Cost of FUE, increasing or decreasing?

[britboy]

Britboy,

 

Do you think you would have had the results you gained via strip if you went to a top recommended surgeon using state of the art work in 2015 having had no surgery previous?

 

A resounding NO, my previous FUT were state of the art look where that got me:-).....and more to point it would cost 3-4 x more to achieve anything near the result I have gotten from my clinic. The smoothness of FUE and all it entails and results to me, far supersedes FUT

Edited March 20, 2015 by britboy

[britboy]

Not sure what you guys are arguing about, there is no getting around the fact that FUT yields better and gives better hair, regardless of whether the surgeon is Lorenzo, Erdogan, Bhatti you name it.

 

Here you go again, dreaming:-)

[Michael Vories, MD]

Just wanted to give my unsolicited two cents. As a surgeon who has practiced FUT for about seven years before switching to FUE, I do not believe FUT delivers "healthier" grafts compared to FUE, or that FUT has better graft survival than FUE. I do believe that FUT grafts that are hand placed are more likely to survive compared to hand placed FUE grafts, due to the skeletal morphology of FUE grafts in comparison.

 

Grafts placed with implanter pens remove this variable, and using them has given me equal survival with the two techniques. My two cents.

[1966kph]

Very interesting you sound as though your a bit of a convert dr vories!

In regard to the implanter pens why do you feel they offer a advantage?

They still need to be

handled to be loaded so were in lies a advantage?

My dr said they tried various inplanter pens years ago and watched the results through to 12-18 months and saw no advantage so carried on with hand placement.

Have a good day

 

Just wanted to give my unsolicited two cents. As a surgeon who has practiced FUT for about seven years before switching to FUE, I do not believe FUT delivers "healthier" grafts compared to FUE, or that FUT has better graft survival than FUE. I do believe that FUT grafts that are hand placed are more likely to survive compared to hand placed FUE grafts, due to the skeletal morphology of FUE grafts in comparison.

 

Grafts placed with implanter pens remove this variable, and using them has given me equal survival with the two techniques. My two cents.

[chrisdav]

Britboy,

 

1996 - 500 micro/mini grafts - hairline and crown - Lathams Huntsville Alabama - Dr Schory

1994 - 500 micro/mini grafts - Lathams Huntsville Alabama - Dr Schory - repair to Slit grafts

1991 - 500 slit Grafts front hairline - Dr May UK aka Dr Frankenstein - Bad Operation

__________________________________________

The surgeons listed above are not world leading surgeons performing state of the art work in 2015.

[KO]

Just wanted to give my unsolicited two cents. As a surgeon who has practiced FUT for about seven years before switching to FUE, I do not believe FUT delivers "healthier" grafts compared to FUE, or that FUT has better graft survival than FUE. I do believe that FUT grafts that are hand placed are more likely to survive compared to hand placed FUE grafts, due to the skeletal morphology of FUE grafts in comparison.

 

Grafts placed with implanter pens remove this variable, and using them has given me equal survival with the two techniques. My two cents.

 

Do you disagree that FUT provides grafts with better supportive tissue, such as subcutaneous adipose?

[Michael Vories, MD]

There is no evidence that adipose tissue is supportive of graft survival. I believe that FUE grafts, because of the blind dissection, need to be examined for transection. As long as the tissue is kept moist, is intact and placed without trauma, there should be full growth.

 

In hand placing grafts, the bottom of the graft, which contains the integral dermal papilla, needs to be grasped for insertion. With FUE grafts, it is very easy, even with experienced placers, to grip the bulb too tightly, and cause blunt trauma. With implanter pens, the dermal papilla is not touched. Instead, the upper third of the graft is gripped to slide down the lumen of the implanter pen. The result is a "no touch" system of placement (in terms of the dermal papilla). The result for my clinic when adopting this system is much more reliable growth, and led to my adopting FUE.

 

It is a little ironic that we term the procedure FUE, when I believe the system of placement is more important than how the grafts are extracted.

Edited March 19, 2015 by Vories
grammer

[Squatch]

Hey can we sticky this thread? Because in two weeks another thread will appear and the same old argument (FUT vs. FUE) will manifest itself after about three posts. The original post is always lost. I never see any ones mind being changed. I'm pretty sure that the Mid-East "Peace" Talks have a better chance of coming to fruition first. Please answer me the question..... Why can't someone get what they want? If you want a FUE, get one. If you want a FUT, do it. Where? It's up to you. Okay now how am I just shill for some sort of procedure or clinic? :confused:

[1966kph]

Personal choice all round,Fut, Fue,Country, Clinic,Dr involvement ect ect.

And your probably right with the calm coming about in the middle east before fut v fue gets settled.

Have a good day.

