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The pros/cons of FUE. Myths dispelled.


Mickey85

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Dr Feriduni said both were possible. This was just from photos, though.

 

Unfortunately his prices are out of reach for me.

 

If someone like Feriduni said both are possible, I would take his word over basically 99% of surgeons out there. Even if you don't go with him. He is one of the most ethical surgeons out there.

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Hi Mickey,

I have known about FUE, and i have been informed by some clinic that with FUE you can't see the direction of the hair properly which is not good for eyebrow or beard I am not sure that this can add in your cons or not.

 

Hmmm i understand what you say but am unsure about the validity of the clinic's claim... the eyebrow transplants i have seen via fue have all been quite superb and there has never been a mention of this problem with fue. I would definitely add to if there was some proof or a general consensus on the matter.

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Hmmm i understand what you say but am unsure about the validity of the clinic's claim... the eyebrow transplants i have seen via fue have all been quite superb and there has never been a mention of this problem with fue. I would definitely add to if there was some proof or a general consensus on the matter.

 

Can any doctor explain about this please. To make sure that the reason that doctor mention about shape and direction are not excuse that he or she don't want to do fue

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Hmmm i understand what you say but am unsure about the validity of the clinic's claim... the eyebrow transplants i have seen via fue have all been quite superb and there has never been a mention of this problem with fue. I would definitely add to if there was some proof or a general consensus on the matter.

 

In the case of Dr. Umar or my case, there is absolutely no validy to the claim of directional problems with FUE and how it relates to eyebrows. I am living proof, and have seen other examples of Dr. Umar's eyebrow work. Flawless. Now if a Doctor sucks at directional placement, he does not have the proper skill and artistic eye to replicate natural hair placement, whether it's FUE or FUT.

 

Atticus

600 FUE - 12/07 - Performed by Dr. Umar of Redondo Beach, CA

*****300 leg hair FUE implanted 7/12 to the eyebrows - 150 each eyebrow. Performed by Dr. Umar.

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In the case of Dr. Umar or my case, there is absolutely no validy to the claim of directional problems with FUE and how it relates to eyebrows. I am living proof, and have seen other examples of Dr. Umar's eyebrow work.

 

Atticus

 

Indeed. FUE doctors worldwide would have problems with the direction of the grafts in general if this way the case. Even comparing FUT grafts and FUE grafts, the direction remains easily visible. Some clinics will say almost anything to put people off a method. Dr. Radha turned a guy away from FUE stating he would only get 40% yield maximum. Why bother offering FUE?

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I can't think of any reason for graft placement or directional growth problems with FUE. Like Mickey said, the placement should be the same, regardless of whether the graft was extracted with FUE or FUT.

"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.

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I have to believe that this is a misunderstanding. With FUE the direction of growth underneath the tissue cannot be 100% determined since it is a blind harvesting technique. Once extracted, and the graft is deemed viable, then placement is no different than that of a graft from FUT.

The Truth is in The Results

 

Dr. Victor Hasson and Dr. Jerry Wong are members of the Coalition of Independent Hair Restoration Physicians

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One concern is the potential damage to grafts. In theory if it's done carefully, there should be no problem. But if you're moving 3k units one by one, in the end the doctor is human, and in a laborious process like this, fatigue has to make an impact.

 

Whereas in FUT, you can basically turn it into an assembly line where doctor extracts the strip, techs slice it up etc.

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One concern is the potential damage to grafts.

 

Whereas in FUT, you can basically turn it into an assembly line where doctor extracts the strip, techs slice it up etc.

really? and what about the damage to the FUT grafts when the skin is cut from ear to ear and excised. you dont think grafts are damaged during that process?

 

fatigue plays no role in that which is why FUE is far superior.

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really? and what about the damage to the FUT grafts when the skin is cut from ear to ear and excised. you dont think grafts are damaged during that process?

 

fatigue plays no role in that which is why FUE is far superior.

 

Very good point GNX1.

