Does FUE cause more damage than FUT to donor area?

[lucldh]

I am from India and facing hair thinning in the area affected by MPB. As of now, I have hair all over (with temples having receded much) but the problem is that they are thinning. I am using Minoxidil regularly and have undergone QR678 treatment with doctors Debraj Shome and Rinki Kapoor in Mumbai, India. It has helped me combat hair loss and grow few more hair, but the effect is not significant because I declined to use saw pulmetto/Finasteride - I have observed that my face becomes too heavy and I feel tired all over the body after consuming saw pulmetto for around 3-4 months. Not sure whether anyone else has experienced this situation or maybe I am the unfortunate one!

 

Anyways, I am contemplating a hair transplant now. On reading reviews on this forum for good HT surgeons in India, I cam across name of Dr. Radha Rani. I happened to call her and discussed my situation with her. Though she told me that she would tell me the estimated number of grafts after seeing my pictures, she advised me to go for FUT if I need more than 2000 grafts. She opines that FUE if done for more than 2000 grafts causes a lot of damage to donor area and may affect future HT needs. I tried to search across google but did not learn much about this concern raised by Dr. Radha Rani. Can someone throw some light on this?

[Mickey85]

Of course Rahda said that, she is the same surgeon who convinced a patient wanting FUE to go to strip because "60% of the follicles don't survive" with FUE. That is because she is not adept with FUE. There are surgeons who regularly perform 3,000 graft sessions via FUE and get great results. Radha is a mainly a strip surgeon and it is in her best interests to promote strip to patients. I personally would go to a good FUE surgeon instead.

 

FUE allows to obtaining grafts over a much larger area than strip does, although 100% of the grafts cannot be extracted as it would leave no hair left. The general consensus is about 35% of the FUE safe zone can be extracted and the appearance will still look full, more than that and it can look a bit thin. The collective scarring is more than with strip but is cosmetically less evident(you can shave down closer with FUE and not show signs of surgery).

 

If you do not want to go strip, DON'T go for it regardless of what a surgeon says. It is your scalp and FUE is at a stage now where it can be on par with strip results and is less invasive. If you want strip, there are some great strip surgeons out there.

[irishsailor]

Of course Rahda said that, she is the same surgeon who convinced a patient wanting FUE to go to strip because "60% of the follicles don't survive" with FUE. That is because she is not adept with FUE. There are surgeons who regularly perform 3,000 graft sessions via FUE and get great results. Radha is a mainly a strip surgeon and it is in her best interests to promote strip to patients. I personally would go to a good FUE surgeon instead.

 

FUE allows to obtaining grafts over a much larger area than strip does, although 100% of the grafts cannot be extracted as it would leave no hair left. The general consensus is about 35% of the FUE safe zone can be extracted and the appearance will still look full, more than that and it can look a bit thin. The collective scarring is more than with strip but is cosmetically less evident(you can shave down closer with FUE and not show signs of surgery).

 

If you do not want to go strip, DON'T go for it regardless of what a surgeon says. It is your scalp and FUE is at a stage now where it can be on par with strip results and is less invasive. If you want strip, there are some great strip surgeons out there.

 

Sorry for jumping in here with a question,

 

Mickey, how many grafts do you think the average guy has for transplanting, if they work on taking approx 35%, basing it on guy with average density?

 

Cheers mickey, hope yr keeping well.

[1978matt]

It all has to be considered on a case by case basis. If you're a Norwood 3 and not likely to progress beyond a 4 (for whatever reason: on meds, family history, age etc), then FUE could be the way to go. However, if you're looking to maximise the lifetime number of grafts you need as baldness progresses then FUT may be better to start with.

 

FUE can compromise future FUT because it puts a lot of scar tissue in the donor making dissection more difficult.

 

It also depends on what you hope to achieve long term. If you're lucky you may be able to get 7,000+ grafts FUT to cover your entire scalp. With FUE the maximim you can get is usually less unless you want to take Body hair.

[Mickey85]

Sorry for jumping in here with a question,

 

Mickey, how many grafts do you think the average guy has for transplanting, if they work on taking approx 35%, basing it on guy with average density?

 

Cheers mickey, hope yr keeping well.

 

I think the general estimate for an average person was something like 4,000-5,000 grafts without a visible 'hit' in the donor. Anything more than that and the donor can look thin and/or the ability to shave down to a grade 1 or 2 would show signs of surgery. Some patients are ok with pushing the limit and obtaining more grafts at the expense of being able to shave down to a grade 1 or 2.

 

Thanks champ, hope everything is good with you too

[irishsailor]

Thanks for the quick reply fellas

[Mickey85]

 

FUE can compromise future FUT because it puts a lot of scar tissue in the donor making dissection more difficult.