 

Hey can we sticky this thread? Because in two weeks another thread will appear and the same old argument (FUT vs. FUE) will manifest itself after about three posts. The original post is always lost. I never see any ones mind being changed. I'm pretty sure that the Mid-East "Peace" Talks have a better chance of coming to fruition first. Please answer me the question..... Why can't someone get what they want? If you want a FUE, get one. If you want a FUT, do it. Where? It's up to you. Okay now how am I just shill for some sort of procedure or clinic? :confused:

[KO]

There is no evidence that adipose tissue is supportive of graft survival. I believe that FUE grafts, because of the blind dissection, need to be examined for transection. As long as the tissue is kept moist, is intact and placed without trauma, there should be full growth.

 

True,there is no evidence for the importance of supportive tissue, except that it helps to hold grafts, which is moot with an implanter pen. So I hope you are right.

[KO]

To elaborate on Vories point regarding handling, here are FUT vs FUE grafts:

 

 

As you can see, with a forceps you have more stuff to hold on to with a FUT graft, so with a skinny FUE graft, if you use an implanter, you will never touch the dermal papilla, in theory yielding better rates.

[britboy]

Britboy,

 

1996 - 500 micro/mini grafts - hairline and crown - Lathams Huntsville Alabama - Dr Schory

1994 - 500 micro/mini grafts - Lathams Huntsville Alabama - Dr Schory - repair to Slit grafts

1991 - 500 slit Grafts front hairline - Dr May UK aka Dr Frankenstein - Bad Operation

__________________________________________

The surgeons listed above are not world leading surgeons performing state of the art work in 2015.

 

1bad in UK, 2 corrective and additions in USA. All 3 FUT

[britboy]

Personal choice all round,Fut, Fue,Country, Clinic,Dr involvement ect ect.

And your probably right with the calm coming about in the middle east before fut v fue gets settled.

Have a good day.

 

Yes personal choice and the fue v fue argument is exhausted. The real hidden issue is price which is what is worrying USA FUT clinics and moderators on this forum.

[britboy]

To elaborate on Vories point regarding handling, here are FUT vs FUE grafts:

 

 

As you can see, with a forceps you have more stuff to hold on to with a FUT graft, so with a skinny FUE graft, if you use an implanter, you will never touch the dermal papilla, in theory yielding better rates.

 

Depends how good the technicians are I guess, thankfully my technicians were excellent. My results have been extraordinary. FUE in my experience wins Hans down

[1978matt]

It should be noted that FUT was first described in 1995 and refers to removal of an elliptical strip of hair from the back of the head, microscopic dissection of it and subsequent implantation of follicles in the recipient area using natural hair groupings.

 

It is not to be confused with hair transplant techniques of the 1980s and early 90s, i.e. micro/mini grafting. It is disingenuous to claim they are the same.

 

It is just as bad as referring to modern day FUE as 'punch grafting'.

[britboy]

It should be noted that FUT was first described in 1995 and refers to removal of an elliptical strip of hair from the back of the head, microscopic dissection of it and subsequent implantation of follicles in the recipient area using natural hair groupings.

 

It is not to be confused with hair transplant techniques of the 1980s and early 90s, i.e. micro/mini grafting. It is disingenuous to claim they are the same.

 

It is just as bad as referring to modern day FUE as 'punch grafting'.

 

I think in recent topics and threads FUT is referred to as cutting or slicing strips of donor from the back of the head for arguments sake as against FUE follicular unit extraction (one by one) as against FUT dissection of the strip.

 

A strip was cut from the back of my head on 3 occasions referred to as FUT by all surgeons and while at the same time using micro/mini and slit grafts as the donor action.

[1966kph]

It would be interesting to know how accurate this grip is on the grafts shown meaning are they generally held at those points or higher up were grip pressure is less likely to cause critical damage?. How high can they be held to still facilitate implantation?

 

To elaborate on Vories point regarding handling, here are FUT vs FUE grafts:

 

 

As you can see, with a forceps you have more stuff to hold on to with a FUT graft, so with a skinny FUE graft, if you use an implanter, you will never touch the dermal papilla, in theory yielding better rates.

[Blake Bloxham]

Sigh .....

 

I thought if I spent some time and made a long, logical post addressing both the contrasting arguments and sharing data I could avoid the exhibition responses. Guess I was wrong. I thought I could avoid comments about physician-less procedures being the wave of the future and North American doctors huddled in a room shivering because their beloved strip procedure is going the way of the buffalo. But alas, I was wrong.

 

Clearly, I'm not going to reach some people here. That's fine. However, let me address a few points.