 

As I have stated in the advantages list(which can be viewed as an FUT disadvantages list) FUT does waste more grafts then people assume:

 

-The dormant(invisible even under microscope) grafts in the strip are discarded and not used. about 10% of all hair in the scalp is dormant. 10% of 3,000 FUT grafts means 300 grafts are basically wasted as they cannot be seen. Avoided with FUE.

 

-The transection of hair when cutting the FUT strip will also kill many grafts. Sure they won't be used, but it is a waste of grafts. If the Doctor is cutting a 30cm strip(over 60cm when you account for the top and bottom incisions and the corners) you are going to transect alot of grafts which would otherwise be spared if FUE was used.

 

-The traintrack effect also kills grafts. Again, a waste of grafts.

 

You have 3 factors that are considered a waste of grafts that FUE totally avoids. Sure the transection of FUE might be higher but you are already losing well over 10%(just from the dormant follicles being discarded) of the potential grafts by FUT by default. Add the transection during the incision of the strip and you lose a few hundred more give or take. No one ever(I mean EVER) mentions this but they very easily throw out the "FUE has higher transection due to blind extraction" but will negate the aforementioned factors which can be more detrimental in the long run.

 

Some will say "but those dead grafts don't get implanted" but they are still transected. What difference does it make if they are killed during the FUE extraction, strip incision, being discarded because they are dormant or from strangulation via sutures or staples? A dead graft is a dead graft and it hinders not only the result but the total quantity of grafts a patient can benefit from.

 

I really would like an accurate test of how many grafts on average are lost during FUT due to dormant follicles and transection during incision. If 10% of all hair is dormant then add the transection during incision and it could amount to 15-20% of x,000 grafts. That is staggering...

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Which clinic was it champ?

 

Sorry friends, I cant say the name of clinic out because it may be about laws or not. All I can say he is highly respected here and coalition member. He just started FUE not more than 5 years. I don't know why the clinic tries to push me for FUT just for not more than 500grafts but end up with a longer scar. I'm not sure that the admin in this website can help me talk to the clinic or not why he is giving me such of this reason about direction. I think that every clinics should be sincere to the patients if the clinic is not professional at FUE just tell patient the truth, do not give false excuse but after if patient still want FUE that is his choice.

Edited by bkkbaldeyebrows
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I have to believe that this is a misunderstanding. With FUE the direction of growth underneath the tissue cannot be 100% determined since it is a blind harvesting technique. Once extracted, and the graft is deemed viable, then placement is no different than that of a graft from FUT.

 

Thank you for help but please explain your answer because the clinic told me that FUE process need to shave the hair a lot shorter that's why direction will be harder to forecast when it grow out long.

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Thank you for help but please explain your answer because the clinic told me that FUE process need to shave the hair a lot shorter that's why direction will be harder to forecast when it grow out long.

 

The clinic you spoke to is referring to the actual direction of the graft being hard to determine after FUE extraction. So when they implant they have a hard time judging the correct direction and angle they should go for. This is not a common problem at all.

 

Joe was referring Fto the inherent difficulty of being unable to 100% determine the direction and angle of the donor graft whilst extracting. FUE is a blind harvest technique as we cannot see under the scalp and the graft direction(for extraction not implanting) may slanted etc. What Joe said is totally correct. What the clinic you spoke to said is incorrect.

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really? and what about the damage to the FUT grafts when the skin is cut from ear to ear and excised. you dont think grafts are damaged during that process?

 

fatigue plays no role in that which is why FUE is far superior.

 

What damage? The grafts that are transected during the cut are not going to be implanted. And the damage is limited as it occurs on the edges of the strip. Once the strip is excised, the interior follicles can be dissected under a microscope, minimizing transection. On the other hand in FUE, each follicular unit is painstakingly removed piece by piece, and fatigue will have a role. If you minimize transection here, you end up with a larger punch, and if you use a smaller punch, then you risk damage to the follicle.

 

FUE has an important place in HT surgery, but it is not far superior.

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What damage? The grafts that are transected during the cut are not going to be implanted, nor were they intended to be. And the damage is limited as it occurs on the edges of the strip. Once the strip is excised, the interior follicles can be dissected under a microscope, minimizing transection. On the other hand in FUE, each follicular unit is painstakingly removed piece by piece, and fatigue will have a role. If you minimize transection here, you end up with a larger punch, and if you use a smaller punch, then you risk damage to the follicle.

