Donor scar options

[Mickey85]

So what if a patient went to Lorenzo ( or any other top fue surgeons) with great laxity, poor density and a high norwood level, would these doctors also be considered unethical for performing surgery on this patient?

 

The main problem with this debate on each side, is people try to compare the best case scenario of the method they support with the worst case scenario of the method they hate.

 

 

If the patient's desires were above what was possible and it was not made clear to the patient by the doctor. Then yes. If the patient was informed that a conservative approach would be necessary and realistic expectations were laid out, then no. I don't believe that is unethical. A big concern is that strip is far more invasive than FUE. I do believe that the more invasive technique(in any surgery) should be a last resort(in general given the right circumstances). If a patient has some slight wrinkles and Botox or a peel will clear them, a surgeon performing a facelift would be unethical to me.

 

Your case is valid by the way given you had poor density and high laxity and were a higher norwood. I don't believe Rahal acted unethically by performing strip on you.

Edited October 5, 2013 by Mickey85

[greatjob]

 

Your case is valid by the way given you had poor density and high laxity and were a higher norwood. I don't believe Rahal acted unethically by performing strip on you.

Yeah of course, especially since I already had a strip scar from a doctor who completely lied to me about what I could expect. I have no problem with you or a lot of people who don't like strip as long as they keep it real, and my biggest problem with doctors is misleading or outright lying, which can happen regardless of the procedure. My first doctor completely over sold the procedure and I think he was highly unethical, and my strip scar caused years of problems, however even if I went to a doctor who didn't mislead me or lie to me strip would still be my best option.

 

Anyways from the last debate you and me had about this issue I think we both have the same opinion of the hair transplant industry, we're just in two completely differently circumstances.

[Mickey85]

Yeah of course, especially since I already had a strip scar from a doctor who completely lied to me about what I could expect. I have no problem with you or a lot of people who don't like strip as long as they keep it real, and my biggest problem with doctors is misleading or outright lying, which can happen regardless of the procedure. My first doctor completely over sold the procedure and I think he was highly unethical, and my strip scar caused years of problems, however even if I went to a doctor who didn't mislead me or lie to me strip would still be my best option.

 

Anyways from the last debate you and me had about this issue I think we both have the same opinion of the hair transplant industry, we're just in two completely differently circumstances.

 

I agree unequivocally

[Spanker]

In regards to the "3 or so doctors" that perform exquisite FUE, it is more than 3. More list of recommended FUE surgeons are(as of this moment); Feriduni, Bisanga, Mwamba, De Reys, Lorenzo, Reddy, Maras, Hakan and Erdogan. Nine. It is a short list.

 

In regards to top surgeons taking hair outside the safe zone, I would like some citation of that. Not that I don't believe you, but for my own records so I can reevaluate my sentiments on those particular surgeons and inform others.

 

 

 

The 3 or so is just my personal list of who I would personally let work on my. I can count 2 out of the list that I would definitely let work on me if I were to have FUE done and another 2 that I would consider as well. I have always said that for me, a recommendation by the board does not mean that they are right for me personally.

 

As far as pulling from outside of the safe zone, these cases are not hard to find but I can PM you my thoughts on it tomorrow. It's less common to see in the surgeons you mentioned and some of them I have not seen this problem, but overall in the entire FUE industry I think it is a major problem which is why, just like with strip, people need to be very picky about who they chose, as this can be a complication down the road for someone that decides to have FUE with just anyone, or someone that really stretches their donor area to the limits.

[Mickey85]

The 3 or so is just my personal list of who I would personally let work on my. I can count 2 out of the list that I would definitely let work on me if I were to have FUE done and another 2 that I would consider as well. I have always said that for me, a recommendation by the board does not mean that they are right for me personally.

 

As far as pulling from outside of the safe zone, these cases are not hard to find but I can PM you my thoughts on it tomorrow. It's less common to see in the surgeons you mentioned and some of them I have not seen this problem, but overall in the entire FUE industry I think it is a major problem which is why, just like with strip, people need to be very picky about who they chose, as this can be a complication down the road for someone that decides to have FUE with just anyone, or someone that really stretches their donor area to the limits.

 

Please do, especially if they are surgeons I mentioned.

