The pros/cons of FUE. Myths dispelled.

[Atticus]

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.

 

I don't blame you.

 

Atticus

[Mickey85]

Also the poor-average yield that Dr. Gho's results show makes things even questionable. Did the grafts get transected? Did they survive but he didn't get enough of the graft? Will the graft grow back in the donor? I'd really love for it to be true and legitimate but I'm having a hard time believing it. The donor area does look much better than the equivalent FUE donor would though I will give him that much.

[moopookoo]

 

 

Ghos patient;Gho uses .6mm to extract follicles

 

if you zoom in you will se there are 3 hair follicles in recipient area, it means it is possible to extract them with such a small punch

[Mickey85]

 

 

Ghos patient;Gho uses .6mm to extract follicles

 

if you zoom in you will se there are 3 hair follicles in recipient area, it means it is possible to extract them with such a small punch

 

its whether the grafts grow or not that tells if they survive the extraction. gho's results in general show me a pretty bad yield.

[PupDaddy]

I personally don't see how Dr. Gho is getting away with .5 to .6mm punches whilst not transecting the follicle.

 

I think the point of Gho's procedure is to deliberately transect the follicle (longitudinally), yes? By using such a small punch, he claims to longitudinally transect the follicle, leaving in place a sufficient amount of the follicle's stem cells to regenerate the follicle in the donor whilst extracting a sufficient amount of the follicle's stem cells to generate a duplicate of the follicle when implanted in a recipient site. That is my understanding of his process, anyway.

 

The lack of density of posted results could be more attributable to factors other than poor yield from the process itself. As I recall from his web site, he does/did a maximum of 1,000 grafts per session, and the tool he was using for implantation did not allow for true dense packing (I recall that he was supposed to be working on a new tool that would allow for denser packing). With those limitations, even with 90%+ yield, it would require several sessions over several years for patients with significant hair loss to see results rivaling those of standard FUE. Also, just in terms of ht artistry and skill, I'm not sure how Dr. Gho and the physicians in his clinics stack up to top tier ht physicians.

 

When I first learned of Gho's work a year or two ago and looked at some photos of his patients, I emailed his clinic to ask whether only one-hair follicular units were extracted and duplicated and/or whether the extraction process would produce only one-hair per follicular unit, whatever its original number of hairs. The response was that one, two, and three-hair follicular units were duplicated and transplanted.

 

I, too, am skeptical of the efficacy of Dr. Gho's procedure as a regular, viable alternative to standard FUE, but I suppose we shall see with more time and more patients.

[Mickey85]

understood however i fail to see how he could only extract a section of the graft blind, that is without any optical assistance. fue doctors need alot of skill not to transect whole follicles using .8mm punches.

[Mickey85]

I'm looking into Acell used in conjunction with the FUE donor area. Apparently it can help regenerate some of the grafts but I have not explored it in depth. One Doctor(not Gho) claims that it does regenerate some follicles in the donor area but I'm not too sure of the validity or the veracity of his claims as he is quite a eccentric Doctor and not totally reliable... If it is valid however I will add it to the "Pros" list but it will definitely not be listed one account of one shady surgeon.

[HARIRI]

I think you mean Dr. Cooley. He is the most doctor who promotes this product along with Dr. C***. I heard that Acell is good for recipient area but not safe to be used in donor area especially strip scars where Acell sheets will be used. However Im not convinced so much about it, its remind me of PRP and other products and its price is $500 which I find it overpriced.

[Mickey85]

I think you mean Dr. Cooley. He is the most doctor who promotes this product along with Dr. C***. I heard that Acell is good for recipient area but not safe to be used in donor area especially strip scars where Acell sheets will be used. However Im not convinced so much about it, its remind me of PRP and other products and its price is $500 which I find it overpriced.

 

I'm not talking about Dr. Cooley, your second suggestion is correct though. Not talking about it's use in FUT donor closures but its use in FUE.

[Mickey85]

I have added "Retains natural hairshaft diameter/groupings gradation" to the advantages list.

Edited March 10, 2013 by Mickey85

[socates123]

Hi there, just wondering, if a person who is heavily dependent on toppik with an norwood classifcation of 3/3A/4, would it be more prudent to go for a FUT instead of an FUE?

 

This is because to not drag with multiple sessions and reduce the dependence on concealers, within a shorter time frame.

 

Does anyone have these thoughts? Do share your experience and your decision making process.