 

FUE has an important place in HT surgery, but it is not far superior.

 

Please check my reply a few posts back. The transected grafts of the edges of the strip are wasted graft that can equal several hundred depending on the size of the strip. 30cm at the top and 30cm at the bottom. All dead grafts that could have been other wise used to maximize donor quantity if done by fue. Combined with the 10% of follicles in the strip that are discarded because they cannot be seen even under microscope and you can have 600 to 900(approx, rough figure) dead grafts that are wasted that otherwise could be used or spared via FUE. That is much worse then the transected grafts by the hands of elite fue surgeons who put out fut-like yield results like feriduni, bisanga, hakan and lorenzo.

 

I do believe fue is a superior method. The advantages much outweigh the disadvantages by almost double. It's not vastly superior but superior none the less. In my opinion

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FUE has an important place in HT surgery, but it is not far superior.

grafts are destroyed when they are cut. no getting around that. a HT procedure that doesnt leave you looking worse then you did b4 by leaving you horribly scared and disfigured surely is superior.
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This is what FUT clinics either do not acknowledge or ignore altogether. Several hundred graft(can be between 200-900 depending on the size of the strip) are basically killed or discarded via the FUT method which could have been spared via FUE. They constantly bring up the transection issue with fue which can be countered with practice but they never mention the incision transection and lost dormant grafts that cannot be avoided via fut. FUE can(not will but can) maximize the usage(not neccessarily growth) of grafts mich better than FUT. Transecting a graft via a punch is just the same as transecting grafts via scalpel and the discarding of dormant grafts. All are wasted grafts. Only difference is the wasted FUT grafts are not implanted. At least with FUE a skilled surgeon can yield a great amount and avoid the colateral damage inherent with FUT.

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grafts are destroyed when they are cut. no getting around that. a HT procedure that doesnt leave you looking worse then you did b4 by leaving you horribly scared and disfigured surely is superior.

 

Yes, the vastly superior procedure is the one that actually reduces the number of grafts you can extract. The most skilled FUE surgeons can match FUT in terms of yield, but when it comes to moving a lot of hair, the most efficient way is strip surgery.

 

Feel free to post multiple 5k+ graft FUE procedures on NW6 patients. I'm waiting buddy.

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Yes, the vastly superior procedure is the one that actually reduces the number of grafts you can extract. The most skilled FUE surgeons can match FUT in terms of yield, but when it comes to moving a lot of hair, the most efficient way is strip surgery.

 

Feel free to post multiple 5k+ graft FUE procedures on NW6 patients. I'm waiting buddy.

 

Fue has 16 advatages over FUT with 9 disadvantages. The proof is in the pudding. Almost double. I would say fue is superior(my opinion).

 

Type in 'injerto capilar' on Youtube and you will see 180 before and afters of dr Lorenzo's work. Many of which are upward of 6,000 fue grafts. Also results of fixing fut scars(a byproduct of fut) via FUE. I cant post the videos here because he is not recommended on this forum.

 

Whilst fut is effecient in that it can move more hair in a single session, the procedurr itself is vastly ineffecient. In order to extract the hairs a large and wide strip of deep flesh must be removed.... in order to remove those grafts. Hardly effecient.

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The problem with this debate about how many grafts are destroyed via strip excision vs. FUE extraction is based on too many variables and assumptions. Mickey85 and GNX1 are saying that strip excision automatically, by default, means that "several hundred" grafts are destroyed whereas with FUE this is not an issue. Let's examine this a bit closer.

 

1. It is assumed by the previous posts that when the scalpel is being directed through the donor zone there is a blatant disregard for the position of the follicular units in the path of said scalpel. Well, this depends on who's holding the scalpel, and in some cases, scalpels with an "s". Yes, some clinics use dual or even triple blade scalpels which will in fact destroy many viable follicular units. This is because the scalpels cannot be individually maneuvered to avoid any follicular unit groupings.