 

 

 

Strip can compromise future FUE due to the surgeon not being able to extract hair in the vicinity above the strip scar because those hairs are needed to cover the scar. Erdogan said that it can sometimes equate to 1,000 grafts that cannot be extracted due to this depending on the scar length and width.

 

The patient can elect for the 'strip zone' to be left untouched and for the surgeon to extract around the zone via FUE if he really wants to play it safe but I am a strong advocate for leaving strip as a last resort.

[lucldh]

Of course Rahda said that, she is the same surgeon who convinced a patient wanting FUE to go to strip because "60% of the follicles don't survive" with FUE. That is because she is not adept with FUE. There are surgeons who regularly perform 3,000 graft sessions via FUE and get great results. Radha is a mainly a strip surgeon and it is in her best interests to promote strip to patients. I personally would go to a good FUE surgeon instead.

 

FUE allows to obtaining grafts over a much larger area than strip does, although 100% of the grafts cannot be extracted as it would leave no hair left. The general consensus is about 35% of the FUE safe zone can be extracted and the appearance will still look full, more than that and it can look a bit thin. The collective scarring is more than with strip but is cosmetically less evident(you can shave down closer with FUE and not show signs of surgery).

 

If you do not want to go strip, DON'T go for it regardless of what a surgeon says. It is your scalp and FUE is at a stage now where it can be on par with strip results and is less invasive. If you want strip, there are some great strip surgeons out there.

 

Thanks for your advice. I personally think that with FUT, scarring will be in a particular area as opposed to FUE. I am only 28 and I think that I will head for Norwood 5 for sure unless some revolutionary treatment comes up. I feel that if I undergo FUT now, it will leave room for my future HT needs. Am I mistaken?

[lucldh]

It all has to be considered on a case by case basis. If you're a Norwood 3 and not likely to progress beyond a 4 (for whatever reason: on meds, family history, age etc), then FUE could be the way to go. However, if you're looking to maximise the lifetime number of grafts you need as baldness progresses then FUT may be better to start with.

 

FUE can compromise future FUT because it puts a lot of scar tissue in the donor making dissection more difficult.

 

It also depends on what you hope to achieve long term. If you're lucky you may be able to get 7,000+ grafts FUT to cover your entire scalp. With FUE the maximim you can get is usually less unless you want to take Body hair.

 

Thanks for sparing time. But after reading Mickey's views, I am bit confused. Let's assume that I will head for N5 or N6, which among the following will be the best if I have average donor density:

1. FUT now and FUE later.

2. FUE now and FUT later.

3. FUT now and FUT later.

4. FUE now and FUE later.

 

I know nothing in this world is perfect despite best efforts and what works best for Mr. X may not at all work for Mr. Y. Raising the issue on this forum will probably help me get few good opinions based on others' experiences.

[1978matt]

Thanks for sparing time. But after reading Mickey's views, I am bit confused. Let's assume that I will head for N5 or N6, which among the following will be the best if I have average donor density:

1. FUT now and FUE later.

2. FUE now and FUT later.

3. FUT now and FUT later.

4. FUE now and FUE later.

 

I know nothing in this world is perfect despite best efforts and what works best for Mr. X may not at all work for Mr. Y. Raising the issue on this forum will probably help me get few good opinions based on others' experiences.

 

We can't answer that, only a doctor can after looking at your scalp. Get the opinion of 3 or 4 in person and see what they all say. Then if you still want to go ahead with it then go with the one you trust the most.

[lucldh]

We can't answer that, only a doctor can after looking at your scalp. Get the opinion of 3 or 4 in person and see what they all say. Then if you still want to go ahead with it then go with the one you trust the most.

 

Your quick response is much appreciated. Thanks again!

 

I will still want someone else to share his opinion on this. I am not able to decide between FUT and FUE keeping in mind my future HT needs. Seeking only surgeons' opinions may not all that help - sometimes the ones who have undergone HTs may have few subtle details to share (this anyways does not undermine the credibility of surgeons).

 

I stumbled across Hasson and Wong's website and observed that they have achieved wonderful results mainly with FUT. That entices me not to leave FUT as an option unless I clearly understand the effect of FUT/FUE on my future HT needs. As of now, I think that I will do great with 2200-2500 grafts, but I am unsure about my future needs.

[Jotronic]

I stumbled across Hasson and Wong's website and observed that they have achieved wonderful results mainly with FUT.

