I like it but I'm also realistic about it.

[Questionmark]

Of course you would look like a plugged chicken considering the amount of grafts that were needed. Nobody said that covering such a large area in such a case (!) would be achievable only via FUE, or without FUT (if so, I`d love to see that quote). Only FUT is able to provide grafts without thinning the donor, I guess everybody got that.

But the point is that as long as the donor doesn`t get thinned out via FUE so the skin will shine through, there is no advantage to FUT. It`s only advantage is for the very rare cases in which

1. the donor can`t take any more thinning, but

2. is still thick enough so the broad FUT scar will not be visible.

Literally a thin line.. Obviously you were one of these cases, and only FUT was able to provide you with the monster result you came out with. That said, I guess that being able to extract 10k via strip only is very exceptional, and I congratulate you for this. I am not advocating against FUT in general, but as long as the donor is thick enough, I couldn`t understand anyone who would go with FUT if he also had the option to do FUE, as I still se no reasons other than

1. in very rare cases as defined above

2. together along with FUE for high NWs in order to provide the maximum amount of grafts possible via HT methods

3. one hasn`t a problem with the scar, the more invasive surgery, the longer healing period, the longer inability to do sports, the potential eradication of the natural flow due to the scar, the risk of scar stretching etc.

Edited July 23, 2014 by Questionmark

[1978matt]

With FUE I would look like a plucked chicken before I would get to half that number.

 

 

I like that analogy.

 

The case for Strip becoming obsolete is so often: "But what about Lorenzo's NW5 and 6 results?". Well, people should take a good hard look at these patients donor areas.

 

They have an abundance of density, usually thousands of 3, 4 and sometimes 5 hair follicular units. This is not your average person and why the doctor can cover such a large area of baldness using FUE.

 

Think about it:

 

If you extract 1000 x 4 hair follicular units you get 4000 hairs and 1000 'dot' scars.

 

If someone else with a lesser donor doesn't have any 4s and hardly any 3s then doctor has to take 2s instead:

 

Extract 2000 x 2 hair follicular units = 4000 hairs and 2000 dot scars.

 

I.e. the same amount of hair is taken but with twice as much dot scarring, twice as many gaps in the back of their head.

 

You don't necessarily need 50% original density to look dense either. It also a product that depends on the calibre of hair and the wave/curl. So in the two scenarios above they could have the exact same type of hair/wave/curl but the latter persons donor area would need to be depleted 100% more to achieve the same result as the guy with outstanding donor

 

If they both go from a NW6 to NW2, one will look like a plucked chicken, the other won't.

 

Anyway, hope that makes sense!

[GreatPelo]

....a young person with an already NW5 pattern, even with thick donor, is taking a chance considering the number of FUE cases and scarring all over donor he will have to go through. Every case is different, just as there are unethical doctors who don't care versus those who will push a patient out the door who only wants FUE but isn't a candidate.....

 

Every case is different......but handled professionally and ethically. However, when there FUE equipment companies promoting the FUE method as if it's the only way to go and everyone is a candidate and no scarring and back to work the next day.....not right!

[Jotronic]

Questionmark,

 

Nobody said that covering such a large area in such a case (!) would be achievable only via FUE, or without FUT (if so, I`d love to see that quote).

 

Please keep in mind the context of my post. I was referring to the statement made by s2thoudriver where he said that strip is old and how no one should be performing it.I'm not debating the merits of either technique, just refuting silly statements like his.

[1978matt]

Quote from BHR (BHR Clinic - Hair Transplant Clinic - FUE, Strip and Repair Surgery - Brussels):

 

"Hair characteristics and FU constitution can play a large part in how suitable FUE can be; it is misunderstood that FUE is suitable for all hair loss stages and hair types and some may not have the right attributes to ensure a solid result. This can be due to reasons such as donor hair density or hair diameter, including the % of miniaturisation in the donor or the average size of a person’s natural groupings of hair as well as skin texture and healing properties. If there is a doubt when consulting on line then a personal consultation would always be the best option before making your decision."

[Rootz]

As far as Rootz, you can harvest more donor with the FUT without difusing the donor area than using the FUE method. You'll be left with a linear scar that can later be improved upon if need be.

 

Diffusing the donor area by around 20% from native density generally has no meaningful impact on the appearance. If you need so much hair that you need to harvest more than that, then yes I can see how a FUT + FUE combo can come into play. However, as you know, the linear scar may very well be a problem... so in my opinion it's best to use FUE as plan A, and FUT as plan B.

 

Extract 2000 x 2 hair follicular units = 4000 hairs and 2000 dot scars.

 

The more grafts you need with FUT, the larger the scar also. I'd rather take small white dots that are almost imperceivable over obvious line scars.

[GreatPelo]

"If you need so much hair that you need to harvest more than that, then yes I can see how a FUT + FUE combo can come into play." By Rootz

 

This is the point we've been trying to make all along.