 

With a single blade scalpel the incision can be directed in between follicular units to avoid transection. When tumescence is utilized this becomes a fairly simple affair in that the spaces between the follicular bundles is increased. We've been doing it like this for years and even back in 2002 Dr. Feller was quoted as saying, after watching Dr. Hasson remove a donor strip, that he felt that "not a single hair was transected".

 

Does this negate the fact that many clinics take out donor strips in 20 minutes without concern for peripheral damage to the donor zone? Not even close but better clinics DO take time and effort to remove a donor strip properly. It takes us, both Dr. Hasson and Dr. Wong, at least one full hour to remove a virgin donor strip and many times up to 1.5 hours. Repair cases can take longer. Unfortunately, there are still clinics that use multi-blade scalpels for which there is NO excuse.

 

2. In one post earlier, Mickey85 states (in response to a post by GNX1)

 

-The dormant(invisible even under microscope) grafts in the strip are discarded and not used. about 10% of all hair in the scalp is dormant. 10% of 3,000 FUT grafts means 300 grafts are basically wasted as they cannot be seen. Avoided with FUE.

 

This is incorrect.

 

At one point you state that the percentage refers to "hairs" then you correlate that percentage incorrectly to the number of "grafts". The correct reference is hairs, not grafts so your math is off. It is assumed in this thread that when telogen occurs it occurs to an entire follicular unit. This is not entirely true. Individual hairs in a follicular unit will go into telogen on a different time table than a neighboring hair in the same follicular unit. Therefore, the majority of the time, there is no issue with destroying follicular units due to the whole FU being invisible during telogen. In fact, this would indicate that FUE would have a higher transection rate of these telogen hairs BECAUSE they are in a visible grouping that is assumed to have fewer follicles than it really does. For instance, if a particular sized punch is chosen for a two hair grouping but that grouping is in reality a three hair grouping because of a follicle that is in telogen then it stands to reason that the follicle in telogen may be destroyed. Remember, we have to assume that the smallest punch safely possible is being used so any punch selection cannot take into account any individual hairs that may be invisible.

 

Mickey85,

 

Type in 'injerto capilar' on Youtube and you will see 180 before and afters of dr Lorenzo's work. Many of which are upward of 6,000 fue grafts. Also results of fixing fut scars(a byproduct of fut) via FUE. I cant post the videos here because he is not recommended on this forum.

 

Out of the before/after videos that Jose has posted there are 12 that have results of over 6000 grafts. Subtract three of those because there are multiple videos showing the same patient at various stages of their development going as far back as 2008 so I believe there are nine results out of the 247 videos he has posted that are over 6000 grafts. This is quite a feat to be sure. Keep in mind these are totals that take a long time to achieve and are not performed over the course of a few days. It's more like a few years.

 

You and I discussed how he was able to get so many grafts out of his patients and I said that it was because of his local (mainly Spanish only) pool of patients. We have found that the Spaniards typically have a higher donor density than patients we've worked on from other regions and countries. When I was having dinner with Jose just two weeks ago he confirmed this. Regardless, it sounds great knowing that there are cases of FUE that have been able to get big numbers however it cannot be disputed that FUT in the right hands will get more grafts over "x" number of procedures than FUE in equally skilled hands over "x" number of procedures. There will be exceptions to the rule of course but in life that is with anything.

The Truth is in The Results

 

Dr. Victor Hasson and Dr. Jerry Wong are members of the Coalition of Independent Hair Restoration Physicians

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The problem with n vs. FUE riables and assumptions. Mickey85 and GNX1 are saying that strip excision automatically, by default, means that "several hundred" grafts are destroyed whereas with FUE this is not an issue. Let's examine this a bit closer.

 

1. It is assumed by the previous posts that when the scalpel is being directed through the donor zone there is a blatant disregard for the position of the follicular units in the path of said scalpel. Well, this depends on who's holding the scalpel, and in some cases, scalpels with an "s". Yes, some clinics use dual or even triple blade scalpels which will in fact destroy many viable follicular units. This is because the scalpels cannot be individually maneuvered to avoid any follicular unit groupings.