 

 

Lucidh,

 

Thank you for the comment but our results are all FUT, not just mainly but completely:)

[lucldh]

Lucidh,

 

Thank you for the comment but our results are all FUT, not just mainly but completely:)

 

Sorry for that. Had cost not been the factor, I would have taken next flight to Vancouver. Man, you are way too much unaffordable for the people who live in the other part of the world - I will save my year's salary and will still not be able to afford you. Make it 3$ per graft flat from starting graft to ending graft so that we can also have access to quality HTs !!!

 

Anyways, I am still evaluating FUT.

[MAGNUMpi]

Another thing to consider are the possible down sides of each procedure. Whats the worst that could happen with each method. etc.

Also your donor laxity matters if you are thinking FUT.

[hairthere]

For an advanced NW with no intention of wearing their hair buzzed super tight or shaved completely, I would recommend strip surgery and then FUE.

[Raj Jayukdht]

This is very interested thread and I must say after my first FUT HT back in feb 2011, I would now go for FUE.

[lucldh]

This is very interested thread and I must say after my first FUT HT back in feb 2011, I would now go for FUE.

 

You shared something interesting with me in PM that I feel that I should share with all: Get 1-2 FUTs done from some leading FUT surgeon and then few years later get FUE done for scar repair from not so expensive but good FUE surgeon in India.

 

I have found this an interesting suggestion. Also, I have hell lot of hair on my beard and chest (also nape and shoulders but these hair are not that thick) that I feel that I can use wisely.

 

This is something that I referred to as SUBTLE and that people can share only from experience.

[scar5]

The answer is simple.

 

Strip all the way, until FUE at the very end for a 'touch-up'.

Why? Because FUE grafts don't work (except for the touch-up at the end) lol

 

Strip has more robust grafts, but the price is? Strip also kills more grafts. It is like taking the whole army over the hill through a minefield. There are casualties but you win the hill. But unfortunately, due to the strip scar,you can be spotted by reconnaissance aircraft.

[hairthere]

lucid, I can only speak from the experience that I have had with HTs. This approach may or may not be right for you....

 

I've had 3 strips, then FUE, then strip. They all were successful surgeries except the first strip. I went FUE in between because it was for a small number of grafts to address some temple point recession. My strip surgeries were as follows: 3200, 2300, 1500. I have one strip left in the tank (approximately 1500) and then maybe another 1200 available via FUE. My first strip scar yielded maybe 600-800 grafts and was performed by an inferior surgeon. I am confident that all my grafts were taken from a safe zone. I have what looks like a full head of hair, especially for a NW 5. Both of my strip scars are wider than optimal. I am, however, able to buzz my hair down to a number 3 without the strips being visible, and they are ear to ear.

 

So the grand total, if I was to have that final strip and FUE, would put me at around 10k grafts. Would I have been able to pull this off safely and/or financially if I went solely FUE? Realistically, no. Am I enamored with the thought of having two strip scars that widened on my head? No. But I can tell you that I am very happy with the head of hair I now sport.

 

Unfortunately there is no perfect HT solution. Both surgeries have their pros and cons, and I think Magnum had the most sage advice on this thread: weigh every single pro and con of each surgery as they apply to you. Think through every possible case scenario.

 

Best of luck!

[xtatic5]

Thanks for sparing time. But after reading Mickey's views, I am bit confused. Let's assume that I will head for N5 or N6, which among the following will be the best if I have average donor density:

1. FUT now and FUE later.

2. FUE now and FUT later.

3. FUT now and FUT later.

4. FUE now and FUE later.

 

I know nothing in this world is perfect despite best efforts and what works best for Mr. X may not at all work for Mr. Y. Raising the issue on this forum will probably help me get few good opinions based on others' experiences.

 

 

Several members on these forums have agreed that for maximum lifetime yield the best method is FUT then FUE. It should also be noted that other doctors have posted their concerns about excessive FUE scarring, even turning patients away because further surgery was not possible. If you are destined for extensive hair loss I would not do FUE only. A spotty donor area cannot be repaired.

[Nick153452]

Thanks for sparing time. But after reading Mickey's views, I am bit confused. Let's assume that I will head for N5 or N6, which among the following will be the best if I have average donor density:

1. FUT now and FUE later.

2. FUE now and FUT later.

3. FUT now and FUT later.

4. FUE now and FUE later.

 

I know nothing in this world is perfect despite best efforts and what works best for Mr. X may not at all work for Mr. Y. Raising the issue on this forum will probably help me get few good opinions based on others' experiences.