[Mickey85]

A 3,000 graft FUE session could be done quite easily. Some reputed FUE surgeons split the session over two days to avoid fatigue. If you required anything more than 3,000 grafts then most Doctors would require two actual sessions split many months apart. There are a few that perform more than 3,000 in one session but few and far between and I personally would not choose it.

 

For me, I would not undergo FUT for anything less than NW4. A NW 5, 6 and 7 would most likely get a better result due to more grafts being harvested from FUT in total but for a NW 1 to 3 I find the compromises of FUT do not warrant whatever advantages are inherent in the method. A NW 4 could go either way but with a good surgeon and good donor, it is possible to achieve good coverage and a good look.

[dingdong12]

in retrospect i wish i had opted for fue.

 

i received 1500 grafts via fut .

 

i am very pleased with my results one year on however i buzzed my hair down to a number two at sides and back and was a bit horrified to see that my scar was visible .

 

i had hoped it wouldnt be visible at number two but has obviously stretched along the way.

 

im planning to go back for a second procedure soon for around 800 grafts and shall be opting for fue to beef up hairline and perhaps put some grafts into scar.

 

as mickey states for people hovering around a norwood 1-3 i would recommend fue .

 

fut is great and has its place and gives the patient more scope as more doctors are proficient with the fut technique than opposedto fue.

 

for me though looking back i wish i had opted for fue .

[Mickey85]

I too wish I opted for FUE man.. I can't even shave down to a grade 5 convincingly. Shaving down to a grade 3 is as good as it gets for FUT unless you are one of the VERY lucky few. I have only seen a handful that can shave down to a grade 2. It certainly is not the general consensus. Grade 3 for FUT(unless it stretches) and grade 1 or 2 for FUE(the latter if ALOT of grafts are harvested).

[dingdong12]

i dont think this is made clear enough to most patients before hand. i really like the way my hair looks at grade two which is the really frustrating thing!! ;-(

 

perhaps inserting some grafts into region will help but if opted for fue this wouldnt be an issue.

 

another thing that really annoys me is some doctors and the like are so quick to point out that fue is not scarless . to me this is nonsense , okay it might not technically be scarless as all surgerys leave a scar but for all intensive purposes fue is undetectable to the human eye at grade one which is what i think we are all after!!!

[Mickey85]

i dont think this is made clear enough to most patients before hand. i really like the way my hair looks at grade two which is the really frustrating thing!! ;-(

 

perhaps inserting some grafts into region will help but if opted for fue this wouldnt be an issue.

 

another thing that really annoys me is some doctors and the like are so quick to point out that fue is not scarless . to me this is nonsense , okay it might not technically be scarless as all surgerys leave a scar but for all intensive purposes fue is undetectable to the human eye at grade one which is what i think we are all after!!!

 

What angers me is they are quick to point out that FUE is not scarless(which is true) but they evade the effects FUT causes on the donor area like distorting the natural growth direction and natural hairshaft diameter gradation.

[dingdong12]

makes you wonder their motives !!

[Mickey85]

makes you wonder their motives !!

 

Indeed...

[Mickey85]

Have added "Avoids the irregularly angled hair protruding through a trichophytic donor closure" to the advantages list.

[Mickey85]

Have added "Avoids the 'traintrack' effect that can occur from a FUT closure" to the advantages list.

[Mickey85]

Have added "Hair taken from the nape area and upper donor can be prone to future loss" to the disadvantages list.

[Atticus]

Great write up!!! Damn. You are absolutely correct regard FUE vs FUT. Excellent compare and contrast.

 

You are RIGHT on the money when you say:

 

-Optimal for small cases/eyebrows/beard work/scar repair: Say you needed 400-700 grafts for some minor hair recession. Undergoing FUT would not be desirable for such a small amount of grafts. FUE would be perfect. If someone wanted eyebrow restoration of 300 of so grafts, again, FUE would be the best method for that quantity. The Doctor could even select single hair grafts and finer hair so get as close to natural eyebrow characteristics are possible. Many patients with stretched scars or discontent with their FUT scar can have a few hundred FUE grafts inserted to fill it in.

 

In my case, Dr. Umar selected my leg hair for my eyebrows. As you know, leg hairs mimic eyebrow hair.

 

Gotta roll,

 

Take it easy! :cool:

 

 

 

Thanks,

Mickey!