 

Dr. Vories:

 

I think the evidence behind adipose tissue increasing graft survival is pretty sound. Dehydration of grafts is one of the biggest offenders when it comes to poor graft growth. In fact, I thought this is why you stopped using the vacuum feature of the NeoGraft? To add to more than just years of anecdotal evidence from the hair transplant community, I think Dr. Ronald Lauster and Dr. Aaron Gardner's hair multiple research shed a whole new light on the role of adipose tissue and the cross talk between dermal papilla/bulge stem cell and adipose stem cells. Essentially, dermal papilla stem cells were unable to grow in fibrotic, adipose stripped bald scalp without the addition of adipose tissue. Dr. Garner came to the conclusion that any success in hair multiplication could only be accomplished by also adding adipocytes to the implantation site.

 

Dr. Wesley showed something similar during his studies with his endoscopic (Pilofocus) hair transplant technique. He states that yield with strip grafts is superior to FUE as well. He then showed that by extracting grafts from an endoscopic approach, he was able to retain more surrounding tissue and the yield improved (to the level of FUSS grafts).

 

Also, I think the image KO showed above better states the point I was trying to make about grafts dissected under microscopes versus grafts extracted with 0.7 - 0.8mm punches. The shape and amount of surrounding supporting tissue is simple different.

 

I've heard similar arguments about not needing to touch the dermal papilla with the implanter pens. Frankly, I've always believed that a tool is only as useful as the hands operating it! Clearly there are many getting great results with forcep assisted placement, and there are many obtaining great results with implanter assisted placement.

 

You know I've always been a fan of your FUE results, and I definitely think you're doing something right!

 

Britboy,

 

Brit, I hope you don't take my statements as antagonist or personal. I know you underwent poor work via strip in the "dark ages" so I understand your passion for FUE and for tech clinics that offer the procedure at a lower price. However, I don't think it's "fear mongering" or agenda-driven to say that some people will still get more "bang for their buck" from the strip procedure.

 

In my mind, it's all about informed consent. If a patient is aware of the reality of the linear scar - which can be unpredictable - and is more concerned about growth yield and session size, then I have no problem with them opting for a strip procedure. If a patient feels strip is antiquated, knows the scar will be an issue, and understands that yield is more variable, I have no problem with them opting for FUE. Really, this is all I'm trying to say.

 

I like FUE. I think it's a solid procedure for a lot of patients. However, I think a lot of people are still well-suited by strip as well. Like I said before, I don't think strip is going to disappear. From my first-hand experience, most of the patients I see are more interested in moving as much hair as possible in one sitting and have no intent on shaving their parietal/temporal scalp to a level where the scar would be an issue.

 

Is this really that outrageous or controversial? I think patients should have both procedures fully explained to them and both the doctor and the patient should pick a surgical plan that best suits the patients needs. Period.

 

Altogether, Brit, I'm very happy for you. At the end of the day, this community is about patients and you've clearly undergone an impressive transformation with FUE. I thank you for sharing your experiencing.

[BaldingBogger]

Without wading too much in to the old arguments banded around the Fue Fut comparisons.

 

I would point out that undertaking Fut is by no means a guarantee of top yield or a top result as seems to be the presumption with a lot of posts. Years of extensive research I've probably seen such as many duds with strip as fue.

 

Again it really comes to choosing the right Dr. In the right hands a top yield can be expected with either procedure . Donor supply is another issue.

[Michael Vories, MD]

Thanks Blake-

 

As I am sure you know, adipose tissue is not dermal tissue. (A common Board question). The presence of dermal tissue to maintain hydration and some pH control is necessary for tissue survival. Adipose tissue beneath the dermis has not been proven necessary for graft survival. In fact, most grafts extracted (FUT or FUE) lack adipose tissue when removed from the body, and when implanted do not reach the full depth of the dermis. Thanks again.

[Blake Bloxham]

Dr. Vories,

 

Yes, I do understand. I suppose it would have been more accurate to describe the tissue as "supportive" versus true adipose.However, I thought it would be a bit confusing based on the following:

 

As I'm sure you know, both fat and dermis come from a mesodermal germ layer. Additionally, multiple studies have shown the proper follicle function and survival comes from cross talk between the ectodermal portion of the follicle (bulge stem cells), the mesodermal portion of the hair follicle (the dermal papilla cells), and the surrounding mesodermal stem cells. While the subdermal fat layer isn't generally part of the dermis itself, there are adipocytes in the reticular dermis (where anagen follicles lay). Here are a few excerpts from an article published in Experimental Dermatology in 2014:

 

Underlying the reticular dermis, a thick layer of adipocytes exists that encases mature hair follicles in rodents and humans. Furthermore, the development of adipocytes in the skin is independent from that of subcutaneous adipose tissue development. Finally, the role of adipocytes has been shown to be relevant for epidermal homoeostasis during hair follicle regeneration and wound healing. Thus, we propose a refined nomenclature for the cells and adipose tissue underlying the reticular dermis as intradermal adipocytes and dermal white adipose tissue, respectively. Defining dermal adipose tissue. - PubMed - NCBI.