 

With a single blade scalpel the incision can be directed in between follicular units to avoid transection. When tumescence is utilized this becomes a fairly simple affair in that the spaces between the follicular bundles is increased. We've been doing it like this for years and even back in 2002 Dr. Feller was quoted as saying, after watching Dr. Hasson remove a donor strip, that he felt that "not a single hair was transected".

 

Does this negate the fact that many clinics take out donor strips in 20 minutes without concern for peripheral damage to the donor zone? Not even close but better clinics DO take time and effort to remove a donor strip properly. It takes us, both Dr. Hasson and Dr. Wong, at least one full hour to remove a virgin donor strip and many times up to 1.5 hours. Repair cases can take longer. Unfortunately, there are still clinics that use multi-blade scalpels for which there is NO excuse.

 

2. In one post earlier, Mickey85 states (in response to a post by GNX1)

 

 

 

This is incorrect.

 

At one point you state that the percentage refers to "hairs" then you correlate that percentage incorrectly to the number of "grafts". The correct reference is hairs, not grafts so your math is off. It is assumed in this thread that when telogen occurs it occurs to an entire follicular unit. This is not entirely true. Individual hairs in a follicular unit will go into telogen on a different time table than a neighboring hair in the same follicular unit. Therefore, the majority of the time, there is no issue with destroying follicular units due to the whole FU being invisible during telogen. In fact, this would indicate that FUE would have a higher transection rate of these telogen hairs BECAUSE they are in a visible grouping that is assumed to have fewer follicles than it really does. For instance, if a particular sized punch is chosen for a two hair grouping but that grouping is in reality a three hair grouping because of a follicle that is in telogen then it stands to reason that the follicle in telogen may be destroyed. Remember, we have to assume that the smallest punch safely possible is being used so any punch selection cannot take into account any individual hairs that may be invisible.

 

Mickey85,

 

 

 

Out of the before/after videos that Jose has posted there are 12 that have results of over 6000 grafts. Subtract three of those because there are multiple videos showing the same patient at various stages of their development going as far back as 2008 so I believe there are nine results out of the 247 videos he has posted that are over 6000 grafts. This is quite a feat to be sure. Keep in mind these are totals that take a long time to achieve and are not performed over the course of a few days. It's more like a few years.

 

You and I discussed how he was able to get so many grafts out of his patients and I said that it was because of his local (mainly Spanish only) pool of patients. We have found that the Spaniards typically have a higher donor density than patients we've worked on from other regions and countries. When I was having dinner with Jose just two weeks ago he confirmed this. Regardless, it sounds great knowing that there are cases of FUE that have been able to get big numbers however it cannot be disputed that FUT in the right hands will get more grafts over "x" number of procedures than FUE in equally skilled hands over "x" number of procedures. There will be exceptions to the rule of course but in life that is with anything.

 

Good points Joe. However i must say i find it particularly hard to believe that any surgeon can excise a strip without transecting at least some hair/grafts. I have acknowledged many time that hasson and wong take the best care and time in regards to strip excision AND closure but i really doubt a strip can be taken without slicig through some follicles. donor hair does not grow like crowfields and the is no 'line' of hair and nonhair. It zig zags, overlaps etc.I did give a varied range(200-900) and Hasson and Wong are definitely on the low end(200) of that spectrum and that was combined dormant follicles and strip transection. All these number are approximate and very rough but gives an idea.

 

In regards to thr Spanish patients having denser hair. Certainly dr. Erdogan's clients are not exclusively Spanish. Dr De Rey's patients are not exclusively Spanish. You can find patients across the world from any ethnicity that have been restored via 5000 fue grafts. Not as prolific as fut megasessions, but fue is newer and has not been embraced by many surgeons. Anyone regardless of race with a thich enough donor that is good for large FUT sessions is probably good enough for large fue sessions. Laxity is a non factor for FUE so it could be even more eligible for some people over fut for large sessions. Its not like every individual with below average donor can get 6000 grafts out of strip either. Again not saying fue can give more grafts in total but it certainly is not exclusive to Spanish only patients.