[scar5]

people need to be very picky about who they chose, .

 

Oh...and my best strip scar - and it's a world beater, I guarantee it, - and my worst, a 10mm disaster, came from the same doc!!! :confused:

 

How could it be?

 

He was the president of the IRHRS !! Could I have not been more diligent in my research? I got him recommended to me by a well respected radiologist as being the best in the country.

 

What could I do better??

 

Key point.

 

Strip scars are UNPREDICTABLE and especially when you come for follow ups - and you might as well, if you have already started!

 

So you can say, go here, do your research, choose well, etc., gold standard strip etc., etc., but you are rolling the dice with whomever you choose.

 

But even so, a beautiful thin scar can still cause you nightmares down the road, if the stars align.

[SteveB806]

Call me crazy, but of all of the pictures I've seen on this forum, most scars are virtually undetectable if done correctly, even if the hair is relatively short. Even if people can sometimes notice it, if your hair looks overall good, why can't you just tell someone you can surgery; the type of surgery doesn't have to be explicitly stated. Maybe I'm just being overly confident in FUT?

 

 

I wish my FUT scar was vitually undetectable and may hair didn't look good over all after 2 strip procedures so I turned to FUE this summer - already seeing much better growth, but still having to live with my unsightly scars. Definately proceed with caution over confidence with FUT, I wish I had

[Spanker]

I wish my FUT scar was vitually undetectable and may hair didn't look good over all after 2 strip procedures so I turned to FUE this summer - already seeing much better growth, but still having to live with my unsightly scars. Definately proceed with caution over confidence with FUT, I wish I had

 

Who did your strip.

[s2thoudriver]

So, just to clarify what i've read so far here, we are saying that....

 

If you want to initially save money/can't afford FUE, want to save the surgeons time in the operating room, have potential on-going pain and numbness, an ear to ear scar and potentially have to have further scar repairs/cover up work (or 'bolt on services'), all based on the fact that there are some surgeons 'recommended by the HTN' (not a medical body, they pay to be recommended on here) who still practice strip HT's (to capitalise on all patient markets) and do so because they say that the yield is better (proven not, especially if you go to a decent FUE clinic), then you should have strip surgery. To be convince yourself into having strip surgery, you should then.....

 

...Ignore the fact that the majority of advanced HT clinics have stopped doing strip surgery, (regardless of the fact that it can generate more profit for the clinic and is less time consuming for the surgeon), overlook the fact that regular 4,000+ FUE sessions are now successfully taking place (at clinics who are prepared to work the long hours), you should forget that with FUE you eliminate the risk of ear to ear scar or risk of scar stretching, ignore the many results put on this form that clearly show that the yield is just as good with FUE (or better is the technicians cutting the grafts out of the strip are inexperienced and transect them), it has a quicker recovery is less invasive and less prone to any further repair work down the line.

 

Yeah, still a clear market for the strip method :rolleyes:

[scar5]

Reminiscing about strip vs FUE debates over the past ten years, as you do, in the life of a HT tragic, on a beautiful morning, I can't help think of an irony, at the thought of so many well-meaning and innocent , matter-of-fact viewers rolling back the eyes, saying, oh..no! Here we go again. I am SO sick of these debates" .

 

But now we have reps , strip reps fighting a war on two fronts. To the west, us stripped guys bithin' , and to the oth direction, finally, some happy FUE guys! - with results ( remember the refrain from strip, " Show me results! Results! I don't see any results!" See, FUE is rubbish. " )

 

And it was, I think, in these, "boring" debates that a broader view has been forged out of the commercial storm of pressure that strip has rained upon us.

 

Such a poet.

[Spanker]

Reminiscing about strip vs FUE debates over the past ten years, as you do, in the life of a HT tragic, on a beautiful morning, I can't help think of an irony, at the thought of so many well-meaning and innocent , matter-of-fact viewers rolling back the eyes, saying, oh..no! Here we go again. I am SO sick of these debates" .

 

But now we have reps , strip reps fighting a war on two fronts. To the west, us stripped guys bithin' , and to the oth direction, finally, some happy FUE guys! - with results ( remember the refrain from strip, " Show me results! Results! I don't see any results!" See, FUE is rubbish. " )

 

And it was, I think, in these, "boring" debates that a broader view has been forged out of the commercial storm of pressure that strip has rained upon us.