 

 

That is a very tough question to answer. Many factors come into play. Some patients have such good laxity and density that they can extract more than 10,000 grafts via FUT and thus never need to result in FUE. Some patients have horrible laxity, but good density, so they may be able to resolve the issue vie FUE. Some people have average of both and are generally benefited from getting FUT to max out with what their laxity allows, and then moving into FUE to extract what they were unable to extract prior. It a case-to-case scenario that you will have to discuss with your doctor. For me, I have about average density with good laxity, and course hair, so I may be able to be resolved with FUT. Go talk with a great doctor who is has your best interest at heart. Mickey is right though, FUT only doctors tend to be a little biased, but then again, I'm sure FUE doctors sort of understate the disadvantages for getting FUE for certain individuals.

 

Hope I was clear.

[Shadow of the EMpire State]

Look, there is a very, very simple way to resolve this question.

 

Step 1: Spend a few months on hair boards like this one.

 

Step 2: Total up all the people who talk about how much they hate their strip scar.

 

Step 3: Total up all the people who talk about how much they hate their FUE scars.

 

I have seen hundreds upon hundreds---possibly thousands---of people saying that a strip scar ruined their lives and made them desperate for corrective surgery. By contrast I have never seen *anyone* talk about how FUE ruined his life, disfigured him, or made him desire additional corrective surgery.

 

Now I fully understand (a) that modern strip procedures have better results than older ones; and (b) that strip procedures far outnumber FUE procedures, meaning that there will be more negative strip outcomes simply by force of the number of procedures. But even accounting for those factors, a strip scar is still much, much more likely to turn out badly than FUE scars. A cursory review of hair boards cannot yield any other conclusion.

 

Period.

[xtatic5]

Look, there is a very, very simple way to resolve this question.

 

By contrast I have never seen *anyone* talk about how FUE ruined his life, disfigured him, or made him desire additional corrective surgery.

 

Here's one! http://www.hairrestorationnetwork.com/eve/168898-my-regretful-hair-transplant.html

 

I have seen several posts of bad FUE scars from both patients and surgeons. If you don't look, you won't find them.

[Mickey85]

Here's one! http://www.hairrestorationnetwork.com/eve/168898-my-regretful-hair-transplant.html

 

I have seen several posts of bad FUE scars from both patients and surgeons. If you don't look, you won't find them.

 

Does not even measure to the amount of patients coming on here seeking advice on how to repair their stretched strip scars, not even close. To do I have only seen a handful of people complaining about their FUE scars. I have lost count at the amount of people complaining about their strip scars. The guy in the thread wouldn't get looked at twice with his 6,000 graft depleted donor shaved that low. I wonder how he would go walking around with that buzz after a 6,000 graft strip procedure.

[Mickey85]

Mickey is right though, FUT only doctors tend to be a little biased, but then again, I'm sure FUE doctors sort of understate the disadvantages for getting FUE for certain individuals.

 

 

 

I'm not arguing with you here, I just wanted to elaborate on the difference between strip and FUE doctors. I won't deny that FUE surgeons might downplay the disadvantages of FUE and/or elaborate on the disadvantages of strip. However I do believe that the surgeons who moved away from strip to practice FUE did so because they believed it had less drawbacks, was a superior method of obtaining hair and was better for the patient. Yes the cost per graft via FUE is more than strip, but they discarded the ability to perform 6,000+ graft strip megasessions which would have profited them the same as a 3,000 graft FUE session. They stuck with FUE when it was in its infancy and when it was treated as a failed abortion of the hair transplant industry. "Plugs but smaller" was a phrase commonly used by strip surgeons in the early FUE days.

 

I find it very difficult to comprehend how strip surgeons continue to perform strip on patients with minimal loss when they know exactly how unpredictable the scar turn out may be. I can't fathom how they continue to perform strip when they know exactly what it does to the donor area. The possibility of permanent numbness. The disruption on hair direction. The eradication of hair caliber gradation. The misangled hairs emanating from the praised trico-closure. The strangulation(loss) of hair from the use of sutures.

 

I totally acknowledge that FUE has its disadvantages. It thins out the donor area. The grafts are more susceptible to transection. But the advantages FAR outweigh the disadvantages when compared to strip. As some people better candidates for strip? Yes. But I believe the majority of people are better suited for FUE. Laxity does not play a factor. Look at all the Umar repairs. You will find a decent portion of them are from the plug days, flaps, scalp reductions but a large percentage are from strip surgeries. A small percentage are from unsuccessful FUE. People resorting to body hair into their strip scars, SMP into their strip scars. They are seeking a remedial procedure for a remedial procedure. To date I have only seen ONE(1) person who was in a panic over his FUE scars and wanted body hair implanted in them, everyone thought he was over-reacting. Compare that to the amount of people who feel disfigured over their stretched strip scars. It doesn't even compare.

 

People will disagree with alot of what I have to say, that's totally cool. That's what makes this forum great. I don't have a problem with people disagreeing.