 

I will respond to the dormant grafts theory also very soon as i feel that one warrants a detailed rebuttal.

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Good points Joe. However i must say i find it particularly hard to believe that any surgeon can excise a strip without transecting at least some hair/grafts. I have acknowledged many time that hasson and wong take the best care and time in regards to strip excision AND closure but i really doubt a strip can be taken without slicig through some follicles. donor hair does not grow like crowfields and the is no 'line' of hair and nonhair. It zig zags, overlaps etc.I did give a varied range(200-900) and Hasson and Wong are definitely on the low end(200) of that spectrum and that was combined dormant follicles and strip transection. All these number are approximate and very rough but gives an idea.

 

Any? Ok, maybe four? Five? Point being, it's very very few hairs that get transected when done right. Regarding Dr. Feller's comment, you have to ask him about it, but that is how top clinics remove a donor strip; with extreme care and precision. Remember, when we are doing this we are operating with the tissue inflated and expanded so the spaces between the grafts are greatly increased AND we are viewing this area under 10x magnification and the scalpel being used (#10 blade) is extremely sharp so it's not like a bull running loose in a china shop.

 

I appreciate your kudos to our clinic but for us to destroy 200 hairs during a normal strip removal would be a particularly bad day. And this may be surprising to you but follicular units do in fact grow in loose lines in the donor zone. They are not perfect but under magnification and tumescence these lines can be seen and utilized for safe passage through the bundles of hair.

 

In regards to thr Spanish patients having denser hair. Certainly dr. Erdogan's clients are not exclusively Spanish. Dr De Rey's patients are not exclusively Spanish. You can find patients across the world from any ethnicity that have been restored via 5000 fue grafts. Not as prolific as fut megasessions, but fue is newer and has not been embraced by many surgeons. Anyone regardless of race with a thich enough donor that is good for large FUT sessions is probably good enough for large fue sessions. Laxity is a non factor for FUE so it could be even more eligible for some people over fut for large sessions. Its not like every individual with below average donor can get 6000 grafts out of strip either. Again not saying fue can give more grafts in total but it certainly is not exclusive to Spanish only patients.

 

Let me be clear. I did not say Spanish patients are the only patients with very high donor densities and I did not say that other nationalities are immune from such large numbers over two, three or more procedures. We have little experience with Turkish patients but it is irrelevant. We have had very high density donor zones from patients all over the world. We have several 8000 grafts cases in North America. We have the largest ever performed at 9162 from Italy. We have several 7000 graft cases in California, etc. They are indeed all over the place but I pointed out the fact that Spaniards in general have above average densities because you have on numerous occasions pointed to Dr. Lorenzo and his results as proof that high numbers can be achieved without compromising cosmetic donor density. This goes for the Turkish patients you mentioned or any other patient that has had high numbers of grafts via FUE. Higher donor densities allow for higher numbers of grafts before donor scarring becomes easily visible or donor density becomes unacceptably low on a cosmetic level. It's simple math.

 

What I hope can be avoided is any idea that FUE allows for the same numbers that FUT allows for, patient for patient, because it does not. Technically you can remove every single follicular unit in one's donor zone via FUE but who wants that? You could literally make a monster permanent mohawk on a patient should they so wish:D But in reality, where one does not wish to stand out with an odd hairdo, FUT will still move more grafts. Yes, yes, this depends on the clinic of course. In our clinic the average patient has 7000 to 9000 grafts over "x" number of procedures assuming we have them from beginning to end.. Another clinic may say that the average is 6000 to 8000. Regardless, you will not find FUE clinics saying that the average patient can get this many grafts before donor scarring becomes an issue or the donor zone is too severely thinned. And to GNX1, I'm not talking about BHT because that does not qualify in my book. I'm talking scalp hair and when people are discussing FUE in general they are also referring to scalp hair. BHT is BHT.

The Truth is in The Results

 

Dr. Victor Hasson and Dr. Jerry Wong are members of the Coalition of Independent Hair Restoration Physicians

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