 

Such a poet.

 

I am not fighting a war. I am offering a balance to the simplicity of the one sided debate that you offer.

 

I also think that there are a lot of good FUE results. My mind is not so closed that I can not see the benefits to both procedures. I have not seen anyone state that they do not see any good FUE results, and when I see them, I usually post that it is a great result. Sometimes I won't comment if I feel that the photos are not consistent as they should be, sometimes I won't comment if I feel like the donor was harvested from an unsafe zone(either too high or too low), but for the most part, if I see a nice FUE result, I will post so. I am not anti-FUE, I am just saying that it is not as fool proof and limitless as you and some others seem to claim that is and the while FUE offers advantages over strip in some areas, strip also offers advantages of FUE in some areas as well. The decision of which procedure to choose is not near as black and white as you make it out to be.

 

You threw it out that I was a rep fighting a "war." Do you think that I need to have this debate with you because of the clinic that I represent? Do you think that any of the top surgeons who perform strip have their calendars emptying? I weigh in on this issue, again, because of the blanket statements, fear mongering, and fallacious nature of some of the comments that a select few bring to this debate. This issue should be looked at with more reason and balance instead of trying to peel away an option (strip) that will best serve some people, in the same way that FUE will best serve some people. I don't feel that there is anything radical about my views on this issue.

[s2thoudriver]

I still cannot see who "strip would best serve" in this day and age, over and above good FUE?? Other than"those who cannot afford FUE, but then the advice should simply be "come back when you can afford FUE".

 

If it is because the surgeon being represented is good at strip but not experienced in FUE, then the advice to the patient should be "just go to another surgeon who is doing consistently excellent FUE procedures", not talk them into an old procedure, just to secure the work.

 

If the answer to the above is the usual "it would best serve those with a thin donor area" then i would argue that they shouldn't have either HT, as FUE might thin it out too much and stip could leave a very visible scar through the thin donor site.

 

Other than that, can you shed some more light on this?...

 

Rob

[chrisdav]

"come back when you can afford FUE".

 

Rob,

 

I will be able to afford either procedure FUT or FUE if and when I need another procedure. Depending on the size, it is near certain I will choose FUT again.

[Mickey85]

Do you think that any of the top surgeons who perform strip have their calendars emptying?

 

Actually a very prominent strip clinic(I'm talking in the top 3 in the world) has dates for surgery available within 2 weeks whilst surgeons who predominantly practice FUE like Erdogan, Bisanga and Feriduni are booked for months. BHR(Bisanga said they were booked til January, Feriduni is booked til April and Erdogan is booked out til January. Lorenzo(prior to his move to the UK) was booked out for almost a year in advance. I certainly see less people opting for strip. Certainly compared to previous years.

[s2thoudriver]

Chrisdav

 

It's your scalp buddy, you choose who and how you want it cut up. Though i notice you are going to Feller, who has a preference to perform strip surgeries, further promoted by his sales team.

 

I hope it goes well for you.

 

Rob

[scar5]

I am not fighting a war. I am offering a balance..".

 

War? Well, war was a silly metaphor of mine.

Offering balance?

 

And what would that balance be?

70% strip, 30% FUE and the books are in order?

 

And what will that 'balance' be in three years?

Will the same proportion of people be candidates for FUE and strip?

 

Or will balance be 'adjusted' to market pressure? (again) ?

 

Do you think that there is 'a line', a consensus among the experts?

 

I am only arguing with the tenants of the strip marketeers, not so with the argument that strip doesn't provide bold, robust and rapid transforming results economically. There is no doubt in my mind about that, or that FUE grafts are butchered in extraction in a higher percentage than claimed. I have no quarry with that. But the 'balance' argument is all about the clinics, momentum, patient ignorance, economics etc., There is no 'balance' about getting a strip scar or not. It is categorically black and white.