 

 

 

 

 

With so much misinformation coming from various factions, it is easy to get a false picture of FUE. I thought I would write up a list of advantages and disadvantages. Now there will be glaring comparisons to FUT, that is a given. I will say that the disadvantages of FUT listed are not in the majority, but I feel obliged to mention them because they can occur and sometimes do. I feel that patients and potential patients have the right to know the differences between the two methods so they can really make an informed decision. The list will be quite exhaustive and brings up many factors that are very rarely spoken about.

 

Advantages

 

-No linear scar: This is the most obvious advantage. With FUE the follicles are not taken in a linear fashion. They are scattered about. And while the remnants are scars, they are usually much less detectable and scar visibility is reduced especially when hair is wet etc. This also allows for different hair styles such as messing up the back and sides.

 

-Less invasive: Because a small(.75mm-1mm) punch is used and not a scalpel that cuts into deep tissue, healing time is usually much quicker and mostly less painful than FUT. No sutures or staples are used as the punch sites are so small that they heal without such methods. The donor area can look untouched within a few weeks without the redness of an FUT scar that can linger for over 6 months. That said, FUE is not a painless surgery and temporary shockloss can still occur.

 

-Graft selection: This is a big one that not even the ardent FUT enthusiast can debate. FUE allows the Doctor to 'cherry pick' grafts that are necessary for an optimal result. He/she can select finer hair to use in the hairline, he/she can target 3-4 hair grafts for the crown and/or added density. He/she can extract only single hair grafts for hairline designs. These factors are left to chance with FUT.

 

-Retains donor growth patterns/swirls/direction/angle: With FUT, the natural direction, swirl, wave etc of the donor area is eliminated(for lack of batter word) due to the removal/closure of a section of donor area. In some cases the effect is minimal but in others it can be more drastic. It can created a "step" in the donor area where it looks like hat-hair or just unnatural. In patients with wavy/curvy/frizzy hair, the effect is much more noticeable. With FUE, the direction/swirl etc retains its natural course as the donor area is not manipulated in such a way that a large section is removed.

 

-Retains natural hairshaft diameter gradation/groupings: With FUT, a section of scalp(usually 1-1.5cm wide) is removed and dissected with the open wound closed up. Much like how FUT distorts the natural angles, direction and swirl of the donor area, it also destroys the natural gradation or progression of the hairshaft diameter/groupings. You may find the coarse, multi-graft, thick caliber hairs in the middle of the donor abruptly meeting the finer, smaller caliber single hair grafts toward the bottom of the donor. The smooth natural transition is obliterated. This is avoided in FUE as no area is cut out and closed off.

 

-Exact graft count: The surgeon can stop at exactly the right quantity he/she desires. No overshooting. You need 2,000 grafts and only 2,000 grafts? That is what you will get. This is important for donor conservation. We all know with FUT that it can be hard to estimate donor density and sometimes the doctor overshoots leading to more grafts than needed or undershoots.

 

-Use of body hair/beard hair: The advent of FUE has also allowed for the exaction of non-scalp hair. This can be extremely useful for repair patients, patients of depleted or low donor hair etc. Say what you want about body hair transplantation, but it is here to stay. Doctors like Dr. Bisanga and Dr. Umar have pushed the boundaries on what can be done with body hair.

 

-Allows for shorter hair: This is an obvious one. Most doctors say you should be able to shave down to a grade 1 or 2 after FUE. It's very rare anyone claims to be able to shave to a zero guard. In FUT, Doctors/reps claim you can shave down to a grade 3, which is possible if the scar does not stretch. Some FUT advocates claim you can shave down to a grade 2 but this is not the rule but the exception. You can get a great FUT scar, you can get bad FUE scars. But in general, FUE scars are less evident than an FUT scar.

 

-Less chance of nerve damage: Due to the punch sites being smaller and less confluent, the nerves repair themselves much quicker than FUT. With FUT, a large section of tissue is removed so it can take longer for the nerves to re-adjust and realign. Some people who have undergone FUT say that they still have feelings of numbness/tingling in the donor area many years after their procedure. Permanent nerve damage, although rare is possible. Permanent nerve damage is possible with both FUE and FUT, but less likely with FUE.

 

-No transection of follicles from strip incision: During FUT, the surgeon carefully cuts the strip with a scalpel. However, it is almost impossible to avoid cutting through follicles given that the intersect like a zig-zag pattern. Those follicles are transected and rendered dead. Now if a strip is 30cm long, you have to factor that that is 60cm of follicles at the top and bottom edge of the strip(plus the corner). I don't have the exact math as it would be based on patient density and doctor skill but you are going to transect something. I will get into FUE transection in the disadvantages section, don't worry.