 

Another general excerpt (wiki) explaining this further: The dermis is composed of three major types of cells:[3] fibroblasts, macrophages, and adipocytes. - http://en.wikipedia.org/wiki/Dermis

 

So, what I was trying to say - and I should have been more specific initially - is that the cross talk between the hair bulb, the bulge of the follicle ORS and the supportive, surrounding tissue is imperative. The surrounding tissue provides an additional layer of stem cells of mesodermal origin. These may not all be adipocytes, but they are one of the crucial cells in the supportive tissue layer. Per the article above, they also surround the follicle and are interspersed in the supportive dermis.This is one reasonable explanation as to why surrounding tissue is so important.

Edited March 19, 2015 by Blake_Bloxham

[scar5]

What are you guy talking about, you think you are doctors, or something? Really, this is a hair transplant forum!

 

If the hair grows I'm all good, but anyway, we were not talking about fat per se. I think the fat is a good for forceps to hold and I think fat is good for strip clinics to hang on to too. It is their last hope.

 

Really, the OP, will FUE prices fall has got be based on the widespread use of tech extracted FUE and Blake has dropped A BOMBSHELL here on this very thread. We are now covering it with smoke by talking about fat.

 

Blake said here, in the good 'ol U S of A, clinics are performing tech-extracted FUE. We are hair transplant guys, right! This is a forum ab out HTs, so where are the clinics doing tech-extractions in the US?

 

What are they charging?

 

I think Britboy is on the mark.

I think all of you talking about fat are off the mark.

I think Blake saying, 'Hey, I don't mind either way - I'll do both' is just fine and dandy and completely useless, worse, it misleads you to thinking that you come to an HT clinic with a clean slate and that the determination to have strip or FUE is entirely independent of the context within which that particular clinic operates in and the momentum surrounding its marketing, and set-up.

 

You WILL mind Blake. If you have to do manual FUE day in day out, week in , week out, you will be in a mess soon enough, and you sure know that!

 

Now, can US clinics do tech-extraction? If so, where? Which states? Which clinics? How much do they charge? Are we not allowed to talk about them?

 

By the way, FUE started in 1988. Strip, before. This FUT acronym is really BS and just typifies the bubble that US HT operated in then. Calling it FUT and contrasting it to FUE which is, and always was FUT itself. But that is a minor quibble.

[KO]

Blake - while I agree with your point that the cross-talk between the three compartments - dermis, bulge, and dermal papilla are important, if the surrounding tissue was crucial, wouldn't FUE grafts in general give very poor yield? Say 10%, if that?

 

Scar5 - Janna from Shapiro has confirmed that in Minnesota techs can extract grafts. In Canada, Rahal has techs do extractions as well. It depends state to state.

 

http://www.hairrestorationnetwork.com/eve/162401-my-fue-dr-rahal-3000-grafts-large-procedure-38.html#post2410509

[Blake Bloxham]

Scar,

 

You're right, we're way off topic here. This is initially why I didn't go into detail in my original post and I think I mislead Dr Vories a bit.

 

I can't speak for all clinics or physicians. There may be some who discuss both procedures with a patient but still push one procedure over another without clearly explaining the pros and cons of both. To me, this isn't true informed consent.

 

In order to really figure out which states "could" have technicians extract, you would need to dig through state laws on a state-by-state basis. It would take a lot of work. As far as the clinics that do it, you'd probably have to do some deep research as well. I think we see this most often in situations where companies like NeoGraft and ARTAS send technicians out to offices to operate the device.

 

The point, however, is the argument that US docs all push strip because technicians can't extract grafts in the US is false. Why? Because it's a state-by-state case, and there are states where the restrictions on non-physicians puncturing the skin aren't as tight. This then begs the question: why hasn't this model taken over here? Why don't doctors just open up tech clinics and offer patients the benefits without the travel? I believe it's because these doctors don't believe in this model and support physician-driven procedures. Some may disagree - I believe Brit says he thinks it would be a malpractice problem.

 

Also, you're dead on the with "FUT" acronym. FUT actually stands for Follicular Unit Transplantation or Follicular Unit Hair Transplantation, which is any hair transplant procedure performed with follicular unit grafts. Both FUE and strip (or Follicular Unit Strip Surgery - FUSS) are "FUT" procedures.

 

But again, I'll lay off this technical jargon.

[Blake Bloxham]

KO,

 

Why would it give 10%? There is still supporting tissue, just much less. Maybe I'm not understanding? Also, I think reduced supporting tissue is only one of the reasons as to why FUE yield can be more variable.