[Spanker]

Actually a very prominent strip clinic(I'm talking in the top 3 in the world) has dates for surgery available within 2 weeks whilst surgeons who predominantly practice FUE like Erdogan, Bisanga and Feriduni are booked for months. BHR(Bisanga said they were booked til January, Feriduni is booked til April and Erdogan is booked out til January. Lorenzo(prior to his move to the UK) was booked out for almost a year in advance. I certainly see less people opting for strip. Certainly compared to previous years.

 

You can PM me more detail if you want, but just because a clinic now has a date or 2 open in 2 weeks doesn't really mean a lot. The doctor's schedule could have changed, there could have been a cancellation, etc. The point is that I don't post on this subject because anyone needs the business.

[Spanker]

people with curly hair

patients who easily cap or have high transection rates

people that want to maximize their their lifetime yield and supply

people that do not want to shave their donor

people who want to have a really big procedure (I have missed all of those regular 4000+ single sessions that are taking place)

 

Or anyone who is more concerned about what Mickey wrote below than a strip scar, and believe it or not, those people do exist:

 

-Cost: Given the labor intensive nature of FUE on the surgeon, FUE rates are generally higher than FUT rates. This can be a factor for alot of people. While not a flaw in the FUE technique itself, I feel compelled to mention it. Some Doctors in Europe and Turkey perform FUE at a much lower rate but they are few and far between. In general, FUE is usually just under double the cost per graft compared to FUT. This may change in a few years.

__________________________________________________ _______________________________

 

-More sessions needed for higher Norwood patterns: Most FUE clinics cap off their sessions at 3,000 grafts, some even less. Some split their large sessions over a few days like 1,500 over 2 days etc. In general if a patient needs 5,000 grafts, it would have to be done in 2 sessions with a 12 month wait in between. With FUT, 5,000+ grafts can be done in one day. Again this may not be a flaw to the FUE technique, but it can be a hindrance to the patient and a disadvantage.

__________________________________________________ _______________________________

 

-Potential higher transection: With the nature of FUE and our inability to see under the scalp, it is up to the surgeon's skill to evaluate the angle, direction and depth of the graft he is about to extract. Some surgeons do this better than others. Failure to properly diagnose these factors can result in transection and a dead graft. With FUT, the grafts are cut under powerful microscopes and transection is generally lower. Semi-dormant grafts(2 hair or 3 hair grafts that contain dormant grafts) can also be mistaken for a smaller graft and be partially or fully transected by using too small of a punch size.

__________________________________________________ ________________________________

 

-FUE scarring: With the extraction of FUE grafts, the donor area may look thinner after the procedure depending on the quantity taken. FUE does leave behind small white punctate scars that are scattered through the donor area. This will inhibit the ability to shave down to a grade 1 for example, again, especially once large amounts have been taken from the donor. While FUT can thin out the donor area(especially after multiple procedures, Jotronic mentioned this) due to the scalp losing laxity and the skin spreading, thinning the donor is a disadvantage of FUE also and can be more evident.

 

Here is an example of poor FUE scarring:

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-Can damage surrounding follicles: If a punch too large is used, it can hit grafts around the target follicle. If a punch too small is used, the target follicle can be transected. These are potential pitfalls of FUE and can occur, especially with a poor/inexperienced surgeon. Again some surgeons can avoid this better than others, but it is a potential occurrence.

__________________________________________________ __________________________________

 

-Less tissue surrounding the graft: In order to reduce scarring and avoid damage to surrounding follicles, the Doctor tries to use the smallest gauge punch possible whilst still preserving the graft. This leaves the graft with less protective tissue surrounding it compared to FUT grafts which makes them more fragile and susceptible to damage.

__________________________________________________ __________________________________

 

-In general, less hair can be obtained overall: In comparing FUT and FUE in terms of the amount that can be harvested overall(exclusively with each method, no combination FUE/FUT), FUT can generally obtain more grafts. Factors such as scalp laxity(FUT) and hair density(FUE and FUT) certainly play a large role but the possibility of a nw 6 patient getting good coverage and density with FUE is lower than with FUT. The amount of harvestable grafts from FUE is generally lower than FUT by the nature of its design.