 

-Avoids the irregularly angled hair protruding through a FUT trichophytic donor closure: Given that a trichophytic closure is the worldwide standard now for FUT closures, one common side effect is that the hair growing through the scar itself will be at a different angle to the surrounding hair. This can be quite drastic and stark and is different to the previously listed disadvantage of FUT "Retains donor growth patterns/swirls/direction/angle". It is also dependent on the patients physiology, luck and surgeon skill. It is especially noticeable when the donor is cut short.

 

-No dormant hairs are lost: At any given time on any person's head, about 10% of the follicles are in the dormant cycle, meaning in their resting phase and are unseen for that given time. As they move into the cycle they become live while other live hairs become dormant etc. When a FUT strip is excised, it contains some dormant hairs which cannot be seen under microscope. Those dormant hairs(which would become live) are then discarded. 10% of 3,000 grafts equals 300 lost grafts. This is not a factor of FUE as the Doctor only targets grafts he can see.

 

-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.

 

-No potential scar stretching: In FUT, the linear scar can stretch, regardless of the surgeon's skill and closure technique. It has to do with the patient physiology and scalp tension. I have seen stretched scars from all Doctors. No Doctor can guarantee a scar will stay 1mm thin. With FUE, the scars won't stretch. I will elaborate on FUE scars in a later section.

 

-Optimal for small cases/eyebrows/beard work/scar repair: Say you needed 400-700 grafts for some minor hair recession. Undergoing FUT would not be desirable for such a small amount of grafts. FUE would be perfect. If someone wanted eyebrow restoration of 300 of so grafts, again, FUE would be the best method for that quantity. The Doctor could even select single hair grafts and finer hair so get as close to natural eyebrow characteristics are possible. Many patients with stretched scars or discontent with their FUT scar can have a few hundred FUE grafts inserted to fill it in.

 

-Avoids the 'traintrack' effect that can occur from a FUT closure: When a FUT closure is sutured or stapled, there runs a chance of killing hair surrounding the scarline if the sutures/staples are too deep, tight etc. It can strangulate the follicles and result in perpendicular scarring to the lateral linear scar much like train tracks. Even a thin scar can have some traintrack effect. Avoided with FUE.

 

That is it for the advantage section, if any more come up, I will add them. Like I said, it is quite exhaustive. It should be noted that some of the factors like the FUT nerve damage or scar stretching are circumstantial in that they do not occur to everyone, but they can occur, even if they are in the minority. For those member who will jump on this thread and say "I had FUT and I didn't get any of those nasty things you say!" that is fine. I'm glad your procedure went smoothly. But if 1 in 20 FUT patients experience scar stretch or numbness, that makes it a potential disadvantage. I'm just making people aware on the potential pitfalls of both procedures. Disadvantages on FUE coming up.

Edited March 21, 2013 by Atticus

[Mickey85]

thanks Atticus some people may consider me biased because i really think fue is the better procedure for patients up to a norwood 4. i have issues with the invasive nature and severity of the fut technique as have personally had fut and suffer from alot of the disadvantages of it. i really disagree with its use in general but i acknowledge that a nw 6 or 7 ia most likely not going to get good coverage and densiry via fue and a nw5 is a bit too far unless an excellent surgeon and donor density are present.

 

dr wong says fut is so efficient and that is true in terms of time and how many grafts they can implant in one day but it is not efficient in terms of practicality in my opinion.

 

all that said and done i have tried to remain as honest and unbiased as anyone could be. i have listed cost as a disadvantage to fue even though it is not a flaw of thr procedure itself and many doctors charge the same for fue as the western doctors charge for fut. i have also invited and welcomed anyone to debunk any of the statements i have written.

[AlBrown]

Amazing thread! Thanks so much to everyone regardless of Team FUT, Team FUE, or neutral!

 

I was recently wondering about FUE and as luck would have it, alot of my questions were answered here. I had never even heard of body hair being successfully used...interesting.

[Atticus]

Amazing thread! Thanks so much to everyone regardless of Team FUT, Team FUE, or neutral!

 

I was recently wondering about FUE and as luck would have it, alot of my questions were answered here. I had never even heard of body hair being successfully used...interesting.

 

Well, now you know! knowledge is great no matter where it is attained,