 

....and If the linear line is handled by a knowledgable surgeon, with an FUE touch up on the scar there shouldn't be a problem.

[eyebrowqueen]

Pretty much this. Those surgeons who recommend strip over FUE for eye brows are not confident with their ability to perform FUE. It is wrong in my opinion to recommend a more invasive procedure for such a small number of grafts, especially because FUE has the advantage of targeting the finer grafts in the donor.

 

Mickey,

 

Is it your opinion that Dr. Ron Shapiro, Dr. Rahal, Dr. Epstein, Dr. Keene and Dr. Wong are not competent enough to perform an FUE procedure if it is in fact the best option? That is a strong statement and I would like to hear their reps comments on this. All of these surgeons (with the exception of Dr. Epstein) are coalition members and all of them perform both FUT and FUE on a regular basis. Dr. Epstein performs more eyebrow transplants than any other surgeon I have come across (4-5 per week) and he has used both methods and prefers FUT because of the higher growth rate. Dr, Shapiro offers two types of FUE procedures at his clinic (manual FUE and ARTAS Robotic FUE) so I think it's unfair to say that he is not a *true* leader in FUE. It is my understanding that FUE was developed specifically due to the advantage of no linear scar in patients who want to wear their hair short in the future. This does not apply to me as I have very long hair. All of these surgeons and coalition members recommend FUT over FUE for my eyebrow transplant for the following reasons:

 

1) Extraction - FUE would require me to shave a patch of my hair, whereas FUT will not. Even if I were to shave a more inconspicuous patch behind my ears, it would still be very visible when I wear my hair up. This would probably not be a huge concern for someone with short hair, but for someone with long hair, it would take a long time to grow back.

 

2) Scar - Yes FUT will leave a small linear scar but because they will only be harvesting 500 grafts, the scar will be very small and completely hidden underneath my hair. Because I never intend to wear my hair short, the scar is not a concern for me. FUE, on the other hand, even when performed by a top surgeon, has the risk of leaving spotty scarring. Every person heals differently and there is no way to predict if it will scar. I would rather have a small linear scar that can be hidden under my hair then a bunch of spotty scarring on the back of my neck or all over my legs that will be very visible.

 

3) Survival rate - All of the above surgeons (who perform both FUT and FUE) contend that FUT has a better survival rate. Grafts harvested with FUE are finer with less tissue protection and therefore more susceptible to trauma, and there is a potential for less yield.

 

I am not advocating FUT over FUE, I am simply stating that I was told I am not the best candidate for FUE because of the reasons I listed above. I think it is misleading to make blanket statements such as "FUE is best for eyebrows" when that may not be the case for everyone. I have seen some excellent results with FUE for eyebrows, but I have also seen excellent results with FUT and I don't think anyone should be discouraging people from listening to the advice of top surgeons in the field, even if their opinion may different from yours - they are the experts for a reason.

[Rootz]

"If you need so much hair that you need to harvest more than that, then yes I can see how a FUT + FUE combo can come into play." By Rootz

 

This is the point we've been trying to make all along.

 

I see. So you would agree that FUE should generally be the plan A course of action if the amount of grafts you need can be conservatively harvested (~20%) with FUE?

[Rootz]

eyebrowqueen,

 

I know you directed the question at Mickey, but I would like to point out that cosmetic surgery is very much a product of demand. In other words, as long as people are willing to line up to get FUT done, and it's a reasonable procedure, I'm sure many ethical and competent doctors keep doing FUT and not worry about FUE. Supply and demand. They already know FUT, FUT is easier to supply than FUE, and there's still a lot of demand for it.

[GreatPelo]

Many factors are involved. If it's a young patient with limited loss with excellent donor....let's do FUE so he can wear his hair as short as he wants. If it's a 25 year old patient with aggressive hair loss, we'd recommend FUT to get him as close to his coverage and density goal and then can finish up with FUE, especially to improve the scar if need be. The latter may have to leave his hair longer in the donor area, but he'll achieve his goal quicker, protecting donor better for future surgeries, not to mention saving a ton of money if it's a patient that has to do several surgeries (money may not be the most important factor, but important non the less).

[eyebrowqueen]

Hi Rootz,

 

I understand your point about supply and demand. I am, however, prepared to pay more for an FUE procedure if it is a better option for me, and I stated this in my consultations. It would seem to me that if a doctor has a patient willing to pay double for FUE, they would not encourage that patient to do an FUT procedure for half the cost unless it truly in their better interest. This was the case with both SMG and Dr. Rahal. They have both performed FUE and FUT and said that yes, they could do FUE if I insist they don't recommend it for me. Instead, they both recommended a procedure that costs less because they think I will get better results with FUT and I don't have to worry about a visible scar. Dr. Shapiro uses the ARTAS Robotic technology so I don't think it's just a matter of FUT being easier than FUE.