__________________________________________________ _________________________________

 

-Hair taken from the nape area and upper donor can be prone to future loss: While this is totally within the control of the surgeon, I have seen leading FUE surgeons extract grafts from the lower and upper regions of the 'safe zone' where it might lead to loss years down the line. No one can predict how low the crown loss will be or if the nape hair will miniturise so I feel it is warranted to mention that as a potential disadvantage. Especially on larger FUE cases, the Doctor may be tempted to 'chance it' and extract slightly out of the safe zone as he doesn't want to over harvest any particular area.

__________________________________________________ ________________________________

 

-Head must be shaved for anything more than very small sessions: Unlike FUT, for anything above a few hundred grafts(not sure on exact figure) the whole donor region must be shaved down. This can be a disadvantage to some patients who generally wear longer hair.

[Spanker]

War? Well, war was a silly metaphor of mine.

Offering balance?

 

And what would that balance be?

70% strip, 30% FUE and the books are in order?

 

And what will that 'balance' be in three years?

Will the same proportion of people be candidates for FUE and strip?

 

Or will balance be 'adjusted' to market pressure? (again) ?

 

Do you think that there is 'a line', a consensus among the experts?

 

I am only arguing with the tenants of the strip marketeers, not so with the argument that strip doesn't provide bold, robust and rapid transforming results economically. There is no doubt in my mind about that, or that FUE grafts are butchered in extraction in a higher percentage than claimed. I have no quarry with that. But the 'balance' argument is all about the clinics, momentum, patient ignorance, economics etc., There is no 'balance' about getting a strip scar or not. It is categorically black and white.

 

You assume that everyone that gets a strip scar is butchered, will eventually need to shave his head, and is ultimately super concerned about his strip scar. It is true that having a strip scar is a black and white issue, but there are many more issues to look at for other people besides a strip scar. Obviously, you are super fixated on scars, and I understand that, but not every one is.

[Mickey85]

You can PM me more detail if you want, but just because a clinic now has a date or 2 open in 2 weeks doesn't really mean a lot. The doctor's schedule could have changed, there could have been a cancellation, etc. The point is that I don't post on this subject because anyone needs the business.

 

Im talking about regular vacancies that are not filled continually, not just at one time.

 

I do see what you mean about your reasons for posting. I don't mind that you are a rep debating about strip because you bring up good points.

[Spanker]

Im talking about regular vacancies that are not filled continually, not just at one time.

 

I do see what you mean about your reasons for posting. I don't mind that you are a rep debating about strip because you bring up good points.

 

Thanks Mickey.

[irishsailor]

Surely mathematics need to be factor into the decision?

 

If yr a high Norwood scale or have a history of high norwoods in the family then even with the risks strip surely offers the better solution.

 

If I needed less than 4000 grafts during my lifetime then I would of gone fue all day long but unfortunately that's not the case with me and I went with strip.

[greatjob]

I still cannot see who "strip would best serve" in this day and age, over and above good FUE??

 

Me.

 

I am a diffused NW 6. I have good laxity and low density. With fue I would have been lucky to get 3000 grafts over my lifetime. I have currently extracted more than 4000 grafts with strip. Depending on how my laxity comes back I will probably have somewhere around 3000 grafts left in the bank.

 

If fue was the only option, which you claim it should be, I would no longer be a candidate for hair restoration. Therefore fue is not a replacement for strip until consistent regeneration is achieved, because it is still a better option for some patients.

 

People like you are arguing against a straw man. You are arguing against the old arguments made against fue. It's interesting in the argument of fue vs. strip the roles of the debaters have reversed. It used to be strip advocates speaking in absolute blanket statements against fue, but now it is the fue advocates speaking in absolute blanket statements against strip.

[s2thoudriver]

Dear oh dear, well if the reps still selling risky old FUT can sleep at night and there are still those prepared to run the risks, then so be it.

 

I just hope we don't continue to see the'help, my scar has stretched' posts on here and those still opting for the slice don't face any complications or have to have subsequent repair work or cover up work such as SMP further down the line.

 

Rob

[gillenator]

I would imagine it is the same thing gillinator brought up with the Fox test that he was then mocked over by scar5.

 

Mocked over? Is that what you call it? LOL!!!

 

Well at least I can respectfully disagree with others without having to resort to name calling, etc.

 

I have stated what needs to be stated and so has others.

 

Just a reminder: Both techniques have their place!